Debates of June 15th, 2000

Supply

[Paul Forseth, Reform, New Westminster—Coquitlam—Burnaby, BC]

Mr. Speaker, I only have 10 minutes to speak to the motion of my caucus, the Canadian Alliance, which states:

That this House recognize that the health care system in Canada is in crisis, the status quo is not an option, and the system that we have today is not sustainable; and, accordingly, that this House call upon the government to develop a plan to modernize the Canadian health care system, and to work with the provinces to encourage positive co-operative relations.

I cannot cover the scope of the problem at this time, but I can briefly say that we must first understand that medicare is the constitutional responsibility of the provinces. The federal government, through the Canada Health Act, controls a declining portion of the funding in exchange for the famous five principles.

As predicted at the start of medicare, the principles have been abandoned by all governments, yet the hollow phrases are fought over for the political advantage of posturing before the public about what party or government is more caring, wiser, and therefore should be trusted and supported by the voters.

The principles are: accessibility, portability, universality, comprehensiveness, and public administration. However, we must look at the five principles of the Canada Health Act and question if they are working.

Concerning accessibility, in the nineties there was an increase in people waiting for care. In 1993 the average wait was 9.3 weeks, but in 1998 the average wait was 13.3 weeks, an increase of 43%. Patients wait months to see a specialist. There is a huge shortage of technology that is available in other countries but is spread thinly in Canada. People are dying because they cannot get timely access, or they suffer needlessly.

What about portability? This supposedly means that every Canadian has the right to be treated anywhere in Canada. However, Quebec patients outside Quebec are required to pay upfront because the Quebec government did not sign the portability agreement and cannot be counted on to pay up.

I am told the reverse is even worse, about a person from B.C. who gets sick in Quebec and about how that person is seemingly discriminated against in the Quebec system. In other words, the interprovincial payment system is full of problems.

Next we have so-called universality. There are great shortages of services in outlying areas of Canada, far beyond the expected concentration of special services in regional centres. Where one lives, how and where one acquired the medical need and one's personal legal status all undermine universality because these affect what one gets from the system.

What about comprehensiveness? That has never been followed from the beginning. Each province has a different list of things that are covered and those that are not. As the pressure has mounted, provinces have been forced to delist services. In other words, there is no operational, national working agreement of core services. Consequently, Canada does not have comprehensiveness.

Finally, what about public administration? Most of it is public, in theory, except that there is a lot of contracting out that goes on for efficiencies such as computer services and financial support, and the labyrinth of personal cash payments for services mixed with tax dollars. As well, about 80% of total public spending for health care is consumed by labour costs for doctors, nurses and administrators.

Public administration of the complexities of medicare should be held accountable for cost and efficiency, but since there is no real competition how do we know what is happening?

The main point of a recent national study was the huge list of things that the system really did not know, could not account for or measure. In other words, medicare is administratively in the dark.

Dr. Heidi Oetter outlined the situation eloquently when she said in the Vancouver Sun :

This is the year I turn 40. It is a reflective year, a time to take stock of the past and ponder the future. When I was 20, I chose to stay in British Columbia and finish my education at the University of British Columbia's faculty of medicine. When I was 30, I chose to stay in Canada, unlike many of my classmates.

Since then, I've participated in more committees than I care to count, provincially and federally, to try and make Medicare work. Sadly, as my fourth decade comes to a close, I have to publicly say Medicare is decaying rapidly, and if we don't act now, its future is bleak...

Each new discovery, medication, diagnostic machine or operating device is expensive. For example, the additional equipment to do laparoscopic gallbladder removals—the cameras, TVs and laparoscopes—typically costs $100,000. The new neurosurgical equipment that will use computers to assist in brain surgery will cost upwards of $1 million. A magnetic resonance imaging machine (MRI) costs $1 million. B.C. has nine MRIs and should have 18...

In reality, it is difficult to fund research and new technologies when the Medicare system cannot even keep up with today's demands. Already we have medications and new technologies that Medicare simply cannot afford. Three times last year I referred patients to the United States, not to avoid the long Canadian waits, but to obtain a service that just was not available here. There now is better technology with improved outcomes for the public, but it's so expensive that Medicare cannot provide it.

I doubt my parents' generation will accept anything less than the best for the management of their heart disease, diabetes, cancers and chronic illnesses. Yet, my boomer generation, by sheer numbers alone, will challenge the sustainability of Medicare, as we age into our costliest health consuming years...

So, what do I want for my birthday? I would like to see further serious public debate on the issues as we have some serious decisions to make. We have to ask: “How much will we spend on Medicare? How will we fund new medicines and technologies? How do we decide what is necessary? What will our spending priorities be?...Our reality is that Medicare is decaying and is at risk of imploding. So, let's talk sustainability”.

Dr. Heidi Oetter is a practising family physician in Coquitlam and chair of the British Columbia Medical Association General Assembly.

What can we do, especially for those who really care about health care rather than health politics? We can be very watchful of the motives and the understanding of those who rant and derisively point the finger, saying “Someone wants two tier, American-style health care”. All agree that Canadians want great health care that is provided fairly and without catastrophic personal cost.

The constitution of Canada gives the provinces jurisdiction over social services, including health, education and training, and social assistance. We need to respect our constitution and refrain from intruding into the provinces' jurisdiction, including the formulation of social policy. Is Quebec listening?

The public sector now spends about $60 billion on health. A cheque the size the premiers want would boost that sum by a little more than 5%. Their report says that at a minimum “health spending could increase by close to 5% per year during each of the next 27 years”. The premiers estimate that by 2026-27 health expenditures will be 247% higher than today. That prospect is not sustainable.

We believe all Canadians should have access to quality health care regardless of their financial situation. We need to provide greater freedom of choice because it raises standards. The needs of patients must come first in the delivery of health care services, before restrictive union contracts and administrative empire building. We must work co-operatively with the provinces so that they have the resources and the flexibility to find effective approaches to the financing and management of health care.

We should not be afraid to allow the greatest freedom possible to Canadians in their choice of natural health products. We need to introduce restrictions only on those products that the government can clearly and scientifically demonstrate to be harmful. With the right incentives we can learn to manage for health rather than for sickness.

We can fix the national economy for real growth through tax reduction and spending reallocation so that we nationally can create the wealth to pay for the medicare economic challenge and create a reliable long term funding base.

The provinces are calling for $4.2 billion, and we need to grow it, rather than borrow it from the next generation. We can bring standards and independent auditing for greater transparency in the delivery of health care. We can initiate relations with the provinces to support and co-operate, not punish. We can examine and challenge the traditional roles of administration to get better efficiency and productivity. We can become more patient focused with the timely use of comparative measures. We must give evaluative tools to patients so they can make the local system more accountable and responsive to them.

