Debates of Dec. 5th, 2002

Supply

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

Yes, it is.

According to Mr. Romanow, in the best case scenario, we are going to contribute 25% of the costs of the health care system. That is what the Romanow report says.

This means that the provinces will still have to bear 75% of the costs. Are we to conclude that this would have been the case if the federal government had shouldered its responsibilities, and had not made such cavalier and shameless cuts? There was no constitutional conference on the cuts to transfer payments and no vote in this House; Canadians and Quebeckers were not asked what they thought about all this.

There was a program review and then, in its authoritarian and centralist manner, the federal government made its cuts. That is the reality.

The Government of Quebec, one of the best to occupy the government benches of the National Assembly, has set its priorities. No other government, since the quiet revolution in Quebec, has invested as much in health as the Parti Quebecois.

Just this weekend, the Premier of Quebec, the head of the government, said, “We will create a health fund if the federal government re-establishes the transfer payments, as everyone in Canada and Quebec has been asking”. The Premier of Quebec, the head of government, has promised that all of the funds received from Ottawa would go into a fund earmarked for health care.

Could the Government of Quebec be any clearer in making major commitments to the effect that health care has been set as the top priority? As long as the Bloc Quebecois is here in this House, we will never accept that the provinces should be held accountable to Ottawa, to federal bureaucrats. We will never accept that. That is no doubt the difference between those of us on this side of the House and the members opposite.

The Romanow report inferred—quite unfairly, by the way—that there are no mechanisms for accountability. In Quebec, the health budget is $17 billion. There are accountability mechanisms. Obviously, there are elections and question period in the National Assembly. There are also health reports tabled by the regional health authorities. There is the National Assembly's social affairs committee.

There is a commissioner responsible for all citizens' complaints regarding services in health care institutions. Health reports are released, providing a classification, or ranking, of how health care institutions fulfill their obligations.

But, most importantly, Minister Legault announced a health care plan two weeks ago. He told Quebeckers that, in the next few years, if they wanted a good health care system, if, from the cradle to home care, Quebeckers wanted access to all the services they needed, an additional $1.8 billion would be needed. The Minister of Health did what the Coalition québécoise en santé asked him to do and indicated how this money would be spent.

We learned that $160 million would be invested in family physician groups. Another $177 million would ensure the provision of comparable services and extend the hours of the 147 CLSCs in Quebec, which we are so proud of because they provide access to health care. The CLSC provide access and front-line services. They operate in every community. English-speaking Canadians come to study the way the CLSCs operate to find out how we managed to set up such a network.

However, the CLSCs are not open 24 hours a day, something the public has been complaining about, and rightly so. The availability of some services in the CLSCs has also been a concern. According to the health minister, for the CLSC network alone, an additional $177 million is needed.

For home care services for seniors losing their autonomy, $133 million will be set aside. Also, $152 million will be earmarked for adding beds in long-term care centres. Medical and hospital services will need $162 million.

So, those who are watching us now realize that we have an action plan. The Government of Quebec has taken its responsibilities. It has invested as much in health care as it can afford. It has set some priorities. It is willing to work with all of the stakeholders who know the network, make the decisions and are held accountable.

What comes next? We have to ask the federal government to reinvest in health care. If fact, at the premiers' conference in Halifax, all the premiers asked for federal funding to be increased by at least $5 billion a year. The federal contribution must increase from 14%, as it stands now, to 18%.

The Romanow report recommends 25%. That is good news. But let us not kid ourselves. We need to properly identify the responsibility centers. The federal government simply cannot tell the provinces how to deliver the services and to whom to report.

The Bloc Quebecois will be keeping a very close eye on this issue. I will now to defer to my colleague from Drummond.

[Serge Marcil, Liberal, Parliamentary Secretary to the Minister of Industry]

Madam Speaker, the hon. member made a very good speech. He referred to the Quebec government's health plan, in which they talk about having all primary care services, CLSCs, open 24 hours a day, seven days a week. He also referred to home care, which is one of the issues stressed by the Clair commission, and for which $133 million were invested.

Does the hon. member think that the recommendations made in the Romanow report are fully and totally in line with those of the Clair commission, which looked at primary care services, home care and the updating of the technology used?

Also, could the hon. member tell the House if the $133 million amount that was recently announced in the presence of general practitioners for home care comes from a primary care health transition fund, which was established under the September 2000 agreement with the premiers, and which is exclusively funded by the Government of Canada?

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

I thank the hon. member. His participation in the debate is all the more important since he is a former minister in the National Assembly. I am sure that he is proud of that period in his life.

