Debates of June 15th, 2000

Supply

[Paul Szabo, Liberal, Mississauga South, ON]

Madam Speaker, the member used a lot of general terms, such as provide leadership.

The member will know that when the government was elected in 1993 one of its platforms was the creation of the national forum on health. During the national forum on health study the best health care experts in the country worked for two years consulting with Canadians. One of the findings in the report issued at the end of 1996 was that money was not the problem. There was enough money in the system. It was how wisely were we spending it.

The member also said that we should provide leadership and work with the provinces. That is exactly what the Minister of Health has done. There have been consultations already with the provinces. There is a meeting tomorrow. In September the first ministers will be meeting to finalize the discussions and negotiations on health care between the federal and provincial governments.

What is the Conservative approach? It is not a matter of money, even though our funding has increased to $30 billion this year compared to $28 billion back in 1993. What does the member's party propose? In one of the reports on poverty the member's party said to increase the transfers under CHST but only if the provinces matched that money. In other words, let us only give it to those provinces who can afford to match some federal funding.

Obviously it is just another case of a two tier system: improvements for provinces that have money and no improvements for those who do not. How does the member square his policy with the need for leadership?

[Greg Thompson, Progressive Conservative, Charlotte, NB]

Madam Speaker, there is nothing like a lynching in the morning to focus the mind. That is exactly what is happening on the health care issue. The government knows full well that it has mishandled it for seven years. The lynching of course is the election.

The Liberals are smart enough to know that unless they do something about it, they are in big trouble. Support for the Liberals is about a mile wide and an inch deep. The witness to this is sitting next to me, the member for St. John's West. The Liberals went into the byelection 25 percentage points ahead and that member beat them. Why? Because a mile wide and an inch deep is what their support amounts to.

Money alone cannot fix the system. We are smart enough to know that. Our leader has stated that. We need innovative ideas and leadership which Joe Clark is prepared to do. He did that in the House of Commons in 1979 when he had a four year plan to lead the country out of debt and people rejected it. It was a bold initiative which he took at great political risk. He is prepared to do the same thing on the health care file.

One point we agree on is money alone will not fix it, but the government is bereft of ideas. The slogan in the next election should be, no ideas, no votes. It is as simple as that. If the Liberals do have an idea, they should be committed to keeping it. The electorate should hold the Liberals' feet to the fire.

We are getting more into economics than health care, but the Liberals railed against the GST in 1993. How many Liberals said, “If we get elected we are going to eliminate it”. Today the GST brings in $22 billion in revenue. If that is added to the $30 billion they have taken out of health care at the end of their tenure, that is $52 billion. I could balance the books with that set of numbers.

It is all phoney baloney. They have nothing to brag about on this file. They are going to bankrupt the system and health care truthfully is in a crisis.

[John Solomon, NDP, Regina—Lumsden—Lake Centre, SK]

Madam Speaker, my colleague from the Conservative Party made reference to Saskatchewan Premier Romanow and the great job the NDP are attempting to do in the face of the massive cuts by the Liberals in terms of health transfers. As a matter of fact he made reference to the historic fact that Saskatchewan led the way by initiating medicare and starting a medicare plan for all of its citizens a full six years before NDP and CCF members of parliament persuaded the federal government to adopt such a program for all citizens.

Saskatchewan again is taking the lead in defining a new vision of medicare to meet the challenges of the 21st century. Premier Romanow for a couple of years now has been pushing for a national review of the medicare system to improve it. He now plans to concentrate on what is important in Saskatchewan because the federal government refuses to look at this issue in a comprehensive way.

This morning the premier announced the commission on medicare. The commission will be headed by health consultant Ken Fyke and will identify challenges facing medicare, outline potential solutions and engage the public and health care providers in a discussion of new ideas. The premier said that Saskatchewan pioneered publicly funded, publicly administered health care in Canada and today Saskatchewan once again leads the way in finding solutions to strengthen medicare and protect its core values into the future.

New Democrats believe very strongly that a family's health should never have to depend upon a family's wealth. This is the underpinning of our support for medicare.

My Conservative colleague who just gave his remarks on this issue was a member of the Mulroney government which initiated a plan of consecutive three year cuts to the health transfers to the provinces. The plan of the Mulroney Conservative administration, which was roundly rejected by Canadians in the 1993 federal election, would have made Canadians not just money deprived in terms of health care by this year, but it would have eliminated any transfers to the provinces for health care by the year 2000.

Could the member from the Conservative Party share with the House whether he supported that initiative of the Conservatives? His leader Joe Clark supports bill 11 in Alberta to privatize health care. Does he support his leader on that issue? Does he agree with the byelection results in Edmonton, which was run on the issue of bill 11 where the NDP candidate won with 60% of the vote in the Conservative province of Alberta? I look forward to his answers.

[Greg Thompson, Progressive Conservative, Charlotte, NB]

Madam Speaker, some if not all of what the member had to say is inaccurate.

In terms of the transfers from the federal government, when we were in power from 1988 to 1993, as an example we planned to cut back on the rate of increase. For example, we would project a 5% increase in transfers to the provinces which might go to 4%. The NDP took that as a cutback. NDP members are very selective in their use of figures. This is one case where I agree with the member for Calgary—Nose Hill. Today, the point is that the feet of the government in power should be held to the fire.

In terms of Joe Clark's position, that is totally inaccurate. Joe Clark supports the five principles of health care. He suggested a sixth one, which no other leader has been brave enough to do. We are convinced that to solve this crisis we have to have open and honest dialogue and that also means open and honest dialogue for the NDP premier.

I talked about Roy Romanow and I tried to be generous, but with those kinds of remarks from the NDP member, it is pretty hard to be generous. The truth is that Roy Romanow will have to do the horror of all horrors. He will have to define what will be paid for by the province. I mentioned this in a speech in the House about a month ago, long before the NDP knew what Roy Romanow would do.

The truth is that he will shorten the list of services that will be provided by the province of Saskatchewan. The truth is that he is being forced to do it by the federal government. It is no different from any other premier. It is no different from Ralph Klein in terms of bill 11.