The Canadian Alliance believes that families should get the best health care when they need it, regardless of their ability to pay.

Our plan to address the issues will only work if Canadians accept the need to innovate and change through co-operation rather than coercion, local adaptability rather than condemnation of others.

We can change the present dismal picture and place ourselves in the top one-third of OECD countries for health care, with no waiting lists, services that are not in jeopardy of being delisted, reversing the brain drain and ending the shortage of health care providers through wise incentives rather than defensive, punitive rules and barriers.

Who we are as Canadians and our standard of living will depend largely on the quality of our health care system. Instead of resisting change, we need to embrace it to solve the challenge of medicare in our time.

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, it is a pleasure for me to engage in the debate today on health care.

I had the privilege of hosting a health care forum in my riding only a few weeks ago, so I am very familiar with some of these issues. In attendance were the former Ontario deputy minister of health, some of the leaders of our hospitals, some primary care workers and some home care workers.

We are now having the debate in the House. Members have talked about money. They seem to think that the simple solution is just to put more money into health care and suddenly all the problems will go away.

Members will be interested to know that the health care workers themselves, while they of course would like more money, made the statement that it was not about money. Indeed, Canada is the fourth highest spender on health care in the world. We spend 9.6% of our GDP on health care, $86 billion a year. I have heard members of the Alliance, surprisingly enough, who are so cost conscious, say that maybe it should be 12%. I was quite incensed by that.

One of the conclusions of the health care forum that I put on was that we could not continue to put money in the top of this thing because it was not coming out the bottom and it was not being delivered to the patients.

Do we have a problem in health care? Yes, we do. We have a problem getting the newest technology. If we look at the waiting lists, we see that they are getting longer and, at the same time, we are paying more money for the system. There is definitely something wrong with the system.

We also see that our health care costs have been rising at the rate of about 5% a year and are scheduled, because of our demographics and our aging population, to continue to rise. People say it will rise as high as 6%.

Mr. Speaker, I do not have to tell you, as I know you have studied the economy quite a bit, but our economy is only expanding at the rate of 3% a year. In other words, health care costs are actually rising twice as fast as the economy is growing. Obviously, we cannot continue that because instead of talking about tax cuts, we would be talking about tax increases to maintain a system like that.

There is no question that we need some changes in the health care system but what changes are needed? Maybe some doctors are listening to this today and I do not want to offend them, but one of the comments I heard was that a normal doctor-patient ration is about 2,000 patients to 1 doctor. There are differences depending upon specialization and so forth, but as a general comment, as a quick working tool, based on the province of Ontario's population base, we should have about 5,000 doctors. In fact there are 9,000 doctors in the province of Ontario and I am told Ontario is screaming for more doctors.

What is the problem when we look at that quantitative analysis? One of the other members actually mentioned some of the structural problems. It would appear that many doctors are not engaged in the practice of medicine or, seemingly, not on a full time basis. In fact, it is thought that almost 40% of their time is taken up with administrative duties, such as filling in forms, pushing papers and so forth because of structural problems. By the way, these are structural problems that provinces have put in place.

I dare say that the whole question of malpractice also creeps into this, the question of how to protect oneself in public liability cases. This has created a big paper burden as well for the medical profession. The reality it that these structural problems have basically created a health care system which, quite frankly, is broken and is not working.

By the way, I will be splitting my time with another member.

We can agree on a number of things. First, I do not think we have full agreement about money. I hear politicians of all stripes saying “Another $4 billion on the table will solve all of our problems”. That is not so. If it were $4 billion this year, it would be another $4 billion year after year after year. It will never go away and the system will not get any better because we will not have changed the structural problems with health care.

What are some of the problems in health care as I perceive them? Some of them are that we do not have an integrated health care system. In many of the regions we do not integrate the health care system itself. In other words, when somebody gets sick at home and has to go to the hospital, a bunch of health care providers are involved in that: ambulance drivers, paramedics and so forth. In fact, by the time the person actually ends up in the hospital almost 40% of the costs have got nothing to do with health care workers.

How do we integrate those services to ensure a proper delivery of the system? What occurred to me is that in many parts of this country we do not have a fully integrated health care system. We are not using some of our best technology. We know that we are in a technological revolution but if we go to some of our hospitals, although we do see doctors working on computers rather than working on patients, we also see a lot of people pushing paper around. We also find that we cannot track patients. In other words, we do not have the simple technology of a health card with a computer chip on it that gives information on our health record when we travel from one place to another in this country. We have the technology to do that but we are not spending the money on the technology to make it more efficient. In that sense, we are not using the new technology available.

Because we have so much inefficiency within the health care system, we have also made choices on how we spend the money. We have spent money in areas where it is not very efficient and we have neglected to spend money on those things that are important, like investing in new technologies. I am not just talking about information systems, but also the newest equipment that we need to keep our people healthy.

There is no question that people are healthier today than they were 15 years ago. We would rather be sick today than 15 years ago. All the talk in the House about the health care system being a terrible system has been a little bit overexaggerated.

What are people looking for? They understand that the system is not up to speed. They also recognize that the Canadian population is an aging population and that this problem is just going to continue to get worse. The reality is that they do not really care.

When I had my health care forum, I was amazed that people did not care whether it was the federal or provincial government that was presenting the health care forum. All they wanted was somebody to take some leadership on this file, solve these problems and stop all the finger-pointing back and forth between governments about who is responsible for what. It is not about private health care as opposed to public health care. It is about how we can make the existing system work better.

There are some ways we can make the system work better. We must have an accountability framework to find out what people are concerned about in this country. People are concerned about getting 24 hour primary care. They are concerned about the long waiting lists that they are suffering in getting to see a specialist, in getting specific knee transplant operations, or whatever the case may be. We can define the targets.

What do we have to do as a government? Unfortunately, or some may say, fortunately, we do not administer the health care system. We are simply the givers of money. People are fed up with that kind of attitude. It is not about giving money. The federal government must re-impose a vision of health care in this country. That vision must be from sea to sea to sea and it must be based on basic standards that people find acceptable.

When we put the money on the table we are going to say that we are putting it on the table but under certain conditions. The conditions will be that these objectives may not be met today, but that over a period of time we must see progress in creating a better health care system or there will be no more money.

Maybe some of the provinces will not buy into this accountability network. We must also get the provinces working together. The provinces must have their own permanent registry system so that they can determine best practices between provinces. One of the other members talked about the inter-transfers between provinces not working well. The sharing of best practices between provinces does not exist. The sharing of medical records does not seem to exist. We have to do these fundamental things in order to have a better health care system.

I believe that is what the Canadian people want. They want to stop this silly debate that we are having in the House and in the media about money, money, money. This is not just about money. It is a much more difficult problem to solve. We have it within our power to solve it. That is the vision that this government has going forward.

