Debates of May 18th, 2000

Supply

[Gary Lunn, Reform, Saanich—Gulf Islands, BC]

Mr. Speaker, first, I want to remind the member, in case she has forgotten, that we are the Canadian Alliance and we are very proud of that.

Second, why are we staying on the HRDC issue? I remind the member that this government gave more money in this fiscal year to grants and contributions under HRDC than it gave to health care. That is why we are questioning it. We do not believe in that program and we think we need to look at it again and redirect money into core programs, such as health care.

Do I believe a private for profit health care system is inflammatory? Yes. We have specialists in the public health care system who get paid very well, as they should. If they can also earn a living in a private setting and do just as good a job, then we should be open to that. I believe in my heart that the status quo is not going to work.

Let us listen to the people who want to try new ideas. This is not about politics, this is about something that is very dear to Canadians. We have to be open to new ideas. We have to look at how we deliver health care. We have to make sure we can afford it.

With all respect to the member, the only thing I hear is that we should raise taxes, which I do not agree with. The NDP believes Canadians should be taxed more. Since I have belonged to the Canadian Alliance, formerly the Reform Party of Canada, nobody has ever once suggested that health care should not be available to every single Canadian. It should be available to every single Canadian regardless of their ability to pay. We in this party believe in that principle and we will fight for it. However, we will not have that if we are not open to new ideas, not willing to try new things and if we do not recognize that we have to have the economic prosperity to deliver those programs. If we stay on our present course, public health care will no longer be available. That is a fact.

The issue of health care is something Canadians take seriously. Let us look at it, cut out all the politics and work together to find solutions instead of playing politics with this issue.

[Ted McWhinney, Liberal, Vancouver Quadra, BC]

Mr. Speaker, it is a pleasure to intervene in this debate which has given us the opportunity across party lines to examine the Canada Health Act and the fundamental principles of which our system of social insurance and health is based.

My own constituents have made it very clear to me, and I have communicated their views to the Prime Minister and the government, that as we attain our budgetary surplus, as we have done in the last three years, 50% of the surplus should be used to reduce taxes and amortize the external public debt and 50% should be used in priority areas, such as advanced education, research and health and health insurance. Those principles have been accepted by the present government and they are the hallmark of the present budget and the present administration.

Many on this side of the House would take credit for the health care system and the work of Paul Martin Sr., the distinguished minister of health of some years ago, in the establishment of the Canada Health Act and the establishment of the five fundamental principles on which it is based: universality, comprehensiveness, accessibility, portability and public administration.

The motion before us is very specific and it has been given an even more specific association with the reproaches to the Minister of Health that he has not been combative enough, that he has not gone mounted on a charger against the enemy, sword in hand, and put them to flight. This minister is known for his quiet judgment and the use, as many skilled appellate lawyers like himself have, of the velvet hand in the iron glove, or reversing it if hon. members wish, the iron hand in the velvet glove. In other words, economy in the use of power, but use power when one has to. It is reproaching the minister for being something that he is not.

Our preference is co-operative federalism. We are often reproached for not being co-operative enough. It is interesting, from one of the parties in opposition, to have the reproach that we are not aggressive enough and we should be more so.

We have been trying to have a dialogue with provinces over a period of years; not always a happy situation. Some provinces, given money for education purposes, have used the moneys to build highways into the never never land. We do not like that and in those cases we are forced to take action of a corrective nature.

In relation to health care and health services, it has been suggested to us that we are neglecting certain legal principles. It has been said that we should get a reference to the supreme court. That is a misunderstanding of the nature of the supreme court reference. The supreme court reference is always on a hypothetical question. It is always on an abstract question. It is not and cannot be a substitute for a case controversy, even an anticipatory case controversy, and I think the minister, as an excellent lawyer, rightly rejected that approach and rightly rejected the possibility of a situation where the supreme court would rule against us, saying that it would not exercise jurisdiction.

Equally, however, the suggestions for disallowance of a provincial bill, bill 11, ignore the fact of the evolution of our constitutional system. The power of disallowance has not been used in half a century. In fact, I remember as a private citizen giving advice to a prime minister 30 years ago that the power was dead and that there were other remedies, and that it would be a constitutional voie de fait, a constitutional tort, in effect, to try to revive it at this stage. That is not our way.

We do, however, have ample powers under the Canada Health Act to take corrective legislation if and when that should come to be demonstrated as necessary. But the demonstration, the prior fact that it is demonstrated as necessary, has to be properly proven and properly established for us.

There are problems that I will take the opportunity of referring to, legal problems, and I would hope that these would be discussed by the Minister of Health with his provincial counterparts. One of these is simply that if private health facilities are allowed on a commercial basis, then under the provisions of NAFTA it is potentially open on a legal ground for foreign, financially based private institutions—I guess they are always financially based—from abroad, from the signatories to NAFTA, to enter Canada on a competitive basis. Some would say in the spirit of the market economy, what is wrong with that?

I will communicate to hon. members, nevertheless, reservations communicated to me by the board of one of our great hospitals in Vancouver—and the boards include many people with skilled knowledge of NAFTA—that we could see a situation of selective competition by specialist foreign—that is, U.S.—institutions with existing Canadian all-purpose hospitals.

