Mr. Speaker, I wish to begin my remarks today by asking why we are suddenly debating health care. Is it because the federal government is doing something about health care? The answer is no. Is it because the federal government has any new policy for health care? No. Is it because the federal government is announcing any new funding for health care? No.
In fact a representative of the government today barely spoke at all on health care. I am appalled. I wish no insult to the parliamentary secretary but the government called this debate on health care and it would have been appropriate for the Minister of Health to come here and begin this debate today.
Instead, all we got was a very brief lecture which seemed to concentrate mainly on the necessity that we all live more healthy lifestyles. This unfortunately is standard practice. This is the second take note debate we have had in the House, a standard practice of the government which, at critical times, wants to change the subject, indulge in rhetoric rather than action and engage once again on a critical matter in careful positioning: watch where all of the various opposition parties stand before taking a communications position itself.
We have seen this before. We saw it even last week. Since I became a member again in May we have had scandal after scandal and so last week suddenly an ethics package appears. It turns out the ethics package has nothing to do with changing any of the practical rules for the ethical standards of the Prime Minister and members of cabinet whatsoever.
We have the same thing with Kyoto. We have the Kyoto accord which is sinking fast. Today it was mired in provincial opposition at the conference in Halifax. We had this developing last week. There was lack of industry consensus and lack of a plan. Suddenly late last week we had a Kyoto package, although the Kyoto package of course provides no key answers to questions on targets or costs.
I would suggest that this particular manner of acting by the government is most dangerous in the area of health care where people are genuinely being affected by it. We have had nine years now of excessive rhetoric from the Liberals on health care and lack of action, which is genuinely contributing to the continual deterioration of our health care system.
Of course this reached a crescendo in the last federal election, and I will speak about this later, when the government attacked provinces that were trying to reform the health care system while offering no alternatives of its own. Much of this situation comes today because of the cutbacks that the government introduced in health.
I remind the House that the former minister of finance loves to take credit for the elimination of an over $40 billion federal deficit. We have never begrudged him that credit but he also must be frank about how he did that. Between 1995 and 1998 tax revenues rose $30 billion. In other words, three-quarters of the deficit was eliminated by taxes. Ten billion dollars was eliminated by a reduction in expenditures in which $6 billion came from a reduction in health care transfers to the provinces.
The record of the government in health care and in federal spending was that it cut in its own back yard on its own administration by 2%. It cut military spending and security by 20% and cut health care by one-third. These ratios are exactly the opposite of what every province did to balance their budgets, although every province ultimately managed to balance their budget.
As a consequence of this, according to data from the Organisation for Economic Co-operation and Development, today we have a health care system that ranks 18th in terms of access to MRIs, 17th in terms of access to CT scanners and 8th in terms of access to radiation machines. In terms of risk of death by breast cancer, for example, Canada ranks sixth among OECD countries. According to the Fraser Institute, across Canada total waiting time is high both historically and internationally compared to 1993. “Compared to 1993, the waiting time in 2001-02 is 77 per cent higher”. Waiting time under this government has increased in all but one of the past eight years. Canadians deserve a much better health care system than that.
When the government came to power it was very common to hear Canadians refer to our health care system as the best health care system in the world. It is extraordinary now how seldom we hear that phrase spoken.
Before I move on to what we think is critical in health care, let me talk once again about the values that should guide us in the health care system. Whatever flaws our health care system has today, it is the only one we have and the only one ordinary Canadians have come to depend on it. In fact we were promised we could depend on it and persuaded to do away with most other alternatives.
Canadians are increasingly worried about the future of the health care system, which is one of the reasons I re-entered politics. Now that my wife Laureen and I have children we have had discussions over the past several years about our future, about planning our future and about planning our children's' future. We have had repeated discussions about some of the challenges we face and health care has come up a lot. My wife and I know we are at the end of what is called the baby boom and that by the time our critical health care needs develop health care will be well into a massive crisis unless something is done about where the system is going.