[Louise Hardy, NDP, Yukon, YT]

Mr. Speaker, I was listening very closely because I think the whole idea of accountability is an important one. My focus would be on accountability toward the health of Canadian citizens, not necessarily a focus just on money. I do not know if that was what the member was pointing to.

I think we should have accountability and integration. I was one of the MPs at the ecological summit. We heard reports from various doctors saying that to have better health for Canadians, we have to integrate our food, our agriculture, our environment department and our health departments. We cannot exclude any of them or look at them independently because when it comes to our health, they are interconnected.

Along the lines of preventative health, our health care system should include naturopathic doctors. That has not been done. These doctors have to get a bachelor of science degree. They have to train. We have an eminent institution for naturopathic medicine in Toronto. The doctors have to train there for three more years and then they have to specialize. They are doctors in their own right. We should be able to connect with them as well as with our medical doctors and have that integrated to add to the health of our community.

I keep hearing that we cannot just throw money at it. Nobody is saying that we should just throw money at it. That is not happening. Medicine and care is labour-intensive. People cannot be left sick and alone. There has to be money for primary care. I would like the member to respond to that.

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, I respect some of the things the member for Yukon has said. Indeed, our definition of health care, if we expanded it, although I think it has expanded, most people, if asked about health care, would include naturopathic medicine even though traditionally it has not been included.

Her concerns about the doctors recognizing naturopathic medicine goes beyond that. I know in my own province, my own audiologist, who grew up in New Brunswick and has a three-year university degree, cannot prescribe a hearing aid without a doctor signing the certificate. This is ridiculous. These are structural problems that would exist within the purview of the provinces.

While I understand what the member is saying, I have heard her party say that we should simply restore the funding to health care. I do not think that is all that is needed. I think we want to do more than just restore or increase the funding to health care. We want to go beyond that to an accountability framework.

[Loyola Hearn, Progressive Conservative, St. John's West, NL]

Mr. Speaker, when the hon. member was speaking, he talked about certain targets. When we talk about the infusion of money needed into the health care system, quite often we hear people say that the best bargain we have in health care is in proper home care and in such things as personal care homes, which really cost very little in relation to keeping the same individuals in major nursing homes or hospitals.

However, the government seems to hesitate putting adequate funding into programs where we can keep individuals in their own homes and in their own communities where they will be happy, where they will have their own families and where the cost to government would be minimal in comparison to putting them into different institutions. The people who are charged with caregiving are given a meagre sum to carry out their work. It is almost minimum wage.

I just wonder what plans this government might have or what the member's idea would be in relation to developing a health care system where everybody plays a part and those who are involved in caregiving—

[The Deputy Speaker]

I am sorry to interrupt the hon. member. A one minute response, please.

[Alex Shepherd, Liberal, Durham, ON]

Mr. Speaker, I might not have specifically mentioned home care in my speech. Indeed, home care is one of the answers. There is no question that various studies that have been undertaken confirm the member's finding that it is a lot cheaper to maintain an adequate home care system rather than institutional care.

After all those barriers it was also found that patients prefer to be in those places. In my province the estimated average savings is $2,500 per patient if they were on home care rather than institutional care.

It is part of our government's thought process on how to enhance health care and how to do away with the so-called geriatric beds within our institutions to get those patients out of there and into better areas.

The big problem about universal home care is how to define it and what is included and what is not. We are still—

[The Acting Speaker (Mr. McClelland)]

The hon member's time has expired.

[Karen Redman, Liberal, Kitchener Centre, ON]

Mr. Speaker, I am pleased to speak to this motion. It gives me an opportunity to set the record straight on the federal government's share of Canada's health care funding.

It was announced in the 2000 budget that the government strengthened for the fourth consecutive time the cash transfers to provinces and territories through the Canada health and social transfer.

On February 28, 2000, the federal government announced a $2.5 billion increase to the CHST for provinces and territories to use over four years for health care and post-secondary education. Let us not forget that $2.5 billion increase flows from an investment made through the 1999 budget, an $11.5 billion increase in funding over five years specifically for health care.

The Canada health and social transfer provides support in the form of both cash and tax points to the provinces and territories for health care, post-secondary education, social services and assistance programs. The Canada health and social transfer is block funding. It gives provinces and territories the flexibility to allocate payments and to choose priorities of their own among social programs.

In the year 2000-01 the Canada health and social transfer will reach a new high of $30.8 billion. Of this amount, $15.3 billion will be in the form of a tax transfer and $15.5 billion will be in the form of cash.

Transferred tax points are not easy to understand, but they do form a fundamental part of the federal contribution to establish programs in both health and post-secondary education. This is how we have been transferring money to the provinces since 1970.

The tax transfer occurred in 1977 when the federal government agreed with provincial and territorial governments to reduce its personal and corporate income tax rates, allowing them to raise their tax rates by the same amount. As a result, revenue that would have flowed to the federal government to be redistributed began to flow directly to provincial and territorial governments. It continues to flow in line with the growth of the Canadian economy.

Provinces and territories maintain the flexibility on when they draw down the $2.5 billion. They can draw upon it to meet the most pressing needs in health care and in universities. At any time over the course of the four years they may do what they see fit. It is anticipated that the increase of $2.5 billion to the Canada health and social transfer will be drawn down by provinces and territories in a somewhat gradual manner.

What does all this really mean? The bottom line is that the federal government spends in excess of 34 cents of every public health care dollar spent by governments in Canada. That is clearly more than the 7 cents or the 11 cents that some provinces and the opposition are claiming the federal government spends.

Let us review the facts. It is projected that governments will spend $64 billion on public health care in the year 2000-01. The federal government will transfer $30.8 billion through the CHST to provinces and territories. Based on the historical allocation this will translate to $18.5 billion for health care in the year 2000-01. In addition, the federal government spends over $3 billion directly each year on aboriginal health care and health services for the armed forces and the RCMP.

Federal direct funding combined with the $18.5 billion means that about $22 billion of next year's projected $64 billion public health care expenditure, or 34 cents for every dollar spent, will be financed by the Government of Canada.

If we factor in the $9.5 billion the federal government will transfer to the less prosperous provinces and territories to invest in health care and other priorities, total federal transfers in the year 2000-01 will be over $40 billion. All told, federal spending on health is at least 34 cents of every dollar spent.

The federal government recognizes the need to ensure that health care continues to meet the needs of Canadians well into the future. However, additional money is not the only solution. In a word, our health care system requires innovation. We must find new ways of responding to the health needs of Canadians. With this in mind, the federal government remains committed to the five principles embodied in the Canada Health Act: public administration, comprehensiveness, universality, portability and accessibility.

