Debates of Oct. 30th, 2002

Health Care System

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I know the member would like to speak more on this because he has worked on this project for so long. I want to let him know that I wholeheartedly support that. When he started his speech I was meeting with the generic representatives. I have three questions for the hon. member; two easy and one hard.

First, does the hon. member think there have been examples of abuse of the patent rule, pushing it beyond 20 years?

Second, with the U.S. now coming into line with the rest of the world to stop this abuse, will that make it easier for us to get this through Canada?

The hard question is this. If we are the only country in the world that allows this abuse of extending patents, the brand companies might say that it is a great environment for investment and they can protect their patent a lot longer. Therefore we would have a lot more investment in Canada.

[Dan McTeague, Liberal, Pickering—Ajax—Uxbridge, ON]

Mr. Speaker, those are excellent questions and I know the member for Yukon has shared these views very passionately.

The example is that the United States, which of course is home to many of the national brand name manufacturers for which Canada is home to none except for the warehouses and our generic industry, has already demonstrated that this abuse must stop. Senator McCain and Senator Schumer led the charge in the United States. In Canada our industry committee tried to do the same. Unfortunately there seems to be a deliberate attempt not to try to tackle the real issues.

I know the hon. member finds this interesting. There are some in this House who may want to suggest that generic drugs are more expensive in Canada than anywhere else in the world. They are 400% less in Canada than they are in the United States after we take into account the difference in the dollar valuation. That is as a result of what happened 20 to 30 years ago when we brought in the ability for compulsory licensing.

It is very clear that Canada remains the only nation in the world, after this floor order goes into place, that has automatic injunctions which costs everybody. We have to stop be the world's international thumb-sucking dolts on this one.

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

Mr. Speaker, I rise today to speak to the motion, which reads as follows:

That this House take note of the on-going public discussion of the future of the Canadian health care system.

We are dealing with an unfortunate situation. After several weeks of debate following the Speech from the Throne, the federal government, lacking leadership, has proposed a debate that is meaningless, because we are beyond the stage of government action.

The mere fact that we are talking about the on-going public discussion of the health care system, claiming that there is a Canadian health care system, reflects a problem with existing jurisdictions, with provincial and federal responsibilities.

It is important that we be aware that there is an urgent need to take action in health care, a need to ensure that there will be funds available and that services will be delivered as efficiently as possible.

However, we were hoping that this government would move beyond this situation, would take into consideration the various reports that it has received and that it would take a stand. If it would prefer to wait for the Romanow report, it should do so. But imposing this type of debate, at this time, demonstrates a lack of leadership on the part of the government.

However, since we are being given this opportunity, we will indicate which are the important elements we should be considering.

Senator Kirby, the chair of a Senate committee, tabled a report. He proposed health care funding solutions, including a new tax, or an increase in the GST, to fund the health care system. We find this unacceptable.

Currently, Quebec and the other provinces agree unanimously that there is a fiscal imbalance between the provincial governments and the federal government. The solution to this fiscal imbalance is not to tax people more heavily.

The federal government must stick to its own jurisdiction and free up the available money in order to ensure adequate health care services in every province, in every region and in every municipality.

At the end of the day, whether it be where I come from in La Pocatière, or in Rivière-du-Loup, or in Abitibi, or anywhere in Quebec or Canada, this is the situation right now.

A part of the problem stems from chronic underfunding of health care, given new variables that we are experiencing, such as the aging of the population.

The federal government does not need to hold more take note debates on the matter. It needs to take action to ensure that, indeed, more funding is provided to the provinces so as to produce more positive results.

In 2000-01 for example, federal transfers accounted for only 16% of revenues in Quebec, as compared to 28% in 1983-84.

This drop in the funding provided through federal transfers forces the provinces to make choices. At present, discussions are taking place within Quebec, where the political parties will be putting forward various options. The fundamental problem is that we must make choices based on funding that is insufficient, because the federal government, as tax collector, collects more money than it really needs. It then uses the excess for other things, when this money should go to the provinces, to be put toward health for instance.

So, while health costs skyrocketed and its revenues increased, the federal government reduced transfers to the provinces, causing the fiscal imbalance we are experiencing , which affects the health care sector.This imbalance is jeopardizing social and economic programs in Quebec.

At this rate, all decisions would be made in Ottawa. Clearly, this is part of a strategy which, with the Romanow report and the Kirby report, will force us increasingly to accept federal interference. This is an increasingly common approach because of the money available. It imposes restrictions on what the provinces can do, when the expertise and know-how in heath is in the provinces. It already exists. What the provinces need more than anything else is to get the funding that would allow them to do proper work in that area.

Coming back to the report of the Kirby committee, this committee concluded that there were only two ways to ensure funding for the health care system and to make it viable. The first one is to increase the GST by 1.5%, from 7% to 8.5%, and the second, to have taxpayers pay, through the tax system, a national health care premium, the amount of which would depend on each person's taxable income.

In my opinion, both solutions need to be rejected. What is needed instead is the courage to find out how much is needed, and to accept the fact that transfer payments will be made to the provinces in greatest need of funds. Moreover, the hon. member for Joliette, who is the Bloc Quebecois finance critic, has made it clear that the Kirby report recommended an increase in federal funding for health care. This may be praiseworthy in itself, because it is in line with what Quebec and the provinces have been calling for, but the means to that end are irresponsible.

We all know that more money is needed for health, that the federal government has that money in its coffers, and that it needs to agree to give it to the provinces. The choices around this may be painful ones. It is true that the debt needs to be paid down. There needs to be a specific plan for reducing the debt. At the same time, when responsibilities within Canada are not assumed, society's needs are not being properly served, and the needs as far as health is concerned are great.

