Debates of Dec. 5th, 2002

Supply

[Mario Laframboise, Bloc, Argenteuil—Papineau—Mirabel, QC]

Mr. Speaker, it is a pleasure for me to rise today on the motion put forward by my hon. colleague. Sometimes, politics has its reasons, which have nothing to do with logic. I will attempt to show the Liberal Party of Canada's lack of logic, something that has been one of its characteristics since its early days.

People go into politics for a reason. Before coming to this House, I was in municipal politics for 18 years prior to 2000. In November 2000, I had the privilege of being elected by my constituents to represent them. Those listening, as well as my colleagues, former colleagues, mayors and councillors have, over the past decade, since the early 1990s, experienced the domino effect of the federal cuts, which led to the fiscal imbalance.

This is what fiscal imbalance is all about. In fact, the federal government dropped its funding in certain areas. The imbalance in health is an example. I do not want to repeat what my hon. colleagues have said in this House. However, it should be noted that, in the early 1990s, the federal government was oaying 22% of health care costs. When the system was created in the early 1960s, the federal government was paying 50% of health care costs. It was a cost-shared program. It was split fifty-fifty. At the time, the provinces and the federal government were not quarrelling. It was simple. The federal government transferred funds and the provinces provided the services.

Things got complicated because, since the early 1990s, the federal government, which should not have gotten involved in health care, of all things, started announcing to the provinces from one year to the next, “Next year, I am going to cut transfer payments, because I have accumulated a deficit”. And it was not just the Conservatives who racked up the deficits. The Liberals did their part in creating deficits in Canada. I will not reopen the debate on this issue.

Nevertheless, the federal government decided that, in an attempt to counteract this, it would slash health care transfer payments. This of course had a domino effect on all stakeholders in the Quebec community, as well as in the provinces. Repercussions were felt all across Canada. Provinces offloaded responsibilities onto municipalities and school boards. This just added to the burden. Let us not kid ourselves, there is only one person paying for all this. There is only one taxpayer.

Obviously, taxpayers are the ones footing the bill. That is what happened back in 1992, and I can understand that today the Quebec Liberal Party, the Parti Quebecois and the Action Démocratique are unanimous in telling the feds “Listen now, we are short of money for health. When this whole health care system was created, you were involved. Back in the 1960s, you were paying 50%. Then by the early 1990s, it was 22%. Basically, what the Romanow report recommends is to get back to having the federal government invest more or less what it did in the early 1990s.

In the meantime, municipalities within the provinces were the ones getting it in the neck, along with the school boards. In 1992, we had the Ryan report, which landed the municipalities with $200 million in bills. My former colleagues, municipal councillors and mayors, will remember those days. Then there was the Trudel reform, started by the Parti Quebecois, which dumped $360 million in bills onto the municipalities.

The purpose of all this was to be able to keep a health care system in the provinces that was still more or less adequate. So this was what brought about all the imbalance. Ottawa cut its transfers to the provinces for health, and health budgets went up. Now there is unanimity in Quebec for the first time in history. Minister Legault clearly acknowledges that there is a shortfall in health funding. All the health critics accept this, saying, “For once, a Quebec minister is acknowledging that he is short $1.8 billion for health”. On top of that, every year, 5.2% needs to be added to the health budget, a budget that totals some $16 billion to $17 billion.

That comes out to $800 million a year that needs to be added in order to maintain an adequate health care system in Quebec.

So I can understand why all of the members of the National Assembly in Quebec, all of the parties together, are saying to the federal government, “Listen, we do not need you to tell us how to spend money on health care. The Government of Quebec has been the one providing services in Quebec since the health care system was created”.

Meanwhile, the federal government, which should have been providing adequate support, cut back. It went from 22% to 14%. It is being asked to return to 22%, and now it wants to set all kinds of conditions, because it has decided to put money back into health. Something is not quite right.

The federal government had no power before and the Province of Quebec is prepared to recognize the powers that it negotiated over the years. All that is missing is the money. The health care system has been studied at least three times in the last ten years, with all of the stakeholders, commission after commission, including the Clair commission; and all that is being asked for is additional funding.

Anyone who has anything to do with the health care system, including sick people, men and women who are in hospitals and who are waiting for this money to help solve their problems, people in emergency rooms and everyone listening today, is obviously conscious of the fact that all that is lacking in the system is money.