Governments at the federal, provincial and territorial levels cannot afford to spend their limited resources on health care ineffectively. This is why the federal government is strongly committed to partnership. It is through these efforts at reform and renewal that our health care system will carry Canadians well into this century.

Many premiers have stated that in their view there is a need to reshape Canada's health care system and make necessary changes to ensure that it is sustainable over time. The Government of Canada welcomes their view. It is their leadership on this subject and our determination to work with them that will give us the vision that is required for health care.

Both federal and provincial governments recognize that over the longer term future decisions about investments in health care must be based on a plan that responds to the desire of Canadians for a more integrated approach to health care. New resources in the future must be based on the shared objective of meeting the needs of Canadians for quality health care.

The federal government is the first to say that innovation in itself will not sustain public health care unless it is supported by adequate funding and a comprehensive plan of action. Let me emphasize, as the Prime Minister and the Minister of Finance have said before me. If more money is needed to ensure an accessible and sustainable high quality health care system in the 21st century, the Government of Canada will contribute its share toward long term financing based on this comprehensive plan.

We agree that the status quo is not an option, but we will not go down the path of the Canadian Alliance. We will not go where it would take the country. The Minister of Health has shown that he is ready, willing and able to work with his provincial and territorial counterparts to achieve the kind of vision that will result in sustainable, renewed public health care for all Canadians. The minister met with provincial ministers in March. He has spoken with many in recent days and will continue to teleconference. As a matter of fact he is teleconferencing with all provincial health ministers tomorrow.

The government continues to work co-operatively. Canadians are tired of having different politicians at the multiple levels of government point fingers at each other. They are interested in a spirit of co-operation in achieving something that will make all Canadians proud and serve our needs as we are an aging population. That is the kind of health care system that the government is prepared to support and defend. We are showing leadership and we will continue.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, it is my privilege to speak to the amendment. I thank the many members who have spoken to the motion today.

Many members have made somewhat the same points. The system does need a lot help. I am disappointed that the health minister would choose to say that he would not support the motion. Therefore I guess he is saying that he does not believe the system is in crisis, that he believes the status quo is an option and that he thinks the system is sustainable. Obviously by opposing the motion he is saying those things. I am rather surprised that all members of the House could not agree that this is a non-partisan issue. It is an issue that we should be looking at because 78% of Canadians are saying that is their number one issue.

In summarizing what we have heard today, basically there are problems between the federal and provincial ministers talking to each other. We have heard about some of the turf wars that go on, whether it is between governments, between various professions or something much smaller at a very local level. We have heard about the lack of long term funding, the sustainability of that funding, and a major disagreement as to who is funding what and how much.

We have also heard from members that we are spending an adequate amount comparable to many of the OECD countries. We have had comparisons to some of them. We must recognize that the World Health Organization has said that we are falling in terms of our position in the world on health care. The OECD puts us in the bottom third for a great many areas within health care delivery.

We have heard a great deal of rhetoric and promises. We have not heard very many solutions or calls to action. We have not heard what we will do about the brain drain, technology, demographics and increasing drug costs. We really have not addressed a key factor, the extremely growing cost of health care.

Health Canada today says that the costs will increase at 3% a year for the foreseeable future. With our present spending of $86 billion on health care, by the year 2020 that figure will be $160 billion. That is our total budget of today. We are saying in some 20 years that will be the figure for health care alone. How will we deal with that? How will we come up with some solutions?

Let me try to put some of them on the table today. Obviously we do not have all the answers, but we are saying that someone had better start looking at them. We are saying it should be non-partisan. We are saying it should be for Canadians. Canadians do not care whether it is federal or provincial. They do not care whether it is one party or another party. They care about a system which 78% of them agree is broken.

Let us look at the solutions. I will try to summarize them. I remind members of the House that the former Reform Party had a task force report on health care entitled “New Directions: Setting the Course for Canada Health Care in the 21st Century”. I recommend that people read it. It has been condensed down to about 90 pages. It set some targets and goals. I certainly wish members of the House would quote it as opposed to quoting some of the other fictitious statements we have heard here.

To emphasize what I am talking about, our party would put forward to the House a patient centred, results based health care system. In a patient centred system the patient is number one. What helps the patient? What problems is the patient having? It is not the systems, not the government, not the various organizations, but the patient. The patient is number one. Then we need to look at the results. What are we achieving? We do not need to keep protecting the Canada Health Act and hiding behind it. We need to ask whether it is getting the results for the patient.

Let me start with two recommendations. The first one is to promote federal-provincial co-operation. How will we do that? We could go back in history and obviously say that in the sixties we came up with a formula where the federal government would provide 50% and the provincial government would provide 50%. Then we worked up to another system where we used cash and tax points. I do not think I need to go through all those figures. Then of course by 1995 we got to the CHST.

If we look at the 1993 figures, the federal government was transferring $18.8 billion. In 1998 it went to a low of $12.5 billion. Now it has been raised back to $15.5 billion. If we take all that into consideration, no matter how we do the math, had we stayed with the 1993 figures we are $24 billion short of what we would have been had we kept it at the 1993 figures.

No matter how the government twirls that around and hides that, those are facts that the provinces have recognized and identified. It does not matter whether it is Mr. Romanow's government, Mr. Harris' government or Mr. Tobin's government, they are all telling the federal government the same thing. We have to stop antagonizing the provinces. I certainly commend Mr. Romanow who said, I suppose in frustration, that he wanted to start a national study on this and at least hopefully get the ball rolling.

The reality is that people do not care about whether the jurisdiction is provincial or federal. They want it fixed. The need is obvious. The problems are obvious.

What about the solution to this federal-provincial co-operation? Let me put five things forward for consideration.

First, we believe as Mr. Romanow does, that we need a health care advisory board, a group made up of federal and provincial citizens and of course health care workers. We need to have that advisory group to look at the situation immediately. The federal government should be taking the leadership role, not the provinces.

Second, we need to restore long term stable funding to help federal-provincial co-operation. We cannot go to the table with the provinces and say, “We are not giving any more money”. We do not have to say how much we are giving them but we need to put all the cards on the table and talk about the money issue.

Third, we need to have an independent auditing of the health care system. It needs to be audited. It cannot simply have money thrown at it and no one knows what anything costs. I have visited many hospitals in the last three months and I keep asking, “What does that cost? What would that cost? What would it cost if we did this?” No one seems to know.

The health minister talked about the U.S. system and its administration and that all the costs are known. I am not saying that is what we want. I am saying we need to know. We need some accounting. We need to know what things cost.

Fourth, we need to learn about the innovations in other places. I was very fortunate to visit the Swiss health care system a few weeks ago. I was rather shocked at what I found. I was shocked that when a gentleman with heart pains came to the emergency ward he was immediately met by two cardiovascular surgeons, two doctors and two trained nurses. There were eight MRIs and he was in an intensive care unit within six minutes. All of his medical history was on a card. They knew exactly what medications he was on and what treatments he had had. Now that is technology. That man's life may well have been saved because of those improvements in that health care system.

