Debates of Oct. 28th, 2002

Health Care System

[Dennis Mills, Liberal, Toronto—Danforth, ON]

I am going to answer why we pulled the money. Especially after the Human Resources Development Canada debate we had here, the Auditor General decided that before any government funds would be transferred to organizations, and there were no exceptions, they would present a proper business plan and an indication of how the funds would be spent.

With all the affection and admiration I have for Participaction, it failed to deliver that business plan. It resisted. Those are the facts and they can be checked anywhere.

I would like to go to the member's opening comments about putting feet to the fire. I have challenged my own government on the whole issue.

Three years ago we should have spent $100 million in mobilizing Canadians around the whole area of physical activity. I think Canadians would welcome an investment of $100 million if we could save $5 billion. It would be a great thing if the opposition could help press that point. It is a heck of a lot easier to spend $100 million to save $5 billion than to throw $5 billion at something without knowing where it is going.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Speaker, I think most of us would agree with the member, to use the old expression, that an ounce of prevention is worth a pound of cure.

If we are talking money we would accept what the member is saying that prevention could save us a lot of money. I am not sure if it could save billions but let us assume that he is correct on that.

I do know that the Kirby report identified a couple of areas where we have to spend money. One of them is the catastrophic drug prices. I do believe that the member is supportive of our patent law legislation that protects pharmaceutical companies on the research side. Being a free market person himself I think he understands that and supports it. Does he support the idea that Canadians should have protection against catastrophic drug prices, in other words, that they would pay no more than 3% of their income on drugs?

[Dennis Mills, Liberal, Toronto—Danforth, ON]

Mr. Speaker, I thank the member for the question.

I support my colleague, the member for Pickering—Ajax—Uxbridge. The most profitable sector on the planet is the brand name pharmaceutical drug sector which makes more money than the banks. I for one have passionate views that there has to be a way to do that. We have to respect the drug companies' research, but we also have proof of a lot of examples where sales and marketing were lumped into research to get certain percentages.

It is an absolute shame, the drug costs for seniors in Canada. They are using their equity, their savings, to buy pills to keep themselves alive. In a country like ours, shame on us.

[R. John Efford, Liberal, Bonavista—Trinity—Conception, NL]

Mr. Speaker, I have listened intently to members on both sides of the House debating this issue today. I have been around provincial politics for about 17 years and for just a short time here in the House of Commons. I want to say at the outset I do not think there is any piece of legislation or any issue that could come before any house that is of greater importance than this issue and where we are going in the future.

I have listened to some rhetoric from the Canadian Alliance. I was a bit disappointed this morning when the Leader of the Opposition made some very derogatory comments about the Canadian health care system. I know the health care system needs a lot of improvements but I do not believe that anybody in Canada believes it ranks where the Canadian Alliance leader said it did this morning.

We live in the greatest country in the whole world. I believe that the health care system in Canada is very, very good. Does it need improvements? Absolutely. Do we have major problems in the health care system? Absolutely. However, to say that it ranks where the leader of the Canadian Alliance said it did this morning is very unfair to the people who live from one end of the country to the other and benefit from the health care system.

In talking about the national health care system, I will focus more on a regional level and my own province of Newfoundland and Labrador. Newfoundland and Labrador has a population of approximately 510,000 scattered over a vast geography. The province is actually four times larger than the country of Japan which has 125 million people. Therein lies a major problem in delivering the health care system in my province. Because the population is scattered over such a massive geography, the cost of delivering health care is much greater than in many other parts of Canada. Even though rural Canada, the northern parts and many other parts of the country have similar problems, because of our small population, the problems are escalated in Newfoundland and Labrador.

What I find a problem with and which I hope will be addressed in the decisions that will be made in the federal health care system is the delivery of funding when it is increased. If it will be delivered according to the formula used in the past, on a per capita basis, then there will be a problem for Newfoundland and Labrador. With such a small population the province will not get sufficient moneys from the federal system that it would need to deliver the health care system in Newfoundland and Labrador.

Money is not the only issue nor the only problem in the health care system. I heard comments made earlier today on accountability. Accountability is a major issue. When I ran for the leadership of the Liberal Party in Newfoundland and Labrador, I said that before I would put any more money into the health care system, I would have to know exactly where the problems were and the accountability in all of the hospitals and delivery systems throughout the province. Once it is known where the problems are, the money can be spent more wisely to address the problems rather than doing it in an ad hoc manner which has been done far too much in the past.

Money is one issue. Accountability is another issue. As was stated earlier today, prevention is a major issue. How do people living from coast to coast in Canada look at their own personal health? Should solving the problem of health care begin with money, begin in the hospitals, begin in the delivery systems, or should it begin right at home? I believe very strongly it should begin right at home. How we manage our personal day to day lives is a major problem for our health care system.

I visit hospitals in my riding occasionally. The first thing I see on the hospital steps are people smoking. Around any public building or institution anywhere we see people smoking. Areas in restaurants and public places are set aside for people to smoke.

Those people who add what is close to the greatest costs in the health care system are the people who abuse their own health in relation to smoking. If we could convince people that smoking is a major problem and get people to stop what I would call a crazy way of trying to get some satisfaction then we would save millions and billions of dollars in this country.

The other thing that we should be doing is promoting healthier eating habits. I have had occasion to visit Japan a couple of times. There are 125 million people there. When we look at the general population of Japan we seldom see an obese person, because of their eating habits. The Japanese are concerned about their own personal health, and the type of food that they consume gives them a better, healthier environment.

In fact, as far as I understand, about 85% of the food consumed in Japan comes from the ocean. There is not a healthier food we can eat. Regardless of the type of food, eating wisely and keeping good, healthy eating habits is certainly a major step in beginning not only to improve our own personal health but certainly to lessen the costs and burdens on ourselves as taxpayers and governments, whether federal or provincial.

The other thing I think we should be looking at is our drinking habits. Again, as has already been said today, an ounce of prevention is worth a pound of cure. I think if we lessened the ounces of alcohol consumed throughout this country it would be many pounds of cure that would be seen throughout our health care system.

The problems in solving health care, as I said earlier, are not just money, accountability and how the delivery system actually works. This begins right with Canadian citizens. This is what I would like to hear throughout the country: a greater role for people accepting responsibility for the problems we have in our health care system. If only we can convince, through public relations, through the appropriate programs throughout the country, the Canadian people to start thinking “This is my problem”. If only we can convince them that this is a problem that they personally can play a role in solving, without any cost to them whatsoever, probably less than the cost of the day to day and week to week spending on themselves personally, whether it be eating, drinking or smoking. We could then begin to improve the health care system in our country in which we all are now experiencing major problems.