The Romanow commission has said that the federal government must provide money, but that there needs to be conditions. This is what always upsets me in this House, especially coming from the Liberal Party.

First of all, the Liberals never have problems, never. Know why? Because if they say there is a problem, then they have to solve it. That is the problem. Right now there is a problem and my colleagues are absolutely right. There is a problem because all the provincial premiers have come together and are now advertising in every province, or at least in Quebec, and I know that Ontario is too. They are advertising so that people will get the message, “Look, the federal government is paying 14 cents out of every dollar”. Therefore, the federal government is paying 14% and the provinces are paying 86%.

The federal Liberal members are not in this House to defend the interests of the public; they are here to make the public understand the interests of their government. There is a difference.

For instance, there is no problem granting sponsorships and giving money to their friends or establishing a gun control system that exceeds the estimated cost by $1 billion. It is no big deal.

However, currently in the House, we are talking about human lives, men and women who expect that the federal government is going to restore the funding for all health care networks, regardless of the province.

I can understand all the members of the National Assembly of Quebec standing together, setting party politics aside and saying to the federal government, “You have to give the money unconditionally, because the sick want unconditional money and they want unconditional services”. That is all we are asking.

This is still asking too much from the federal Liberals, who would rather have the public believe that it does not really have any needs. Yet another network of bureaucracy will be established.

It may be true that there are problems with bureaucracy in the provinces, but the bigger the organization, the bigger the problems. This is something we have been witnessing daily for almost two years. Look at the size of the federal system and at what it costs. Sponsorships, gun control and so on are unmanageable. The bigger it is, the more difficult it is to control. That cannot work.

We do not want to fight, and it is not the provinces that are fighting right now; it is the federal government that wants to establish an administrative level again, when everyone is telling it, “What we want is money for the sick. We do not want to establish a new administrative system”. No one wants that, except for them.

It will probably be 12 to 18 months before any thought is given to this. During that time, they will save money and can give some to their friends.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I believe that our hon. colleague has shown great wisdom, and has as usual risen above party politics. I want to ask him a few questions.

Some historians claim that the Quebec Liberal Party is more progressive and more nationalistic than the federal Liberal party. I questioned my hon. colleague on the government side who represents the riding of Beauharnois—Salaberry and was formerly the minister responsible for manpower training in the National Assembly during the final years of the Bourassa government. He told everyone here in the House that had he been in the National Assembly, he would have asked Jean Charest not to vote in favour of the consensus.

Are we to understand that there is a rift, as he sees it, between the Liberal Party of Canada, and the Quebec Liberal Party, and are we witnessing a most unfortunate squabble at the expense of Quebeckers?

[Mario Laframboise, Bloc, Argenteuil—Papineau—Mirabel, QC]

Mr. Speaker, my hon. colleague is absolutely right. It is deplorable.

The problem with the federal Liberal members is that once they are in Ottawa, they totally lose touch with the public. It is as simple as that. They live in a bubble and are power hungry. Every day they hope to get new powers because they think they do not have enough.

I am not surprised that a former Liberal MNA from Quebec came to Ottawa and told us he would not have acted this way in Quebec. In fact, he would have voted according to the party line. If he had remained in Quebec and if he had never set foot in the House, he would have voted the same as his colleagues in the National Assembly of Quebec. What the public wants is simple: money for health. That is what everyone in Quebec wants.

The problem with the federal Liberal members is that they are out of touch with the people of Quebec.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, it is true, many managers of the system are facing financial problems. The ten premiers and the territorial leaders have said so.

Does my colleague not believe that there is also a need to reorganize the system? For instance, when I meet with hospital administrators, I am told they have 90 to 105 union certification units in their institution. Of course, that can only complicate the coordination of all the work.

Yes, we need to invest in health care. The federal government must take its responsibilities, but there is another aspect of this issue that we need to think about, and it is the reorganization of the system. Does the member agree with that?

[Mario Laframboise, Bloc, Argenteuil—Papineau—Mirabel, QC]

Mr. Speaker, I want to thank the hon. member for Hochelaga—Maisonneuve for his question. As health critic for our party, he obviously is quite familiar with this issue.