We need to learn from those innovations. We need to look at what Sweden, the Netherlands, Germany, Switzerland and other countries are doing. Please, Mr. Speaker, advise the members on the other side to stop talking about the U.S. health care system as the only example. There are many other much better health care systems we should be looking at that are spending the same amount of money that we are. Switzerland spends 10.2% of GDP. We spend 9.8%. That is awfully close for those two different health care systems. We need to look at that.

Fifth, I would recommend that we appoint a health care auditor. He should be empowered by the Canada Health Act to standardize, co-operate and modernize the Canada Health Act. He should have that kind of authority. It is important to Canadians so that should be in place.

Those are concrete recommendations. There is a great deal of detail that can go with those which we will be providing.

We need to modernize the Canada Health Act. That is a complex issue which I can only touch on in the minutes I have left. We oppose a two tier American style health care system, one for the rich and one for the poor. Nobody wants it and nobody is talking about it or suggesting it. It certainly is not this party's position. There, it is said. I could repeat it three or four more times, but I am sure the crowd across the way still will not understand it.

I will state our position on the Canada Health Act. We believe in the tenets of the Canada Health Act, but we are saying it is not working. It needs to be modernized. I have heard many people say that in the House. I have heard many provincial health ministers say that.

The system is not accessible the way it is today. Some 200,000 people are on waiting lists. A lady in my riding wrote me a letter saying she had just come from her doctor and she needed to see a specialist and her appointment with the specialist was scheduled for April 11, 2001. That is not accessibility. That is a system that is broken, that is not working, that is in crisis.

We could talk about the shortage of MRIs and other technology. The average age of specialists is 59. It takes 14 years to train them. We train 1,600 doctors and some years 800 leave. We cut the number of spaces available for training doctors. We need 2,200 doctors just to replace what the system is going to require. It is not an accessible system. We need to fix these things. We need to fix the brain drain. We need to get the technology. We need to be prepared for what we are going to be facing in the years to come.

It is not a portable system and many have talked about that, whether a person is in rural Canada or whether they need specialized treatment or whether they are in Quebec. I have asked doctors in hospitals here about patients from Quebec. They told me that they encourage them to pay first and then to go back and fight with their government to get the money. That is not a portable system. That is not acceptable.

Is the system universal? In Alberta there are 333 positions open for rural doctors right now. It is certainly not very universal. The presence of specialists is not very universal, as I have touched on.

Is the system comprehensive? There are a number of delisted items from health care. We have a real problem with a comprehensive health care system. We are suggesting again that we must fix it.

Home care is another major issue. My mother is in Saskatchewan and is presently having serious problems. That province was a founder of health care and if that is how people are treated, it is inhumane and very troubling. We need to look at the home care and palliative care issues and see what we can do. The Senate just reported what it thinks about Canada's palliative care system and the report card was pretty dismal.

Let me talk about public administration. It is fine to say that the system is fine the way it is, but we need to look at how we administer health care. We have to open that up. We have to look at the options. I mentioned the Swiss system and I do not have time to go into that. This summer I intend to visit other systems and look at how they work.

We agree with the principles contained in the Canada Health Act, but they are not working. There is not a Canadian who is not touched by that. What are the solutions? Let me summarize them quickly.

One solution is a long term stable funding commitment with a minimum term of five years. We must work out that deal collectively with the provinces.

We must develop technology so that we enter the 21st century and not stay in the 1960s where we seem to be mired. I have talked about that. There is a surgeon who did a heart operation in New York and the patient was in Idaho. A robot did the surgery. The surgeon is able to do three of those a day just by running that equipment.

On education I have mentioned what we need to do in terms of the financial commitment to fix that problem. It is not the only answer but we must come to the table with some dollars.

We need to show leadership to modernize the Canada Health Act, to demonstrate co-operation between the federal and provincial governments. The health minister talks about it but then he goes out and does something dumb which makes the provinces that much madder. That will not fix the Canada Health Act and it will not fix what Canadians want fixed.

We need a health care auditor. As I said, we need independent auditing to make sure the provinces are abiding by the Canada Health Act and to make sure patients are not abusing the health care system. We need to know what things cost if we are to have a health care system like this.

We do not need to reinvent the wheel; we can learn from others. Many innovative things are happening in Sweden where the system now is 50% public, 50% private. I do not know if that is the way we should go, but we need to look at it. There are various insurance options. We need to look at those. We need to have open minds and not live with a 1960s socialized state run health care system such as those in North Korea and Cuba. We have to move out of that mindset.

We need to modernize the whole system. We need patient centred health care. We need to be prepared to look at medical savings accounts and patient guarantees. We have to fix the waiting list problem. We need to be prepared to look at new technology and decide if that is a solution to the problems we face. Above all, we need to work with the provinces and not work against them. We have to stop the drive-by smears. We have to stop the $2 million advertising campaign against the provinces. We have to stop antagonizing them.

In conclusion, the Canadian Alliance stands for fiscal responsibility. Members know that. We have developed our principles there but I want to say in the House that we have a social conscience. There are no hidden ghosts, as my colleague from the health committee might intimate. There are no ghosts. There is no hidden agenda. We believe in a patient centred, results based health care system instead of the Liberal two tier, turf dominated, non-sustainable, deteriorating health care system. Remember that we spend the fourth most of the industrialized countries and we are in the bottom third in terms of rating our health care system.

As we develop this policy collectively with the help of other Canadians, with the help of the provinces, we must remember that this patient centred health care system will result in something that is sustainable for Canadians. It shocks me that the government or any member in the House would not support that kind of co-operative policy to do what is best for health care for Canadians.

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

Mr. Speaker, I have waited all day for the promise from the Canadian Alliance of solutions to the health care situation we find ourselves in today. I have waited all day to hear what members in that party really mean when they talk about innovation. I am still waiting. I have rarely heard, except from perhaps the Minister of Health, such empty rhetoric and flowery statements with no substance. I have listened very carefully.

[Jay Hill, Reform, Prince George—Peace River, BC]

Like the NDP.

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

Mr. Speaker, my alliance friend said, “Like the NDP”. This morning we gave him a detailed list of an entire program for renewing our health care system.

I would have expected Canadian Alliance members by now would be somewhere close to the point of putting some flesh on the bones and telling us what they plan to do with our health care system. We are no further ahead today than we were this morning or last week or last month when their leadership candidates talked publicly about creating a parallel private health care system.

I am left with a question. Is the motion today a euphemism for their intent to destroy the health care system? Are they trying to destroy the health care system in order to save it? Is that what they are proposing today?

