Debates of June 15th, 2000

Petitions

[Eleni Bakopanos, Liberal, Ahuntsic, QC]

Mr. Speaker, I thank the hon. members for their consent.

I would like to table two petitions. The first concerns rural mail couriers. The petitioners are asking parliament to repeal subsection 13(5) of the Canada Post Corporation Act.

[Eleni Bakopanos, Liberal, Ahuntsic, QC]

Mr. Speaker, the second petition asks parliament to declare that Canada objects to the national missile defence program of the United States and to play a leadership role in banning nuclear weapons and missile flight tests.

Questions On The Order Paper

[Derek Lee, Liberal, Parliamentary Secretary to Leader of the Government in the House of Commons]

Mr. Speaker, Question No. 86 will be answered today. .[Text]

Question No. 86—

[Ted White, Reform, North Vancouver, BC]

With respect to the RCMP ownership of 0.50 calibre Browning M2 machine guns under the armoured public and police safety vehicle program: ( a ) what are the circumstnaces under which this program might be deployed by the RCMP; and ( b ) would the RCMP, in such circumstances, be fulfilling a role which would normally be carried out by the military?

[Lawrence MacAulay, Liberal, Solicitor General of Canada]

Currently, the .50 calibre machine gun capability of the RCMP is restricted to the armoured public and police safety vehicle program and could be deployed when there is a requirement for the protection provide by such vehicles. Before any such deployment is authorized, very careful consideration is given to the situation. Restrictions on the deployment of the program's full capability could be imposed prior to any such authorization.

The RCMP cannot comment on the role of the military in Canada; however, there are provisions in the National Defence Act, for the military, upon request, to lend assistance to civilian authority, should the situation be beyond the capability of the police.

The RCMP is dedicated to the safety and protection of the Canadian public.

[Derek Lee, Liberal, Scarborough—Rouge River, ON]

I ask, Mr. Speaker, that the remaining questions be allowed to stand.

[The Deputy Speaker]

Is that agreed?

[Some hon. members]

Agreed.

Supply

[Bob Mills, Reform, Red Deer, AB]

moved:

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.

[The Deputy Speaker]

Since today is the final allotted day for the supply period ending June 23, 2000, the House will go through the usual procedures to consider and dispose of the supply bill.

In view of recent practices, do hon. members agree that the bill be distributed now?

[Some hon. members]

Agreed.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, it is my privilege to have moved this motion today. I intend to try to share some of what Canadians have been saying about the health care system and to put forward some of the solutions we would like Canadians to look at.

We are opposed to a two tier, U.S. for profit health care system. Through the course of the day members of my party and I will demonstrate exactly what we see as the future for health care and the direction it might go.

It is fair to say that Canadians are extremely concerned about their health care system. I will quote from some recent articles that have appeared in newspapers right across the country. One headline read “Gloom deepens about health care, new polls show”. Some 78% of Canadians think the health care system in their province is in crisis and 75% believe the system currently is facing a major crisis around funding. So the headlines go: “Mediocre health care called brain drain factor”.

All kinds of other health care shocks are part of the system. We hear about over 1,000 people in Quebec on waiting lists for heart surgery. Cancer patients are waiting sometimes up to three months before they can get any treatment.

I will be sharing my time with the member for Fraser Valley. I will come back after that to carry on with some of the solutions I propose for the health care system.

What is wrong with this system? If we take a broad view we find there are many turf wars. There are turf wars between the federal and provincial governments. Things are happening within the system such as the so-called driveby smears that are occurring. There is a $1.8 million ad campaign against the Ontario government. There is a real ongoing battle between the federal and the provincial governments.

Canadians do not care who fixes the health system. They want Canadians to fix the health care system, both provincially and federally.

We also have system centred health care. We are always concerned about the system and seldom seem to talk about the patient. We do not talk about what is best for patients, be they senior citizens who are having difficulties finding a place to go for their declining years or people with impending heart surgery to save their lives. We do not talk about individual people. We always talk about the system and saving the system. That is wrong. We have to change that focus.

As well we have to take a look at a state run, socialized type of system. Maybe it works in North Korea and in Cuba, but I am not sure it works in modern Canada. We also have to look at doctor and nurse shortages. We have to look at all groups that are concerned about health care. We have to end the turf wars. We have to get down to a patient centred focus where health care should be.