Where will ordinary Canadians go when we enter this crisis? The government has a monopoly on key health services. My wife and I and many other Canadian families have saved a lot of money for our retirement and other things, but not necessarily for health care. We thought we were paying tens of thousands of dollars a year in taxes toward a long term health care system. For most of us, unlike the Liberal elite in this country, running to the United States to get health care services is not an option simply because those services are expensive. They are expensive not just in absolute terms but expensive because of the policies of this government. With our dollar falling every year, anything purchased in the United States becomes more and more expensive.
What is important? Anyone who thinks about this should be very worried about this in the next 10 or 20 years. Anybody who thinks about this will need to ask some important questions. What is important about the health care system? What is it we are trying to preserve? What is it that we have to let go?
We will hear the Liberals tell us a number of things about the health care system and how important they are, but these often miss the point. They will talk about this as being a Canadian value, a nationalistic thing. They will talk about the public non-profit nature, about equality and about the fact that services are free. Let me address some of those issues because it is important that we have an honest debate.
First, is it really critical for us as individuals seeking health care that this system is Canadian, that somehow it defines the country and our nationalism? We are told this repeatedly by the Liberals and I know it is a popular view, but is it really true? My ancestors engaged in two world wars to fight for the values and freedoms of this country. They fought in those wars without a public health care system. I am not suggesting they did not want one. In fact, having public health care has been one of the benefits of winning those wars, preserving our freedom and moving our society forward. However, we did not fight wars to preserve the health care system. I would suggest that not many Canadians are willing to die for a health care ideology in a health care line-up. They may be willing to die for their country but they are not willing to die for the Liberal definition of the health care system.
When I talk about the health care system as a national value, I will speak specifically about the federal role in health care which has been particularly problematic.
Second, is the important thing about health care that it be public and non-profit? Contrary to a lot of Liberal rhetoric, the fact that our system is public is not what actually makes it terribly unique. For instance, even in the United States a majority of health care is provided publicly, not privately. The most recent figures I have suggest that roughly 69% of our health care is public versus 53% in the United States.
Most Canadians are shocked to learn, particularly with the deterioration in federal funding for health care, that the United States now actually spends more per capita on public health care than we do in Canada. All this spending should point out that while health care is non-profit in most cases in Canada, it is certainly not charity. It is an expensive business.
Do people care about how the health care system is delivered? I would suggest not. They care about whether they are getting treated or not. When we have a public system that increasingly justifies its monopoly through rationing, I must point out that this is having real impacts on ordinary Canadians with diagnoses, treatments and ultimately on mortality itself.
The third point is equality. Equality is an important value in our system and I must say that health care is more equally accessed in Canada than in the United States. That is an important value and one that we should continue to preserve.
However, health care is not equal in this country in any absolute sense of the word. I have already mentioned the fact that some Canadians, including the Liberal elite, can go regularly to the United States whenever the health care system fails them here, but not all Canadians have equal access to health care. Depending on where they live, their province, and whether they are rural or urban, some have superior access, as is the case in any publicly run monopoly. Those who are connected with its running have superior access.
Most important, public health care in Canada has never come close to covering all health services. Most Canadians have supplementary health care coverage. Some pay for it individually and others have it paid by their employers. The House of Commons has one of the best supplementary health care packages in the country. It is simply not available to average Canadian workers. We are fooling people if we think that somehow every Canadian gets equal access under our system.
Is it important that the system be free? First, let me be clear that no reasonable person believes that our health care system is free. We do not generally pay at the point of service, but our health care system is very expensive. It is very expensive and increasingly slow to deliver and hard to access.
The cost of our public health care system in 2001 was about $75 billion. Over $100 billion was spent on combined private and public services. It is not free. It is reflected largely in our tax burden. Our tax burden is too high. It is close to half of the disposable income of the average Canadian. In the U.S. the equivalent tax burden is only about one-third.
All those things may to some degree define our system, but if all of them are not what really matters or what should matter to people in our health care system, then what should matter? I would suggest two things.