Basically Ralph Klein said that he did not want to do it but was being forced to do it. I am sure Roy Romanow does not want to do what he will do, but he is forced to do it. On that we could agree, but I am disappointed in the tone and the comments made by the NDP member.

[Werner Schmidt, Reform, Kelowna, BC]

Madam Speaker, it is a privilege to enter the debate. There are two parts of it that I find disconcerting. Probably the most significant part is that the government of the day does not seem to accept the idea that health care is in crisis.

I took the liberty to get an official definition of the word crisis. There are two parts to the definition which are very significant. A crisis is defined as a decisive moment or a time of danger or great difficulty.

At this point in time the health care system is in danger. Is it the system that is in danger or is it the people who are in danger? I would suggest that it is the people of Canada who are in danger because the health care system is failing them.

I want to approach the definition of crisis from the point of view of the five principles of the health care system as laid out in the Canada Health Act. Those principles are accessibility, portability, universality, comprehensiveness and public administration. I want to look at each of them in turn.

The great danger is that what we are told we have and what we believe we have in terms of health care coverage is not what in fact we have. It is a bit like buying an insurance policy on a vehicle, thinking that there is appropriate and sufficient coverage for public liability, property damage and things of that sort, and then discovering when an accident occurs that the policy does not cover such things. What we thought we had we do not have. That is very dangerous.

We thought we had accessibility. The Minister of Health suggests that the health care system is not in crisis, that we have the five principles and that is exactly what it is all about. That is not the case. It is a bit like having a child showing the symptoms of an illness and the parent denying the symptoms by simply saying that the child is not sick. If the child is really sick the child's life is in danger. If we do not deal with it at the time, by the time we are prepared to do so it may be too late.

The time is now to recognize that we have a problem. It is up to the minister and the government to recognize that we have a problem. We are in a crisis situation. The people of Canada are in danger. If we ask the people of Canada whether they think Canadian health care is where it ought to be, they will tell us that it is not.

Does it mean the health care that is delivered is not delivered well? No. There are very good practitioners in Canada. I recently received some treatment from some specialists and they were extremely competent. The difficulty is to get it. It is not universally accessible. Accessibility should be available when it is needed, not some time in the future. That is a very important issue.

I will give the example of a gentleman who went to his family doctor and said that he had severe abdominal pain. The doctor looked at him and said that he would have to be referred to a specialist, which is what he did. When he went to see the specialist he could hardly make it up the stairs. There was no elevator. He was doubled over in pain by the time he got there, and without even looking at him the receptionist asked him if he were a patient of the doctor. He said no. In that case, he was told, he would have to wait at least nine months before the doctor could see him.

This man thought he had a health care system and he thought he would get service. He reminded the receptionist that he had a referral from his general practitioner, and she told him that he could not see the doctor for at least nine months. He left that doctor's office and 10 days later he was in the emergency ward of a hospital and within two days was dead.

Since 1997 there has been a 30% increase in the people waiting for care. In 1998 a total of 212,990 Canadians were waiting for care. In 1993 the average waiting time was 9.3 weeks. In 1998, five years later, the average wait was 13.3 weeks. That is an increase of 43% in a matter of five years. People wait for up to nine months to see a specialist, such as in the case I just mentioned. There are huge shortages in technologies like the MRI.

I refer to another incident that happened recently. We have two health care delivery systems in Kelowna, the general hospital and the cancer centre. There is an MRI machine at each of those locations. One of the machines broke down. Were the patients allowed to go to the other institution for treatment? No. They did not have the people to run the MRI in one case and the others were idle. Could they bring them over? No. It was a jurisdictional dispute. This is serious business.

Some will say that is not the health minister's concern. It is not directly his concern, but indirectly it is because there is an attitude out there that somehow the system is not geared to the patient but is geared to some other standard that has nothing to do with the patient. That is significant.

The second principle under the Canada Health Act is portability. How portable is it? I want to review a couple of facts. Any Canadian has the right to be treated for an injury that happens anywhere in Canada. The concept or the principle is that we should have treatment anywhere in Canada. People living in Newfoundland, British Columbia or the Northwest Territories should have access to health care anywhere in Canada. It should not matter where their health cards were issued.

Unless something has happened in the last couple of hours, Quebec patients outside that province are required to pay upfront because their government did not sign the portability agreement and cannot be counted on to pay. That is very serious issue. I looked around a bit to see if this were really the case, and it is. If Quebec chooses it will pay claims at the rates set in Quebec regardless of the cost of the service provided elsewhere. Many other people who go out of the province have difficulties getting medical treatment.

I happened to come across a family of a child that came from Quebec who had contracted some kind of illness in Manitoba. The child was taken to the medical clinic and the family was asked to pay upfront. The individuals said they were on a trip across Canada, for which they had saved over the last 10 years. They really wanted to travel across Canada. If they had to pay upfront they would have to spend their money on the health bill and would be unable to complete their journey. That was a serious infringement on what they thought they had. They thought they had portability but they did not. It is very serious when that sort of thing happens.

The third principle is universality, which really means that all kinds of issues are covered. What about access in a rural community?

[The Acting Speaker (Ms. Thibeault)]

I apologize for interrupting the hon. member, but is he sharing his time with another colleague?

[Werner Schmidt, Reform, Kelowna, BC]

Yes, I will be sharing my time. I will deal with the other two principles. On the comprehensive nature of our public health care system, a lot of provinces have had to delist services. If we are to have a comprehensive system virtually all services originally listed should be retained. It should not be arbitrarily decreased.

What about public administration? The largest expenditure in the health care system is the cost of administration of hospitals. In British Columbia it is about 58% of health care costs and the budgeting is done on the basis of global funds. A global budget provision splits the administrators and the government into two negotiating teams. The administrators say that they need more money than they had last year and the government says they have to get by with less. The patient is lost in this battle between the negotiating teams. It is not in the interest of the patient. That has to be examined very carefully.

Is this something that the Minister of Health can do alone? It is not. He should recognize that there is a crisis. Unfortunately, human nature being what it is, he will do nothing. None of us will do anything until we recognize that there is a problem and that we need to do something.

The minister needs to do something. The government needs to do something. If we achieve nothing else today, hopefully we will impress upon the minister that something has to be done. He has to get together with the provinces to get it done.