We have to talk about funding. Obviously we can go back in history to the sixties when a 50:50 agreement was made by the provinces and the federal government. The federal government obviously has different responsibilities from those of the provinces but they agreed to a common funding. In 1977 it was agreed to change the way the funding occurred from strictly dollars to a dollar and tax points system. We could go into great depth and detail about how it works, but I do not think that is the point of today's debate.

In 1995 the government again changed the system and the method of funding to the CHST grants involving a block of money. We really lost control of what was happening and how the system was being monitored. The auditing of the system is just not there. This block of money is transferred. We do not know how provinces are using it or what they are using it for. No one seems to know what anything costs.

We should address the fact that in 1993 the amount of money being transferred by the federal government was $18.8 billion. By 1998 it had declined to $12.5 billion or close to a 40% cut in funding by the federal government. Since then it has increased to $14.5 billion this year and $15.5 billion next year. If we add each year's cut in funding from the 1993 levels, the bottom line is that today's total would be a cut of about $24 billion in federal funding. That is the point that the Ontario government is trying to make to the health minister and which the health minister seems to fail to understand.

Instead we enter into a kind of shell game with the Prime Minister saying that he is transferring more money than ever before. Even in Las Vegas this sort of shell game would not be accepted by the players in that city. What is happening with the funding? The federal government has definitely cut the funding and the provinces are saying it must at least return it to 1993 levels. To this point we have no response. Nothing has happened.

We need to look at the rating of our health care system. We need to look at a study done by the OECD on the 29 industrialized countries of the world. We find that we spend somewhere between the fourth and fifth most on health care of those industrialized countries. We spend 9.2% to 9.8% of our GDP on health care. That is similar to most of those other top industrialized countries.

The problem is that in many other areas we are in the bottom third of the rating of those countries in terms of the delivery of service. If we spend the fourth most and we are the 23rd best, there is obviously something wrong. It is not to point fingers or to blame anyone; it is a matter of looking at what is wrong and why it is happening.

As well, the World Health Organization is coming out with a report, which we have seen parts of already. On June 21 that report will be made public. Again, there will be an evaluation of the 181 countries in the World Health Organization. In the report, on the area of life expectancy, it indicates that we have dropped from second to twelfth.

The decline of Canada and Canada's health care system is of major concern to Canadians. That is why 78% of Canadians say that their health care system is in crisis. That is why they are asking and demanding that Canadian politicians, provincial and federal, look at health care, identify what is wrong and fix the system.

We have heard a lot of talk in the House about how the government cares about health care. However, we really have not seen very much. We pretty much have a white page of solutions coming from the government. It is not a white paper; it is just a white blank page as far as the solutions that the government is putting forward.

I could go on and talk about education, the brain drain, the lack of technology and the huge problems we have. I had the occasion to tour a Swiss hospital recently. I could not believe the difference between the Swiss hospital and some of the hospitals I have toured in Canada. The emergency room crisis, the aging population and the rising drug costs are all things that Canadians expect us to deal with.

I want to tempt you, Mr. Speaker, to be here a little later in the day when I will talk about the solutions to health care. I will also tempt the health minister to be here as well to hear the proposals from the Canadian Alliance as to what we should do with the provinces to fix the health care system.

Because my time is up, I will turn it over to the House leader for the official opposition.

[The Deputy Speaker]

Before we hear from the House leader for the official opposition, there are five minutes for questions and comments.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, the member talked about a blank page. Yesterday, I had an opportunity to visit the Canadian Alliance website to look at the proposed solutions to the challenges of health care and I found that there was a blank white page.

There is a common discussion going on among all people interested in health care in Canada about the need for additional injections of money, but also money where it is targeted to areas in which there will be meaningful change and improvement in the delivery of health care to Canadians.

It does not take a lot of detail to answer. I simply ask the member whether the Alliance believes that the government needs to transfer more money to the provinces for health care, or whether moneys should be put in with the understanding that there be conditions on measurable standards so that Canadians fully believe and understand that they are getting quality health care.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, first of all, I became the critic on January 1. We are in the middle of a leadership race. I can assure the House that our web page will be full of health care solutions as we proceed in this process.