I want to conclude by saying these words. In the Province of Newfoundland and Labrador we accept a responsibility for solving the health care system's problems. We do not say to the federal government that it is the government's problem alone. We, the people, accept responsibility and the government accepts responsibility, but we also are looking to the federal government and the federal treasury to help solve the major problems we have.

We ask, in the recognition of and in the upcoming decisions that the government will be making with the Minister of Finance and the Minister of Health, the government to look at the geography of Canada, to look at the diverse population of the regional and rural parts of Canada, particularly the Province of Newfoundland and Labrador. We ask it to take into consideration that one size does not fit all. We have to make decisions based on the great country of Canada that we live in for the benefit of all the citizens and regions of Canada, and in particular the rural regions, our Atlantic region and the Province of Newfoundland and Labrador.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, I have one quick comment and a question. I would like to clear up the hon. member's comments in his speech, because I think he referred to my leader as suggesting that he had some opinions about how our health care system was ranked. I would like to make a reference to that ranking, because that was not our leader's suggestion. It is the OECD nations that have ranked Canada eighteenth as far as MRIs, seventeenth for CT scanners, and eighth for radiology equipment. But when it comes to per capita dollar spending we are fifth. If we get rid of the United States, because it is not an example we like to look at, and factor in age in Canada, we are putting in more dollars per capita in Canada than any of the OECD nations do. These are what the facts are and they are not our facts. That is out of twenty-four.

As for the question I would like to ask, I think the member made reference to the piece of legislation that we are dealing with here. I would like to know what that is because I do not know what piece of legislation we are dealing with. In fact, I do not even know what we are debating, because the motion today states the debate was to be on health care. I am not sure. But let us have a plan to debate. I do not see a plan coming from the other side to have a good debate on, unless the hon. member has something.

[R. John Efford, Liberal, Bonavista—Trinity—Conception, NL]

Mr. Speaker, it is quite clear that the hon. member is trying to defend his leader, but what is also quite clear are the facts in his leader's statements made over the last number of days, in particular early today.

Let us get right back to the proposed legislation that we are discussing here before the House. When decisions are to be made in the House of Commons to put extra funding toward improving the health care system, I suspect that not only will the Minister of Health and the Minister of Finance have to make decisions, in the upcoming budget they are going to have to make major decisions which are going to, I suspect, call upon changes in legislation that will have to make things happen in future. We sure hope that those decisions will be made for the best interests of the health care system for all Canadians.

[Yvon Godin, NDP, Acadie—Bathurst, NB]

Mr. Speaker, I do not know if I can ask this question, but the debate started this morning with a speech made by the parliamentary secretary that lasted only five minutes.

Could my colleague tell the House how seriously the Liberals are taking the issue of health services, since the minister chose not to speak on this motion? She wants to improve health services, invest more money and try to solve the problems, but she was nowhere to be found today.

[R. John Efford, Liberal, Bonavista—Trinity—Conception, NL]

Mr. Speaker, I would support and recognize the major role that the Minister of Health is playing in the health care system of the country. I have no doubt that she is working very diligently on the things that need to be done and meeting not only with her own department but with Canadians right throughout the country, when the appropriate time is allowed, to make improvements to the health care system.

A person's absence from this hon. House does not necessarily take away from her ability to do what is necessary to improve the health care system in the country.

[Andy Mitchell, Liberal, Secretary of State (Rural Development) (Federal Economic Development Initiative for Northern Ontario)]

Mr. Speaker, I appreciate the opportunity to rise on debate today. I will be sharing my time with the member for Yukon.

I am pleased to have an opportunity to speak to this debate, which is about putting forward ideas about health care. This debate allows members of all parties on all sides of the House to give us, collectively, ideas about how we should move forward into the future. This is an opportunity for a brainstorming session, so that all members can give us their ideas about the types of approaches that the government ought to take.

In speaking to my constituents and talking to Canadians as I travel right across Canada, I have learned that they are not particularly interested in hearing a partisan debate about health care. They are not particularly interested in seeing one level of government point a finger at another level of government or one side of the House point a finger at the other side of the House. They do not want to hear that. They do not want to see that. They want us as parliamentarians, as governments, to come up with the solutions to deal with the renewal of health care in the 21st century. That is what Canadians want and that is what this debate is about. That is why I am pleased to participate in it today.

I want to follow up on comments made by my hon. colleague in terms of talking about health care from a particular perspective. It comes as no surprise that as the Secretary of State for Rural Development my perspective deals with the realities of rural Canada. If we are going to be successful at renewing our health care system, and if we are going to develop something that will work in the 21st century, we need to ensure that we take into account the realities of rural Canada. That is something I am absolutely convinced of. When we develop a health care system we have to ensure that it is not an attempt at making one shoe fit all. Rather, we have to understand that we need a flexible system which would allow for the delivery of health care in a rural context in an effective way.

That is important. Besides the reality that 30% of Canadians live in rural Canada, there are some unique and particular realities about rural Canada and health care. First, if we take a look at the demographics, and this is important in terms of health care, generally speaking there is an older population in rural Canada. That puts a demand on our health care system to a greater extent in a rural context than in an urban context.

If we look at the issue of life expectancy, there is a lower life expectancy in our rural areas than in our urban areas. The mortality rate in our rural and remote areas of Canada, particularly the infant mortality rate, is almost twice as high as it is in our urban areas. These types of health care outcomes speak dramatically and specifically to the need to design a system that is particular to rural Canada and will deal with the issues in rural Canada. Another important issue is the number of physicians available to rural Canadians. There are about half as many physicians available for a population of 1,000 in a rural context than in an urban context.

These are health care outcomes that make it absolutely essential that as we reform the health care system we do it in a way that will meet the needs of rural Canadians and rural communities.

When looking at the types of initiatives that we ought to undertake in this renewal, there are some that I would like to put forward to my parliamentary colleagues and place on the record in respect of rural areas in Canada, initiatives that I think we should consider.

First is a principle that I believe it is absolutely essential to follow, that is, access to the health care system should be based on Canadian citizenship and not on where we choose to live. In other words, all of us, whether we live in rural and remote or urban Canada, should have access to a good and totally accessible health care system.

That is a principle that I believe we need to keep in mind as we reform the health care system in the 21st century. It is something that I firmly believe in and I believe rural Canadians across this land think that is an important principle we need to follow.