[John Duncan, Reform, Vancouver Island North, BC]

Madam Speaker, I think most hon. members would agree it is fair to say that health care is the number one issue for most Canadians. Political parties grapple and posture over the Canada Health Act, medicare and the delivery of health services. The public sees through most of this and in many ways is far ahead of the political parties in terms of understanding the major problems in health care.

For example, I was in Nova Scotia last week and met a middle aged woman with undiagnosed recent loss of feeling in her midsection and legs. This is obviously a major concern to her and to her family. The doctor's office triumphantly phoned her to say that it had obtained an appointment for her for an MRI on November 5, five months away. These Canadians will be forced to go to Bangor, Maine, and pay approximately $2,500 on demand for an MRI. Any reasonable analysis would conclude it should be a priority necessity of health care delivery. This is not an isolated story. This story could be replicated across the country. In B.C. they would go to Seattle or to Spokane rather than to Bangor, Maine, and so on from west to east.

The public knows full well that there is rationing and that is a two tier system is in play big time already. Politicians who close their eyes or reject this reality are doing a great disservice. We have seen evidence of that happening here today.

The answer for Canada lies in harnessing the best delivery mechanisms for all Canadians at a cost society can afford. No Canadian should be denied basic health care delivery. Nor should Canadians who wish to step outside the public health care delivery system be told they cannot do so. We do not tell the Vancouver Canucks, the Toronto Maple Leafs or the Montreal Canadiens that their hockey clubs cannot have their private hyperbaric chambers or that they cannot have their team doctor, do we?

I will reiterate the official opposition supply day motion:

That this House recognize the health care system of 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 on the government to develop a plan to modernize the Canadian health care system, and work with the provinces to encourage positive co-operative relations.

That is a reasonable and progressive motion. Yet the Minister of Health has already indicated the government will not buy into supporting it.

The Liberals are health care hypocrites and hypocrites generally. The 1997 Liberal red book stated that the Liberals would not allow a two tier health care system and that they were committed to a continuing role in the financing of medicare.

What is the Liberal track record on financing health care? The provinces know their federal transfers have been cut since 1993. The Liberals spin the numbers and say, “Well, no, not really”. Meanwhile, the naked truth is that the Liberals cut health care to avoid other program reductions in the 1990s in order to balance the annual budget. The deficit was eliminated by the finance minister by off-loading a bigger burden for medicare onto the provinces, and the Liberals have never made good for those cuts.

Now the Liberals want to portray themselves as the great defenders of medicare and place impossible constraints on the provinces. The provinces are in an increasingly difficult set of circumstances and we are witnessing some things that are coming from that. We have bill 11 in Alberta. The Saskatchewan health care review was announced yesterday. All the provinces are demanding that the federal government reinstate funding to 1993 levels before the provincial governments will co-operate on other issues with the federal government.

Health care delivery is a provincial responsibility. The only way to focus on the patient is to encourage the provinces and the federal government to check their politics at the door and concentrate on stabilizing the funding and modernizing the Canada Health Act. This will only happen through innovation on the part of provinces and a flexible federal government that provides freedom to the provinces to push ahead.

Here is a partial strategy that we should consider. The provinces need leadership from the federal government to help orchestrate change. Respecting the existing jurisdictional framework is the surest way to begin building a sustainable, enviable health care system. The long term funding base must be restored. The provinces are calling for a $4.2 billion annual increase.

The feds must initiate relations with the provinces to support and encourage a health care system that works in the best interests of Canadians. Co-operation is the key but that is not what we have been seeing coming from the government recently, in particular from the minister. We must dedicate our efforts to a universal, portable, comprehensive and accessible health care system. Does that remind you of the Canada Health Act, Madam Speaker? It certainly does to me.

We must examine the roles of administration for better efficiency, productiveness, and overall better service for the patient. We must create standards and independent auditing for greater transparency and delivery of health care. Without that transparency we do not have accountability.

Our present health care delivery system has one fatal flaw: the average consumer who utilizes that service has no idea what that service actually costs. If the consumer does not know that, most often the deliverer does not know that either. One cannot begin to reform a system until both sides of that equation are well aware of what the costs are. Canadians deserve no less. Health care hypocrites, like the Minister of Health, should actually get out of the way.

I now want to review the five basic principles of the Canada Health Act, in particular the accessibility provisions. In 1993 we had an average wait of 9.3 weeks and in 1998 it went up to 13.3 weeks. People are waiting up to nine months to see a specialist. We are also losing on the technology front.

Earlier I gave an example of what is happening with MRI waiting lists in Canada and how different it is from the U.S. We are failing on that score.

In terms of universality, I have pointed out in this place and in correspondence how remote communities are so discriminated against in terms of their ability to access health care. Very often it is the federal government, which is removing federal infrastructure, that is actually working against the universality of health care provision by its other actions. I have a major concern on that front. The government is really not addressing that and, in many ways, is discriminating against remote communities.

The final thing I want to talk about is public administration. Eighty per cent of health care costs are labour component, whether it is doctors, nurses or administrators, and we must look at that whole area in a constructive fashion.

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

Madam Speaker, I want to ask my colleague in the Canadian Alliance whether or not he is familiar with the announcement made yesterday by Premier Roy Romanow in my province of Saskatchewan. Does the member support the initiative taken there, which is to establish a commission that will spend the next six months doing a study, issuing an interim report and then a final report in one year's time? All that is within the parameter of abiding by the principles of the Canada Health Act and perhaps expanding those principles in order to meet the challenges of the 21st century.

The important thing about the Saskatchewan study is that it believes in a single tier system, which is the premise of health care in the country, and a publicly financed system.

As the member is probably aware, medicare was started in the province of Saskatchewan by former Premiers Woodrow Lloyd and Tommy Douglas of the NDP and CCF, and, of course, carried on through Allan Blakeney and now Roy Romanow. Saskatchewan once again is the only province that has struck a commission to do a study on the future of health care.

I just want to know if the the member supports the Saskatchewan initiative and the parameters of the study. Does he think it would be a helpful example for the federal government to perhaps emulate at the national level?

[John Duncan, Reform, Vancouver Island North, BC]

Madam Speaker, I did touch on that initiative in my speech and I do support it. I think the provinces are actually doing things in a vacuum from the standpoint that the federal government should actually be the one providing the leadership for that.