In the city of Vancouver, one such hospital I have been associated with, St. Paul's, right in the heart of the city, performs the most advanced style of research and corrective medicine in those areas at the frontiers of medical knowledge.

That hospital is also downtown, so it deals, particularly every Friday and Saturday night, with emergency cases: hit and run accidents, incidents in bars, cases of drug overdose. It is pointed out to me that in terms of quantifying and costing the hospital administration, those are cases literally handled at a severe loss in medical terms. They are balanced, however, by the more specialized type of work this hospital does for which higher, offsetting compensation is available.

That concern has been expressed to me and I think it is a serious concern, one which warrants conversations between the Minister of Health and his counterparts in the provinces, and this would include the province of Alberta. I can see solutions here, but it would be premature, I think, to get into these.

The act as it stands has opportunities for the federal government, constructively and pragmatically, to talk with the provinces in the spirit of co-operative federalism to see if differences can be ironed out.

There are some principles that go beyond the five principles of the Canada Health Act that I have already adverted to, and it is perhaps worth referring to them.

We make full cash contributions to the provinces on the principle of good faith, but on a basis of specified conditions, and I will simply recite them for the record: no extra billing by medical practitioners or dentists for insured health services, no user charges, and reporting at the times and in the manner prescribed in the regulations. These are very basic conditions. If they are not complied with, the precedent exists, and it has been used, to cut back, or to indicate that one is prepared to cut back on the transferring of funds to the provinces.

It is enough in many cases to indicate that the power is there. It is certainly premature and not good federalism to apply the remedies before the actual case of conflict exists beyond the point where it can be settled by negotiation.

The attitude indicated by the Minister of Health is simply this. On his legal advice he was satisfied that he had no grounds constitutionally for challenging the specific bill, the Alberta bill 11, at this stage. This is not to say, though, that at a future stage, on particular facts, it could not arise on constitutional grounds.

More importantly, however, if breaches did occur, and one was satisfied that they occurred through an exercise of ill faith or a lack of appreciation and respect for the principles of co-operative federalism, then the machinery could be set in motion of corrective legislation by the federal parliament, or the use of the full discretionary power that remains in the federal government to withhold, to reduce or to block altogether the transfer of funds to the provinces.

I say, in this context, that there are extremely positive initiatives which flow from the emphasis that my constituents and I gave, and no doubt other people in the government caucus, and I am sure other members on the other side of the House, to the emphasis on spending of surplus constructively in subsidizing medical research and services. The present budget provides $2.5 billion additional to the Canada health and social transfer. It is a 25% increase over the last two years alone. There is a further cash component that will reach $15.5 billion in each of the next four years, and it will continue to grow as the economy increases.

I welcome, on the government side, the support given by all parties in opposition for spending our money on medical research. The amount of investment in medical research is simply remarkable, and I would say to members on the other side of the House that the concentration on the frontiers research in medicine in western Canada is truly remarkable.

I take great pride in the concentration in British Columbia, but it does extend to other provinces. That is reflected in the extra funding under other areas of the budget for research, for fundamental research in medicine, for the creation of the millennial professorships which will allow us to arrest the brain drain of our leading medical researchers who have been going to the United States. There are already very welcome signs for people who could quadruple their salaries in the United States by moving there that they are satisfied with the relatively modest increases in their stipendiary under the millennial professorship plan and they intend to remain here.

This joins the increase in cash transfer payments and the commitment that we have made and the minister in particular. This is a man who relies on friendly persuasion, but as an experienced lawyer well recognizes that a certain element of power can be used, if it should be, but it should not be escalated or opted for in too quick a fashion.

That is our position. At the present stage we are monitoring the situation in relation to the province of Alberta, which has been specifically raised with us. We will seek to work with the province of Alberta. If we find that actions taken are incompatible with the Canada Health Act we will move at the appropriate time. But we will continue to discuss. We will bring, in particular to the attention of the province of Alberta and its health minister, the fears that we have under NAFTA.

I would be very sorry to see an institution like St. Paul's have its frontiers research experience and expertise drained away by competition from a sort of single issue specialist institution from another country. I think that any institutions coming in would be expected to play their part in carrying on what might be called the ordinary, tedious, but so vital a part of hospital administration's work.

That is the message from the minister. He will not engage in an unnecessary war with the provinces. He is determined to maintain the five fundamental principles of the Canada Health Act. He is determined to see that there will be full co-operation by the provinces in the spirit of that, but he will look to ways of working with them to effectuate that purpose.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, the member for Vancouver Quadra lives fairly close to a private clinic called the Cambie Clinic. This clinic is unable to look after individuals from British Columbia. It is illegal for them to enter the door. But this clinic can look after people from the U.S., from Asia, from Alberta, people who come from outside B.C.'s boundaries. However, those who are Workers' Compensation Board patients and those who have become sick through the armed forces or the RCMP have access to that private clinic.

Does this clinic cause any anxiety to the member opposite?

[Ted McWhinney, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I thank the member for that question. This is the sort of issue that I would expect, in the spirit of co-operative federalism, will be part of the ongoing discussion between the federal government and the provinces.