Second, is the whole issue of technology. I and my colleague beside me have often spoken about the need to ensure that our rural communities have access to high speed and broadband Internet access. It is not that we want to have quicker e-mails or more computers in rural communities. It is about ensuring that we have the technology so that our rural communities can have access to health care in a new and innovative way.

The opportunity to have a diagnosis done remotely is important. It provides the kind of access that rural Canadians need. This technology, which we want to assist through a public-private partnership being rolled out in rural Canada, will help in that respect in terms of treatments as well. It goes beyond just diagnostics. We can use the new technology to treat Canadians in rural remote areas in a way that we could not have even dreamed about when medicare was first brought into force in the 1960s. As a second principle, we need to look very closely and strongly at this and move to ensure that rural communities have access to the technology that will give them an opportunity to have full access to the health care system.

Third, it is important that when we train health care professionals, be they doctors, nurses or other health care professionals, we do it in a way that makes sense for rural Canada because the issues that a physician, for instance, may face in a rural context can be very different than those of an urban context. For instance, oftentimes, if one is practising in a rural area, one is expected to undertake a number of additional tasks that one may not have to do in an urban context where there is a far greater number of specialists that may be available.

What that means is that physicians who are intending to practise in a rural area need the training in a broad range of functions that they may have to undertake. That is why it is important, when we look at reforming the health care system and look at how we train our health care professionals, that we understand and recognize there may have to be a different rural curriculum than there is, a broader curriculum or at least an additional part of the curriculum that reflects the kinds of challenges that a physician or other health care professionals may face in a rural context. It is absolutely essential we do that. That would be a third issue that I would like to see put forward as we reform the health care system.

Fourth, is the whole issue of health research. Many of the health related issues that are faced by rural Canadians are a bit different or can be somewhat different than those faced by the general population. It is absolutely essential, as our Institutes of Health Research undertake their work, that they apply what I like to refer to as a rural lens to ensure that it is undertaking that research in a way and on issues that have an impact directly on the lives and on the health of rural Canadians. As a fourth issue, we have to take a very close look, when we do health research, to ensure that we do it in a way that will address the challenges and address those issues that rural Canadians face.

My fifth point is particularly important. It has to do with the recruitment of health care professionals. Most of us who come from rural communities have faced, and our communities have faced, the challenge of attracting health care professionals to those communities, whether it is doctors, nurses or technicians. That is a key issue. We need to undertake some steps that will help to alleviate that. In many respects the provinces will need to undertake some of that activity.

Being a fellow member of Parliament from northern Ontario, Mr. Speaker, you will be familiar with this. One of the innovative things that we have been able to do through FedNor is to help with a study that is leading to the establishment of a northern Ontario medical school. What that means is that we will be able to train our health care professionals in northern Ontario. What the evidence has demonstrated to us is that where people train is where they tend to practise. This is a major step forward in terms of ensuring that we have health care professionals in a rural area, in a northern area.

In closing, let me just say I am pleased that we have the opportunity to have this debate and that all members have an opportunity to help chart the course for the reform of health care. I would very much want to ensure that we undertake those issues that affect rural Canada in a way that makes sense to rural Canadians and to the communities of rural Canada.

[Paul Crête, Bloc, Kamouraska—Rivière-Du-Loup—Témiscouata—Les Basques, QC]

Mr. Speaker, I listened with great interest to the speech made by my colleague but, as is often the case, this government manages to find a solution that is more complicated than needed to solve the problem.

I too represent a rural riding and I am very aware of the situation that exists in health care. The question that I will ask of my colleague is the one that everyone in my riding has been asking, especially over the last month or two, ever since it has been known that the government had a $9 billion surplus last year, and will have another surplus of several billions this year, while the provinces' health care needs are not being met.

Why does the government not apply a simple solution to the fiscal imbalance problem and find a way of transferring the necessary funds to the provinces to enable them to adequately manage their health care system? This is what has to be done so hospitals in the provinces can have the equipment and the staff they need.

It is not about having somewhat useless debates, as is the case today, on a problem that has been known about for a very long time. Will the government finally decide to transfer the money to the provinces so they can take their responsibilities?

[Andy Mitchell, Liberal, Parry Sound—Muskoka, ON]

Mr. Speaker, I appreciate the question of the hon. member and I know that over the years he has worked on rural development files and is very dedicated to the issues of rural Canada.

In terms of funding, as I am sure has come up in this debate already, in the year 2000 the federal government put an additional $21 billion into the health care system. We have transferred increasing dollars to the provinces for health care. It has been an important thing to do and we have worked in that respect. However reform of health care is more than just an issue of dollars, although the hon. member is right, dollars are important. It is also an issue of how we will redesign the health care system, what kinds of structures, delivery platforms and new technologies will be in place.

I do not agree with the hon. member when he suggests that the solution is easy and we should simply just stop talking about it. That is not the case. Just transferring money will not solve the problem. There are some real structural issues in reforming the health care system with which we need to deal. We need to ensure that we understand it. We particularly need to understand it in a rural context. That is why I rose in debate. That is why it is appropriate to have this discussion, and I am pleased to see members participating in this debate.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I would like to talk about a few things generic to the north and will basically build on what the Secretary of State has said. I want to emphasize the problems that we have in rural areas.

I agree with a lot of the suggestions the minister has related to in serving rural areas because some of our problems are different. One of the main problems is the recruitment of health care professionals for the north, doctors, nurses and other specialists. I have mentioned this in the House and I have worked with the Yukon Medical Association to try to come up with ideas and plans as to how we might deal with that problem.

The Yukon Medical Association believes that all the elements in the Canada Health Act are threatened with the present pressures on health care system in the north. Accessibility, comprehensiveness and universality means something different to a northern resident. If the residents in the north expect to have the same advantage as the majority of Canadians, then some changes in how we train health care professionals and deliver the services have to occur.

The fragile nature of recruitment and retention of medical and other health care professionals puts the system under growing stress. Uncertain financial sustainability, new technologies, increasing expectations of patients and greater difficulty in accessing the specialized medical care outside Yukon add to this stress.

Yukon has a population of 30,000, for which we have about 45 physicians and a number of extended role nurses for carrying on their rural needs. Over the past four years, we have had a turnover of 24 physicians, or more than 50% of our physician population. Fifty per cent of our physicians are over 50 years of age, thus our turnover will continue to be high. Many of the physicians who left were very talented and over the years developed many skills to assist them in the delivery of medical care specific to the needs of the north. We have encountered a special difficulty in replacing these skilled physicians.