On the other hand, the Romanow commission report seems to be in favour of the imposition of uniform standards and objectives. In this regard, the Romanow commission is announcing that there will be a single Canadian vision, when the constitution says that health is a provincial responsibility. By means of this Canada-wide commission, the federal government will succeed in imposing standards for all of Canada and attempt to develop expertise in an area in which it has none at present.

One of the reasons for doing this is that, internationally, the federal government needs to answer for the health programs in place in Canada. Lacking expertise as it does, rather than allow the provinces to participate in the international fora and to accompany it when international agreements relating to health policies are being discussed, it is trying to acquire expertise and make itself the sole interlocutor on the international level. This is an approach that has no future and one that ought not to be pursued.

Again, as regards the report of the Romanow commission, we are waiting to see its vision for the future. However, it is rather clear that the report will recommend the establishment of a broad primary care system that would be available 24 hours a day, seven days a week.

This recommendation is already included in the Clair report. What is the Clair commission? As strange as it may seem, we currently have a federal commission, the Romanow commission. However, in Quebec, we had the Clair commission. That commission did somewhat similar work, dealt with all sorts of issues relating to health, and made recommendations. The Romanow commission is clear evidence of unjustified duplication, with the result that a lot of money was once again spent ineffectively.

The federal government should accept the fundamental principle of the existence of a fiscal imbalance in health. This is a historical reality. Indeed, the debate on the issue of transfer payments and the provinces' responsibility regarding health is not new, far from it.

We were told that as early as the end of World War II, the first seeds of disagreement regarding this issue were more than obvious.

In 1942, Ottawa invoked the war effort to impose tax agreements on the provinces. Since then, the federal government has never really withdrawn from these areas. We had the act that includes the five principles regarding health: universality, accessibility, comprehensiveness, portability and public administration of the system. These principles are now in jeopardy, because of the pressures on our health system. However, one of the main reasons why these five principles are in jeopardy can be summarized by the following question: Do we have the necessary money to meet these objectives? The answer is no, because of the fiscal imbalance that exists all across Canada and which really hurts the whole system.

It has also been obvious that the federal contribution is melting away, like snow on a sunny day. For some years now, since the early 1980s in fact, federal transfer payments have accounted for a smaller and smaller share of the Government of Quebec's revenues. In 2000-01, we are told that this share represented only 16% of Quebec's revenues, whereas it represented over 28% in 1983-84. This federal share of health expenditures, or rather this decrease, has as the obvious result that we are experiencing what amounts to a withdrawal. For example, the percentage of Quebec's health spending covered by federal contributions is expected to drop from 22% in 1993-94 to under 13% in 2005-06, or close to 9 percentage points in just over a decade.

The federal government needs to reverse its direction totally and make substantial investments in this sector.

The federal government will, of course, deny that it is contributing so little, by using the argument of tax points. It considers the tax room it transferred to the provinces in 1967 to be an integral part of its contribution to provincial social programs.

The tax points transferred to the provinces do not, however, constitute a form of federal assistance, nor any kind of manifestation of its spending power. They are, in actual fact, a tax rebalancing mechanism that has always been part of the federation, and have absolutely nothing to do with the Canada social transfer. The reason the federal government transferred tax points to the provinces in the 1960s was to restore to the provinces part of the tax room they had handed over to the federal level in the early 1940s to finance the war effort. This argument does not stand up to scrutiny, therefore, regardless of how it is defended by the federal government.

In the past, there was much talk along the lines of “The Government of Quebec is a government of sovereignists, and that is why it is so critical of the federal government. It is asking for far too much”.

With regard to health care, that argument falls short, because every province in Canada is upset about the federal government pulling out of health care funding. In August 2001, at a meeting in Victoria, the premiers reached a consensus and agreed that Ottawa should provide adequate funding for health care. They came to an agreement on the following measures: first, that the federal contribution to health care increase from 14% to its 1994 level of 18%; second, that the $10 billion ceiling on equalization payments be removed.

The premiers showed their good will. They met twice in 2002 to develop an action plan to improve the management of their own health care systems.The House should remember that the provinces were often criticized and told that federal funding was not the only problem and that they had to make their health care systems more effective and efficient. Efforts have been made in this regard. In fact, provinces have done and are doing their homework so that the problem can eventually be resolved.

However, federal funding is crucial if we are to get rid of the current fiscal imbalance.

One of the reasons for the current fiscal imbalance is that the provinces cannot shirk their social obligations in order to reduce their spending. Provincial jurisdictions affect quasi-daily activities, whether it be welfare, health, or transportation. Budget cuts can hardly be made in these areas, which require a lot of money.

The federal government has other kinds of responsibilities that could be reduced without necessarily affecting its effectiveness.

It is mainly its visibility that would be affected. Since the federal government has a lot of money, it often has a tendency to spend money in areas under provincial jurisdiction because it makes it more visible. That is what the federal government is looking for, but it does not necessarily have a positive impact on what the public wants.

One of the main problems is that, if people try to assess the accountability of each level of government in the area of health care, they will have a hard time figuring it all out.

This situation has to be clarified so that the responsibility of those who have the money is also the responsibility of those who provide the services. This way, the public would be able to assess whether or not their province is doing a good job.

This would also make it possible to know clearly if the money has indeed been transferred by the federal government and to ensure that there is no duplication, in the sense that the central government makes ad hoc interventions in the area of health care and then creates obligations for the provinces at the same time as it has been reducing its contribution for several years.