Since health care accounts for 34%, which is a third, of the budget of Quebec--about the same as in the other provinces--with an annual increase of 5.2%, this represents a lot of employees, and management and administration are required.

At this point in time, properly reorganizing the system would require new money. Employees need to understand that there are better resources available that would lead to better services. We can reorganize and remodel the whole system and that can be done at the same time.

For two years now, the Government of Quebec has been looking at reorganizing the system, and I think they know how to go about it. What is needed to get all the employees on board is new money, which should come from the federal government.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I will split my time with the hon. member for Vancouver Centre.

Over the past 18 months, the Romanow commission has pursued an ambitious agenda based on extensive research and consultations that have allowed tens of thousands of Canadians, including Quebeckers, to express their views. The main message conveyed by these people is that the new federal money must be used to fund changes.

It was Einstein who said, “The definition of insanity is doing the same thing over and over again expecting a different result”. Canadians agree.

Today the Pollara poll shows that Roy Romanow's prescription for medicare reform has the support of two-thirds of Canadians. Pollara found that 66% of Canadians approved of the work of the Romanow commission.

Don Guy said, “Basically, they've said this is the right prescription for medicare”. It is not surprising.

As many commentators have noted, we can hear the voices of Canadians coming from every page of the commission's report. The report is as a result of the most legitimate consultative process in the history of Canadian royal commissions. The insistence upon transparency of the submissions and commissioned research and the utilization of every possible modern tool of citizen engagement, traditional hearings, web based consultations, as well as genuine deliberative models, have ensured that ideological arguments from the left or the right have been confronted with a sound metanalysis of the evidence and underpinned by resounding consensus of the values of Canadians for the important double solidarity between the rich and the poor and the sick and the well.

Canadians are fed up with the federal-provincial gridlock that has wasted, among other things, 1.8 million provincial health care dollars for TV spots and full page newspaper ads squabbling about who pays. They know that it is all their dollars and that they could have a fabulous health care system with less than 10% of the GDP. They want us to get on with it.

How do we move forward? How do we create the unstoppable momentum that will put all levels of government on notice, that it will be at their political peril if the first ministers meeting in January looks anything like previous ones. Canadians have never been clearer: they want medicare to work and they understand the trade offs necessary to ensure its sustainability. They want to know where the health care dollars are going and the value they are getting for the money. They agree that all levels of government must report to Canadians on the performance of the health care system, how it compares within Canada and internationally.

Canadians have been suffering through a crisis of confidence and a crisis of governance in health care. They want this fixed. Importantly, they are prepared to come on board in their triple role as empowered patients, effective advocates and engaged citizens. They want to help make it work. Canadians are not, as they are sometimes unfairly characterized, greedy and wasteful. They do not intentionally clutter up emergency departments, have unnecessary surgery, tests and drugs that lead to the call for medical savings accounts and user fees to curb their cravings.

The polling data has shown that Canadians want a strong federal role in health care. However, Mr. Romanow understands that federal leadership is very different from federal dominance. He proposes two brilliant solutions that demonstrate his sensitivity to the difference.

First, he devised a haggle free formula for health care funding that clarifies the responsibility of the federal government in perpetuity.

Second, he wants an innovative, intergovernmental mechanism, the health council of Canada, to evaluate the performance of the system and provide strategic advice on emerging issues by using the methodologies pioneered by the commission and the ongoing advice of a permanent advisory committee. The council would have: seven government members, two federal and five provincial; and seven civil society members, three from the public and four provider-experts. With citizens at the table, the finger pointing should become impossible.

At issue at the first ministers meeting will be whether we can begin the process of new collaborative relationships. I believe every person with any responsibility for health care in Canada, every single person in the trenches of health care, understands the huge advantage of a cooperative approach that will begin to address the gaps, duplication and incentives that could provide optimal health care for Canadians. We must ensure that the negotiators from all levels of government at next month's meeting include those who have some knowledge of the health care file. Simply sending finance and intergovernmental affairs officials will never work. Canadians should insist that the turfmeisters are excluded from the meetings and only those interested in real solutions are included.

We have been in pan-Canadian gridlock. Everything we care about in this country resides in at least three levels of government and three government departments. If the enormous pressure to get health care right enables us to listen to Mr. Romanow and respond in a creative way, this may be the opportunity to not only solve medicare, but to begin the process of wrestling this country back from a technical federalism that has lost the confidence of Canadians. A successful response to Romanow can refocus all levels of government on the public good and on working together to achieve our common goals based on our shared values.