The medical needs of the north are unique and the skills and training required to provide for these needs are much broader than in the south. It would indeed be difficult to bring physicians from larger communities in the south and expect them to be comfortable quickly with family or specialty practice in the north. In fact we tend to recruit from a very small pool of physicians, the same physicians who would go to northern Ontario or rural B.C. Yukon does not have the funds to compete with most provincial jurisdictions when recruiting for medical talent. As well, many larger jurisdictions develop their own recruitment initiatives that they hope will give them an edge in attracting physicians to their areas.

Physicians for very small northern communities are especially hard to recruit. Frequently, the population base does not support the number of physicians necessary to allow a high quality of professional and personal life.

Governments have been slow to recognize the measures necessary to support physicians in smaller communities. Flexible primary care delivery models that enhance a physician's ability to both care for his or her patients and himself or herself are necessary. These programs frequently have to be tailored to the individual northern communities.

New technologies include everything from new treatments and cures for cancer, treatments of the unborn baby, brain implants that cure blindness, mechanical hearts, ears, joints, cloning, et cetera.

Patient expectations are creating major pressures on our health care resources. With the increase to direct patient advertising, medical websites, designer drugs and sensationalized medical miracles, physicians and other health care providers are under increasing pressure to try to meet escalating patient demands.

Patients are much more sophisticated about their health care needs and are becoming more directive about their care. They understand to a much greater degree the differences between various medical investigations and treatment options. With this sophistication comes an expectation by many patients that they have access on demand to outside specialists and advanced technologies at the expense of the local government.

Yukon, like most other isolated areas, does not have easy access to a lot of the most basic investigations and treatments, let alone cutting edge technologies. These treatments and investigations will be very expensive, probably far more expensive than most publicly administered health programs will be able to afford, should they be available at all. Should Canadians be allowed to access them in Canada under any circumstances? Will our only chance to access them be by leaving the country? This is what northerners are asking themselves.

Yukon has a small population. This has important implications when it comes to decisions on what health care services and technology should be available in Yukon, particularly if we are concerned about having an efficient and effective health care system. Specifically it means we must consider the population base, skills and support services that are required to acquire and maintain advanced technologies and services such as CT scans, cardiac stress testing, MRI scanners, hip replacement surgery, organ donation programs, full time internists, TB laboratory services, renal dialysis, autologous blood banking, et cetera.

The list can be endless. We can fall into some expensive and inefficient programs in response to pressures from various groups with a special interest in one disease or another. On the other hand, there may be some compelling reasons to provide some of these services in Yukon and avoid the need for travel to outside centres. It is clear that Alberta and British Columbia do not make decisions about their health care system with the needs of Yukon in mind. We must develop a plan to determine which of these services should be publicly available in Yukon, which should be readily accessible referrals outside Yukon, and ensure these services will be available when they are needed.

The medical association has some ideas and options as to what we might do to improve the recruitment in the northern and rural areas. First, it suggests that we form a board of relevant stakeholders to determine the physician resource needs and develop initiatives tailored to the recruitment and retention of needed specialists and family physicians.

Second, as a government we should acknowledge that the recruitment and retention of health care professionals in the north is difficult and offer enhanced funding to allow northern jurisdictions to compete for these skilled health care professionals.

Third, we should support the funding of training for northern specialists and health care practitioners to enhance their skills in training centres to the south. A lot of this training is not in the north and it is expensive to get out to them. These skills can be brought back to the territory.

Fourth, we must recognize that some isolated communities do not have sufficient populations to support the number of physicians necessary to provide a sustainable service. The alternate funding models and tailored primary care delivery models that enhance professional and personal quality of life must be recognized as necessary.

Fifth, we must develop guidelines as to what is affordable and what can be handled and delivered in Yukon.

Sixth, a board should be established to develop a plan to determine which technologies should be publicly available and which should be readily accessible and available by referral outside Yukon.

Seventh, the government in conjunction with the local governments should develop guidelines for reasonable access to advanced technologies with a specific view on how isolated, northern and first nation communities can access them in a timely fashion.

Finally, the local government should negotiate with individual hospitals, the private sector and other provinces for assurances of access to the necessary medical facilities, technologies and specialty services outside Yukon.

Certain things will be affordable and certain things that are not as essential or urgent will have to have a lower priority. One thing that is not negotiable is the length of the waiting lists. These must be cut down when life is at risk. It is intolerable for a person to wait for either a diagnosis or required surgery. I have had people come to me in relation to knee surgery saying it has taken far too long to get on the list and similarly in cases where there has been a diagnosis of a cancer. The longer one waits the more dangerous the situation becomes.

In the north we are totally different compared to the rest of the country in that we are sort of held hostage to southern systems. We do not have the major surgical or technical equipment and we must Medivac people at great expense to Alberta or British Columbia. Of course, this upsets their system. There is no organized guaranteed time that we have in those systems. I am hoping that as we review the system and fix it we will be able to determine some sort of system, either by purchasing time or some guaranteed schedule, so that Yukoners can have access to southern hospitals and specialists and can be guaranteed that in their times of need.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Mr. Speaker, today the government has called for a take note debate on health care. We should point out that there does not seem to be a lot of taking note here. The health minister has not spoken. Some of the members who have spoken are reading canned speeches with no new ideas coming forward and just a lot of platitudes about health care. The country is owed a lot more from the government than just filling some space.

We hate to be cynical in this place and I know you are not, Mr. Speaker, but some of us do tend to be from time to time. It leads me to wonder whether this debate is not just designed to be a distraction from the nuclear fall out from the Kyoto implosion or whether the government has nothing to put on the agenda so it has just asked members to speak about health care because it knows Canadians care about it. It is difficult to say because there is so little focus from the government.

The lead-off speech by the parliamentary secretary which was about four minutes long said that we need to lead healthier lives. This is not what we would call leadership on the number one issue on the minds of Canadians.

If the government cared about health care, then we wonder why it has spent so much of its time and credibility making us all believe that spending billions and billions of dollars on an accord which will slow the production of carbon dioxide into the atmosphere by .25% is a priority.

The government's own numbers are $16.5 billion a year to fund this Kyoto project that the Prime Minister has latched on to. If we have $16.5 billion a year the Liberals might be talking about putting that into health care if they care about it so much. But no, they are talking about putting $16.5 billion into slowing the production of carbon dioxide, which is not even a pollutant, by .25%.

That is the priority of the LIberals and yet they call a debate on health care when that is the kind of mess that they have put us in.