In fact, one might wonder how the federal government can justify such blackmail when it provides only 13% of health care funding and the equivalent of 8 p. 100 of education funding.

All of these conditions demonstrate that the situation has evolved within the Canadian federation, but the way the federal government is acting has not. It continues to collect as much money as possible through taxes and employment insurance premiums.

As we saw again this morning, the Auditor General criticized the federal government's actions when it comes to employment insurance as bordering on illegal, by misappropriating contributions from employers and workers and by creating a program that is very harsh for the unemployed.

Last year, $4 billion of the $8 billion surplus was collected through this program. If the government were being fair in terms of its fiscal activities, and if it really needed another $4 billion to pay down the debt or for other expenses, it should have had the courage to collect it through taxes, or in some other way.

But taking the money from the employment insurance fund, where people make contributions to ensure coverage in the case of job loss, using this money for any other purpose is unacceptable. This situation was condemned by the Auditor General, by the program's chief actuary and more importantly, by those who fund 100% of the program, the employers and the workers who are unemployed and who, unfortunately, find themselves in a rough spot.

This situation needs to be rectified. The Bloc Quebecois has regularly brought this up, we have led an offensive with questions on employment insurance and the fiscal imbalance. We believe that we have made a positive contribution to the current system, until Quebec becomes a sovereign country.

We are making a very constructive contribution by stating clearly how these funds collected by the federal government should be used. This money should be limited to its jurisdiction, to allow the provinces to set things right as best as they can.

So, we have a debate on health care. We have moved beyond this stage, and we would hope that the government will take real measures, as soon as possible.

In February, there is to be a federal budget as well as a meeting with the premiers. We hope that this will produce something positive and constructive to ensure that the provinces have the money they need to fund their health care services adequately, for all those who use them and who deserve a system that is relevant, adequate and effective. This is the challenge we are faced with.

[Peter Adams, Liberal, Peterborough, ON]

Mr. Speaker, I was disappointed that my colleague felt that there was duplication by the provinces and others in considering health care, developing proposals and plans, prior to the Romanow commission publishing its results.

It seems to me that in a confederation that is an appropriate way to go. First, we seek opinion across the country in the different jurisdictions. We seek opinion from those involved, for example, nurses, patient groups and people of this type. Then at that point, the federal government comes in, as it is doing, with the Romanow commission. It is my hope that the Romanow commission will make good use of what all of the provinces and these other groups have done.

I am surprised to hear him dismiss the tax points as a part of the federal government's contribution. That is the most decentralizing thing that we do. Having given up these tax points to the provincial jurisdiction we no longer have control over them and the provinces get the proceeds.

To proceed to say that the federal government is only putting in, and he has the figures for Quebec, nationwide 14%, when in fact we are paying 40% of the health care costs in Canada, is to underestimate the situation. Tax points count as do equalization payments, which benefit the province of Quebec, and so does the direct spending of the federal government on research and things of that type.

I know the member has a strong provincial view and that he passionately supports the people who live in Quebec. I believe however that the federal government should have a stronger not weaker say in health care.

Does he not at least think that when residents of the province of Quebec travel across Canada, or when they move to work in another province somewhere else in Canada, they should get exactly the same care that they get at home? The federal government is the only government that can guarantee that portability of the health care system, which the citizens of the province of Quebec have at the present time.

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

Mr. Speaker, as regards tax points, considering the current approach of the federal government, it is obvious that a federalist may think this is the proper way to do things.

However, let us not forget that tax points are neither a form of federal assistance to the provinces, nor an expression of its spending power. Tax points are a historical fiscal rebalancing tool. The purpose of the transfers of tax points made to the provinces in the sixties was to give back to the provinces some of the taxation power they had given to the federal government in the early forties to fund the war effort.

So, it is a mistake to try to compare tax points as if they were a federal expenditure. They are not found in the Public Accounts of Canada. If they were a federal expenditure, tax points would be included in the section on the transfers to the provinces. That is not the case. This is not a comparison that should be made.

As to why we are upset by federal interference, the best example is the work done by the Clair commission and by the Romanow commission. The Clair commission examined the whole issue of health. If the federal government had understood that its responsibility is to see if it can help by making funds available and by dealing with the fiscal imbalance issue, it would have realized that this is its true role.

By creating a commission that duplicates all the work done by the provinces in this area, the federal government is doing something useless. Indeed, this is a task that could have been much better defined, with very specific objectives, instead of giving such a broad mandate, as if we lived in a unitary state. We do not live in a unitary state. We live in a country where there are provinces that have responsibilities, that have expertise, that have examined the issue and expressed their views, and that are now waiting for the federal government to act.

With respect to mobility, we have the federal government's model that is supposed to ensure mobility between provinces. We have the Council of Ministers of Education. Rules are set by the provincial ministers. This is not a matter of funding; it has to do with how the system operates. The federal government has always tied the funding of the system to standards. That is what the provinces are opposed to, because the reality varies greatly from one province to the next. They have specific needs and different ways of doing things.

Let us take an example slightly outside the area of health. Quebec has put in place a family policy, 5$ day care, so that workers can benefit from lost cost day care. Had we waited for a Canada-wide federal system, we would still be waiting, because this is the kind of need that is not felt the same way in every province. This is probably all for the better. Perhaps $5 day care would be relevant in Ontario, but less so in another province.

There is a need for appropriate solutions in each area. Never in the past did the federal government show any special skill in the area of health. We only need to look at how it operates the only hospitals under its jurisdiction. To look at the kind of health care it has provided to aboriginal people throughout Canada. To look at the cuts the veterans' hospital has been stuck with. It then becomes clear that, in spite of what was said in all the debates and because of our ongoing concern for our fellow citizens, the competence and expertise is in the provinces.