Monique Bégin always tells the story of going to Trudeau's desk here in the House of Commons just before medicare came in. She said that she was really worried that the 10 provinces and organized medicine were against her. Trudeau asked her where the public stood. She said that the public was for it. He said then it was a sure win. She said that she did not find that to be obvious so she went to Jean who was the senior in terms of negotiations. She asked him what it would take to make the provinces understand, what was the language the provinces would understand? He said very simply, “Money”. She said that he was dead on.

Here we are 20 years later and the former Minister of Intergovernmental Affairs is now the Prime Minister and his friend, Roy Romanow, has just delivered the most important report of a royal commission since Monique Bégin supported the Royal Commission on the Status of Women.

The provinces still care about money and Canadians have never been clearer. They want medicare to work and they understand the trade-offs necessary to ensure sustainability.

This time we actually have four provinces in favour of it. Organized medicine is in favour of it and especially the young doctors are in favour of it. Two provinces, Newfoundland and Nova Scotia, are in favour of it, with a but. Three provinces, Ontario, Alberta and Quebec, are against it. British Columbia is against it, with a but.

As we said before these provinces may be well at their peril to be against the Romanow report. In fact with the provincial governments that are against, their citizens are in favour. Quebec is polling at 59%. Ontario is polling at 70%. British Columbia is polling at 69%. Mr. Guy said, “It appears that Romanow and his group have struck a chord with the public in Quebec and perhaps have gone over the heads of some of the elite in that province”.

Second year medical resident, James Clarke says that the implementation of Romanow's prescription will strengthen medicare and that failure to do so will undermine it.

The truly wonderful Dr. Mikhael from the Ontario medical residents has said, “We are calling on the governments of Ontario and Canada to work together to ensure adoption and implementation of the report in 2003”.

Tomorrow I will meet with my wonderful Good Health Through Good Governance Working Group at the Munk Centre. We have isolated three things to talk about tomorrow: accountability; infrastructure; health promotion and disease prevention.

It is quite clear that none of these can be done without collaboration across the country. Tomorrow when the health ministers meet I know they will understand the changes that have to take place and that collaboration is imperative.

As Charles Darwin said, it is not the strongest of the species that survives, not the most intelligent, but the most responsive to change. Money will not fix this alone. Canadians know we need accountability and the ability to share best practices from sea to sea to sea.

As regards the motion presented by the Bloc Quebecois today, Canadians said that they expect the federal government to play a strong role in our health care system. They want leadership, not an automated banking machine.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I would like to point out to our colleague that the provinces are not asking that the federal government act as an automatic teller, but that it stop making source deductions, to borrow a colourful expression from the field of accounting.

I am quite puzzled by the historical background provided by our hon. colleague. As she may know, the Romanow commission gave Professor François Rocher the mandate to look into the history of the Canada Health Act. When the Canada Health Act was passed in 1984, the Liberals were on their way out of office. All of the provinces were opposed to this legislation.

What was to be expected happened. The provinces were opposed. Yet they believed in a universal, publicly administered and accessible system. The provinces were opposed because they anticipated the federal government's withdrawal. What happened? In the early 1970s, Ottawa was contributing 50% to programs. As time went on—it started with Marc Lalonde, and has gone on until just recently—Ottawa contributed less and less. It is now contributing 14% of the cost of all health care services provided.

Will my hon. colleague admit that the federal government has no valid jurisdiction over or responsibility for health care, except for epidemics, quarantines, patents, aboriginals, research and military personnel? In practical terms, in the field, whether we are talking about primary care, hospital care or home care, the expertise does not rest with the federal government. This is precisely why a majority of the provinces already oppose the Romanow report.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, Canadians have said that they want the federal government to have a real role, particularly in the sixth principle of accountability.

One thing that is very important is the billing and information technology system across the country. With the justice system, when a person is arrested the person's file can be pulled up to see if there have been any arrests anywhere in the country. It seems unfortunate that when a person is having crushing pain or a heart attack that we cannot pull up the file across the country.