First, that we actually get health care, that it be available. That is the single-most important thing and it tells us how ideological this debate has become when we have to remind people that health care be available, especially when we are sick. That means that health care must be patient-centred. It is the health of people that we must be concerned about and not as the Liberal government says, not as many of the invested interests of the health care system say, or so-called health advocacy groups say. It is the health of people that matters, and not the health of the system and those who work in it. That is our primary concern here.
Second, health care needs to be affordable. It is important that we can get it and that we can afford it. I would point out that affordability of health care is almost invariably delivered, whether it is publicly or privately, through insurance. Because of the nature of health care and health care expenditures which are unexpected and often large, it is almost always the case, with the exception perhaps of the extraordinarily rich, that health care must be delivered through an insurance program, whether public or private, and almost everyone requires health care insurance in this combination.
That does distinguish Canada, to some degree, from the United States. We have, as do most advanced industrial countries, a universally available public health insurance system. The United States, notwithstanding its large public expenditures on health care, has no such program. This is a system that this party supports. This is a principle which we will always defend and on which we should build.
However, what is important is that all Canadians get necessary, timely service regardless of financial means, that we do not saddle ordinary people with enormous bills for catastrophic health problems or, on the other extreme, provide them with a system that is so monopolized and rigid that they cannot get health care at all, regardless of these principles. The tax burden of doing this and providing this should crush neither our individual pocketbooks or our economy.
In this regard, what are the key challenges that our health care system faces today? First, what must we do about the availability question? This party has been clear. We must support efforts of the provinces and others to ensure that we have greater choice in health care delivery mechanisms.
Several provinces are involved in pushing for alternative private delivery, even on a profit basis. This is a natural development. In a properly functioning system, profit is the reward that businesses obtain for making substantial, long-term capital investments. One of the problems, given the nature of a government or a non-profit model of anything, particularly as we have seen it in our health care system, is the tendency to under invest in the long term.
This is a serious problem in this system. We have continually, progressively under invested in the development of health care professionals and we have under invested in capital equipment and purchasing, particularly as this system is becoming more capital intensive. That is a key reason why it is deteriorating.
Before the Liberals jump to their normal rhetoric, let me be clear that when the provinces today, which are talking about private delivery, talk about it, they are talking about private delivery options covered through public insurance mechanisms. The federal government, the Liberal Party, has been playing games opposing this, sometimes opposing it strongly, sometimes opposing it not so strongly. It is playing games with the health of Canadians, playing games with the efforts of the provinces and others to ensure that this health care system is properly funded and properly invested in for the long term.
During the last election, for example, this was particularly bad. The government attacked the provinces, especially Alberta, and has since attacked Quebec and has made not so subtle attacks on Ontario for all the same reasons, for trying to broaden private delivery of publicly insured health services. The government has repeated and has a rich record of rhetorical excess when it comes to this area. There is no better example of this approach than what happened in Alberta prior to and during the last federal election.
The Alberta government introduced the health care protection act. This act was introduced in the Alberta Legislature March 2, 2000. I want to make it clear what this act did because we would not know it if we listened to representatives of the government. This act banned the operation of full service, private hospitals. It banned queue jumping for medically necessary services, as well as charges for those services. It set out strict patient protection rules for the sale of enhanced services, services outside the medically necessary definition provided in the Canada Health Act.
The one change in this act by the Government of Alberta was to allow alternative delivery of health services. It provided for surgical facilities, whether public, private or non-profit, to receive public funds to deliver such services to Albertans. It did not change how Albertans received health care. They still require only their provincial health care card. It simply changed the way health care was delivered. I would point out that even the World Health Organizations has stated that the ownership of a health facility should not matter, what does matter is control, sanction and regulation by public bodies.
The Alberta reforms were modest. They allowed for surgical services to be delivered outside the public monopoly system. Yet despite their modesty and the sensibility of the reforms, a mere eight days after the bill was introduced, the federal government cranked up its rhetoric about this development.
On March 10 the federal government, in the form of the former health minister, did the equivalent of a drive-by shooting by delivering a speech in Calgary. He did this without first talking to the Alberta government and without letting it know he had concerns about the bill or acknowledging what Alberta's health care protection act actually had. What he did is he gave a speech. It was not a private talk. He gave a public speech in which he implicitly suggested without any evidence that the delivery of health care outside of existing public facilities threatened the system.