The federal government should face the fact and realize that its role is in distributing funding. It must recognize that there is currently a serious fiscal imbalance. This is especially true when the federal government rakes in $8 billion in surplus and the provinces collectively complain about its contribution being insufficient. Somehow, the federal government should realize this.

[Jean-Yves Roy, Bloc, Matapédia—Matane, QC]

Mr. Speaker, first, I would like to thank the hon. member for Kamouraska—Rivière-du-Loup—Témiscouata—Les Basques for his excellent speech.

We both come from regions. I remind members opposite, including the hon. member for Peterborough, that what the federal government collects in taxes does not belong to it. It belongs to the people of Canada and Quebec.

When the Quebec National Assembly unanimously asks the federal government to reinvest in the health system and the federal government says no, I do not think that it is using the taxes paid by Canadians and Quebeckers properly.

As I was saying, I come from a region and I would like to ask my colleague a question. I am personally aware of the impact of the underfunding of health and social services in a region like mine.

The hon. member for Kamouraska—Rivière-du-Loup—Témiscouata—Les Basques and I both come from the same region. I wonder if he could give us his view of the impact of the underfunding of health services in a region like mine.

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

Mr. Speaker, I thank the hon. member for Matapédia—Matane for his very pertinent question.

A few years ago, when the federal government began to back out of funding, we drew up a sort of balance sheet of what the impact on our communities was. If the federal government does not give money to the provinces, the provinces cannot give money to the municipalities, unless they make budget choices that have a negative impact on other areas of activity.

We came to realize that, ultimately, this situation led to the closure of nursing homes, to hospital bed shortages, and to less home care. These are services our people want, services they want to see delivered. As well, society has to meet the special costs involved in providing services to people in the more isolated areas.

The entire territory needs to be serviced. Each region of Quebec has its regional health administrations and these try to perform miracles with the money available to them, in order to deliver proper services.

We have become aware, however, that the lower federal contribution in recent years has ended up drastically reducing the funds available to the provinces, and in the end everyone has had to try to accomplish miracles. The very direct consequences of this have been that our small rural communities are losing residents, as people move to larger centres where they have access to services. I think that this is not a good thing for our communities in the medium and long term. Something needs to be done.

I would like to make it clear that Quebec is convinced that there is a fiscal imbalance. The three parties in the Quebec National Assembly, that is the Parti Quebecois, which forms the government, the Liberal Party of Quebec, which forms the official opposition, and the Action démocratique du Québec, are unanimous on this.

There are also 29 stakeholders from civil society who have taken collective action. According to them, there is only one defendable position in Quebec, which is that we are short of funds. The federal government, a government with a surplus, is the one that has control of those funds, and it is absolutely imperative that it distribute them to the provinces, to do away with the fiscal imbalance, which has such a negative impact on our health system.

[Bob Speller, Liberal, Haldimand—Norfolk—Brant, ON]

Mr. Speaker, I will be splitting my time.

I rise today to participate in the debate on the future of the health care system in Canada. I rise today as the member of Parliament for the riding of Haldimand--Norfolk--Brant in southwestern Ontario, a rural riding that may reflect different realities than other ridings throughout this country. We have a very large agricultural base. In fact I represent about 70% of the tobacco farmers in this country and their lifestyles reflect also a lot of the health realities in my riding. I represent a riding that has the largest first nations reserve in the country, the people of Six Nations. Again it is a different microcosm of lifestyles and health problems that face that community.

I speak knowing that a lot of the services we receive in rural Canada, and even in parts of southwestern Ontario that I would say are not remote, are not at the same level of service as is reflected in some of the urban centres across the country. The rural caucus of the Liberal Party made sure that Mr. Romanow in his deliberations was aware of some of the unique circumstances that we face in rural Canada.

Today I want to talk about the commitment of the government to health care. The Speech from the Throne made it very clear that the renewal of our health care system is a key priority for the government. The throne speech said that no issue touches Canadians more deeply than health care. Our health care system is a practical expression of the values that define our country. If I talked to Canadians, particularly people throughout my riding of Haldimand--Norfolk--Brant, and I asked them what their key concern was, I would say it would be health care and the future of health care in this country.

The commitment of the government is to ensure that there is a comprehensive system of health care that remains publicly administered and in particular, universally accessible. As most of my colleagues know, just last week the Senate Standing Committee on Social Affairs, Science and Technology tabled its report “The Health of Canadians--the Federal Role”, the Kirby report. I encourage all Canadians to look at that report. The committee consulted with Canadians, as has Mr. Romanow. The committee has made specific recommendations that I think should be part of the debate on health care and the future of health care in this country.

In late November, which is just a few weeks away, the Romanow commission will table its report on the future of Canada's health care system. Members of Parliament are anxious, as are the rest of Canadians, to get to the task of setting health care right for the future. The recommendations in both the Romanow and Kirby reports will assist our government in our efforts to do this. The Prime Minister will then sit down with the premiers of the provinces once again, as he did a few years ago, and try to work with them in terms of setting up a future role for health care in Canada.

The Speech from the Throne refers to the 2000 first ministers meeting when an agreement was reached on health care that reinforced our collective commitment to the principles of medicare, to work collaboratively to reform our system and to measure the report of our progress.

Health care renewal is by no means the single area of focus of the Government of Canada. Another issue to which we committed in the Speech from the Throne was healthy living. I do not have to tell members of the House that increased levels of physical activity, healthy eating and other preventive measures would translate to a better quality of life for all Canadians, indeed probably a better quality of life for most members of Parliament, including myself.