In the specific province that has been discussed, the province of Alberta, our big fear is that it will possibly lead to a two tier system of medicine in which the financially privileged will get extra and prior benefits to others. I think that the debate would become simpler if it could be established that such a danger did not exist, but we have to work on the assumption that the principle of fundamental equality of access and of treatment is the bedrock principle of the Canada Health Act. On specific cases, just as I mentioned with the NAFTA situation, I would myself look for further discussion. But we cannot change that bedrock principle. It is fundamental to us and fundamental to the Minister of Health.

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

Mr. Speaker, I am tempted to put a rather rhetorical question to the member, having listened to his very thoughtful remarks, and ask whether Liberal members of parliament were put through a workshop before this debate where they were all trained to express grave concern and then make excuses for the inaction of their government.

It is fine for us to call for co-operative, thoughtful approaches at the federal-provincial level, but are we really prepared to forsake medicare in the interest of keeping peace at the federal-provincial table no matter what the consequences?

If in fact we could believe for one minute that the member's government would be prepared to act immediately upon a violation of the Canada Health Act given bill 11, how can we wait for one second knowing the consequences under NAFTA? Is it not better to be safe than sorry? Is it not better to take every precaution now and amend the act so that there is no possibility of this bill opening the door so that multinational American corporations are able to enter our health care sector in Canada and provide hospital services?

[Ted McWhinney, Liberal, Vancouver Quadra, BC]

Mr. Speaker, I advise the hon. member that if one expects an immediate decision from NAFTA one may be very disappointed. These are lengthy labyrinthine processes. The issue was raised with me because the answers require extensive research and my opinion was asked. I simply said that there will be time, but it is a matter that we need to discuss with the provinces and to point out to the premier of Alberta that this is a matter of concern. If the issue would arise as a practical matter, there are intermediate legal steps that we could take to block any action, and we would take them.

I think it is important not to jump into a case-controversy situation before it exists. That is why I stress the necessity for study and caution before acting. As far as approaches in this government are concerned, my constituency has a very large number of medical practitioners, professors of medicine and others. They have been educating me in their discipline, which I admire and respect. It is part of my response to them that I have campaigned for the last three or four years to establish the centres for innovation, those special centres for medical research that are parts of the last two, three, four federal budgets.

Most of my colleagues are getting the message, just as I think every member on the other side of the House is getting the message that the principle of universality of access to medical care is fundamental to Canadians. If it is threatened in any way in the interstices of federal-provincial relations, we will come down on the federal side. If there is no threat or if the actions of the provinces can be reconciled with those principles, we would be in my view ignoring our responsibilities as part of the federal system if we put it in issue.

As things stand we have full powers. We have not at the present time on the legal advice given to the Minister of Justice found a case warranting action of a punitive nature against a province.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Mr. Speaker, I have great respect for the member for Vancouver Quadra, but in a province like Nova Scotia, for example, we have a critical shortage right now of nurses and doctors. There is no light at the end of the tunnel that this situation will improve.

I ask the member for Vancouver Quadra who is a representative of the Government of Canada what his government will do to address the very serious situation of the shortage of nurses and doctors not only in Atlantic Canada but in more rural parts of the country.

[Ted McWhinney, Liberal, Vancouver Quadra, BC]

Mr. Speaker, it is a very crucial because one of the facts of life one discovers on talking to medical deans and deans of nursing schools is that a very large number of our graduates of nursing schools go on to the United States.

If one experiences any of our hospitals one will know a good proportion of the staff is immigrants from other countries. Solutions there will require larger solutions to the brain drain problem. Part of that is bound up with the principle of reducing taxes which is, as I have said, part of the policies my constituents have communicated. We have 50% of the budget surplus going into tax reduction and amortization of the external debt.

We have looked at the issue of subsidizing medical and nursing schools by means of scholarships and the like. We still face the problem that the salary is too low. We have to get more money into the hospitals. Then we are getting into provincial jurisdiction. We may have to move on that.

Some of us have said what a pity the constitution was not written in 1967. We would have given advanced research and perhaps advanced education to the federal government. Then somebody reminded me that in 1864 universities belonged to the federal government. It was a vestige of royal power. It was after a whiskey laden voyage around Cape Breton and the like that federal representatives dropped higher education into the provincial area of responsibility in 1867.

There, though, we are dealing with problems on which the provinces must move, but I think proposals for ways in which the federal government can help will be received. I take that as the thrust of the hon. member's question.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Mr. Speaker, before I start on this very important issue, I just want to say that I could not help but notice what a great place the House of Commons is for our pages who come from all parts of the country to work and use up their first year of university education.

It is doubly exciting to know that one of those pages is with us today in the capacity of our Hansard concerns. It is wonderful to see them use the experience they gain as pages in the House to secure gainful employment in the House of Commons in other capacities. It is wonderful to see. It is a great improvement for our young people.

Speaking about young people and what we hope to give them in the future, we in the New Democratic Party hold health care as the primary issue. It is the core of what we do in most cases. It is the aspect of why people like Tommy Douglas, M. J. Coldwell and many others brought the issue to the forefront time and time again. I also wish to say that I will be splitting my time with the member for Regina—Qu'Appelle.

I had mentioned to the member for Vancouver Quadra that in Nova Scotia we have a critical shortage of doctors. We also have a critical shortage of nurses. There is a lack of dollars in what the federal government is transferring to the province. The provincial Conservative Party said during its last campaign that health care would not be reduced in any way, shape and form. Then it took $51 million from health care in the recent provincial budget.