The hon. member's question is whether we should put more money in. The point is that we spend about the fourth most of the industrialized countries on health care and we are in the bottom third in terms of our ratings. We are 23rd in the area of technology and so on. If we are in the bottom third with the fourth best investment, money is obviously not the only answer.

It is an answer to return some of the funding to go to the table with the provinces so they will negotiate. We need that money on the table, but that is not the key to solving this problem of health care. I think Canadians know that. I think people in the health industry know that. I think the provincial health ministers know that.

It is a matter of co-operation with them, and coming to the table with an open slate. That is the point that has to be made and that is the point we will continue to make. We are in the process of consulting with Canadians. We intend to do that extensively through the fall. At that point, if the government is not asking the necessary questions of Canadians, we will do that for the government.

[Greg Thompson, Progressive Conservative, Charlotte, NB]

Mr. Speaker, I congratulate the member for his motion today. I think it is timely and worthy of debate.

The member mentioned that his party is not in favour of a two tier system. Everyone heard him say that. My question relates to the leadership of his party, the CA, formerly known as the Reform Party. That party has one candidate vying for its leadership who actually launched his campaign on the basis of a two tier system of health care.

Is the hon. member suggesting that this candidate is out of the race and he will not win it? Where does this fit in? How can the member stand in his place and suggest that his party does not stand for that when one of the potential leaders of his party is actually campaigning on that very issue?

I think it is presumptuous of the member to think that his party does not stand for that. The leadership race is not over. We will not know until June 24 who will win the race. Is he not pre-empting his potential leader?

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, obviously in a leadership race, as he knows and everyone in the House knows, leadership candidates can pretty much say what they want. The point is what happens here. What the party says, what the shadow cabinet looks at and what caucus looks at is what is party policy.

I would remind the member that there was a candidate in the race for the leadership of his party, Mr. Orchard, who obviously was against free trade and against a lot of the things which that party introduced and stood for. I think that says it all.

Obviously we will wait until June 24 to see what the leadership stands for.

[Chuck Strahl, Reform, Fraser Valley, BC]

Mr. Speaker, it is a pleasure to rise today to talk about what Canadians have described as their number one concern, both federally and provincially. They have asked their political leaders to deal with what they see as the decline of the health care system.

We saw on the news last night that the premier of Saskatchewan has struck a committee and a public inquiry, so to speak, into the status of health care in Saskatchewan. It is indicative of what we are going to see increasingly in Canada, which is a grasping for new ideas to make sure that the health care system that we all depend on will be healthy as we go into this new century.

The comments of the Saskatchewan premier last night on the news were interesting. He was asked “Is this an attempt to pressure the federal government to hold a similar type of conference to bring people together to discuss new ideas?” He said “Maybe in part”. I think he understated the case. Certainly many provincial health ministers have been in contact with us, saying that they are very nervous that the federal government has backed away from the idea of the need for all first ministers to get together in a formal way to discuss this very important issue. They are acting a little like skittish fillies. They are prancing around. Everybody wants to get in on it, but they are not sure exactly whether the federal government will provide leadership.

I hope the questions which are discussed and debated today by all sides of the House, especially by the health minister, will address the big problem. The philosophical question is where we will go with this, which is obviously the big problem for Canadians.

There are only so many ways to fund health care, and it does not take long to list them. There are federal and provincial tax dollars involved in the system. There are plans that help to provide and augment those who are fortunate enough to have access. Whether it be an insurance plan, a medical service plan or a provincial plan, people need to know what role those contributory plans will play in the system.

Then there are private funds, which of course fund a lot of the health care system. Anyone who has paid for their own prescriptions, paid fees to a chiropractor or to another health care professional for services that are not covered under the provincial health care system knows that private money is used extensively in the health care system, and that will continue.

The government with its tax dollars, the insurance people and the people with the private funds have to lock themselves in a room and say “When we come out of here we will decide how this system will be paid for”. It has to be paid for, but what will be the provincial role and what will be the federal role? What will be the insurance role? What will we ask insurance programs to look after?

No one will deny that dental care is health care, yet dental care is not covered under most provincial plans. People need private insurance plans. In other words, it is already extensively used. Now we need to decide, in this new, upcoming, expensive 21st century medicare plan, who will pay for what.