The burden of chronic disease on Canadian society is enormous. Currently two-thirds of all deaths in Canada result from four groups of chronic diseases: cardiovascular, cancer, diabetes and respiratory diseases. In consideration of this the federal, provincial and territorial ministers of health agreed in their September 2002 meeting to work together on short, medium and long term pan-Canadian healthy living strategies and to emphasize nutrition, physical activity and healthy weights.

One key to effective, affordable and responsive health care is for governments, the health care community and individual Canadians to concentrate on the promotion, maintenance, improvement and particularly the prevention of illness. While many health promotion and disease prevention efforts have been successfully underway in many jurisdictions for some time, a more concerted pan-Canadian and integrated approach to healthy living is necessary to make substantive changes in the health outcomes of Canadians.

The aims of the healthy living strategy are to promote good health, to reduce the risk factors associated with diabetes, cancer, respiratory and cardiovascular diseases, and the burden and the costs that they put on our health care system.

The Government of Canada will be working with provincial and territorial colleagues to develop short, medium and long term pan-Canadian healthy living strategies that will address these issues. Together with the provinces and territories, we will hold a healthy living summit to bring together health and other sectors of government, non-government organizations, health specialists, first nations and Inuit, business and other stakeholders to the table. It is key, to get these changes, that we need to involve all Canadians because all Canadians have a stake in a healthy Canada.

A series of initial consultations with these stakeholders will precede the summit. The summit will provide an opportunity to set out specific strategies to support healthy living in various settings, one being healthy communities, including rural, remote and northern areas.

As I said, we in rural Canada need to feel we are involved in this process. I know Mr. Romanow was very attentive to the remarks that the rural caucus put forward to him. I think the premiers, the ministers and the public servants working in this area need to recognize more fully that rural Canada needs to have a larger say in these sorts of issues.

In June 2003 ministers of health will be presented with a proposed collaborative strategy for healthy living. It will include an overall vision for action; short, medium and long term objectives; key components, interventions and deliverables; and indicators for measuring progress in the short, medium and long term.

Over the long term the strategy will address a range of health care issues while initially focusing on building on health care promotion and disease prevention efforts which have been successfully underway in jurisdictions for some time.

The government is dedicated to collaborative solutions to ensure that the health of Canadians is maintained and that opportunities to improve health care are available to all Canadians no matter where they live.

[Wendy Lill, NDP, Dartmouth, NS]

Mr. Speaker, I want to thank the member for his comments on health care and his constant references to consultation, the summits on healthy living and so on.

I would like him to comment on what I think are some of the fundamentals for healthy living and for an injection of real health back into our health care system.

In order to give health back to our health care system and restore federal support for health care back to the 25% of the public health care spending in the short term, we need to move it back to the original fifty-fifty federal-provincial split at its inception. Does the member agree?

I am also interested in knowing whether the member is considering the issue of extending universal health coverage to Canadians in need of home care and in need of extended pharmacare. So many people in our ridings are talking about the fact that home care, pharmacare and care for seniors in their declining years is woefully underfunded.

Perhaps the member could talk about the need for more money and the need to actually add into the Canada Health Act some new pillars, which would be such areas as home care and pharmacare, and how that fits into the member's healthy living assumptions.

[Bob Speller, Liberal, Haldimand—Norfolk—Brant, ON]

Mr. Speaker, I want to assure the hon. member, with regard to home care and pharmacare, that I support her view that there should be a role for the federal government. I have been promoting that idea for a number of years.

As she said, it is a collaborative effort. It is an effort where the provinces, federal government and municipalities need to take an important role. With that collaborative effort comes certain responsibilities. It is not for me to say who would best do what. That would be done through negotiation and dialogue with the different levels of government so that each level of government can use its expertise. I support her idea that we must do more in that area.

In terms of restoring federal spending, that seems to be a debate put forward by the premiers in ads on TV saying they are only spending so much. There are different views on what is real spending from different levels of government.

The Prime Minister has said that our levels of spending are back up to what they were. It was in the neighbourhood of 40% to 44%. When the provinces decided that they wanted the system changed to tax points because it would benefit them, the federal government agreed. When the provinces received all the money, they have now come back and said they are not getting as much money.

We changed the system to benefit the provinces. It is not a question of who spends what. Canadians want to ensure they have affordable and accessible health care. All Canadians, no matter where they are from, no matter what their spending power, no matter what their income, should have accessible health care available to them. I am sure through efforts such as healthy living we will be able to do that.

Message from the Senate

[The Deputy Speaker]

I have the honour to inform the House that a message has been received from the Senate informing this House that the Senate has passed certain bills, to which the concurrence of this House is desired.

The House resumed consideration of the motion.

Health Care System

[The Deputy Speaker]

I am aware that the government still has a 10 minute slot available, but the hon. member for Dartmouth has been waiting rather patiently. If members would allow me to give the floor to the member for Dartmouth, then debate would subsequently continue with representation from the official opposition. Does the House agree?

[Some hon. members]

Agreed.

[Wendy Lill, NDP, Dartmouth, NS]

Mr. Speaker, I am happy to be part of this take note debate on the future of the health care system. I know we are here tonight--

[Jay Hill, Canadian Alliance, Prince George—Peace River, BC]

Mr. Speaker, I rise on a point of order. I apologize to the hon. member for interrupting her, but I am a bit confused. Are the Liberals saying that they do not have another speaker and therefore they are allowing the NDP speaker--

[The Deputy Speaker]

No, I do not want to leave anyone with the impression that there are no speakers. There are speakers. This is an accommodation that I have been given the opportunity to put forward. I understood that, but if not, I will go back to the government side.