If we look at the list of suggestions, it is worse than the Liberal government in terms of the studies and reviews they have promised. The solutions are setting up an advisory board, an independent audit, learning about innovations, getting a health care auditor, modernizing the CHA, fixing health care, fixing the brain drain and fixing technologies, with no specifics. Surely by now we should have some details.

When will see some details from them? When will we know the direction in which they intend to take the health care system? While we are at it, could I have a very clear answer from members of the alliance reform party on whether they support bill 11? Yes or no. At least then we might have a good indication from where they are starting.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, as I mentioned to the hon. member earlier, she should not have written those questions before she heard the speech. The problem is that they were prepared this morning. Again it is partisan politics. It is a perfect example of why there are so many turf wars.

We have to put partisan politics aside. Many members in the House today, in fact pretty well all of them, dealt with the issue of health care. They came up with what they thought should be examined and what the solutions might be.

I encourage the member to take a look at our health care task force report. I encourage her to sit down with me and go through it point by point. We only have 20 minutes to talk about it in the House. I understand her frustration.

Bill 11 is no different from what Mr. Romanow did yesterday. He said he was frustrated. Basically he took Saskatchewan party's idea and said that we needed a study because the feds were showing no leadership. Mr. Klein was desperate and thought we must try something new. We support his going ahead with bill 11 as a pilot project to see if it works. If it does not work, it could be scrapped. If it does work, it could be implemented across the country. If Mr. Romanow comes up with some weird idea, he could try it to see if it works. If it does, he could use it.

That is what we have to do. We need an open mind, not a closed mind, not a mind stuck in the sixties as many of the NDP and CCF policies are.

[Jay Hill, Reform, Prince George—Peace River, BC]

Mr. Speaker, I appreciate the opportunity to say a few words about the Canadian Alliance motion.

[An hon. member]

Oh, oh.

[Jay Hill, Reform, Prince George—Peace River, BC]

If my hon. colleague from the NDP would quick heckling long enough, she might hear what I have to say. I listened very intently to the comments of the member for Red Deer about what we really needed in Canada. He did a great job of fleshing out the alliance position and providing some real direction for the government if only it were willing to listen.

Let us look at the legacy of Liberal health care funding cuts in my riding of Prince George—Peace River. As many members House know, my riding covers nearly a quarter of the land mass of British Columbia. The communities in my constituency are isolated in relation to those in the rest of the country. Access to adequate health care is not only hampered by geography but by funding as well.

A surgeon must go through a check list of criteria before an operation, so let us look at the check list for health care in Prince George—Peace River. The average ratio of doctors to patients in Canada is about one to a thousand. Yet in my riding it is one to fifteen hundred. Universality, I do not think so.

There is a need for over twelve full time nurses, at least two general practitioners, two internists, an orthopedic surgeon and a general surgeon. There is one orthopedic surgeon to service 68,000 people. The waiting lists for an appointment to see him takes a year, not to mention the wait for the actual operation. The same 68,000 people have access to only one OBGYN surgeon and one psychiatrist. There is such a shortage of nurses that beds are being closed. The critical care unit in Fort St. John, my home town, is contemplating closing due to staffing shortages. There are also shortages of physiotherapist and pharmacists.

This problem is more than just money, despite what the NDP is saying. It is about taxes, access to education, immigration barriers for medical professionals from other countries and the brain drain. Those are all contributing factors to the critical shortage.

Rural Canadians need more than platitudes from the health minister. They need the federal government to take a leadership role and stop playing politics with the health of Canadians. I can say as the representative of a huge rural riding that this is not unique just to northern British Columbia. The problem is inherent from coast to coast to coast, but it is especially reaching epidemic proportions in rural Canada. We need some answers and some assistance from the federal government. For too long it has sloughed it off to the provinces.

I would be interested in hearing specifically from my colleague, the health critic for the Canadian Alliance, what his thoughts are about the problems of health care in rural Canada and the fallacy of the universality of the Canada Health Act.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, obviously the frustration has been well demonstrated. That is why 78% of Canadians say that the system is in crisis. To have the health minister quote a little paragraph today saying that it is not in crisis is shocking. The other opposition members should be attacking a government that would let that happen.

How do we deal with the brain drain? Who cut the seats in universities for training doctors? Who cut the training in specialist programs? I have talked to a number of hospitals and universities. Sixteen universities teach medicine. All of them have said they have had to cut their programs.

The nursing program in the college in the town I come from had 450 applications but only 60 places for training. That is a problem that has come from the federal government. We need to collectively attack the federal government to fix that problem. The system is broken. We have a two tier health care system or maybe, as most professionals would say, a five or six or ten tier system. That is what we should be focusing on. That is the frustration of Canadians.

I repeat that there will be frustration in the House if the motion on which we will be voting does not receive 100% support. The system is in crisis. The system is not sustainable. Status quo is not an option. If anybody in the House says that it is not true, he or she is saying that the system is not in crisis, that the system is sustainable and that status quo is all right. Those members will hide behind the Canada Health Act and say it is wonderful. They will say “Tommy, you did it for us”, but that was in the sixties.

We have to get into the 21st century. We have to do it collectively and all come up with the answers. As mentioned by the whip of the Canadian Alliance, the cry is coming from everybody.

[Steve Mahoney, Liberal, Mississauga West, ON]

Mr. Speaker, I am torn a bit between saying congratulations to the member for Red Deer and questioning where the backup is to those remarks. If there is one thing we are about in this place, it is words. When the member says that the Canadian Alliance is opposed to a two tier American health care system, I really want to believe him.

The member is articulate. He put his thoughts forward. He justified his case. It is just a shame that he did not decide to run for leadership of his party. Maybe then the words he spoke would somehow miraculously find their way into the policy book.

That is the problem. How do Canadians make a judgment on whom to believe when the provinces are saying different things about who is at fault if there are problems in the health care system? The opposition parties are blaming the government. The government is naturally defending its position by saying that it is prepared to sit down and talk about how we can fix the system.

Those members are calling federal-provincial co-operation some kind of magical thing. What was the nation been built on if not federal-provincial co-operation? There have been some exceptions, I say to my hon. colleague from the Bloc, but even then there were examples when there have been good Liberal governments in the province of Quebec and relations were excellent between them and the federal government.

Those members are calling for something that is the very foundation of the nation. Yet they claim the changes they would put in place would somehow not lead to a two tier system. If the words match the music, if the pants match the suit, maybe Canadians would have some sense of confidence that they are saying what they really mean.

We have seen the examples. I saw the most incredible display the other night while watching the debate on the pension issue on TV. Members of the Canadian Alliance were attacking the Tories and back and forth. There were accusations about promises made. They indicated that they would do politics differently when they arrived in this capital city.