When the premier of Saskatchewan was asked that question last night, he said the same thing. He agreed and was hoping that the province of Saskatchewan's initiative would move the federal government to show leadership and launch a similar national review. We agree with that.

The provinces are doing things that they have no choice but to do at this point because they have a disproportionate share of the burden. It has all happened in a hurry. They have had to increase their spending and take on added responsibilities at a time when the cost of delivering health care was escalating anyway. It is crunch time.

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

Madam Speaker, I think it is very important that the Saskatchewan study is within the confines of the principles of the Canada Health Act. It is important for us to have a public health care system and not a two tier American style system. We need to have a single payer system, which is the public. Health care must be accessible to everyone. Health care must be portable. Access to health care must not be based on income, where one lives, the size of one's bank account or the thickness of one's wallet. Those things are extremely important.

The other thing that is very important is that the federal government provide more funding for health care. Many years ago, when health care came in as a national program, the federal government funded 50% of the cost.

Today, in terms of cash transfers to the provinces, the federal government funds 13 cents, 14 cents or perhaps 15 cents to the provinces depending on the province.

If we are going to maintain health care as a universal program that is accessible to all, portable and publicly financed, then the federal government, with its huge and ballooning surplus, must come to the plate and put $4.2 billion more into the fund every year. This would be equivalent to the money it has taken out over the last number of budgets. I think that is very important. I hope my friend in the Alliance Party would support that point of view as well.

[John Duncan, Reform, Vancouver Island North, BC]

Madam Speaker, I can only conclude that the member for Regina—Qu'Appelle did not hear my speech because I did touch on basically all of those issues and I do support the $4.2 billion.

The one concern I have with the member's comment deals with what I call the mantra of the single payer system from the standpoint that if there is not a pre-existing two tier system in Saskatchewan right now, then it is the only province that does not have it. Canadians are buying health care with their own money where they choose because they have no choice but to do so.

[Bryon Wilfert, Liberal, Oak Ridges, ON]

Madam Speaker, I am pleased to have the opportunity to address the motion today. Let us remember what is important for Canadians. This issue comes down to access to high quality care in our public and universal system.

Canadians value our health care system above all other social programs and it is what sets us apart from other countries around the world. To achieve that, Canadians expect governments to work together, openly and with transparency. A lot of work has been done between the federal, provincial and territorial governments in the past, and that is how this government intends to approach the health care system renewal now and in the future.

In the last two years alone much concrete work has been done to lay the foundation for sustaining Canada's health care system and the health of Canadians. In September 1998 the federal health minister, with provincial and territorial ministers of health, agreed to a number of key federal, provincial and territorial priorities to facilitate governments working more closely and collaboratively. Ministers identified the following future directions and key priorities and emphasized the need to achieve concrete results and improve accountability to Canadians.

Ministers agreed to joint action on maintaining a financially sustainable, publicly funded Canadian health care system; supporting high quality, integrated and continuing community based health services; implementing population approaches to improve the health of Canadians; promoting the development and efficient use of information and research technology, and planning and reporting systems; and, collaborating in areas such as health, human resource planning, identifying best service practices, research evaluation, primary care reform and public health policy.

At their 1999 September meeting, federal, provincial and territorial ministers of health reviewed the work accomplished and noted concrete progress on their joint priorities. They endorsed intensified collaborative work in primary care reform as an essential element to ensuring the sustainability and accessibility of our health care system; tasked federal, provincial and territorial officials with preparing options for strengthening the development of the health human resource professionals; and, undertook to improve collaboration between governments and health care providers.

As part of that commitment, last November the Minister of Health co-chaired meetings of health ministers and representatives of the medical and nursing professions. Furthermore, in the past year federal, provincial and territorial ministers of health released by significant reports on the health of Canadians and the importance of investing in early childhood development; endorsed a national strategy for collaborative action on tobacco controls in Canada; released several reports on pharmaceutical issues to ensure that drug prices are fair and reasonable, and that drugs are prescribed and used appropriately; and, approved the establishment of a council of organ and tissue donation and transplantation.

Madam Speaker, I also point out that I will be splitting my time with my colleague from Waterloo—Wellington.

Provincial ministers of health noted that the federal-provincial-territorial ministers meetings in the fall of 1999 were productive. They supported strategic direction in the ministers' key priority areas such as sustainability of the health care system, health human resources and preparation for an aging population. Today, 12% of Canadians are now over the age of 65. This is obviously a very important area and initiative we will work on with our provincial and territorial colleagues. This is only a partial accounting of the depth and breadth of the federal-provincial-territorial collaboration of the health sector on important health issues.

The government is committed and dedicated to working with the provinces and territories to find common solutions to ensure the future of the publicly funded health care system for the benefit of Canadians. I stress that does not mean that as important and complex issues are being considered, there is not room for different points of view to be expressed and for open and frank discussions to take place. Our focus is to renew the public health care system. Working together on joint objectives and priorities, consultation, and transparent information sharing are some of the ways to strengthen the collaborative partnership. This is what the government will continue to do.

The Prime Minister and the health minister have spoken about the Government of Canada's commitment to sustaining, strengthening and preserving public health care in Canada. The federal minister is actively working with provincial and territorial ministers to lay the groundwork for an agreement on health by first ministers this fall. The federal minister has had positive one on one discussions with provincial and territorial ministers. He is speaking with them collaboratively this week to continue their dialogue and to set out a concrete plan of action to prepare recommendations on health for the first ministers' consideration.

We are confident that this important work will succeed in ensuring that the kinds of broad innovations that are necessary to renew health care in this country are put in place with the support of all governments acting together in the interest of all Canadians.

[Lynn Myers, Liberal, Waterloo—Wellington, ON]

Madam Speaker, I listened with great interest to my hon. colleague. He made a number of very good points as they relate to health care in Canada.

He has done research and information gathering in his own riding and perhaps other parts of Ontario near and close to where he lives. Could he confirm for me whether Canadians really do want the federal government simply to throw more money at health care or whether, as I believe, people in his riding and elsewhere would rather see the federal, provincial and territorial governments roll up their sleeves and work together to come up with a strategic long term plan? Once that was done, then put in the money, the resources necessary to sustain that plan.