[Jay Hill, Canadian Alliance, Prince George—Peace River, BC]

Mr. Speaker, when will they get their extra slot?

[The Deputy Speaker]

In fairness, we have given the floor to the hon. member for Dartmouth. I will let her conclude her remarks and subsequently debate will continue in its normal sequence, continuing with members from the official opposition.

[Wendy Lill, NDP, Dartmouth, NS]

Mr. Speaker, last week we all saw the introduction of the Kirby report on medicare reform. I would say that the Kirby report was a classic case of medical malpractice. It had the wrong diagnosis, in my mind and in the minds of New Democrats, for what ails our health care system today.

Like other opponents of our health care system the Kirby report wrongly claimed that government could no longer afford medicare. It conveniently overlooked the fact that nationally we spent a smaller percentage of our GDP on health in 2001 than we spent in 1992, 1993 and 1994. Is less than 10¢ on every dollar of our collective wealth too much to spend on health care? Most Canadians would say no.

The Kirby report astoundingly, after much supposed consultation, flies in the face of what Canadians want in their health care system. The Kirby report begins with the premise that health care is a commodity to be bought and sold, and that medicare should be subjected to market based reforms. The majority of Canadians have made it clear that they do not agree with this recipe. Instead they view the medicare system as a public good that should be protected from the market.

The Kirby report advocated the further privatization of our public medicare. The report claimed that it did not matter who owned the health care institutions or services. Public studies have shown that private for profit health care is more expensive, inequitable and unaccountable than any public system.

The Kirby report ignored the threat international trade deals pose to our public medicare. The report approved private for profit ownership of care but ignored the far reaching and adverse implications of this under the North American Free Trade Agreement and other trade deals.

The report did not recommend adding home care and pharmacare or long term care to the Canada Health Act. These are issues we have just been discussing across the floor. These are critical issues for an aging Canadian population.

The report recommended a limited approach to expanding medicare to include home care, but did not address the root causes of soaring drug costs and excessive patent drug protection. The report made no specific recommendations for increased public spending of long term care and ignored the need for national programs and standards in these three crucial policy areas. The Kirby report had no cures for our system and simply kicked out further the foundations of our proud, effective and efficient health care system.

The question is, what is it that has brought our system to the state that it now finds itself in? New Democrats and Canadians believe that the Liberal government's policy of underfunding health care has created the breeding ground that enables opponents of medicare such as Ralph Klein and Senator Kirby to exploit public concern. New Democrats will be fighting for full restoration of federal funding for health care, as well as a renewed plan that includes expanded universal health care beyond hospital walls to take in home care and prescription drugs.

Tommy Douglas first established medicare in Saskatchewan over 40 years ago. Twenty years later he saw his vision of a national health care system destroyed by the practice of double billing. In a speech in 1982 he rallied support for federal action by declaring that he for one would not sit idly by and see that happen. The Canada Health Act results from his efforts. Tommy Douglas did not sit idly by and neither will we.

Privatization, long waiting lists for surgery, crowded emergency rooms, woefully inadequate home care and long term care, shortages of family doctors, nurses and other professionals, that is the Prime Minister's legacy thus far for our health care system.

The Romanow report due in November is expected to provide a blueprint for a renewed federal role in health care. New Democrats believe that this renewed role must be a significant increase in federal funding to the provinces, an enforcement of the Canada Health Act to stop the proliferation of private clinics and hospitals, and the introduction of the long promised national pharmacare and home care programs. New Democrats will be fighting for these measures, and will oppose any “rob Peter to pay Paul” proposal for funding the federal increase in health care transfers.

We have seen trial balloons about increasing the GST or further cutting employment insurance to pay for increases in health care funding. Such moves would be unfair and unacceptable. If the Liberals need more revenue for health and social programs, they should look first at the ill-advised tax cuts contained in the former finance minister's 2000 budget. Those tax cuts benefited the banks, big business and the wealthy.

People often ask: How would the New Democrats fund the health care system, and where would they create the wealth that is required to put this system back in the shape that is required? I would like to put forward some concrete ways that we would suggest to put the needed resources into health care.

Next month, Mr. Romanow will complete his report on health care and recommendations for reform will cost money. We all know that. The government has refused to rule out a tax hike. We are against the idea of a tax hike or increasing the GST. We believe in a progressive, sustainable tax system and, moreover, we believe that health care funding should come out of general revenues.

I do not like the idea of dedicated taxes, like those being floated, which would corrupt the flexibility of the federal government. A dedicated tax is a last resort idea which should be adopted only when all else fails. The goal is to ensure that the burden of health care costs would be fairly and progressively shared by restoring the progressivity and the sustainability of our income tax system. Here are some suggestions as to how we could do that, how we could raise the revenue necessary to fund our health care system.

On the revenue side, we would start by closing some important tax loopholes, such as tax expenditures which target certain individuals and industries, and which are not in the public interests. We could close or narrow the scope of some of these tax expenditures to generate additional revenues for the federal government.

For example, there is the capital gains tax. In 2000 the former finance minister announced two consecutive reductions in the capital gains inclusion rate, the first from 75% to 66% and the second from 66% to 50%. The Liberals underestimated the cost of those tax expenditures, almost a million dollars for 2001 alone. If we were to restore the capital gains inclusion rate to 75%, then we would retrieve an average $1.2 billion a year in additional revenue to put back into our health care system.