When the railroad was built across the country, each province was not allowed to build it in a different gauge. We should not allow different language in the health informatics across the country because we cannot compare the outcomes and we cannot give optimal care to the people who need it. Whether they are in Hull or in Ottawa, if they are in trouble their health records need to be available. It is extraordinarily important.

Canadians get it. It was very clear to Judith Maxwell in those deliberative democracy exercises that Canadians understand that they want a real system, not a patchwork quilt of non-systems. There are many other areas in which the government must help. There is a role for government in the measurement of the outcomes and in the prevention and health promotion areas.

In fact the Canadian government is the fifth biggest direct provider of health care. If we look at the aboriginals, our military, correctional services and our veterans, it is bigger than six of the provinces. It is very important that they come together in a neutral space, the health council of Canada. It is important that they share their problems, share best practices and that everybody comes together with real accountability, just like in the social union framework agreement.

It is imperative that all levels of government report to Canadians on the performance of the system. This is not big brother checking on little brother. We have to be accountable to Canadians as the federal government. That is what Canadians have said. That is what 59% of Quebeckers have said

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, the Canada Health Act has been in effect since 1984. This has not prevented the federal government from making cuts and compromising accessibility to services. How does the hon. member explain that, despite the act, the government behaved the way it did?

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, what is extraordinarily evident by the Romanow report is that whether we are squabbling about dividing 14¢ or 34¢, or whatever, 50% of doctors and hospitals, that is not what the deal was. What we need is a new deal and we have to move forward. The floor of 25% is one that Mr. Romanow, in his black and white striped shirt and a whistle, as a former premier, has said is the new deal. We have to go forward from there.

[Sarkis Assadourian, Liberal, Brampton Centre, ON]

Mr. Speaker, I would like to ask the hon. member if she could provide the list. Perhaps she could ask the Quebec government for the list of equipment that it purchased with the $1 billion health fund transfer a while ago.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, if there is to be another speaker from the Bloc Québécois, maybe he or she could answer that. Maybe at that time he or she could also answer why, when Quebec was asking for so much more money, there was still a whole bunch of money in the Toronto-Dominion Bank in downtown Toronto.

Kyoto Protocol

[Don Boudria, Liberal, Minister of State and Leader of the Government in the House of Commons]

Mr. Speaker, I wish to give notice that immediately before government orders, government business No. 9 is next called, a minister of the crown shall, pursuant to Standing Order 57, move that the debate be not further adjourned.

The House resumed consideration of the motion, and of the amendment.

Supply

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Speaker, I rise today to speak against the motion brought forward by the member from the Bloc Quebecois. In order to speak against the motion I want to give a thumbnail history of how cost sharing began.

In 1961, 10 provinces and 2 territories signed an agreement with the federal government for cost sharing for in-patient services in hospitals only. In 1962 they agreed to extend that cost sharing to physicians. Money was directed clearly at specific health care spending.

In 1968 medicare was enacted and between 1968 and 1972 all of the provinces and territories finally agreed to come in and participate in probably the largest social program that Canada has ever known.

In 1984 the Canada Health Act was enacted to enshrine five fundamental principles, and everyone agreed how the money was going to be transferred and how the funds were going to be shared. It was to ensure that the greatest social program that Canada has ever known was paid for with both federal dollars and that the provinces had a role to play.

There was an agreement then. All the provinces, that today are crying out for money to be given to them without any strings attached, were in agreement back then. There is a precedent and history that since 1961 there was a clear agreement that there would be cost sharing and that money would be transferred for hospital and physician services, and medicare extended it even further, into dental care. That is the crux of what medicare was about.

When Roy Romanow went around the country he went not merely as someone who had been there from the beginning but he went also as a premier of a province. This was a man who understood the issues from a provincial perspective. He understood the problems facing medicare. He understood and supported medicare. He heard from Canadians that medicare was a fundamental value to them. They said it was probably the social program that they most believed in. They believed in the five principles of medicare but they wanted a sixth one attached, namely, accountability. We must avoid the chicken and egg game that we keep playing between provinces and the federal government, where one does not do one thing and the other does not do another.

Mr. Speaker, I am here to tell you that as a physician who practised medicine for 23 years, and as an MP for the last nine, I have consistently heard the same story from patients and from constituents across the country. They do not want to hear this squabbling anymore. The same dollar that we are all fighting over is the dollar that came out of their pockets. They were prepared to put that dollar into their tax spending in order to support a social program called medicare. They believed in it in1961 and they believe in it now. If we read the Romanow report Canadians said that, only if necessary, they were prepared to take more tax dollars out of their pockets provided it was to support nothing else but medicare.