Also important is the list of procedures that we will continue to fund for all Canadians. It is no secret, as one of the architects of health care said on the news again last night, that no one thought about the $3 million CAT scan, no one thought about the MRIs and no one thought about the expensive drug treatment programs which are so effective but so expensive when we started this whole medicare plan.

Canadians see these programs, they want to have access to them, but they are told that they will have to wait months for the MRI that should be prescribed for them. It is a modern health care treatment to which Canadians deserve access, and timely access. It is not enough to say there is universal accessibility under the Canada Health Act if universal accessibility means that a person has to wait as long as everybody else. It is no good to tell someone that they are just the same as everybody else because they get to wait a year for their treatment. That is not universal accessibility, that is universal inaccessibility. While it may be equal, it is not fair. I would ask the minister to please address that.

I would also ask the minister to talk about some innovative ideas to which I hope all Canadians and all politicians will be open. We all talk about how we do not want the American system. The American system is nothing like our system. To most Canadians it is a frightening thing. The thought of breaking your leg and losing your house as a result, and all of the horror stories that we read about from time to time, make Canadians nervous. I do not think Canadians want to go there, but if we are not going there, then what new systems will we put in place? The minister should not say we just have to be innovative, he should explain what it is that we will be doing differently.

There are all kinds of innovative ideas. We have talked about savings plans for the private portion that we already pay for in our health care system. Are there ways through tax breaks to encourage people to save funds to look after the health of themselves and their families into the future? What about ideas such as those of Michael Walker from the Fraser Institute? I thought he had an innovative idea. He said “Please, do not change the system that allows everyone universal access to the public health care system, but put in place a system that rewards people who do not abuse the health care system”. In other words, he is saying that we should have a plan that is accessible to everyone, but for those who look after themselves, do not smoke, do not abuse themselves and do not need the health care system because they have taken care of themselves, they should reap a reward for that. Maybe we should look at that kind of thing.

I am sure the health minister will deal with the whole issue of preventive care. What is the role of the federal government in preventive care? Is it primarily a provincial jurisdiction? Largely, I think it is because so many of the social programs are administered by provincial governments. However, he should detail again what it is that the federal government sees as its role. Is there an overarching theme?

One of our members has put forward the idea of a headstart program. I know there is already an aboriginal headstart because that is a federal jurisdiction. We put in an aboriginal headstart to try to deflect some of the high risk kids into treatment, preventive therapy and preventive work in order to keep them out of the health care system when they grow up. Is there a role for all Canadians or does the federal government want to see that dealt with at the provincial level?

It is time to delineate the lines of authority. It is time to start talking about what can and should be done federally, what can and should be done provincially and to be honest with Canadians about what can be, should be and must be done privately. We should be telling them forthrightly what we can do for them and what we cannot do for them.

This is just like job creation. There are some things people have to do on their own. There is a role for government but there is also a role it will take on. I hope the minister will address what he sees as the delineation of authority and the programs he sees the federal government maintaining or enhancing, and then to be honest with the provinces and Canadians about the programs that he will not maintain or enhance.

I hope the government and the minister will talk about the Canada Health Act. It is an old act that has been around for decades and has served Canadians pretty well. However, time and again we have seen the need to bring it forward and open it up, not necessarily for change, but to open it up for debate.

There are five pillars to the Canada Health Act. Should there be six? Should we define what we mean by universally accessible? What about portable? If portable means we can get no service in this province just like we can get no service in the next province, there is no use in it being portable.

Let us describe what we want in the Canada Health Act. Let us not be afraid to talk about it. This is not to say that we will throw the whole thing out. Let us discuss whether there is a way in the 21st century to anticipate the expensive procedures, the expensive drug treatments and the aging population. Is there something we need to do with the Canada Health Act to make all those things possible? Maybe there is not but I think there is a need to talk openly about the Canada Health Act. Maybe we could add another pillar talking about a health guarantee for Canadians, that they will get access to care, not just the same as anybody else but in a timely fashion.

I look forward to the minister's speech. I would like to move:

That the motion be amended by inserting after the words “Government to”, the word “immediately”.