They were not to accept Stornoway as the residence for the Leader of the Opposition. We know what happened there. The leader lives there now, or at least entertains there perhaps. There were not to accept the limo for the Leader of the Opposition. We know what happened there. After the great demonstration of handing the keys over and saying that it would not be used, we know what happened.

What they are saying does not match the actions we have seen in the past by that party. I believe the critic for the alliance who just spoke personally believes what he is saying. He is dedicated and committed to his community and to the health care system. I believe he has credentials which say that. Notwithstanding, it is just a shame that the rest of his party will not come to the same conclusions.

Let us just look at some of the facts, if we might. The former health critic is a man who I also think is a respected person in his community, the hon. member for Macleod. What did he say? He is a doctor and here was his solution to fix the health care system:

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?

Words are really important, but what do they mean? We do not have to read between the lines. We can just read the actual lines. They would provide health care insurance for major catastrophes. They would provide health care insurance for life threatening situations, diseases, injuries, heart attacks or cancer, but they would not provide it without some additional payment for other issues. Perhaps they would knock emphysema off the list. According to them patients on oxygen could live on that and do not need the health care system; maybe that is one thing that could be delisted.

Picture the single mom sitting at home. Perhaps she has a job or is on welfare. She may have a child who has a fever of 103 or 104 degrees, is burning up, coughing and is ill. What does she do? Does she ask “How much money do I have in my medisave account?” Can she afford to take Johnny or Mary to the hospital when they are showing all those symptoms? It is just so bizarre.

The member says he does not support a two tier system, whether it is called American or anything else, I do not really care, but it is clearly a two tiered system that the Alliance Party is talking about, unless it is adhering to what I heard the other night in the debate when a member was asked about his party's position while debating pensions. The member actually stood in this place and said that the Alliance no longer had that policy because it was a new party.

What we are hearing is that it has thrown out the former Reform Party blue policy book, or whatever colour it is, and that the new party has no policies on any of these items.

The other day in the House our finance minister, in response to a question about health care and financing, held up a copy of the Canadian Alliance's web page. In the section that was laid out for health care policies, the words were something to the effect that its position has not been developed yet.

Are we developing policies for, admittedly what the vast majority of Canadians consider to be a most important aspect, the health care system? Are we down to developing policy based on a critic's speech on an opposition day, on a concocted motion that has been written in such a way as to make it perhaps politically difficult to vote against? Is that how we are formulating policy for the development of this country's health care system?

The member mentioned Premier Romanow. I watched the premier on the news last night and I was quite impressed. I say to the member from Regina that I readily and openly admit that Saskatchewan is really the seat of medicare. It is the founding province of medicare. The NDP had a lot to do with that under their former great leader Tommy Douglas.

It is interesting now to see that province, one of our smaller provinces in terms of population, coming up with some constructive ideas about establishing a national report, about looking for ways to work co-operatively with the federal government. I do not see that province flying a bill like bill 11, which everyone in the province of Alberta is frightened to death about because they fear that it will lead to Americanization. Why?

The problem we have is that we have another document, a federal document called NAFTA, the North American Free Trade Agreement. I guess the greatest fear of the people in Alberta is that when bill 11 is put into force, the American health care company service providers will have the ability to come in and open up clinics that will provide surgery, and more than than just day surgery, they will be able to provide beds and care for patients.

Once NAFTA is opened up in terms of the health care services, I submit to all members in this place that we will run a very serious risk. For the members opposite to say that they are not supporting this, let us just pretend that we can take them at their word. The member for Red Deer says that the Alliance is not in favour of a two tier American health care system. How do we stop it once we open the marketplace up to for profit American or even Canadian health care company providers. How do you stop that?

Maybe the member for Macleod's solution for some form of medisave bank account would be the only solution. We would have to go to Canadians if we wanted to ensure that they had accessibility, portability and all the things that are so important in our system: universality, accessibility, portability and comprehensiveness. If we want to ensure that is all there, we will have to write them a cheque if we allow the provision of health care services, through the political games that are being played here, to go the route of privatization.

I am not convinced one way or the other on that bill. I have no problem having a debate on the issue. I do not really agree with the hysteria that we see coming from the NDP and the demonstrations that we see happening in Alberta. I think we do need to look at new ideas, such as the idea that Premier Romanow has floated recently in having a national study put together to see how we can best work together.

The hon. member should not stand in this place as the critic, as a representative of the official opposition, and make statements that are not backed up by the words of the people who are running to be the leader, that are purportedly running to be prime minister, they think in their wildest dreams. One cannot make those statements while there is an all-candidates meeting going on on television and the opposite is being said.

We have one program where we would have a medisave account. Let us talk about some of the other solutions. Again I say to the members opposite, it is wonderful for them to stand in here and make a claim that they are not in support of an American two tier health care system, but what about the member for Esquimalt—Juan de Fuca? He has made privatized medicare, private for profit health care a plank of his campaign to stand for leader of the Canadian Alliance Party. What has he said? In March 2000 in this place, in Hansard , he called for us to amend the Canada Health Act to allow for more private services.

What is really interesting is that at the conclusion of that member's speech, he admitted that it would be an unfair, unequal system. This is person who is running to lead the official opposition who would try to put forth what can only be described as a fraud on the Canadian people.

The Canadian Alliance members have tried to mislead Canadians by saying that their party will somehow, in some magical way, save medicare and that they are not in support of for profit Americanization and two-tier health care, but that is not what their leadership candidates are saying.

The member for Esquimalt—Juan de Fuca then goes on, in that same speech, to ask, rhetorically, if it was unequal. “Yes, it is”, he said. “I would argue that it is better to have an unequal system that provides better access to health care for all Canadians than we have today”. That was said by one of the candidates, a sitting member of this place, who was clearly standing up for what could only be described as the two tier Americanization of our health care system.

Let us go to some of the members who are perhaps in a better place to win that leadership. Let us talk about the former treasurer of Alberta, Stockwell Day. When asked recently what he would let provincial governments do when it came to health care, a provincial politician, he bluntly stated that health care was a provincial jurisdiction. What does that mean? Does that mean that he would perhaps follow the policy book of the former Reform Party which, when it came to how much it would increase health care funding in its policy book, the amount was zero, not a dime, not a cent, not a loonie, not a toonie, nothing?

Is Stockwell Day saying that is his commitment to how he would improve health care? Would he turn it all over to the provinces, turn it over to Ralph Klein or to Mike Harris, and allow them to once again put in place what could potentially open the floodgates under NAFTA to allow for for-profit health care providers to take over the marketplace? I suppose that is clearly an option and one that we do see. The reason that we talk about Americanization is because that is where we see it.