He made sure that this overblown rhetoric was nationally televised. He gave the media advance notice of this address more than he gave the Alberta government. He hand picked the audience. He ensured it was filled with the fearmongers about the health care system in Alberta, the Alberta Liberal Party and also the union backed friends of medicare. Then he sped away from the drive-by shooting without so much as a phone call to his Alberta counterpart to lay out his case. He even refused to provide a copy of his remarks to the Alberta government for three days.
The rhetorical excess of this speech, the refusal to work with the provinces, the imposition of a centralized view of health care from above has not been an isolated event. I could go through example after example of this with regard to various provinces on various issues over the last three years.
Let me point out that only as recently as this September, at a federal-provincial health minister's meeting, and later when the Alberta government made some additional announcements on new facilities, the present health minister was attacking and raising fears about the development of private health facilities within the public system. The position of the government is clear. Both the current and former health ministers have opposed the idea of allowing private firms to deliver health services even when that delivery means no additional charges to Canadians.
I have spent much of my time talking about alternative service delivery within the single pair system. I do so because this is the direction most provinces are moving in. It is a direction the government opposes. It is a direction that we support.
A government monopoly is not the only way to deliver health care to Canadians. Monopolies in the public sector are just as objectionable as monopolies in the private sector. It should not matter who delivers health care, whether it is private, profit, non for profit or public, as long as Canadians have access to those services through the public insurance system regardless of their financial needs.
We are going to have to become a lot more innovative and flexible in how we deliver health care while holding fast to the principle of universal access regardless of ability to pay.
On the affordability of the current system we have the Senate Kirby committee and we expect to have the Romanow commission soon urging that we spend more money on our health care system. We believe that is necessary. We have allocated, in our own draft budget documents, money for additional health care expenditure. We believe that is important, and I will not get into all the considerations today, provided there are careful considerations and we work with the provinces to ensure that these funds are used efficiently.
The Kirby committee and we expect the Romanow commission will go much farther. They are suggesting not just that we need more money but that we need more taxes as well to pay for health care. Let me make it clear on behalf of every member of this party that this is absolutely unacceptable.
The tax burden in this country is too high. It must fall for this country to be competitive, and for Canadians, whether through private or public facilities, to be able to access health care. The government must adjust its priorities to make health care a higher one.
For example, I just cannot help mentioning the money spent on Groupaction and Groupe Everest and all these friends. Is the sponsorship program as important to this country as spending additional money on health care?
I will say again that this is a government that is out of control in its general spending. In the past three years, under the former minister of finance, the government has raised program spending by over $25 billion. Only a portion of that, contrary to mythology, has gone to health care.
I was just looking at the public accounts report for 2001-02. Last year of the over $7 billion in additional spending, less than $3 billion went to fund additional health care expenditure. The question I need to add here is this. Given the way the federal government does it, are those additional infusions of money really even very effective?
This is the final point to which I want to get. Independent of the difficulties I have with the Liberals and some of their individual decisions in the health area, we have serious reservations of whether this is a party opposite that can ever really deal effectively with the health care problem because of the nature of the party's philosophy, in particular the nature of its attitude toward the federal structure of the country and toward the provinces.
It is significant that once again we are engaged in a grandstanding debate here. Literally the government says “Let's talk about health care” but it has no position whatsoever to deliver. We have had three national studies, two that are now completed and one that is ongoing, yet no meaningful proposals from the government. In fact, after 30-some years of federal intervention in the health care area, there remain no real national standards of what constitutes even core or medical services. Instead what we have and have always had is a constant painting of the provinces, which deliver the system and must improve the system, as somehow the enemy of the health care of Canadians. Of course today what we ultimately have over this period is the federal government using the basic fiscal imbalance that we have in the structure of our federation to score political points against the provinces.
The problem is the Liberal government's philosophy. The Liberals have always wanted to centralize all powers and decision making in Ottawa. In their view, while the provinces may be an administrative necessity in such a large country, they are also a nuisance. In our book, the Liberals have never been real federalists. They are centralists.