We believe this is something that Canadians want this parliament to be seized of forthwith.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, the House will know that one of the leadership candidates for the Canadian Alliance is proposing two tier health. It strikes me that may very well be the reason why the Canadian Alliance's web page on health initiatives is blank at this date. It is waiting to find out which leader's policy it will have to follow.

I say that facetiously, but the member for Red Deer talked about how money is not enough and maybe we need new initiatives. The House leader for the Canadian Alliance said—maybe unintentionally but he should clarify it—that we need new initiatives and new ways to do things.

One of the things that he suggested was that maybe we needed incentives for Canadians to save so that they will be able to take care of their own health care needs in the future. That is what he said, and he might want to check the blues. That to me signals, whether it is specific or implied, that a two tiered health strategy for the Canadian Alliance actually is a possibility, that it thinks that somehow if we can get more money into the hands of Canadians they will be able to take care of their own health. As far as I can see, that is a total abandonment of a public health care system.

I would like to ask the member whether or not he clearly supports a publicly funded health care system to the exclusion of any alternatives, including two tier health care.

[Chuck Strahl, Reform, Fraser Valley, BC]

Mr. Speaker, it looks like this is going to go on all day. Of course I did not say that. What I said was that a good portion of health care in Canada is paid for by private funds. Anyone who has bought a prescription for antibiotics for their kids and shelled out $10 or $15 for it has paid for the health of their family out of their own funds.

If I go to a chiropractor I have pay for that because it is not covered under general medical services. My back is being helped but I have had to pay for that repeatedly.

When people get a massage, they have to pay for that themselves. Even if the doctor has prescribed it, it is not covered under the medical plan.

What I suggested was that when people have to pay out of their own pockets, as they often do already for those kinds of services, we should look at something in the tax system that would allow people to save, like we do for retirement or for education, the private portion that we already pay for, not new things, should be looked after by the government in a way that encourages and allows people to save, free of the tax man, something that is specific to their health care. That is what I was talking about.

The leadership candidate, who the member spoke about, is frustrated with the current state of the health care system. I guess it is a case of walking a mile in his shoes. He is an emergency room doctor who has spent many years on the front lines both here and overseas delivering health care to all kinds of people. He spends the summers working on aboriginal reserves, in very difficult situations, giving of his time and providing services where no one else will go. What he sees is a deterioration of the health care system that is very frustrating to him. He has seen people lying on gurneys who are not receiving treatment, and no matter what he, as a doctor, prescribes, nothing happens to them.

What that leadership candidate says is that we have to talk about options. I have thrown some options out this morning, but as a medical doctor and an emergency room specialist, the member for Esquimalt—Juan de Fuca has seen firsthand unnecessary suffering and even death because people have not had access to timely health care.

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

Mr. Speaker, in one way or another, in one form or another, each of the leadership candidates for the Canadian Alliance has advocated private involvement in the health care system, whether we are talking about a parallel private health care system or a greater share of the pie by private forces. That has been clear and it has been stated by the previous health critic and the present finance critic of the Alliance.

I would like to know what the official position is of the Canadian Alliance. Does it support a parallel private health care system, yes or no?

[Chuck Strahl, Reform, Fraser Valley, BC]

Mr. Speaker, Canada already has a private health care system. If we get our teeth fixed by a dentist, that is private. We pay for it out of our hip pockets. If we go to a chiropractor or to many other treatments, they are private.

In my province of British Columbia, the provincial NDP government sends needy health care patients to the United States for treatment. A guy I used to work with needed cancer treatment but the cancer clinic was full. The NDP government not only paid for his treatment in Bellingham, it gave him vouchers to travel back and forth. When he had to stay overnight, the it paid for him to travel to the United States and paid for his overnight stay in a private American health care clinic to receive treatment.

For anyone to say that there is no private health care involvement in the system is incorrect. There is, absolutely. That is why we need to discuss what that involvement should be and how we can ensure that all Canadians have access in a timely way to the health care they need.

[Allan Rock, Liberal, Minister of Health]

Mr. Speaker, I appreciate the opportunity today to speak to this issue. I think it is fitting that on the last day of the session of this parliament we spend our time talking about the number one issue on the minds of Canadians across the country.

It is clear that what we are discussing today is a subject of vital importance to Canadians.

