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.