That instils fear in the people in rural parts of my riding. Indeed that is the case in all of Atlantic Canada and in Nova Scotia especially. It instils fear in seniors, people of fixed incomes and single mothers with children. They wonder what will happen to them if they become seriously ill. Will the hospital remain open? Will there be an ambulance for them? Will they be able to afford the so-called extra user fees that are being charged?

Right now pharmacare for seniors in Nova Scotia has gone up another $160 per person. They simply cannot afford that. Any government, municipal, provincial or federal, should not balance its books on the backs of our most vulnerable people, our seniors. In many cases they are veterans who fought overseas and lost their brothers and sisters. Many of them raised their families during the depression, during war and during the post-war eras as well. It is absolutely unacceptable for governments to treat them that way in their golden years.

Our seniors are our knowledge base. We talk about a knowledge based economy. Our seniors have more history and more knowledge than we could ever care to think about. For governments to treat them as a cash cow on which to balance their books is simply unacceptable. There are many other avenues on which to balance the books without taking it out on our seniors, especially those in the beautiful province of Nova Scotia.

In terms of the hospitals right now, the stress within hospitals is phenomenal. In the news today the husband of a personal friend of mine required bypass surgery. He went to the hospital the other day and waited seven hours for his surgery. He was told at the last minute that his surgery had been cancelled and he would have to come back another day. This is the type of health care we are giving people in Nova Scotia. This man happens to be 63 years old.

Can we imagine the confidence the youth of the country would have in the health care system as they go through life after reading stories like this one? It is sometimes amazing and sometimes not very surprising at all why some people choose greener pastures in other parts of the world when they leave Canada. We in the House all say that Canada is the number one country in the world. One of the reasons for saying that is our health care system or our medicare system. It is absolutely unacceptable that governments at all levels in all provinces have been chipping away at that most basic and fundamental foundation by which we define ourselves as Canadians.

Other hon. members have mentioned that it is time for the Minister of Health, along with all premiers of other provinces, territorial leaders and aboriginal leaders, to get together in a health care summit to start defining the health care of the future.

In poll after poll the people of Canada have demanded through their tax dollars a publicly funded not for profit health care system. This is what Canadians want. This is what they are saying loud and clear. It is not very difficult. They are asking for a publicly funded not for profit health care system to be available for everybody from coast to coast to coast, no matter what their income and where they live. In the unlikely event that they require emergency health care, long term health care, or any health care under any circumstance, they want the service to be there for them. Right now many Canadians are losing trust and faith in the system. It is absolutely unacceptable that we as members of parliament, the leaders of the country, are saying to them that we really do not know the future of health care.

I always like to recite the story of when Tommy Douglas first introduced health care. He was hung in effigy by doctors in Saskatchewan. He was considered Satan. They asked how he could take away the right to earn dollars from medicine and socialize medicine, how he could possibly think like that.

Many New Democrat members of parliament were at the Canadian Medical Association awards dinner the year before last when Tommy Douglas was posthumously inducted to the Canadian Medical Association Hall of Fame. This just showed how ahead of the times he was. He personally fought battles so that the experiences he had would not happen to any child in the country. Our party and indeed all Canadians owe Mr. Douglas, Mr. Coldwell and many others in the movement a sincere debt of gratitude. Without them we probably would not be having this debate today and we would probably be into the American style right now.

It is unacceptable that many groups would love to see a two tier system. Insurance companies would love it. American multinational corporations would love it. Health care spending is anywhere from $40 billion to $90 billion. The figures bounce around a lot. Many private businesses would love to get their hands on that. The fact is that it would place a tremendous burden on those Canadians who cannot afford it, those Canadians who are on fixed incomes, and those Canadians who do not have the wherewithal to compete like that.

I should remind the House that according to the latest statistics from the United States 43 million Americans have no access to health care services, a land that calls itself the land of the great, the home of the brave, the land of great democracy. I would hate to be in the House years from now saying that three million Canadians have no access to health care. That would be a disgraceful thing to have to say.

It is why the New Democrats have brought forth this motion today, so we can stress to the public and fellow members of parliament from all parties the seriousness of this issue. We cannot allow health care to be eroded any more than it has now. We have to reinvest in health care and understand that it is the core public concern today. Everyone talks about health care.

For all governments at all levels to sit back and say that they will think about it and that they are gravely concerned about it is absolutely unacceptable. We have to put those words into action. Part of that action starts with this motion today.

I encourage all members of parliament to think deeply, to look into their hearts and talk to their constituents. See what they say about this motion and what they are saying about health care. I am sure they would find that the majority of people in their ridings agree with us.

Members themselves probably would agree as well, if they would get away from the politics of it and understand what defines us as Canadians. Members should forget about being Liberal, Canadian Alliance, Bloc Quebecois, Tory or New Democrat and think in terms of being fellow Canadians, and to know that no matter where they go in the country if they become ill they will have the best quality health care possible. People should not have to go into a hospital wondering whether they have enough money for a particular procedure. That would be unacceptable.