A second suggestion that would help at this point to get more money into the system would be to restore the progressivity of our income tax system. Over time, the number of income tax brackets and the associated marginal tax rates have fluctuated wildly. In the 1960s the marginal tax rates for top income earners was as high as 60% for incomes over $400,000. However, in 1972 dramatic changes were made in the Income Tax Act, including a reduction to the top rate to 47%, and later to 43%. In 1987 there were 10 marginal tax rates, ranging from 6% on the first $1,320 of income to 34% on taxable income exceeding $63,000.

In conclusion, we believe that by adding another tax rate and by working on capital gains loopholes we would be able to begin to address the inadequacies in the funding in regard to the Canada Health Act.

[Pat Martin, NDP, Winnipeg Centre, MB]

Madam Speaker, I am pleased to have an opportunity to ask some questions of the member for Dartmouth and ask for more specifics about the many ideas she put forward. I believe I understand the gist of most of her comments to mean that it is probably not necessary to look at any new taxation in order to find the revenue we need to backfill the terrible underfunding that has gone in our important social programs such as health care. We need only look at the tax cuts announced recently by the Prime Minister.

I would like her to comment on the fact that in the United States George Bush announced trillions of dollars worth of tax cuts and then 9/11 happened. The country found itself in an emergency situation. Many of those tax cuts, I am sorry, were cancelled. He simply said “We are in an emergency situation. We cannot show this kind of largesse. We have to reverse some of those tax cuts because we have other urgent needs.”

Would she not agree that the health care emergency that exists in this country today would warrant a similar reversal of some of those tax cuts?

[Wendy Lill, NDP, Dartmouth, NS]

Madam Speaker, I thank my colleague for his comments. I agree completely that a national emergency is upon us now in the same way that we have faced national emergencies at other times.

At present our population is struggling under a critical health care shortage. There are ways in which we can address that shortage on a universal basis, which is the bedrock of this system. The most obvious way to do that is to look at our tax system as it now stands. There is a higher capital gains inclusion rate that we could be looking at. We could be looking at a new tax bracket for people who are at the high income rate. These are issues that have been adjusted downward to benefit the very wealthy in this country. What we have seen instead has been a colossal disregard for the health care of the people who are at the lower income spectrum in our country.

Absolutely, we can look at the tax system. The NDP believes that we need a fairer tax system. We do not believe that at the present time the tax system is working in a way that benefits our health care system or the majority of Canadians.

[Pat Martin, NDP, Winnipeg Centre, MB]

Madam Speaker, I thank the hon. member for Dartmouth for her thoughtful response to my comment. I would also like to ask the member if she would entertain the idea of one possible source of revenue if we are looking at harvesting dollars from within the existing tax system instead of raising or increasing taxes. There is one tax situation whereby businesses are allowed to write off fines and penalties as legitimate, tax deductible business expenses. I find this outrageous and I am wondering whether she does as well.

The second thing I would like her to comment on is that a lot of people did not notice that in the $100 billion of tax cuts announced, for over the next five years, one of those tax cuts was reducing the corporate tax from 17% to 16%. I believe it amounts to $750 million per year that the corporate sector would not have to pay in taxes.

If we were looking for revenue, would she agree that these might be two places where we could begin?

[Wendy Lill, NDP, Dartmouth, NS]

Madam Speaker, I am very passionate about this issue, because as we all know in this House, and people in our party have been fighting this for over a year now, right now in our country there are enormous obstacles facing persons with disabilities, around tax issues, around the disability tax credit. The federal government has decided to take aim at the most vulnerable Canadians with cuts to the disability tax credit when in fact it has allowed for tax deductible business expenses to people who are being fined for misdemeanours, and it has allowed for a huge tax cut for corporations. We absolutely have to see fairness in our tax system and stop targeting the people who are the most vulnerable, the persons with disabilities.

[James Lunney, Canadian Alliance, Nanaimo—Alberni, BC]

Madam Speaker, I am pleased to rise today on behalf of my constituents of Nanaimo--Alberni and my party to enter into this take note debate on health care. It has been an interesting afternoon. With the discussions that began a couple of evenings ago in the take note debate, a lot of ideas about health care have been put forward.

What is it going to take to restore timely quality care to Canadians? There has been a lot of discussion about the Kirby report that was just released. Is that going to provide solutions for us? Senator Kirby and his committee from the Senate are recommending a cash infusion of about $5 billion. In order to fund that, will there be an increase in income tax or in the GST or will it be both? On the government side there is a lot of breath-holding while waiting for Mr. Romanow's report, which is expected to come down next month. It seems likely that Mr. Romanow will be making similar proposals.

It sounds like a pattern we have heard before. Coming into the last election in 2000, there was the health ministers social contract, which was signed with an infusion of dollars to solve the health problems, and yet here we are two years later and more money has not solved the problem. The question that might be asked is, how much money will it take to solve the problem?

There has been a lot of talk about the rising cost of drugs and making sure that there is access to the drugs that people need, especially seniors on fixed incomes and Canadians who are required to take drugs.

I will review what has happened with health care costs in British Columbia. In 1990 when I moved to British Columbia with my wife, about 30% of all provincial government expenditures were on health care. By 2000, during the election, it was 40%. Now, just two years later, we are at 42%.

I know that B.C. health minister Colin Hansen is very concerned about those rising costs. In fact even though the government has put a $1.1 billion increase into the provincial budget for health care in British Columbia, there is still a widespread perception that it has actually cut health care funding because there are hospitals closing and services being withheld. The costs are rising so dramatically.

Perhaps we need to look at how many dollars are going to be sufficient and whether any amount of dollars would be sufficient if we keep going the way we are going.