Let us try to add a little clarity to the debate by talking about the issues that the Kirby report of the Senate brought out last week. The main recommendations from that report were set out. I have a lot of respect for the work that the Kirby committee did. It took a lot of time to do this. It brought out six different reports, starting with the background of health care and a read of the international experience in health care because all countries are dealing with the same issues as we are: aging population, dwindling resources, escalating costs for technology and drugs. This is not something that just Canada is looking at but all countries are looking at.

The Kirby committee has done a tremendous amount of work. We owe it a vote of thanks and we should be talking about its recommendations. I do not hear the Liberals talking about the Senate report but we should talk about it.

First, Canadians should know what the Kirby committee is recommending. It is talking about a home care program for patients who are discharged from hospitals. The cost would be shared 50% by the provinces and 50% by the federal government.

I point out in passing that when health care was brought in, in 1968, the federal government said it would fund half of the health care system and the provinces would pay the other half. However it reneged on that promise. The federal government now funds an average of about 14% of our health care system and dumps the rest on the provinces. However it feels free to stand off to the side and carp, complain and criticize at everything the provinces do. It beat its breast about being the guardian of the health care system and the Canada Health Act while it throws a piddling amount of money at such an important program. I am a little skeptical of new programs that the federal government is supposed to fund fifty-fifty because it does not have a good track record on that.

Mr. Speaker, I wish to inform you that I will be splitting my time.

The Kirby committee talked about a home care system for the dying so that a person with a terminal illness could die in comfort and dignity. It talked about capping the out of pocket expenditures on drugs so that it will not be ruinous for people whose drug costs run into the thousands of dollars. I have a nephew who must take a drug that costs him $200 a week. This young man is a doctoral student at McGill and does not have $200 a week. This is a real problem for him and for many other people whose drug costs are very large and who have no way of paying for them.

The Kirby committee talked about a national health care guarantee which would say to Canadians that if they cannot get the kind of treatment they need within a reasonable amount of time where they are, that the health care system would pay for them to be sent to another part of the country or to another country to receive that treatment. That is what the Kirby committee was suggesting.

It talked about a $2 billion investment for new equipment and upgrading facilities. The government likes to boast about the $1 billion it supposedly gave the provinces to invest in upgrading technology: buying MRIs, CAT scan machines and all those good things. However the federal government never did a thing to ensure that the money was actually spent on the upgraded equipment that it bragged about. We know very well that it was not spent on that, that the money went for things that did not fall into the category of medical equipment.

There is no point for the government to say it gave money if it did not ensure that Canadians actually got what they were supposed to for the money. It is not the government's money, it is money belonging to Canadians. If it was put out, cash on the table, to buy certain things, then the government has a responsibility to ensure those things were purchased. They were not in this case and if we are going to put out more money to purchase new equipment then we should ensure that those things get bought.

The Kirby commission talked about a $2 billion investment to develop a national system of electronic health records to bring us into the 21st century, to ensure that we have the kind of record keeping that keeps up with technology and allows us to be more efficient and accountable in the way the system is run.

The Kirby commission talked about $250 million annually to train more doctors, nurses and health care professionals. That is sorely needed. Some bright light a few years ago convinced the Liberal government that if it cut back on the number of doctors and nurses that were being trained then our health care costs would fall. If there were fewer doctors ordering fewer tests and doing fewer procedures, then we would not spend as much on health care. It does not take a genius to figure out that if we do not have doctors and nurses to do the job, Canadians will not be able to get the services they need and that is exactly where we are today.

The Kirby committee talked about a dedicated health care tax. We do not agree with that, nor do a lot of other groups. A dedicated revenue source such as the GST, which is not very popular, is much less stable than a general income base. Stability can best be assured through a legislated commitment to predictable and stable funding, which is exactly what the Canadian Alliance policy is. It states that a federal government would be committed to, and the provinces could be sure they would receive, x amount of dollars from the federal government each and every year on which to plan their health care delivery. Right now, who knows where the Liberals are?

They take away a big chunk, they chop health care funding and then they give a little back. The provinces do not know where they are. We do not need a dedicated tax because that only artificially links funding to expenditures. We need real accountability by having proper reporting on the system, which is what the Kirby committee recommended.

If the government really cared about health care it would not have cut the heart out of it by chopping support big time. It would not be fighting with the provinces and the people who are trying to deliver health care with very little help from the Liberal government. All the Liberal government does is complain, criticize and attack the other players in the health care system while doing almost nothing to make sure the system works. It would have some real proposals to put on the table.

However the Liberals are not even talking about the proposals that other people, like those on the Kirby committee, have put on the table. We just hear blah, blah, blah from over there. They have no plan. It is just a day spent. Why? Because the Liberal government had nothing else to talk about and it thought it would be good to talk about health care, but it is not putting anything on the table.

Canadians deserve better from the Liberal government.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, I listened very closely to my colleague's comments on health care. I am relatively new to the House in the sense that I have only been here since the last election and do not exactly understand all of the integral details of how things work around here. However it seems to me that when a government asks for a take note debate, an emergency debate or a debate on an issue there should be some sort of a plan put before the House so we can intelligently debate it.

What we have today is a debate on health care. We have had 10 years of absolute neglect by the government on health care and yet we were asked to come here and debate but I have heard nothing of any substance at all from the other side.

Why would the government be doing this at this stage and why today? Is there something I am missing? I would like her comments on that.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Mr. Speaker, as my colleague points out, not only does the government have nothing to put before the House to take notice of but--and I know I am not supposed to do this, Mr. Speaker--the health minister has been nowhere in the House for this debate.

[The Deputy Speaker]

Order, please. I would invite the hon. member to take her seat. I must remind the House that it is quite well known, particularly now that everyone is well experienced, some more so than others obviously, that it is never acceptable to refer to the absence of a member in the House at any time.

I will give the hon. member a few moments to wrap up her intervention and then we will move on in the debate.

[Diane Ablonczy, Canadian Alliance, Calgary Nose Hill, AB]

Mr. Speaker, I apologize. I would simply point out that if we are going to have a meaningful discussion about the top issue on Canadian's minds, it is important that we are really engaged in it with, as my colleague said, some meaty proposals on the table and some real solutions to a situation that is obviously of concern to everyone. Even though the Senate has done yeomen's work over about two years to put some very strong proposals on the table, which I have laid out in my speech, they are not even being talked about on the other side.

If we are going to have a meaningful debate, if we are going to get serious about fixing and reinvigorating the most important social program in our country, then I would say that it is up to the government, which called this debate, to have something of substance to put forward for the consideration of Canadians and of the House. I say shame on the government for simply throwing the subject open without taking any leadership at all on this important subject.