If I can do one thing in this House of Commons as a member of parliament for my own two children, it is to stand and fight for the number one concern of Canadians, which is health care. That is why I am standing today on this very important subject. I want my children to have the same access to health care that I had when I broke my leg, when I had my appendix out, when I had my tonsils out, when I fell out of a tree, landed on a fence and stayed for a week at the Vancouver children's hospital back in the 1960s.

I had access in all those instances. My parents had nine children and ran a group home for over 400 children. All those kids had access to health care as well. We have to be able to say that 20 or 30 years from now the children of tomorrow will have the same quality access I had when I was a young man.

I thank the House for the opportunity to speak to this very important motion. I literally beg all members of parliament from all parties to seriously consider this motion and to support the New Democrats on this one.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, I had an opportunity to ask the member from Vancouver what he thought of a private facility in Vancouver. Let me take the opportunity to ask the member from Nova Scotia what he thinks of the Wolfville hospital in Nova Scotia. That hospital was threatened with closure and the Wolfville citizens said, “You are not closing down our hospital”.

Here is what they did. They said they would disregard some of the rules and regulations and charge people for some things such as syringes when they go to emergency. That is against the Canada Health Act according to the rules. That is a user fee. However, the people of Wolfville said their hospital was more important than some rules.

What does the member from Nova Scotia say to the citizens of Wolfville who valued their hospital more than the rules?

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Mr. Speaker, I thank the hon. member, who himself is a physician, for his question. Unfortunately I do not know about the situation at Wolfville at all. It is the first I have heard of it and I apologize for not knowing about it.

I will relate an experience that I do know. Dr. Herb Dickieson, who is the leader of the Prince Edward Island New Democrats, was elected in 1995 because he stood on the principle that he did not want his O'Leary hospital closed. At that time the government of the day in Prince Edward Island was going to shut it down. He fought along with the citizens of that area to keep that hospital open. I am not aware of what he did in terms of funding in order to keep the hospital open.

I can only say to the people of Wolfville that I would assume, and I do not know this for sure, that they probably would not have had to go to the user fee aspect if all governments had respected and honoured the commitment of dollars to that hospital and had not put those people in that situation in the first place. Desperate times call for desperate measures. I am sure they do not like charging user fees for other things as well.

In retrospect, I would have to say that without knowing the incident, those people did what they felt they had to do and there is not much I can say about it. I wish them well in their endeavours but the fact is, if provincial and federal governments did not download and shirk their responsibilities, the people probably would not have faced that situation in the first place.

[Lorne Nystrom, NDP, Qu'Appelle, SK]

Mr. Speaker, today's debate is a very important one in terms of the future of health care in the country.

I come from Regina. Regina was the birthplace of public health care in the country many years ago. It really started with the CCF in the election of 1944. It was after the Great Depression and there had not been an election since 1938 in the province. The previous Liberal government had gone on for six years during the war without an election campaign. When the campaign came, Tommy Douglas and the CCF were swept to power. One of the promises they made to the people of that province was for health care and hospitalization.

In those days there was not any thought at all of the federal government cost sharing health care. Under our constitution, health care comes under the jurisdiction of the provinces and the federal government gets involved through the use of the spending power, but it was a long time before those discussions were held.

The CCF came to power in that small province of about one million people. They had come through the Great Depression and a tremendous dust bowl in terms of drought. There was bankruptcy such that the province was almost foreclosed upon by the bankers. Despite that, three or four years after it came to power, the CCF set up the first hospitalization plan anywhere in North America. That was about 1948.

As the years went on, it became more and more popular and the idea caught on around the country that public health care was extremely important. By the time the CCF government had improved and strengthened the economy with balanced budgets and so on, it made a commitment. In 1960 with Tommy Douglas as premier, it promised it would bring in North America's first public medicare program.

The people of Saskatchewan re-elected Tommy Douglas and the CCF and they had a mandate to bring in public health care. Tommy Douglas resigned about a year later to become the leader of the federal New Democratic Party, but the minister of education, Mr. Woodrow Lloyd, became premier. It was Mr. Lloyd who was premier at the time medicare became a reality in the province of Saskatchewan.

I was 14 or 15 years old at the time and just going into high school. I remember the summer of 1961 or 1962 when health care came in. There was a doctors' strike against what they called the socialistic move to intervene in the marketplace in terms of health care. The opposition of course was the Liberal Party but it was a very conservative Liberal Party, quite similar to what is called the Canadian Alliance today or the Reform Party. It opposed this as a tremendous infringement on the freedom of Saskatchewan people and predicted that it would spread across the country.

The doctors' strike went on for about 28 days and created a great deal of emotion. There were many demonstrations and a lot of struggle and debate in the province, but the provincial government prevailed. I remember very well seeing a picture of the leader of the opposition, because the legislature was not in session in the summer, going to the legislative chamber and demanding that the speaker call a special session to deal with the doctors' strike. Of course it did not happen, but I still remember the picture of him kicking the door of the Saskatchewan legislature. He had his foot up in the air and he was kicking the door. That snapshot of him went right across the country.

The people prevailed and the CCF government of Woodrow Lloyd prevailed. In 1961 and 1962 we had our first ever medicare system anywhere in the country, financed entirely by the people of the province of Saskatchewan as the federal government was not involved in any way in a cost sharing program in those days.

A few years later the federal government established the Hall commission with Justice Emmett Hall of the supreme court. He looked at the idea of a national health care program and federal funding for health care along with the provinces in a co-funding operation.