Madam Speaker, I was remiss in not saying earlier that I will be splitting my time with the member from Surrey.

In our health care spending perhaps we need to look at how we are spending, and perhaps we are not going the right way. I practised for a lot of years as a health professional myself and sometimes I had to use an analogy with my patients. Because we lived on Vancouver Island I would say to patients that if they wanted to drive to Victoria and sincerely believed they were heading that way but noticed communities like Comox and Courtenay as they passed them, perhaps going faster or spending more money would not get them where they wanted to go. They were simply going in the wrong direction.

Perhaps that analogy applies in the health care debate to a certain extent. Perhaps we are missing the mark. Part of the discussion about health care that we need to have is being held to a certain extent, but I do not think it is near enough to the forefront, and that is the discussion about effectiveness and cost effectiveness. That is what I would like to talk a little about.

One of the situations to which I referred during the election involved a person whom I have known for years who ended up with chest pain. He arrived at a hospital on Vancouver Island. His pain was gone in a day but they kept him in hospital for ten days. He would rather have been at home. That was nine days that he did not need to be there. It was nearly $1,000 a day for a hospital bed that he did not need and someone else could have been using. What kind of efficiency is this? It was $9,000 worth of taxpayer dollars spent in the name of health care and it had nothing to do with health care. The only obscure connection is the fact that if they let him go home they knew it would take six weeks before he could get an angiogram in Victoria.

An angiogram was necessary to determine which type of cardiac surgery he would need, whether it would be angioplasty, cardiac surgery, stent surgery or bypass surgery. At that time in British Columbia there was a logjam of 600 people waiting for this procedure and wondering whether they would live or die waiting for an angiogram. Yet if the patient had had the money in his pocket, some $2,000 to $4,000, he might have gone down the street to a very well qualified and I think a very bright doctor in our community who is one of 1,500 doctors in North America who do an alternate form of therapy called chelation therapy. I thought we might talk about that for just a moment. What is chelation therapy? Maybe we should consider alternatives for Canadians.

According to Health Canada, cardiovascular diseases were the most expensive disease category in 1995, accounting for $7.3 billion or 17% of the total direct costs of illness. This is rather serious, as everyone knows, as does anyone who has experienced a heart attack or heart disease. I am sure there are many members in the House who have had surgery. My colleague right beside me can certainly testify to this.

I have here an article about chelation from The Globe and Mail of Tuesday, August 27. It states that patients of intravenous therapy swear that it gives them energy to burn. Now a new study will try to figure out if it works. I am sure this is anecdotal, but the article mentions one gentleman who lives in Burlington, Ontario, Mr. Lathe, who swears that chelation therapy has given him renewed zest. He walks with a spring in his stride, for up to seven and a half kilometres a day. He also testifies that he has had other improvements in his health. He is less forgetful. He said he has had an improvement in his “beep-beep”, something he said is a boon to a man of his age. He is over 80 years of age. In fact it was not a popular drug with a popular advertisement showing a man bouncing like a bunny and singing “good morning” that did it for him; it was an intravenous procedure that restored his function and he was pretty happy about it.

Early this month in the United States the National Institutes of Health announced a $30 million study led by the Center for Complementary and Alternative Medicine and the Heart, Lung and Blood Institute to try to determine the effectiveness of chelation and/or high dose vitamin therapy for people with coronary artery disease. This is a five year trial with almost 2,400 subjects who will be receiving either chelation therapy or a placebo.

In Canada chelation therapy is largely unregulated, but I know from my own community that there are many people who have experienced chelation therapy and swear by it. I have seen people who were at risk of having amputations who have had their limbs spared because this intravenous chelation, which is designed to take heavy metals out of the body, in fact coincidentally seems to strip cholesterol out of the arteries and improves function that way.

There is a person in North Vancouver who has written a book called Addiction by Prescription: One Woman's Triumph and Fight for Change . We talk about the high cost of drugs, but perhaps drugs are not the only answer or in fact the best answer for all conditions. Joan Gadsby has written a book about benzodiazapines. Sadly, up to 30% of our seniors may be taking a drug, a tranquilizer or a sleeping pill that they do not really need.

Going beyond that, a Canadian company has come up with a very creative strategy for mental illness. It has found a very simple mineral supplement that reduces the need for psychiatric medications for patients who are bipolar. An article about it was published in the Journal of Clinical Psychiatry in December 2001. Why is it that Health Canada now has put the brakes on this study that got many patients off their prescription drugs and taking a nutritional supplement that would lead to them becoming low needs patients? This is something we want to see investigated further.

A startling article and new studies coming out are linking SV40, a monkey virus, to being a contaminant in our oral polio vaccine. There are recent studies linking many forms of cancer to a virus that contaminated polio vaccines: mesothelioma, osteosarcomas, retinoblastomas and, I know, non-Hodgkins lymphoma. About 6,000 cases a year are being diagnosed, an increase startling in Canada, but cancer viruses, it appears, can lie dormant in the body for decades before they are activated when the immune system is depressed.

Another article on the same subject states that nine million Canadians were vaccinated between 1955 and 1961. Whether they were infected is a scary thought but if it did come from the polio vaccine, perhaps we ought to look into it.

There are other studies that have just come out. I refer to Maclean's magazine in which it talks about autism and the mercury derivatives that may be causing great problems.

Perhaps we need to rethink some of what we are doing. We need to come up with creative strategies and look at all the alternatives as to how we can reduce costs by effective interventions. Then we would have the money to direct to our concerns for seniors, to palliative and home care and compassionate care for all Canadians.