I have a very close friend who was the best man at my wedding 30-some years ago. He moved to the United States and has a business there. He has lived in Los Angeles and other places for many years. He comes home to Canada all the time. A couple of years ago my friend's wife found out she had breast cancer and had to go for treatment in the United States. This is a family with a small business. They are not multi-millionaires. The treatment to save his wife worked, thank God, but it cost over a quarter of a million dollars.

Where does a family come up with resources like a quarter of a million dollars? Where do they find that money? Imagine the agony of a family in the United States finding out that a loved one has contracted a disease that is going to take a quarter of a million dollars to cure and they have no possibility, no access, no hope of ever coming up with the funding for that.

If the Canadian Alliance truly is opposed to that, I am happy. I just do not understand why we get so many different messages from different people in that party.

Let me talk about the former leader of the former reform party, a current sitting member, although one would find it hard to say that the word sitting is appropriate, the former member for Calgary Southwest. In May, in the Globe and Mail , he was quoted as saying that if he was ever elected prime minister, God forbid, that no province would ever receive penalties for violating the Canada Health Act. He called for user fees, deductibles and private delivery services in a speech to the Ontario Hospital Association Convention in Toronto in November of 1994.

[An hon. member]

He got a standing ovation.

[Steve Mahoney, Liberal, Mississauga West, ON]

He might have got a standing ovation. I am not saying that there are not some people, particularly in the health care industry, who might support user fees, but it is the Canadian public, the small business, the families who are on welfare and the working poor in this country who we must be concerned about. What are we going to do with them, let them sink or swim? It is absolutely unbelievable.

There is another thing that is most interesting when we talk in terms of financial contributions to the health care system. The Alliance has recently joined the Bloc and the NDP in demanding that a cheque for $4.2 billion be given to the provinces, yet this is another area where it simply does not match the policy.

What is the commitment in the policy of either the new Canadian Alliance or the former reform party to funding health care? I have said it before. It is zero, but it wants to stand and say that even though it would not be prepared to do it if it were ever the government, that we should do it, that there should just be a blank cheque with no concern about whether or not that money is used to try to help mental health patients, as an example.

Does anyone think that there just might be a correlation between the fact that Mike Harris closed 6,000 mental health beds in his first term in office in the province of Ontario and the number of homeless people on the streets in Toronto, Ottawa, Vancouver and Montreal? Does anyone think that in Ontario at least there might be a relationship there? Does anyone live on the street in Canada in February unless they are ill or involved in some kind of substance abuse?

It is a mental health problem and it is caused by a provincial cutback in the area of delivering services to mental health at the same time that the provincial government slashes income taxes to its rich friends by 30%. There is a correlation.

This government is not prepared to write blank cheques. We want to know what the provinces are going to do to deliver the proper quality health care to all Canadians. To that end, we will work with the provinces to ensure that happens.

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

Mr. Speaker, I have a question for the Liberal member who just spoke. I agree with his criticisms of the Canadian Alliance, the old Reform Party. Far be it from me to come to its defence, but it was very interesting that he kept blaming the Canadian Alliance for its very conservative agenda. My question for the member is, why is the government basically being driven by the Reform Party? Why has it followed the Canadian Alliance agenda?

The member has a background that is very sensitive to the trade union movement, ordinary working people and progressive movement, but the government across the way is more conservative than Brian Mulroney.

I was here in the Mulroney days and Brian Mulroney would never have cut back on health care like the Liberal government has done. Brian Mulroney would never have cut back on the CBC and Radio Canada like this government has done. Brian Mulroney would never have cut back any of the social programs like this government has done.

Why is this government so afraid of the Reform Party, the new Canadian Alliance? Why has it adopted so much of the Canadian Alliance agenda? Why is it so conservative? I hope the member will answer that question rather than just provide a bunch more rhetoric because it is a curiosity and I hear that question often from my constituents. They ask me “Why is this government so conservative? Why is this probably the most conservative government we have had since the second world war? Is it because the government is so afraid of the Alliance and the Alliance agenda? Why has it picked up so much of that agenda?”

[Steve Mahoney, Liberal, Mississauga West, ON]

Mr. Speaker, I do not know that one could say it is a conservative agenda to support universality, accessibility, portability, comprehensiveness and public administration.

The member says he does not want rhetoric. How about the facts? We have restored funding, with an additional $2.5 billion in the last budget on top of the $11.5 billion for the provinces. We have said that we are prepared to commit more money to health care. I sat in this place today and heard the minister say that. He is prepared to commit more money.

There is no fear on this side of the House of that party. Let the member give his head a shake if he thinks there is one scintilla of fear.

I can assure the member that the Canadian people expect us to be fiscally responsible. If we were to adopt the NDP way we would wind up in a situation after five years like that in the province of Ontario when Bob Rae was the premier and the debt went from $39 billion to $110 billion, with continuous deficits. We will not act like the former Mulroney government and run $42 billion deficits. We will be fiscally responsible and committed to social programs such as health care.

[Jay Hill, Reform, Prince George—Peace River, BC]

Mr. Speaker, may I say at the outset of my very brief remarks that I cannot believe the audacity of the member opposite. He talked about how parties on this side want to write blank cheques and the Liberals are above that. I would submit that if they were not so used to writing blank cheques to all their friends through the HRD department and all their grants and contributions to big business and rewarding friends of the Prime Minister in Shawinigan, maybe there would be a little money left over for health care. People know out in the real world that his statement that they are not prepared to write blank cheques is absolute foolishness.

In his brief remarks he referred to a mental health problem in Ontario. I think the mental health problem in Ontario is with some of the Ontario MPs who are in this Chamber. That is where the problem lies.

The reality is, and I referred to it briefly in remarks that I made earlier today, in rural Canada, in rural British Columbia we have a real problem. Earlier this week my hon. colleague from Prince George—Bulkley Valley brought up the issue of how short we are in our hospitals in northern B.C. and north central British Columbia, specifically in Prince George. The fact is, the cuts from the federal government have created this problem in health care in Canada and it is not living up to its responsibility to provide adequate services so that we can have the doctors we need in hospitals in Prince George.

[Steve Mahoney, Liberal, Mississauga West, ON]

Mr. Speaker, if I thought the member had just a bit of a sense of humour I might not be upset about the comments about mental health. To somehow denigrate mental health or try to turn it into a political issue is disgraceful.

I had a brother, the member should know, who died because of a mental illness. It is a very serious problem.

He should stand in his place and apologize. He really should. The mental health issue is one which I think has been ignored, not only by the provinces but by our own government. I am quite prepared to admit that.

We need to sit down with the provinces to ensure that, if we are going to transfer money, some it goes to mental health. We need to ensure that the money is tied to services for mental health. The money should go directly to help the people who need it most, instead of having spurious remarks made by people like the member opposite about those people.