In 1967, centennial year, I think Lester Pearson was Prime Minister at the time and the health minister was Paul Martin Sr., the federal government finally brought in a national health care program modelled on the prototype in the province of Saskatchewan. The agreement was that the federal government would cost share with the provinces 50% of the costs for health care. In other words for every dollar put up by the province of Nova Scotia, Saskatchewan, or British Columbia the federal government would put up a dollar as well.

In the original negotiations the federal government was not going to be that benevolent or generous. But guess what, it was an Ontario premier in those days as well, and the Government of Ontario under Robarts was threatening not to participate in the national health care program. When the federal government decided to put up 50% of the costs, the carrot was so big that even Ontario with its wealth in those days decided it could not afford not to participate and became part of the national health care program we know today.

Things went pretty smoothly for a number of years. Then in the 1970s if I recall—I was a member of parliament by that time being elected in 1968—the federal government of Pierre Trudeau brought in a bill that untied the federal contribution from going directly to health care in terms of the transfers to the provinces. I remember Tommy Douglas sat roughly where the Conservative Party is sitting today at the far end of the Chamber. He stood up and said that if we untied the federal contribution to health care, that which goes directly to health care, the day would come when the federal government involvement would lessen gradually and gradually and we would have a crisis in the funding of health care.

I remember him speaking in Winnipeg in about 1981 or 1982 and giving the same warning in front of a huge crowd at a national convention. I remember him saying that people assume that health care is here to stay. We assume it is here. It is a good plan. We assume it is here forever but some day someone is going to try to take it away and that day is not too far down the road. How true that was.

If I were to sit back in those days and predict who would try to do it, I do not think I would have predicted it would be a Liberal government that would get us into a health care crisis. However it was the Liberal government, the Prime Minister and the Minister of Finance and their famous budget in 1995 that had the most radical cutbacks in social programs and health care this country has ever seen at any level of jurisdiction in the history of Canada.

I look across the way at the member from New Brunswick, the minister in charge of homelessness, the Minister of Labour. I know her background in activism. I sometimes wonder how she can sit in that government and support it after these tremendous conservative cutbacks that Brian Mulroney would not have even contemplated in his most conservative days when he was Prime Minister.

That is the legacy of the Liberal Party that sits across the way. Now we are in a crisis. We are in a crisis where some provinces, such as Alberta, are getting into the business of two tier medicine and looking at privatizing part of the medical system, allowing people to get back into health care for a profit. If we go down that steep and slippery road, the time will come when health care will be destroyed. We will have two systems in this country, one for the rich who can afford to buy the extras, jump the queues, get health care, and one for the poor who have to line up at the doors of public care institutions.

The reason public health care started in the first place was so that each and every Canadian citizen, regardless of wealth, regardless of income, regardless of region would have equal access to a public health care system. That is the kind of system we are going to have to keep in this country.

I will close by saying something that makes it even more sad in my opinion. I picked up this morning's newspaper and the headline was, “Federal surplus is higher by $11 billion”. The federal surplus is $11 billion higher for the year 1999-2000 than was predicted in the budget last February. In other words the federal surplus will be $14.9 billion instead of the predicted $3.9 billion, an extra $11 billion. A lot of that extra $11 billion could have been spent on health care in terms of helping the crisis from one end of the country to the other.

The money is there. It is not as if we were running a huge deficit. It is not as if we cannot afford to do this. The money is there. What we are lacking is the political will. That is why we tabled this motion in the House today to try to instigate a great national debate, to say “Health care is the most important priority in the country. It is about time we reinvest in social programs, starting with health care”. The money is there. Let us use the people's money to invest in a good health care system for the people of this country for our future.

[Peter MacKay, Progressive Conservative, Pictou—Antigonish—Guysborough, NS]

Mr. Speaker, I commend the hon. member for his participation in this debate, for his words and the actions of his party in bringing this debate forward. It is very timely and very useful that we embark on this debate.

I also thank him for the feint praise that he heaped upon the Progressive Conservative Party, although I believe it should be real praise when one compares the record of that government to the current government.

I listened very carefully because I, like all members of the House of Commons and the Senate, am extremely concerned about what is taking place. One only has to visit our local hospitals, and I have, the Aberdeen Hospital in New Glasgow, St. Martha's in Antigonish and other health clinics, to know the effect that is being felt at this time as a result of the drastic cutbacks that have been downloaded to the provinces as a result of this government's actions. It is, as the previous speaker has indicated, very stark when one considers that this surplus continues to grow while the provinces are crying out for reinvestment in this area.

It is fine to engage in this debate and to talk about what is wrong with the system, but what seems to be missing is: What are some positive initiatives that we can take?

The Progressive Conservative Party and the hon. member for New Brunswick Southwest, who is our health critic, have put forward some positive ideas. He talked first and foremost about the resources that need to be put back in, putting them back to 1993 levels. He also talked about convening a first ministers' conference with premiers.

What positive initiatives are the hon. member and his party putting forward as to how we could fix the crisis in health care? We could talk about it until the cows come home, but what is he presenting as a positive initiative that would work to move the yardstick forward in this area?