The state of our health system is of major concern to our fellow Canadians. It is obvious, and we must be frank during this debate, that we are faced with some major challenges.

We can discuss the long waiting lists, the over-crowded emergency rooms, the shortages of physicians and nurses.

In these circumstances concrete action is required from all governments working together.

In responding to the motion put before the House by the Canadian Alliance Party today, let me make three points. The first is that in the efforts we make to solve the problems facing Canadian health care, we must stick to the principles that are spelled out in the Canada Health Act. Simply stated, a single tier, publicly financed, universal system of health care provided for by the Canada Health Act is the best possible approach to providing health coverage for our population.

Let me explain why I say that. The member for Fraser Valley described the Canada Health Act as an old act, as though somehow in the 16 years since it was adopted by the House the statement of the principles contained in that statute has become outmoded, outdated or must be reframed.

I suggest that the evidence, our experience as Canadians and the experience elsewhere in other countries shows that those five principles in the Canada Health Act are as relevant and as valuable today as they ever were. Those principles are as important and as relevant to health care in Canada today as they were when they were formulated by the Liberal government in 1984.

Why do I say that? I say that for two reasons: First, they spell out the foundation of a system of universal health coverage that is socially fair; and second, they provide for a way of making services available to a population that is economically efficient. I will deal with each of those in turn.

As to social fairness, we all know that Canadians cherish our public system of health care. Why? It is because to them it is about more than just doctors and hospitals; it is about values, about being Canadian and about the way we want to live our lives.

It is about the promise we have made to one another as Canadians that we will look after each other in times of need regardless of wealth or privilege. Access to needed services will not depend on the state of one's bank account, but will be determined by the state of one's health.

That is what the Canada Health Act is all about. It reflects something that lies very close to the heart of this nation's sense of self. For that reason, because of the social fairness of public medicare in Canada, the principles of the Canada Health Act are as important today as ever they were, and it is important that we defend them.

The second reason is economic efficiency. We do not talk about this often enough. Public medicare in Canada allows us to provide health coverage for the population in a way that is less expensive than approaches taken in other nations. Let us look at the comparative situation between Canada and our closest neighbour, the United States. We are so much alike in so many ways, but there are important distinctions that demonstrate the economic value of Canadian medicare.

At the moment, as the member for Red Deer observed this morning, Canadian medicare costs just over 9% of our gross domestic product. For that we insure 100% of our population for medically necessary services. In the United States, health costs are 14.2% of the gross domestic product. Notwithstanding that much higher level of spending, coverage is provided for only part of the population. Today there are 43 million Americans who have no health coverage. There are 100 million Americans who are underinsured and who worry that one day they may have to choose between their health and their homes.

Why is it that we can provide health insurance for everyone for 9% of our gross domestic product and the Americans spend 14.2% and leave so many tens of millions uninsured? It is because the single payer publicly financed universal coverage provided for in the principles of the Canada Health Act is economically efficient. The overhead in the American system is a huge source of cost with so many people providing coverage with private insurers. I will give an example.

Last year a professor from the United States was in Toronto at a conference on this very subject. He described a hospital in Boston which had about the same number of beds as a Toronto hospital. In the Boston hospital there were 317 people in the billings and collection department. In the Toronto hospital there were 16 people in the billings and collection department. That is a vivid illustration of the difference between us.

A few weeks ago I was in Grand Falls, New Brunswick. During my stay in that beautiful community I met a man who had come across the Saint John River from Maine, which is immediately adjacent and just a few moments away from Grand Falls. This American, a resident of Maine, had recently had open heart surgery. He told me that the cost of that surgery was $400,000. This man was among the lucky ones. He had some private health insurance that paid 80% of the cost, but simple arithmetic makes it clear that this man from Maine was obligated to fork out $80,000 of his own money to pay for that open heart surgery. That is a vivid illustration of what happens when private for profit interests take over the organization and delivery of needed medical care.

Surely the case is made to the satisfaction of the party opposite that our first goal must be to hang on to those principles, to preserve this public system of which we should be so proud. In Canada, unique in all the world, we have found a way to provide health coverage to our population that is socially fair, that reflects our values and speaks of the way we treat each other as citizens. At the same time it makes economic sense.