The hon. member is very learned and one with great experience. He was head of the Federation of Canadian Municipalities and he has a great wealth of knowledge. I wonder if he could comment on that question.

[Bryon Wilfert, Liberal, Oak Ridges, ON]

Madam Speaker, I had the pleasure a few weeks ago to attend the Federation of Canadian Municipalities annual convention. Many mayors and councillors gave me the same message which was very clear. Canada's health care system needs more than tinkering with. We need to deal with the structure. Money alone will not solve the problem.

It is very clear that when we talk about pharmacare, primary care and a lot of the structural issues that are delivered by the provinces and territories, we as a federal government are prepared to talk two streams. One is money, but most important, is to make sure that this time next year or even five years from now we are not talking about the same structural issues.

I want to clarify an erroneous impression given by my colleague from the New Democratic Party. This government does not give 13 cents, 12 cents or 15 cents on the dollar. I would point out it is a combination of cash and tax credits. The provinces very conveniently forget about tax points and tax credits because they know they total about 33 cents to 34 cents that the federal government contributes.

If we are going to solve the problem, as my hon. colleague suggested, we have to make sure that those issues are solved for future generations. This is too important an issue to simply talk money which we have already indicated we are prepared to do. But we cannot do one and not do the other. We must solve it for the future. That is what the government intends to do. That is what the government will do. With the support of Canadians and the provinces and territories, we will get the job done.

[Lynn Myers, Liberal, Waterloo—Wellington, ON]

Madam Speaker, I rise today with great honour to participate in this debate. This issue is of great interest not only to me and to all members in the House, but to Canadians wherever they live in this great country of ours. We must ensure that we look at the whole issue of health care and that we have the facts straight when it comes to the things the federal government is doing in this very important area.

Most of us will agree that the state of health care in Canada is the most important and pressing question in the country today. Canadians wherever they live are looking for leadership. They are looking not only to the provincial and territorial governments, but to the federal government as well to play a leading role in this important area and justifiably so. It is something that is so fundamental. It goes to the very core of who we are as a people and who we are as a nation.

Canadians wherever they live expect the federal government and its territorial and provincial partners to work together to make sure that there is a health care system in place not only for us now, but for our children and our children's children. Canadians expect that and rightfully so.

I appeal to everyone to redouble their efforts to make it happen and to make it work. We must get together and have the meetings required to set the long term strategy in place. It is too easy simply to throw money at the system. I have travelled in the last little while in British Columbia, New Brunswick and Newfoundland and I can tell the House that people in all of those places are consistent in what they say. They do not want us simply to throw money at the problem. They want us to put in place a long term strategy and a good plan. They want us to put in place a long term view as opposed to simply throwing money at the system now.

Once that plan and long range vision is secured and most people have agreed to it in terms of what we should do and how we should do it, then put the necessary resources and money behind it to make sure that it happens. It should not be just for the short term, but a sustained process where people can look with confidence at the health care system and know that it will be in place for a while.

We can be justifiably proud of our great health care system. We do not have to travel very far around the world to know that we take an awful lot for granted here in Canada, and health care is one of the things we take for granted. Yes, there are problems. Yes, we need to make adjustments. Yes, we need to work with others. Yes, we need to adjust the whole system to tailor it into the 21st century.

There are a lot of new things happening in technology. Demographics change and affect the system. All kinds of things need to be done. We need to double or triple our efforts to make sure that it happens and put in place the long term plan and strategy and then put the money in place to sustain it.

I, along with the residents of Waterloo—Wellington and others, insist and demand that the federal government take a lead role. I am confident that is precisely what we are doing now and in projections into the future we will certainly do precisely that. That is what Canadians expect of the federal government in this all important area. It is a fundamental core value of this great country of ours that people go out of their way to proclaim and to celebrate. It is certainly something I celebrate and I know other members do as well, and we do so because it is of such great value to all of us.

New demands are being placed on the system. I have already mentioned demographics and how they will affect the health care system in the future.

I also want to talk in terms of care being delivered in new ways. With new technology and new things happening, that is precisely what is taking place. We need to be part of that. That is why when we developed the Canadian Institutes of Health Research in Bill C-13, we did it with vision and foresight. Under those institutes all kinds of things will be coming out, new medical procedures, new cures for diseases and new technology.

We do not have to take a back seat to anyone when it comes to medical science and the great medical community that is right here in this country. One of the proudest things I did as chairman of the health committee was to call in witnesses from the United States. There were five of them. Young Canadians had gone to the United States for experience and might have stayed, but as a result of Bill C-13 and the Canadian Institutes of Health Research, they are coming back to Canada to bring the knowledge gained in other places, in this case the United States, back to their home country. How very, very proud we can be of those young people and the others who will do the same as a result of the good work of the government when it comes to medical research.

We have all heard the stories of emergencies and the backup of people waiting especially during flu season. We know about having to wait for specialists. These are huge problems in the medical system. Quite frankly I cringe when I hear them because it is not what we have come to expect. We need to do the necessary work to make sure that is not the case.

In an interesting poll, Canadians were asked if they had firsthand experience with the medicare system. Of those who said yes, 80% said that it had been a good experience for them. But when they were asked if they had heard stories about problems or if there had been dissatisfaction with what they perceived the system to be, it was the reverse, because 80% said there have been problems and only 20% said there was confidence.

There is a real dichotomy between the reality of 80% of Canadians getting good service and the 20% who feel that they have confidence in the system. Between reality and perception there is this kind of dichotomy.

We need to work hard to change that perception and make it into a reality that all Canadians can enjoy. We need to restore this confidence. That is part of our challenge in this very important health care debate, to make sure that we provide the kind of quality care that is affordable, accessible and beneficial to Canadians and their families.

As my colleague the Minister of Health has stated, this is going to require more than just money. I have already talked about that. We need to put in place a plan. More to the point, we need to put in place some linkages among the various sectors in health care service delivery. We need to ensure that people are receiving appropriate types of care at appropriate settings and at appropriate times. The care has to match the settings, which have to match the times. That is what is required for Canadians wherever they live in Canada.