[Lorne Nystrom, NDP, Qu'Appelle, SK]

Mr. Speaker, we have a five point plan, which starts with more cash from the federal government. That is what I spoke about today. The federal government is putting in about 12 cents or 13 cents on the dollar. It used to be 50 cents on the dollar and we have to start moving back toward that level of contribution.

[Steve Mahoney, Liberal, Mississauga West, ON]

You know that is not true.

[Lorne Nystrom, NDP, Qu'Appelle, SK]

The member across the way is now trying to interject. He is saying that it is untrue. It is 12 cents or 13 cents on the dollar, depending on the province. Those are well documented facts. The only people who dispute them are some Liberal members of the House of Commons. If we look at Statistics Canada, that is the kind of information we get.

The other things we are talking about are home care and pharmacare, as well as amending the Canada Health Act to make sure that bill 11 in Alberta does not pass without the Government of Alberta being penalized. Those are three or four of the points that we are talking about.

[Grant Hill, Reform, Macleod, AB]

Mr. Speaker, I appreciate the member's nice, historical overview of health care. He mentioned Justice Emmett Hall. It is interesting to note that Justice Emmett Hall's son became an orthopaedic surgeon and was so frustrated with the Canadian situation and the technology that we have in Canada that he left. He has abandoned the country of his dad and the country that trained him.

I try to go to the home community of each speaker on this issue and ask a question about what is going on. I lived in Regina—Qu'Appelle as a young man and I have a couple of colleagues who still practise there.

What does the member think, when there is a shortage of capital in his community, of a foundation that is set up to raise money for those nasty for profit corporations? It raises money for MRIs and for equipment that is not available in any other connection. Those foundations are set up literally across the country to raise capital. What does he think of those dollars from those dirty, for profit corporations?

[Lorne Nystrom, NDP, Qu'Appelle, SK]

Mr. Speaker, it is unfortunate that people have to do this. The money is in the federal treasury. There should be more money put into transfers from the federal government. The surplus is now $11 billion more than it was thought to be only a few months ago. The federal government should be putting up its fair share of the money. If that were to happen, then private fundraising would not be required.

I also say to the member that Saskatchewan is one of the few provinces which backfilled the drop in federal contributions dollar for dollar. That is actually quite a feat for a small province which does not have a big treasury like Alberta or Ontario.

[The Acting Speaker (Mr. McClelland)]

It is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Dartmouth, Communication; the hon. member for Beauséjour—Petitcodiac, Human Resources Development.

[Bryon Wilfert, Liberal, Oak Ridges, ON]

Mr. Speaker, I will be splitting my time with my colleague from Mississauga West.

I am pleased to participate in today's debate concerning the Canada Health Act and to deal with the issue of enforcement.

The federal health minister is responsible for monitoring provincial and territorial health systems to ensure that they adhere to the criteria and conditions of the Canada Health Act.

Canada's publicly funded health care system is a partnership. In terms of the federal government, Health Canada is responsible for the administration of the Canada Health Act, while the provinces and the territories are responsible for the organization and the delivery of health care services in their respective jurisdictions. This shared role requires us to work in close co-operation with one another.

The Canada Health Act contains nine requirements that the provinces must fulfil to receive their full share of federal funds, which are provided to the provinces and territories in the form of tax points and cash under the CHST. These include the five program criteria of public administration, comprehensiveness, universality, portability and accessibility, which apply to insured health services.

In addition to the five criteria, there are two conditions of the act, information and recognition, which apply to not only insured health services, but also extended health care services.

As members may know, insured health services are medically necessary hospital and physician services. Extended health care services are nursing home intermediate care services, adult residential care services, home care services and ambulatory care services. Finally, there are the extra billing and user charge provisions, which only apply to insured health services.

The Canada Health Act provides sufficient flexibility for the provinces and territories to restructure their health care systems so that they continue to respond to the individual needs of their populations.

Changes to Canada's public health care system can occur without violating the principles of the Canada Health Act. We all know that the time has come for a national effort to renew and strengthen medicare. All governments believe that the status quo is no longer an option. The changes required can and should occur within our public health care system. The principles of the Canada Health Act are broad and flexible enough to allow for innovation while building on the strengths of our single payer system.

The federal government's commitment to maintaining the principles of the act is to ensure that the integrity of one of the best health care systems in the world is not jeopardized and that Canadians continue to have access to a comprehensive range of medically necessary services on the basis of their need, not on their ability to pay.

Many potential issues of non-compliance with the Canada Health Act criteria or conditions over the years have been resolved without resorting to CHA penalties. In these instances, discussion and negotiation at the official level were instrumental in bringing these matters to a satisfactory conclusion.

In the event that discussions and negotiations between the federal and provincial officials prove ineffective in reaching a resolution, the Canada Health Act provides a process by which suspected violations can be investigated and resolved, or indeed penalized.

When the federal health minister receives information and is of the opinion that there is a suspected violation of the act, the minister must undertake consultations with provincial and territorial counterparts. Only after these consultations does the minister proceed to invoke the penalty provisions of the act, if the facts of the matter under investigation confirm that a CHA violation has occurred.

Under the Canada Health Act penalties for violations of the criteria and conditions are financial. The government uses moral suasion and financial penalties under the CHST to persuade the provinces and territories to take corrective action.