For example, we will remember that recently, and in the last federal election, this government attacked those provinces which had undertaken a comprehensive reform of health care, Alberta and Quebec in particular, provinces which were trying to attract private investment to the health system. The Liberals contended that there was nothing fundamentally wrong with Canada's health care system. That is their philosophy.
Following the election, recognizing public concerns about rising health costs and the deterioration of health care, the Liberals established the Romanow commission, which toured the country for two years at a cost of millions of dollars for a study in an area of provincial jurisdiction. Just weeks before submitting his report, what is Mr. Romanow telling us? He is telling us that there is no problem with the health system, except perhaps for some lack of funding and confidence.
Our party, the Canadian Alliance, must tell the truth to Canadians and Quebeckers. Our health care system is experiencing serious long-term problems. We can inject more money into it. We advocate this, but money alone will not solve the problem. The federal government must recognize that the health care system is first and foremost a provincial responsibility, that it was the provinces that established the system, that run it, and that, in the end, must solve the problems that are plaguing it. It is the Liberal government, it is the Liberals, who messed things up all along, who never kept their promises for funding, who reduced health care funding to balance the budget. They are the ones who are preventing innovation and blaming the provinces for their own failures.
We saw it again recently, when the former Minister of Finance, he who made drastic cuts to provincial transfers, attacked the Action Démocratique du Québec simply because it was suggesting new policies.
Mr. Dumont's ideas are somewhat different from ours. However, his ideas must be discussed by Quebeckers in the debate that is taking place in their province. It is not up to a leadership candidate for the federal Liberal party to decide, a candidate who, more importantly, is the one who created these problems.
A number of provinces are currently trying to cope with the problem by attracting more private investment into publically insured services. The federal government must support this initiative. Ever-growing waiting lists are unacceptable. Regardless of who is providing the health care services, what matters is that Canadians and Quebeckers have access to these services, regardless of their ability to pay.
The hon. member for Yellowhead, our health care critic, and others will speak at greater length today about some of our concerns in the health care area, our reaction to some of the proposals that are on the table and where we think the country should go.
I just want to end here by summarizing what I have talked about today. What I have tried to outline is the contrast between how the Canadian Alliance approaches the health care system and how the Liberals have approached it. First and foremost, just as a general phenomenon, the Liberals engage repeatedly in grandiose rhetoric aimed at generating headlines or diverting headlines from other subjects, headlines that hide the deeper reality that they have done nothing to address the health concerns of ordinary Canadians. This contrasts with our approach in addressing health care in a way that deals with the health concerns of average Canadians, the kind of average Canadians who fund and support the Canadian Alliance.
Second, when it comes to availability, the Liberals have and continue to oppose alternative service delivery for health care by making grandiose claims that this will somehow destroy the public medicare system. This contrasts with our support for provinces that are wishing to find alternative methods of delivering health care, to shorten waiting lists, to improve service and to reduce costs, while ensuring that Canadians have access to insurance services using only their provincial health care card.
Finally, when it comes to affordability, the Liberals engage repeatedly in grandiose rhetoric about the dollars they have spent or the dollars they will spend on health care. Of course the reality is that what they really want is new taxes to deal with health care because they simply cannot control their spending in any area whatsoever.
The reality of course is that after all this spending the Liberals do across the board, health care spending at the federal level is still actually below what it was when the government took office. Instead what we have is the Liberals pursuing this in a way that hampers efforts at reform in a key area of provincial jurisdiction. This contrasts with our approach of accepting the diverse nature of the country and accepting the positive leadership that the provinces have provided historically and are trying to provide now ensuring that Canadians have strong accessible health care services provided in a timely manner.
This party wants to work cooperatively with the provinces in this manner. There is no more important concern that ordinary Canadians have than receiving health care in a timely and accessible way. That is what we will continue to do. We will continue to challenge the government to stop this shameful charade of raising health care, attacking the provinces and, as it has done today, providing no solutions whatsoever.