One of the ways we will go about doing this is by building a more patient-centred approach. Currently, for example, patients who receive prescription drugs free while in hospital have to pay out of their own pockets for those same drugs when they go home, unless they have access to such benefits through their employer, province or territory.

Our mothers and fathers leaving the hospital may not have access to the home and community services they need. Or, if they can find them, they cannot afford them. These are all problems.

One in five Canadian women are providing care for someone at home, on average, 28 hours a week. Half of those women, many of whom have children, also work outside the home.

Too often patients have to navigate the bureaucracy by themselves, without any kind of guidance in a very complex and complicated area. We need to help these people, not hinder them. For some, in fact many, it is much too complex and confusing. Laboratory tests are often repeated unnecessarily. Patients are asked to recount their medical history time and time again. Records are not immediately available when needed.

The point I am making is that all of these are signs and symptoms of a health sector where instead of linkages there are silos. We need to break down these silos and provide the linkages. That is the important part of this whole equation.

What would an integrated health care system look like? That is really getting to the essence of what we should have. What would it look like?

An integrated system would, first of all, bring together health promotion, disease prevention, treatment and care. The full range of medically required health services would be properly funded and closely connected, from primary care delivered by an interdisciplinary team to the hospital bed, to home and community care, and to long term facilities, ensuring Canadians a smooth transition from one health service provider to another. That is important.

By way of conclusion, let me say that this past week I attended a conference on tele-medicine in the riding of Stormont—Dundas—Charlottenburgh. It was as a result of the work done by the Minister of Health, the minister responsible for rural development and the chair of the rural caucus, the member for Hastings—Frontenac—Lennox and Addington, who have put in place tele-medicine for rural Canadians. This is what we are talking about. These are the good things.

[John Solomon, NDP, Regina—Lumsden—Lake Centre, SK]

Madam Speaker, I listened with interest to the comments of the member for Waterloo—Wellington. There appeared to be a different person giving that speech from the person we have come to know as chair of the Standing Committee on Health.

Let me quote a few things from the member's speech. He said that we should be looking at health care, that people are looking for leadership in health care and justifiably so, and that it is at the core of what every Canadian believes is important. He said that we should be re-doubling our efforts, that we should make it happen, that we should make it work and that we should put in place a long term health strategy.

That is incredulous. This very member, the member for Waterloo—Wellington, who was chair of the Standing Committee on Health, refused time after time after time to consider a request from all parties to study the situation of medicare in Canada.

For three years now, the NDP has asked the government to commission a study, as quickly as possible, to look at the crisis in medicare, to look at some of the challenges in medicare and to look at some of the solutions. This so-called member for Waterloo—Wellington has on every occasion denied, blocked, shut the committee down and censored it.

The Saskatchewan NDP, led by Premier Romanow, also tried to help us get a commission. After two years he gave up and commissioned his own study. This morning he announced that Saskatchewan was taking the lead in defining a new vision of medicare to meet the challenges of the 21st century. He is not waiting for the Liberals to do something about health care because they are the ones who have butchered it.

Mr. Romanow also believes that medicare faces many challenges, including new medical treatments, rising costs, an aging population and shortage of key health professionals. The commission the premier struck today will identify those key challenges. Secondly, it will recommend an action plan for the sustainable delivery of health services across the province. Finally, the Saskatchewan commission will identify longer term opportunities for reform that will ensure a strong future for a publicly funded and administered medicare system.

This is my question for the member for Waterloo—Wellington. He talked about all of these things, which he was in a position to do something about for the last two years. Why has the member not undertaken to do what he thinks has to be done? He got up and gave his little speech, which was not worth two cents or the paper it was written on because it did not relate to any of his actions in the past.

Can the member define the comment in his speech that he is going to re-double his efforts?

[Lynn Myers, Liberal, Waterloo—Wellington, ON]

Madam Speaker, members of the NDP are blustering and huffing and puffing as usual. They caterwaul, bray and squeal like stuffed pigs at the slaughter house.

The point is that I was very happy—

[John Solomon, NDP, Regina—Lumsden—Lake Centre, SK]

Madam Speaker, I rise on a point of order. I think the member is taking this personally. I am not sure if you know this, but in Beauchesne's Parliamentary Rules and Forms making reference to members as animals is really not allowed. I would ask you to interject and raise this with the member.

[The Acting Speaker (Ms. Thibeault)]

Yes, I believe the hon. member has a good point. I would ask the hon. member for Waterloo—Wellington to choose his words more judiciously.

[Lynn Myers, Liberal, Waterloo—Wellington, ON]

Madam Speaker, I did not say he was; I said he acted like it. There is a difference here and I will be judicious in that regard.

Let me point out to him that I was very happy to be part of the health committee that looked at natural health products. I was very happy to be part of the health committee that looked at organ donation. I was very happy to be part of the health committee that brought in the CIHR, Bill C-13, which I reported in the House, which NDP members did not want to fully understand. More to the point, they did not want to support it. I scratched my head and asked why the NDP would not support research and development and the doubling of money.

Look at how Bob Rae destroyed health care in Ontario. He closed hospitals and delisted all kinds of services. That is who NDP members are. They are the Bob Raes of the world. They would wreak havoc, left, right and centre—mostly left. They would do it in the most egregious fashion, leaving people decimated in their wake.

In answer to the hon. member's question, I was happy to bring in the CIHR, Bill C-13. Last week I was very happy to bring in tobacco regulations concerning labelling and other requirements. If he thinks that we are not doing anything, he should attend the committee. He should come and look at what we are doing. He would be gratified to see that the health committee is not only working effectively, it is doing the right things for Canadians.

[Reed Elley, Reform, Nanaimo—Cowichan, BC]

Madam Speaker, I rise to speak to the official opposition supply day motion.

I would like to read the motion again. We are partway through the day on this debate and I think it is important that we have this kind of exchange in the House. It may be the only time we will get to talk about health care in this parliament. We certainly cannot talk about it in the health committee. The motion reads:

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 calls 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.

Normally I am delighted to rise to bring the concerns of the constituents of my riding of Nanaimo—Cowichan, and indeed all Canadians, before the House of Commons. However, today I am saddened that we have to have this kind of debate.