While the government is prepared to act if there are violations, let me reiterate that it is always our hope that we do not reach that point, that issues of potential non-compliance can be resolved through discussions and negotiations, without resorting to penalties.

There are broad, fundamental challenges which are facing the health care system in Canada. The federal government is committed to working with the provinces and the territories to meet these challenges. We would always prefer to build on the co-operative relationship we have shared with provinces and territories over the years, and to build on the creativity and innovation which created our public health care system that is the envy of the world.

In response to the auditor general's concerns about Health Canada's capacity to enforce its responsibilities vis-à-vis the Canada Health Act, the federal minister made a statement to the House of Commons on Thursday, May 11, announcing a budget increase of $4 million to the existing $1.5 million for the Canada Health Act division. This will allow for an increased enforcement capacity to monitor and assess compliance with the act across Canada, as well as to investigate potential non-compliance issues on a proactive basis.

As well, the announcement of the realignment of the administration of activities at Health Canada on April 17 will strengthen the department's regional presence and increase the policy and analysis capability in the regions to strengthen Health Canada's ability to monitor Canada Health Act compliance on the ground.

Information is an essential tool for the federal government in administering the Canada Health Act. To that end, Health Canada is developing an improved information gathering framework that will assist the federal government in improving its monitoring, assessment and reporting of provincial and territorial compliance with the criteria and conditions of the Canada Health Act.

Health Canada's response to the auditor general's report, and to Alberta's bill 11, will result in the development of a process which will ensure a comprehensive and fair approach to the administration of the Canada Health Act. This new approach will take time to implement and requires the support of our provincial partners. This is why the government is working closely and collaboratively with the provinces and territories on all the issues related to the Canada Health Act.

Our goal is to ensure that the underlying principles of our health care system are protected for the benefit of all Canadians. By working with the provinces we are putting a much needed emphasis on making the co-operation and administration of our cherished, publicly financed health care system more transparent and accountable to Canadians.

In closing, I want to reaffirm the government's commitment to working with the provinces and territories to ensure compliance with the principles and conditions of the Canada Health Act. The changes that are needed to see us into the 21st century are possible within the public health care system, and are fully consistent with and supportive of the principles of the Canada Health Act.

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

Mr. Speaker, we heard a great deal from the Liberal member about plans by the government to enforce the Canada Health Act. This is of course used as an excuse for its inaction on bill 11.

My question for the member is quite simple. All the enforcement officers in the world will not mean anything if there is nothing left to enforce. A million medicare cops will not do anything if the bill and the consequences under NAFTA are allowed to proceed.

Can the member not see the importance today of amending the Canada Health Act to ensure that there is absolutely no possibility of private for profit hospitals being allowed to be included as part of our health care system?

[Bryon Wilfert, Liberal, Oak Ridges, ON]

Mr. Speaker, I outlined very clearly the process by which the federal government would respond if there were a violation of the Canada Health Act. Having the appropriate information and the proper monitoring is critical.

I will point out to my hon. colleague one of the difficulties we have. Earlier she talked about the fact the we as a federal government gave about 11 cents to 13 cents to the provinces. Again I want to correct that. It is about 33 cents to 34 cents in cash and tax points. I heard some provincial members say that they do not recognize tax points. If that is the case we should simply take them back.

In answer to my colleague, one way to add to the accountability of provinces that are responsible for the administration of health care is to add two new principles: accountability and transparency. If the provinces do not feel that the tax points are of much use to them, maybe the federal government should take them back and go back to silos. My hon. colleague from Regina Qu'Appelle mentioned the fact that we had gone to the CHST. I would suggest to him that maybe we should go back to silos and say that this is for health; this is for post-secondary education; and this is for social services. This would put the onus back on the provinces where it belongs.

In terms of accountability, when we transfer money to the provinces we have no idea what they do with it. Coming from the province of Ontario I can point out very clearly that the province is sitting on half a billion dollars. At this point it has the ability to provide for tax cuts, but it does not seem to be able to provide for the administration of hospitals, which is in its jurisdiction. Those are two principles that my hon. colleague might think about in this debate.

[Angela Vautour, NDP, Beauséjour—Petitcodiac, NB]

Mr. Speaker, if I am correct, I should remind the member that the change to the CHST was made under his government. We know that is a problem.

Would the member admit that lack of funding is the cause of the problem we are seeing in health care right now? Every province is asking for health care funding to be restored to the 1993-94 level. Why is the member's government not restoring it so we can stop the privatization of our health care? I did a survey in my riding—

[The Acting Speaker (Mr. McClelland)]

I am sorry to interrupt but the member's time has expired.

[Bryon Wilfert, Liberal, Oak Ridges, ON]

Mr. Speaker, I point out to my colleague that last year the government restored $11.5 billion in health care transfer payments. It was the largest amount of money that any government put into the health care system. Again this year we put in $2.5 billion.

We have provinces crying for money at the same time as they are giving tax cuts. The Ontario government will mail every taxpayer in that province a $200 cheque. That is $1 billion. If it can afford those kind of tax cuts while sitting on half a billion dollars, it cannot cry wolf too often as it has.

Maybe my colleague might ask her kissing cousins in Ontario, although I am not too sure how close they are in terms of kissing any more, what is going on. How can it afford tax cuts but not afford to restore health care which according to her is a priority under its watch?