In the course of my work in the Prime Minister's government, I have occasion to travel to other countries or to receive here in Canada health ministers from abroad. In the course of those meetings the subject has often arisen whether Canada should import some of the features of foreign health systems and particularly, as the alliance members would contend, the private for profit element to, as some of them say, take the pressure off our public system.

I can tell the House that without exception, every such foreign minister to whom I have spoken has urged me not to follow that course. They have urged me to hang on to our present public system and to do what we must to fix it, but not to go down the road of the private parallel health system. Why is that? They usually give me the same reasons speaking from the experience in their own countries.

They say that if we open the private parallel system of care, then we will lose doctors, nurses and other health workers to the private system. The problems we have now with providing medical care professionals in the health care services will become even worse. It is often the best and the brightest who leave the system to practise privately.

They emphasized that the private parallel service will focus on the simple repetitive procedures where profit is greatest. And as soon as there is a problem, we know where that case will go. A complication will be sent right back into the public system and the public will end up subsidizing the private for profit sector.

These ministers also pointed out that the private for profit element, the private parallel approach, has not resolved problems in public medicare. England is an example where the waiting lists are worse than ever. In England a person can go for the private for profit parallel services, yet its waiting lists are worse than ever.

The members ought not to think that the simple answer to the problems that confront medicare is to establish the private for profit parallel system. It does not work.

There is one other point that those from other countries urge upon me in arguing that we should keep our public system of medicare in Canada. They point out that if we allow the most influential and wealthiest in our society to purchase access to services, if we allow those with money and influence who help to shape public opinion to purchase access to private services in health care, then to that extent we will reduce the pressure on governments across the country to fix the problems in medicare. It will slip down the public agenda and the problems will not be resolved. That is a very important consideration.

The first of the three points I wish to make this morning in speaking to the member's resolution is that we should do what it takes to hang on to our system of public medicare. It is socially fair and economically efficient and it reflects the best that this country has to offer.

My second point is that the public system of medicare must be financed properly. It must have the money it needs to provide the services that Canadians must have. That includes the obligation of the Government of Canada to do its part in financing public medicare.

In 1993 when this government was elected, the total value of transfers to the provinces was about $28 billion per year. This year the total value of transfers to the provinces will be over $30 billion. We have not only restored the transfers, but we have increased them in the time that this government has been in office.

Every year in Canada the federal government contributes one-third to all public health spending. In the last two years we have increased by 25% the cash transfer to provinces, including $2.5 billion just three months ago.

I am not suggesting that we do enough. Indeed, I am an advocate for increased federal funding for health care and for increasing transfers to the provinces for health. The Prime Minister himself has said that the Government of Canada is prepared to increase transfers to provinces for health when we reach common ground with the provinces on a common vision for the future of medicare and an approach to the problems it faces.

The argument in favour of additional funding from the Government of Canada is clear. In parts of the system more money is needed. If Ottawa is to play its role, if it is to have the moral authority to protect the principles of the Canada Health Act across the country, it must have a credible voice at the table. This government will ensure that the Government of Canada is at the table to play its part in protecting public medicare in this country.

That leads me to the third point I wish to make this morning and it is simply this. It is not just money alone that is going to succeed in solving the problems we confront in medicare. Our goal must not be simply to make health care more expensive in Canada. Our goal must be, by supporting provincial innovation, to make access to quality health care available across this country.

We must work with our provincial partners toward developing a common vision and common approaches to the resolution of these issues. We must speak with our provincial partners about establishing these objectives, finding some way to measure the performance of the health care system, and reporting to Canadians whether we are making progress toward those objectives.

Do not misunderstand. I am not suggesting for a moment that provincial governments are accountable to the Government of Canada, but that governments of both orders are accountable to the public of Canada. We must use common indicators to measure the performance of the system and report to Canadians so that we can work toward restoring public confidence in medicare by proving and by establishing that we are making progress toward our shared goals.

We must also identify areas of innovation. The hon. member for Fraser Valley asked for innovative ideas. He wanted to know what would work and what we could do that would help change the system.

I suggest that we know that, from the national forum which the Prime Minister chaired, to the excellent work the provinces have done, including last week when they tabled their cost driver report, to the innovations that the Government of Canada funded through the health transition fund.