Canadians know and cherish the health care system that we have in Canada. For many years we have had a “made in Canada” solution which ensures that all Canadians have access to quality health care. Generations of Canadians have grown up expecting that their loved ones, their families and they themselves will have adequate health care available to meet their needs.

Thanks to the Liberal government, Canadians no longer have this comfort. The cold reality is that the health care of yesterday has been destroyed by the Liberals of today and the system will not meet the health care requirements of tomorrow.

For a few moments I would like to describe the problems which I have seen resulting from the government's uncaring approach to health care over the last seven years.

In 1993 when the Liberals came to power the federal portion of the Canada health and social transfer was $18.8 billion. Within four short years the Liberals had slashed away over $6.3 billion annually. Today the transfers are still $3.3 billion lower than when the Liberals came to power in 1993.

In total they have stripped away $24.7 billion and, according to their budget plans, will continue this pattern with the removal of another $9.9 billion over the next three budget years. The total is an incredible $34.6 billion gouged out of Canada's health care system over a projected 11 years. That works out to $1,100 less in health care for every man, woman and child in Canada today.

Mr. Speaker, can you imagine what another $1,100 spent on health care for every person in your riding would do to alleviate the pain, the suffering and the discomfort which many Canadians feel?

In my riding of Nanaimo—Cowichan there are approximately 100,000 people. That translates into $110 million missing from health care that should go to the people of my riding. That $110 million could have been used to hire more nurses, to maintain and reopen operating rooms. This is money that could have been used to ensure that more people were not subjected to longer than necessary waiting lists, and for the opportunity to purchase or upgrade new medical technology equipment.

There is not a region in this country that has not been negatively affected by the callous financial approach that the Liberal government has inflicted upon Canadians from coast to coast.

At the Cowichan District Hospital in Duncan a dialysis unit sat idle. The primary reason it sat idle, simply put, was because there was not enough money in the system to hire trained personnel to operate the equipment. I ask my hon. colleagues here today to imagine the sense of concern that runs through a parent's heart when their child requires a dialysis machine to live and yet the equipment in the local hospital has never been used because of the lack of funding by the federal government.

I know what that feeling is. My daughter is one of those who may have required dialysis, and yet, even though the dialysis unit was only 15 minutes from our home, the stark reality was that if her one remaining kidney had shut down we were over one hour away from the nearest dialysis unit, and that was not always available to children.

It costs approximately $630,000 to purchase a dialysis unit. The annual operating costs for 36 patients totals approximately $1 million. Can we imagine if a portion of the $110 million the Liberals have ripped out of the system in my riding alone over the last seven years could have been used for dialysis in the Cowichan District Hospital? Can we imagine the sense of relief a parent or patient feels when a unit is finally opened and put into operation? Unfortunately this unit is already approaching capacity and it is expected that in less than one year new dialysis patients will once again be required to make the one hour trip to Victoria for dialysis treatment.

Here is another situation. In 1991 in my riding of Nanaimo—Cowichan Mr. Pat Carson donated $861,000 for the purchase of a CT scanner. Unfortunately Mr. Carson's wife had died of cancer. While there are no guarantees it was thought that earlier treatment for her could have been initiated through a faster diagnosis by way of a CT scan.

I know hon. members are wondering how the scanner is working and if it has indeed saved lives. I am sad to say that the scanner has never been purchased. The money has now accumulated to over $1.3 million and will continue to grow until the operating budget is put in place that can operate this equipment.

What budget is needed? All that is needed is approximately $500,000 annually. On behalf of the constituents of Nanaimo—Cowichan I can easily imagine $500,000 could be found in the $110 million the Liberal government has taken out of health care for my riding alone over the last seven years.

If these were the only stories then the story of health care in Canada today would not be such a sad tale of woe. Unfortunately this is only one of thousands of stories across the nation. Through the rest of today as we speak to this most important subject the House will hear of surgery waiting lists, cancelled surgeries, long waiting periods to see specialists, pain, suffering, and unfortunately even death.

In my home province of British Columbia we have had patients lying on gurneys in the hallways and in the linen closets of local hospitals. Cancelled surgeries at the hospitals in my riding in Nanaimo—Cowichan are a daily occurrence. We have done better in the past but we must do better than this in the future.

The track record of the Liberal government speaks loud and clear. On the occasions when I have raised at the Standing Committee on Health the issue of studying the overall system of health care in Canada unfortunately the Liberal majority said no. During the discussion at the agenda planning subcommittee one day one Liberal member actually had the audacity to state that health care was too big a topic for the committee to study.

Can members imagine that? Canadian health care was too big for the House of Commons Standing Committee on Health to study. If the Standing Committee on Health cannot study health, may I ask who should study health?

Earlier this month the Canadian Institute for Health Information released a report which stated that the number of health professionals from 1988 to 1997 did not keep pace with Canada's population growth, resulting in fewer health professionals per capita in 1997. Over that 10 year period the number of professionals per 10,000 population declined by 1.7%, from 185 to 182. Based on these numbers today we are short 9,000 health professionals in the country.

I further ask hon. members to consider our aging population. According to Statistics Canada the demographics of Canada for 2001 will have 13% of our population aged 65 or older. By 2026, just a few years down the road, this same age group will rise to 21% of our overall population. In real numbers this is a rise from 3,945,000 to 7,759,000, almost a complete doubling of this age group.

I remind hon. members that with a few exceptions it will probably include all of us here. It includes our peers, our personal friends, our neighbours and many family members. If we really want a universal health care system when we reach age 65, we must do something to heal the hurting health system right now.

Currently the Canadian Medical Association has noted with concern that the number of doctors leaving Canada is roughly equivalent to the graduating classes of six medical schools per year. That amounts to almost 40% of our medical school graduates. It now takes half the output of all Canadian medical schools to replace the physicians who leave the country annually.

One reason is simply the high cost of medical education. The president of the CMA asserts that the debt of a graduating medical student can rise as high as a $140,000. Other reasons given by the former director of research at the Association of Canadian Medical Colleges of Canada are health care cuts and plunging morale.