I find the motion to be very droll. If we look at medicare there are three groups involved: the public; the people who provide the care, physicians, nurses, physiotherapists et cetera; and the governments. We have heared from two of those three groups. From Mr. Romanow's report it is clear that the public wants to have accountability in terms of fiscal funding for medicare.

We heared from the Canadian Medical Association in its post-Romanow comments and in its pre-Romanow submission. It said that Canadians had a right to know how much of their federal tax dollar was being transferred to provincial and territorial governments to support medicare.

It is the least that Canadians can expect from their governments in terms of accountability. It serves to underscore the fact that the underlying purpose of fiscal federalism is to support medicare and other important social programs and not the reverse.

This is why the motion we are debating today is not only droll but it is also ironic. I have yet to hear Bloc Quebecois members, who are speaking perhaps on behalf of their province and all of the provinces that today do not wish to have strings attached to the fiscal funding, comment when they are given money under fiscal federalism. They love fiscal federalism. They want more and more money to be transferred in fiscal federalism but they do not believe in one of the primary things that Canadians are seeking in their governments and that is accountability for the taxpayers' dollar. I find this to be sort of talking out of both sides of our mouth.

In order to deliver medicare in New Brunswick, British Columbians, Albertans, Quebeckers, and Ontarians are putting tax dollars into that transfer. The federal government gets its money from Canadians across this country and transfers it to provinces so that every province that gets a transfer of payments for health care gets it out of the pockets of every Canadian regardless of what province they live in.

This is something that I find remarkable, that provincial governments do not understand that they are dependent on the money they are asking for from every province. It cannot be decided on solely by each individual province. There has to be some accountability. People want to know that the money is clearly going to support medicare.

We have seen that there is a need for this accountability over and over again. When $800 million was transferred for primary care innovation, every province took the money. Many of them did not spend it on that. When we transferred into the 2000 budget $1 billion for spending on equipment, we saw lawnmowers bought with that money. Governments like the Quebec government had money that was transferred to it for medicare sitting in some sort of trust fund and was not being used.

Canadians are fed up with this nonsense. It is their tax dollar that is sitting in a trust fund somewhere not being spent. It is their tax dollar that they gave to medicare that was buying a lawnmower somewhere. It is their tax dollar that is building a road somewhere with no one accounting for that money. Canadians have said that they value medicare. They would like, when they are ill, to be treated equally regardless of where in this great country they live or what their pocketbook can afford. This is inherent in the concept of medicare.

Many provinces are already skirting with the five principles of medicare. When I practised medicine, for example, and I had patients come to my office from Quebec, I knew that I would not get paid for the service which I was supposed to under the portability requirements in medicare. I knew that patients would have to take money out of their pocket, pay me and be reimbursed later. However, they would never be reimbursed the money they paid. They would only get what the Quebec government chose to give them.

This is not acceptable to Canadians because that money does not come out of one province. The transfer from the federal government comes from every Canadian regardless of where they live. Canadians want that money to be spent in a manner that tells people that they understand that the money comes from every Canadian regardless of where they live and should be spent on health care.

There are some fundamental issues here. Inherent in fiscal federalism is this idea and sense that there is an entitlement by provinces to get money. The provinces have played fast and loose with this money. The concept of tax points came out of the provinces historically. I would like to go over it even though many members of the House do understand it.

The concept of tax points is where the federal government agreed not to raise taxes so that the provinces could raise the equivalent amount in taxes to fund their programs or their share of programs. That was the agreement. Today, the same provinces ignore those tax points. They love to say that they have cut taxes for people. This is not so. This is playing fast and loose. This is a shell game. This is what makes Canadians so cynical, this kind of game that we play with money and pretend that it does not happen. Those tax points are inherently a part of the federal contribution. When we say we only give 14¢, people are not counting the tax points.

The same provinces also accept equalization payments very happily. It is based on the fact that have provinces contributed money in order that have not provinces could be able to have a level playing field, so that they could produce medicare and valued social programs at the same level across the country because they did not have the wherewithal and thus required an equalization transfer. Those are things that the provinces never count. That is again hypocritical to say the least, and I am trying to use a kind word here.