[Carol Skelton, Canadian Alliance, Saskatoon—Rosetown—Biggar, SK]

Mr. Speaker, I am pleased to rise today to address the House during this supposed take note debate on the future of our health care system.

A recent Environics poll indicated that 80% of Canadians wanted significant reforms to our health care system. A debate of the surrounding issues is quite timely if there was a debate. If the system is going to change, Canadians want to be part of it.

The Canadian Alliance recently conducted its own health care review. We made clear our values on health care. Our policy declares our commitment to ensure that timely, quality and sustainable health care is available to every Canadian regardless of financial means. We will achieve this by placing the interests of the patients first. This is what we expect the government to do and what Canadians expect the government to do.

Unfortunately, the government was disappointingly quiet and unspecific in the recent throne speech when it came to health care issues. While Liberals may try to blame their lack of vision on something else like waiting for the Romanow report, the health care system gets worse every day.

More than anything, our health care system needs to know that there is substantial and sustainable funding from the federal government. We have seen the government shirk its funding responsibilities and then dangle funding carrots in front of the premiers like they are the ones who are solving the problem. Let us put an end to these charades and admit the federal government needs to carry its share of the burden.

While the Prime Minister is focusing on a spending legacy, the irony is that it will be this and the former finance minister's funding reductions in health, education and the military that will undoubtedly be their legacy. When it comes to the military, we believe that the existing funding has been exhausted. However, when it comes to health care, we believe there are still plenty of opportunities for reprioritization and reallocation of funding within the existing budgets before considering massive funding increases.

Only after all these options have been explored should we consider raising the tax burden of Canadians. Nonetheless, the health care system must be patient driven, not system driven. We have a responsibility to determine what Canadians want in their health care system and then find a responsible means to deliver it. It will be Canadians who determine what, if anything, is not covered. It will be Canadians, not politicians, who determine what should be funded.

Our job in the House and within government departments is to come up with a cost effective, sustainable plan to meet those demands. We all use the health care system from time to time. Some of us are lucky and do not require it often, if at all. Others like myself may have had one or two crises in their lives. Still, it is those who must rely on the system daily who need to be heard. They do not enjoy the benefit of good health. Health care is a necessity. This demand on our health care system and the growing dependence on medicare is guaranteed to increase. In fact, some conditions, like diabetes and heart disease, are expected to reach epidemic proportions as more and more Canadians take less and less responsibility for their own personal health.

On October 19 the Globe and Mail reported that Canada had more fat children than adults and that one-quarter of children aged two and three were clinically obese, meaning that one-third of their body weight was composed of fat. The article went on to say because children tended to become overweight and obese, it was widely predicted that rates of diabetes and cardiovascular disease would soar. These problems and lifestyle choices will have to be considered and accounted for in the future of our health care system.

What will be the areas of increased demand and how are we preparing to meet them? Unfortunately, the Romanow commission and the Kirby report are more about ideas than about a plan so far.

While they have suggested some methods for achieving their goals, they both do not have concrete plans with exact costs, responsibilities and targets. This is something that has been missing in the past and I am afraid we may be following the same path again. I look forward to being proven wrong in this regard but I do not think I will be.

I have identified what I think the others should do but I would like to conclude with some comments on what the Canadian Alliance would do and what we would like to see.

Before I outline our plan I want to stress that we would ensure that a timely, quality and sustainable health care system is available to every Canadian regardless of financial means. Our health care system would be patient driven, not system driven. We would give Canadians the health care system that Canadians want. It is their choice.

We would modernize the Canada Health Act in light of the new technologies, priorities and techniques to ensure timeliness, quality and sustainability. We would end the roller-coaster cycle of funding for which the government has become famous. We would work with the provinces to ensure adequate, stable and transparent funding. This is essential in long term planning and preparations for future demands on the health care system.

While working to ensure that Canadians have equal and fair service no matter where they live, we are also committed to ensuring that the provinces have maximum flexibility to deal with innovations and unique service demands. The goals may be the same but the provinces require the flexibility to develop their own strategies to get there.

There is an ongoing debate of the role of the private sector in the public system. We cannot tie the hands of those tasked to deliver health care. We are confident, if given the freedoms to incorporate private involvement, the provinces under direction from their electorate will do so with proper safeguards in place. Let us not tie the hands of those we need to be creative and innovative in conquering the challenges of the system today and in the future.

Finally, we need to have a complete review of the system, its services, its funding, its goals and its sustainability at local levels and, more important, at the first ministers level. All need to be involved from the highest political offices on down to the neighbourhood doctors who are charged with the job of delivering services to their communities.

The motion today calls for the government to take note of the concerns of Canadians. I strongly urge the government to do so and to listen to Canadians. Give them the health care system they want and do so in such a way that it will be there tomorrow and into the future. Let us end the cycle of the unsustainable, underfunded, unresponsive health care that we have today. Let us learn from our mistakes and do better in the future.

[John Harvard, Liberal, Charleswood—St. James—Assiniboia, MB]

Mr. Speaker, I appreciate the opportunity to take part in this take note debate. I congratulate the government for scheduling it at this time. It is not only important to the health care system, but it is important to the country itself. Our health care system is one of the pillars of Canada. As the health care system goes, so does the country.

Over the next few minutes I would like to share some thoughts which I think reflect the thoughts, attitudes, and views of my constituents in Charleswood--St. James--Assiniboia. I also want to share some of my own thoughts and opinions on this very important matter. If I know my constituents quite well, I think many of my views will coincide quite remarkably with their views. I earnestly hope that I represent adequately and objectively the views of my constituents.

My constituents are not unlike all Canadians and it goes without saying that they have concerns about the health care system as we know it. The health care system that we know goes back to the 1960s. There is no doubt that over the last three plus decades our health care system has begun to show some wear and tear and it faces new challenges. There are more older Canadians than ever before. Canadians are living longer. Medical technologies are more comprehensive and more in number than ever before and they are also extremely expensive.

Our health care system faces enormous challenges. Some of the challenges did not exist 30 years ago, but they do now and they raise serious questions. That is naturally one of the reasons that the Kirby Senate committee has been studying the issue for the last three years. That is why Roy Romanow has been studying the issue for the last year or so. These are very important works that are underway. We heard from Senator Kirby last week and we expect to hear from Mr. Romanow in November.

This debate today is extremely timely. The health minister has indicated there will be a health ministers conference on this issue in the month of January.