Here are some other facts. Some 731 doctors left the country in 1996 and 659 in 1997, for a total of 1,390 doctors in just two years. Doctors moving south of the border represent one-quarter of all medical personnel leaving the country every year. Most of those leaving are nurses. A 1997 study of 489 orthopedic surgeons graduating between 1985 and 1994 show that one-quarter had moved to the U.S. and 70% of the rest were considering it. The most common reasons were restrictions on operating time, unavailability of beds and other frustrations with practice restrictions.

CMA has also stated that there is a severe shortage of high tech physicians capable of reading the results of the latest findings in medical technology. There is currently a shortfall of 150 full time radiologists in Canada with an expected shortfall of 500 over the next four years.

Let us not forget that it takes a great deal of time to train the doctors and nurses we need in Canada. Regular training for a general practitioner is at least seven years and specialist training takes thirteen or fourteen years. We are short of trained staff now, not in seven to thirteen years. A crisis looms on the horizon. Yet the government remains intent upon destroying rather than renewing our stressed health care system.

The Liberal government has attempted to make the claim that it is the only party willing to support the five tenets of the Canada Health Act. That is just not true. The 1997 red book stated the Liberals' commitment to:

—the five fundamental principles of our medicare system, and on our commitment to the continuing role, in financing and other aspects, of the federal government in health care.

If that is indeed what the Liberals meant in 1997, why have they misled the Canadian public? How far is that from the reality of today when the government is truly the architect of the demise of the Canada Health Act?

Across the country there are examples of abuses of the Canada Health Act. In my province of British Columbia where the NDP government reigns supreme the workers' compensation board is allowed by the Canada Health Act, and supported by the government, to send its patients with knee problems to a private clinic either in the United States or the province of Alberta. To me that is queue jumping. To me that violates the whole principle of universality. The government ought to do something about that if it is indeed the protector of the Canada Health Act.

People who need MRIs should be careful. There may be a three or four month line-up, or perhaps they can pay $800 cash at a private clinic and avoid the line-up. If they do not like the waiting time involved, they can take their credit cards and head south of the border. Many Canadian doctors and nurses are there already. When they get there, there will perhaps be a reunion of friends they have not seen for a while.

Who then is responsible for the two tier system in Canada today? It is not this side of the House. It is the other side of the House. Has the Liberal government attempted to resolve these issues? The simple answer is no. Rather than working with the provinces and attempting to ensure that all Canadians have quality health care, the Prime Minister and Minister of Health prefer to antagonize, to cause dissension and not to build unity.

In a press release yesterday and in an article in the Ottawa Citizen the Premier of Saskatchewan, Mr. Romanow, is quoted as saying that he has been pushing the federal government for several months to create a national inquiry but was turned down. I am not surprised. I was turned down in the health committee over the last two and a half years. Why should it give me that privilege when it will not even give it to the Premier of Saskatchewan?

Canadians are starting to see past the Liberal smoke and mirror show when it comes to health. I think they are getting tired of it. Canadians are now starting to turn to other people, to other groups in the country and to other levels of government to try to right the wrongs the Liberal government has forced upon them. Corrective actions cannot be implemented immediately, but they could begin immediately if there were some kind of consensus building shown by the leadership of the government to do something about the most important problem for Canadians today.

My colleagues and I recognize that money alone is not the whole solution. We cannot deny that many of the problems were caused by the significant reduction in funding that the Liberal government has slashed from health care. What a drop it has been from 1996 when it committed to a 50:50 split to now when approximately 11% of health care dollars going into the system come from the Liberal government.

Many of the solutions will require funding. Yes, further efficiencies can be found in the system. Certainly we need more trained professionals. Indeed we face challenges that we have not even previously encountered. Yes, we have an aging population. Yes, the delivery of health care services remains a provincial responsibility.

What positive role has the federal government put forward? Can we name one thing it has done? To date it has been nothing. It has been irresponsible in its lack of solutions to the health care crisis we now face in Canada. It has been inconsistent in the enforcement of the Canada Health Act.

[An hon. member]

They do not think we have a problem.

[Reed Elley, Reform, Nanaimo—Cowichan, BC]

Yes, they do not think we have a problem. The Minister of Health stood in the House today and said there was not a crisis. I was on a radio talk show not too long ago. That is not what Canadians are saying.

The government has been hypocritical in its actions with the Standing Committee on Health. Even past Liberals such as Tom Kent state that the Liberal government is the biggest threat to medicare in the country. In short, the Liberals have continually thrown roadblocks in front of every possible means of finding a positive solution to the greatest problem we currently face in Canada today. It is time to walk the talk, but talk is all we seem to get from the Liberal government on health care.

What can Canadians expect to receive from the Canadian Alliance when it becomes government? As my hon. colleague from Red Deer previously stated, health care has been on the back burner for far too long and must be moved to the front. It is the issue that concerns Canadians the most. It is the issue, contrary to Liberal rhetoric, on which Liberals have spent the least amount of constructive time, energy and financial resources.

The Liberal government has made every effort to destroy any possibility of a healthy, co-operative relationship between the federal and provincial governments in health care. If it were really concerned about co-operating with the provinces, it would have had a high level meeting between the Prime Minister and the premiers a long time ago.

Under the Canadian Alliance, Canadians expect two central themes, patient centred and results based health care. I believe that for far too long the patient has taken the backseat in health care, and yet the patient is supposedly the focal point of the entire system.

I believe we need to move beyond traditional thinking. We need to remember why we have a health care system. Is it to create newer technology? Is it to create jobs for health care professionals? Is it to create an industry for the drug companies? The simple answer is, no. The health care system should be centred on the patient first.

The second issue is one of a results based health care system running tandem with the centrality of patient care. If we started to zero in on both of those things in this country we could expect to have results and a better health care system than we have right now.

[Larry McCormick, Liberal, Hastings—Frontenac—Lennox And Addington, ON]

Madam Speaker, I thank my hon. colleague for having put such an important issue in front of this House on the opposition day. It is something we need to work together on.

As a member from Ontario, I think about the hundreds of thousands of dollars, perhaps millions, that Premier Mike Harris spent on advertising to attack the health care system.

When my hon. colleague returns to his riding would he consider asking his provincial colleagues to work with the federal government because, yes, we do need to fix this problem and we do need to work together on it?