When we play these games with money, we are playing games with taxpayers' money. This is not my money. The federal government does not take money out of a tree, it comes out of taxpayers' pockets. It is taxpayers in their own good will in British Columbia agreeing to transfer money to Quebec, and people in Quebec agreeing to transfer money to Ontario, and people in Ontario agreeing that their taxpayers dollars will be transferred to help New Brunswick. This is how it works. This is what fiscal federalism is about.

When Canadians agree to pay tax dollars they put a value on how they want that money spent and where they want to see that money go. Mr. Romanow did not produce Roy Romanow's report. Mr. Romanow spoke with the voice of Canadians. He echoed what he heard.

I am not Roy Romanow but I hear the same things wherever I go. People are saying they do not particularly care what the provinces and federal government want to do, they just want to ensure that medicare, which is important to them, is there when they are sick.

A wag once said that medicare was too important to leave to politicians. I would like to prove that wrong. I would like to prove that federal and provincial politicians can come together in a spirit of cooperation and an understanding of what Canadians need, and get together and deliver on medicare.

[Rick Casson, Canadian Alliance, Lethbridge, AB]

Mr. Speaker, the member spent a lot of time giving her version of what tax points and transfer payments meant.

The Romanow report called for a huge increase in the amount of money to go into health care. Where is she suggesting that the money come from when we realize that there is only one taxpayer in this country? It does not matter at what level people are being taxed, it all comes out of the same pocket.

Where is she suggesting that these billions of dollars that have been recommended in the Romanow report come from?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Speaker, that is exactly what I said, that it is coming out of taxpayers' pockets. However what Canadians told Mr. Romanow is that they are prepared to put taxpayer dollars, that they are currently putting into the system, into medicare. They value it that highly. That money is coming from taxpayers.

Mr. Romanow suggested the federal government take a leadership role and put forward a definite 25% of cash into the system to ensure that this happens. He suggested exactly where it should go. He suggested the money be tied directly to specific health care programs. What is suggested in the motion is that we do not account to taxpayers for the money that is put into health care.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I am a little surprised by the hon. member's comments. I will even tell her in all friendship that she went a bit far calling our motion ironic. Our motion is dictated by common sense and by the interests of Quebeckers. This is what has always guided Bloc Quebecois members.

I know that the hon. member knows the health system well, since she was a doctor at St. Paul's, in Vancouver. We want to make it very clear that all Bloc Quebecois members believe in the need for accountability mechanisms. I repeated this all day long.

When questions are put to Minister Legault in the National Assembly, there is accountability. When performance reviews are conducted, there is accountability. When the budgets of regional boards are tabled at the Commission des affaires sociales, there is accountability.

I would ask the hon. member to recognize, and take steps to ensure that her party recognizes, that there are in Quebec specific strong and effective mechanisms for accountability. The inconsistency, however, would be that the federal government, the level of government least knowledgeable about the system, would be the one to whom the reports would have to be made. I say no to bureaucratization, and yes to transparency. That is what the Bloc Quebecois is calling for, and that is what all of the provinces are calling for. It seems to me that this is easy enough to understand.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Speaker, my hon. colleague from across the way is passionate about Quebeckers. I am a British Columbian and I am also passionate about Quebeckers. In fact I am passionate about all Canadians.

I would love for Quebeckers to receive the best quality of health care regardless of where in Quebec they live and regardless of the size of their pocketbook. That is precisely what Canadians, who will be supporting with their tax dollars the transfers to the provinces that the federal government is being asked to put forth, are saying, that it must go to health. That is one condition, that it must go to health. The other condition is it must go to specific spending in health where there is need for specific spending right now. That is what accountability is all about.

[The Deputy Speaker]

It being 5:15 p.m., pursuant to order adopted on Wednesday, December 4, it is my duty to interrupt the business of the House and to put every question necessary to dispose of the business of supply.

The question is on the amendment. Is it the pleasure of the House to adopt the amendment?

[Some hon. members]

Agreed.

[Some hon. members]

No.

[The Deputy Speaker]

All those in favour of the amendment will please say yea.

[Some hon. members]

Yea.

[The Deputy Speaker]

All those opposed will please say nay.