My constituents certainly are concerned. Even though they are concerned, I think I can say without any equivocation and without any doubt in my mind at all, that they overwhelmingly support our health care system. They want a health care system that is publicly controlled. They want a health care system that is publicly owned. They want a health care system that is publicly administered. In other words, my constituents want a health care system that is much like the one we have now. Yes, it needs improvements but they want something like they have now. They certainly support the five principles of the Canada Health Act.

My constituents do not want to go back to the old days. There are many of us who remember what health care was like before the medicare system came to us in the 1960s. We do not want that kind of system.

Thirty-five or 40 years ago, there were many Canadian families who denied themselves necessary medical treatment because they simply could not afford it. We do not want that kind of a situation. We want a system that provides the needed care when the situation arises. That is very important.

It is interesting to note that polls indicate that those who have experienced the health care system, who have received service from it, are much more supportive of it than those who have never used it or who have used it extremely infrequently. That tells us something right there. I think those who have had this experience are in a better position to judge it. Others who have not perhaps are relying on perception. Sometimes perception, while it can be reality, is still very faulty.

Canadians, and certainly my constituents, cherish access to our health care system. That is their number one priority, besides naturally getting the kind of service and treatment they need. They consider it a right of citizenship. It is a right of citizenship. When they are sick, they do not want to be judged by their bank accounts; they want to be judged by their needs.

We all have to realize that at some time or another, whether we are young, middle aged or getting older, we all will need health care. Canadians want what might be called an egalitarian system. Certainly they want a level playing field. With all playing fields, there are good parts and perhaps some bad parts. We Canadians have decided that we want the level playing field, the good parts even with some of the bad parts. We will take the good parts with the bad parts.

My constituents certainly do not want anything to do with what is called queue jumping. They think it is inherently unfair. They do not believe that their fellow citizens should be able to reach into their pockets, certainly if they have deep pockets, to jump to the front of the line for service. With medicare having been around for as long as it has been, they feel that is fundamentally unfair and they do not want that.

It goes without saying that when it comes to health care, we all have to be involved, the rich and the poor. We have to be careful not to give any kind of support or comfort to those who would want to hive off a system of their own, a system for the rich. That would hurt our health care system. If that were allowed to happen, sooner or later it would lead to the political erosion of the system. To use the analogy of a motor vehicle, I want all of us riding in the same vehicle and if we can all ride in the front seat, so much the better. It is extremely important that we maintain that kind of a medicare system.

Those are some of the feelings and views held very passionately by my constituents in Charleswood—St. James—Assiniboia. I certainly feel that the status quo is not an option. That there are these new challenges of Canadians living longer, more older Canadians than ever before, and expensive medical technologies, would suggest that the status quo is not an option.

That is one of the many reasons for the Kirby report in the Senate. That certainly is why the government headed by the Prime Minister decided to appoint Mr. Romanow to head a commission. I have no doubt that Mr. Romanow has done thorough work and that he will have a strong report that will generate a lot of debate. That is all well and good, but I think we can also expect from Mr. Romanow a fairly strong blueprint, a plan which, if enacted, or at least much of it, will lead to a better health care system for all Canadians.

As I said, the status quo is not an option. One of the things that concerns me is that we do not have enough information about what is going on inside the health care system. I am depending on Mr. Romanow to help us in that regard. As we seek solutions and improvements to the health care system, one thing we have to insist on is better outcomes. We have been somewhat complacent in that regard. To a great extent we have not been demanding enough. We must insist on better outcomes, better performance of the health care system.

For example, when it comes to a lack of information, I do not think we really know how the money is being spent in the provinces. As we know the federal government has a block fund. We provide block funding under the CHST to the provinces. We do not ask any questions. The money simply goes to the provinces.

I do not want to show any disrespect to the provinces. I am quite sure that in the main they try to spend the money responsibly, but the fact of the matter is we really do not know where that money is going. We should know where absolutely every nickel goes. We should not be satisfied with anything less than knowing where all that money goes.

I think it was a mistake on the part of the federal government several years ago to come up with block funding. I want the federal government to be a full participant in health care funding, but we should send health care money to the provinces and insist that they spend every nickel on health care and that none of it be bled away into some other areas of provincial budgets.

When it comes to outcomes, do we really know who is doing a good job, who is doing a mediocre job and who is doing a lousy job? I doubt it. I am sure that there is a range of knowledge and expertise in that area, but does the public really know who are the good doctors, who are the mediocre doctors and who perhaps should be given the pink slip? I am not here to cast aspersions on any doctor, but it goes without saying that it is humanly impossible for all doctors to be top performers. Some will be top performers. Some will be something less than top performers. We should know who is and who is not. We do not have that kind of information and we should have.

There has been a lot of bickering and political fighting going on between the provinces and the federal government over the past many years about health care. Maybe some of it is necessary, but I get the sense when I talk to my constituents that they are getting sick and tired of it. They want it to stop. They want us to fix the system wherever the fix is required. They are turned off by the bickering, the shouting and the screaming. They expect something better from us. There is enough blame to go around.

I am sure that we at this end, at the federal level, have made some mistakes but I think the provinces have too. I get the feeling from my vantage point in Ottawa that the provinces think it is in their political interests to band together and to attack us. It may work in some regard, but I think that overall it is hurting them. It certainly hurts us in Ottawa, but I think most of all it hurts the country's health care system and that we cannot afford. As politicians, we simply have to do a better job.

On the question of privatization, this is my opinion and I think it is the opinion of most of my constituents, that is, when it comes to core services there can be absolutely no privatization, none, zero. Would my constituents tolerate some privatization with respect to some supply and services on the periphery of the system? Yes. But when it comes to core services, I do not think for a moment that my constituents want anything to do with privatization. All we have to do is look at the situation in the United States. If privatization were as good as some people suggest, then we would just have to model our system after that of the United States. I do not think we would want to do that.

Let me say just a couple of things about the American system. This is not designed as American bashing, but the fact of the matter is that the American system is hugely costly. It is very costly. The Americans are spending almost 15% of their GDP on health care services. We in Canada spend a little under 10%. There is another thing, and I do not know why it is not mentioned more often. I know that here in Canada, and rightfully so, people get concerned about either a lack of beds or the long waiting lists. What about the Americans who have no health care at all, none? I have seen estimates that between 40 million and 50 million Americans have no health care at all. We do not want that kind of system. We do not want any risk whatsoever of our system being changed so that we would find ourselves drifting in that direction, none at all.

Let me say in closing that I welcome the Kirby report from the Senate, with Senator Kirby and his co-workers suggesting that another $5 billion be pumped into the system. I am not too sure whether that is necessary. I certainly respect his recommendation. I, for one, though, want to feel absolutely sure that this kind of extra expenditure is necessary. I am not going to give Mr. Kirby just a blank cheque in that regard.