In 1997 we set aside $150 million in the health transition fund. We have funded over 400 pilot projects across the country, demonstrating the value of new approaches in home and community care, in primary health care reform and in integrating health services. We have learned from those pilot projects.

We have watched as provinces themselves have innovated. Now is the time for the Government of Canada to get behind those provincial efforts, to broaden and to accelerate the innovations in which they have engaged in order to make real progress in improving access to quality care.

I believe we know the broad directions we must take. It is now up to governments to work together to ensure that we pursue them.

Primary health care reform and broadening the availability of home and community care, those are the changes that will take the pressure off our emergency rooms by making services accessible. Dealing with shortfalls in medical equipment, investing in health information technology to integrate our health care system and sharing information among providers about patients, dealing with the issues of the right number of doctors, nurses and specialists to care for Canadians, these are the issues we must pursue in common. We have begun.

Let me also mention wellness because there is an important federal role in that regard, not just to think about treating those who are sick but to think about encouraging all to remain well.

Cardiovascular disease continues to be the number one killer in the country. There are four risk factors, three of which are within our control: diet, exercise and smoking. That is why we will continue our aggressive efforts against the tobacco industry to encourage Canadians to understand the tactics of big tobacco, to encourage young people not to begin and to protect children from the tactics of big tobacco.

I stress that we must work with our provincial partners to achieve these goals.

We have already begun. Six months ago, I wrote to my provincial and territorial counterparts, inviting them to the negotiating table, inviting them to work with me to identify priorities and to develop an action plan to address these problems.

This afternoon, I shall be holding a conference call with them. I trust that, in coming weeks, we will be face to face around the negotiating table.

I want to ensure that we put before the first ministers when they meet in September something upon which we can agree as common ground and a common vision for the future.

In conclusion, I do not support the motion before the House. I am as concerned as the next person about the issues in medicare. We are confronting them with our provincial partners. I disagree that the health system is in crisis. I believe we have grave issues to deal with, but let me quote from the provincial report last Friday wherein the provinces said:

Canada's publicly funded health care system is not in crisis. Canadians continue to be well served by their health care system but it is under serious challenges due to rising demand and cost strictures.

I entirely agree with the provinces. Let us work together to make sure that we preserve our greatest social asset, our public medicare system.

[Bob Mills, Reform, Red Deer, AB]

Mr. Speaker, we heard a lot of motherhood, a lot of status quo and a lot of comparison to the U.S. system which no Canadian wants. Why even talk about it? It keeps coming out.

The real question is that today we spend $86 billion in public money in total on health care. The projections of Health Canada are that it will increase at 3%. That means that by the year 2020 we will be spending $160 billion on health care.

We want the new technology. We want the new medications. We want all that. The Premier of Newfoundland says he is already spending 42% of his budget on health care. Other provinces say they are spending 30% of their budgets on health care. What is the right amount to be spent on health care? If we are to spend $160 billion, what about all the other things government has to do?

The minister talked about the system not being in crisis, but 78% of Canadians say that the system is in crisis. The people are saying that. The only people who do seem to be hearing it are the politicians.

[Allan Rock, Liberal, Etobicoke Centre, ON]

Mr. Speaker, I am afraid the hon. member has to accept the fact that the provinces in their report last Friday declared that the health care system was not in crisis. It faces serious problems, particularly in relation to cost pressures that must be addressed.

Let me come to the member's question. The cost drivers in health care can be managed through changes in the way health care is organized and delivered. That is why we are anxious to support provincial efforts to innovate in areas like primary health care reform, for example the current system of fee for service as opposed to a different approach.

The province of Ontario has talked about getting 80% of its physicians over the next four years on to different methods of payment, apart from fee for service. I am anxious to support innovation of that kind. I believe that by using information technology, by measuring performance and by looking at the way we can influence the rate of increase of costs we can indeed keep our system sustainable. It will take innovation. It will take change.

The alliance party opposite would have us go in a different direction. It would have us go toward the private parallel for profit system of health care. The facts show that will not work.

I disagree fundamentally with the approach it favours. I do not believe Canadians agree with that approach for a moment. I think Canadians expect us to work very hard to keep the principles in place to preserve the public nature of medicare but not to take the American style approach. It will not work and it will not be supported by Canadians.