The other thing is that I want this debate to continue. I think it is very important for all Canadians, because as the leader of the New Democratic Party said earlier today, let us keep the dream alive. This is the social program in Canada and we have to do absolutely everything in our power to maintain it and keep it performing at an extremely high level.

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

Mr. Speaker, when I listen to the hon. members, especially from the government side, talk about health care, it seems that everybody is waiting for a report to come in so they can do something. We are talking about Romanow. We have just seen the report from the Senate. It might be very interesting to compare both, I suggest to the hon. member, to see which is the better one, especially if we factor in the cost of both reports. However, once we get both of them, what is government going to wait for then? Because it is not moving on dealing with the major health care problems in our country.

One of the major problems is the discrepancy in how we fund health care. Most of the funding, as the hon. member well knows, that goes to the provinces goes through the Canada health and social transfer payments on a per capita basis. I have said before here, and the more people that understand it the better chance we have of clarifying this discrepancy, that this works exceptionally well for provinces with populations that are expanding or increasing. It works in the reverse for provinces with populations that are declining. Unfortunately, or maybe fortunately, we only have one, and that is Newfoundland and Labrador. Instead of getting more money as health care costs increase, we get fewer dollars because the population is dropping. The people who leave the province are the young and healthy. The people who remain are the older people who require more health care costs. Consequently, we get fewer dollars and we have greater costs and a geography that is comparable to none in the country over which we have to deliver health care.

How does the member suggest that a province like Newfoundland can receive equal treatment from the federal agencies in relation to funding that would be able to provide the same level of service in such a province, and I know there are others of varying degrees, compared to just a blanket formula that rewards some and punishes others?

[John Harvard, Liberal, Charleswood—St. James—Assiniboia, MB]

Mr. Speaker, I appreciate the comments made by the hon. member from Newfoundland. I know that he is concerned about his constituents and his great province. I would like to address both his observations.

First, he started by suggesting that we as a government are not moving. I would suggest that we are moving, and I think we are moving rather expeditiously. Let me just put it this way. I think that a lot of the opposition members around here forget that we did provide, just less than 24 months ago, something more than $21 billion toward the health care system. I would consider that action.

We have the Romanow commission. The government has decided that it will not do this without a good strong study, without getting input from all Canadians. That is what Mr. Romanow has done and we will get that report in the month of November. As the health minister has already indicated, there will be a health ministers conference in January. Are we moving fast enough? Maybe not for the hon. member, maybe not for some other opposition critics, but I think we are moving as quickly as we can.

He wondered about equal treatment for smaller provinces, and Newfoundland and Labrador is certainly one, as least when it comes to population. Let me just point out one thing, because I have a set of figures in front of me. When it comes to the federal share of provincial health spending by province, the Province of Newfoundland and Labrador ranks number two. The federal government shares 62% of all the health care spending in the Province of Newfoundland and Labrador. Only Prince Edward Island exceeds that, at 68%. My own province, the Province of Manitoba, is down at 46%.

Of course the other thing when it comes to a Province like Newfoundland and Labrador, and the hon. member perhaps just forgot, is that we do have something called equalization payments. That is what equalization payments are all about: to address the financial abilities from one province to another. That is why Ontario does not get it. That is why Alberta does not get it . That is why, up until I guess recently, British Columbia did not get it. So we do have something to address the issue that the hon. member has just spoken about.

[Suzanne Tremblay, Bloc, Rimouski-Neigette-Et-La Mitis, QC]

Mr. Speaker, I listened very carefully to the remarks made by my colleague. I know that accessibility is one of the fundamental principles.

He told us that all his constituents are against total privatization. I hear a lot of people, a lot of politicians, say that they are against a two-tier health care system. In Canada, we already have a three-tier or four-tier health care system in some places, and a single-tier, the lowest tier, system in other places. It is quite simple. Let us not be hypocritical. Let us just look at accessibility. Even in Rimouski, all health care services are not accessible.

What is the government of my colleague willing to do to respect the five principles for the benefit of the people of this country? It is fine to say that one is in favour of comprehensiveness, universality, portability and public administration, but what about accessibility? Personally, I live in Rimouski but I have to go to Quebec City to be treated for heart problems. The cardiologist told me that if it takes more than three hours to get to the hospital after a heart attack, the patient will die.

How many Canadian men and women risk their lives because health care is not accessible?

Personally, I would like to see an end to the empty rhetoric and more emphasis on reality.

[John Harvard, Liberal, Charleswood—St. James—Assiniboia, MB]

Mr. Speaker, I think the hon. member has touched on a very important matter and some of what she says I think is true. There is no doubt that in a country of this size and of this population there are inequities with respect to health care. There is an uneven distribution of health services.

If one lives in downtown Toronto, one perhaps may be just down the road from Sunnybrook Hospital. If one lives in my riding, there is a great hospital called Grace General Hospital. In fact, from my home I could drive to the Grace Hospital in perhaps two minutes. Do I have greater accessibility to nearby service than someone who lives way up in northern Manitoba at Norway House or Pukatawagan? Of course. Can the system be improved in that regard? Yes, and I am hoping that someone like Roy Romanow can address that very issue.

Will the playing field be level for all 31 million Canadians, whether they live in Rimouski, in Sept-Iles, in Olds, Alberta, in Kamloops, British Columbia, or in Wawanesa, Manitoba? I do not think so. Can we do a better job than we are doing now? I hope so, and I hope someone like Roy Romanow will provide some of the answers.

[The Deputy Speaker]

With two minutes remaining I would ask the cooperation of the hon. member for Calgary Southeast to divide that time with his colleague across the way in his response.

[Jason Kenney, Canadian Alliance, Calgary Southeast, AB]

Mr. Speaker, I have just a couple of points. This member repeated the hackneyed Liberal rhetoric about health care being the unique value which distinguishes Canada. Is the member not aware that virtually every single democratic developed nation in the world, with the exception of the United States, has a universal, comprehensive health care system?

Why is it that he and his colleagues constantly make reference to the straw man, the bogeyman, of the United States, when I do not know of a single person in public debate in Canada who proposes that as a model for this country? Why does he not make reference to the public universal health care systems with varying degrees of private options and different ways of delivering and financing services in capitalist countries like Sweden, Norway, Finland, France, Germany, Italy, Australia and New Zealand? As opposed to attacking a fake straw man, would he not be willing to actually look at countries that provide universal comprehensive insurance through different ways than we do as possible models for reform?