I hope that we can count on his support, should the Romanow report become government policy. Hopefully, he will support the consensus of the National Assembly.

The hon. member is right to point out that the problem is not with diagnostic services. Seven of the ten provinces have had commissions of inquiry. We know that people will live increasingly longer, that they will want to live in their natural surroundings—this is called home support—and that there will be specialized services, because people who live increasingly longer will live with disabling incapacities for increasingly longer periods of time.

So, we know where the needs will be in the system. What we are concerned about in the Romanow report is not diagnostic services. The Romanow report is the most contemporary voice and the most visible face that federalism wants to adopt to achieve centralization.

Journalist Chantal Hébert, who is no friend of sovereignists, nor considered to be a Bloc Quebecois supporter, said that for the first time in 50 years, social programs are being cast in a centralist frame with the Romanow report. The federal government took a centralist stance on the constitutional issue and now, the Romanow report is giving the federal government another opportunity to centralize on the issue of social programs.

According to the Romanow report, and I heard the commissioner's news conference, there should be a common market of health care systems. He wants a single Canadian health care system. This is nation building with health, with the impetus coming from the federal government. This is what we cannot accept.

When we see the Auditor General's reports, the level of government with the least amount of expertise in health—the federal government manages no hospitals, with the exception of hospitals for the military and aboriginals—the level that knows the least about service delivery, is the federal government. It should have the modesty to recognize this fact.

Our colleague, the member who was formerly a minister in the National Assembly, should add his voice to those of Mario Dumont, Jean Charest and Bernard Landry, and say that the Romanow report should not become government policy beyond its call for transfer payments.

As for accountability, I mentioned this in my comments, and Bloc Quebecois members will repeat it throughout the day. The member is aware, since he was a minister in the National Assembly, that when the opposition asks questions of Mr. Legault, they are about accountability; when the regional health authorities appear before the assembly's social affairs committee to defend their budgets, that is called accountability; when François Legault releases performance contracts, the health care providers' reports, that is called accountability. We did not need the Romanow report to be transparent and accountable to the public.

[Pauline Picard, Bloc, Drummond, QC]

Madam Speaker, I want to congratulate the hon. member for Hochelaga—Maisonneuve, who is the Bloc Quebecois health critic, for his very eloquent speech. He obviously knows his stuff. It is difficult for me to rise after him and to match his energy level in sharing my thoughts on the motion that we are presenting today.

I will read that motion for the benefit of the public, because we did not hear it this morning:

That the federal government give the provinces the additional money for health unconditionally, with the promise of the provinces to use all of it for health care.

This opposition day follows the tabling of the Romanow report. It can now be said that we did not need this report to tell us that more funding is needed for health. As my colleague pointed out, seven provinces have already released reports. These reports were prepared by competent people, who have already told us about the problems relating to funding.

Indeed, the Clair report and the Séguin commission on the fiscal imbalance clearly showed, with studies conducted by very serious firms and with supporting figures, that an additional $7 billion to $8 billion was needed to maintain Canada's health system and to respect the five major principles that were the foundations of that system when it was first created.

The federal government did not need to spend $18 million and have a large number of witnesses come and tell us that the problem with our health system is related to a shortage of money, or to factors such as the aging population. This is not the first time that this issue has been raised. We have been talking about it since the Bloc Quebecois first came here, since 1993. The problems in the health system began when this government made deep cuts to the Canada health and social transfer. There has been no new money and no increases since. We were already experiencing growth problems, because of the aging population, which requires more care, and rising costs for new technologies and drugs. In 1994, before the budget cuts, we already needed money.

We did not need the Romanow commission. We already had reports from seven of the provinces. In Quebec, we had the Clair report. My hon. colleague identified the problems quite well. We have a prescription drug plan. We have developed a network of CLSCs, which provide basic health services. We have all that. People from the other provinces and even other countries come to Quebec to see what we have done to meet our pressing health care needs.

There are deficiencies in the system at the present time. Of course, the program is not perfect. However, if we had money right now, things would be different. We have determined how to improve the programs. All we need now is the money. In his report, Mr. Romanow, for whom I have a lot of respect, clearly said what the Prime Minister of Canada wanted to hear.

Yes, the government will invest. They are aware that the system is underfunded. They are aware that they have cut our health care to the bone. They cannot keep saying “No, there is no fiscal imbalance” when everyone else recognizes that there is fiscal imbalance between Ottawa and the provinces in the health care sector. It starts to sound a bit silly. The government can no longer say that there is no fiscal imbalance where health care is concerned. It does not make any sense.

The Prime Minister said to Mr. Romanow “Yes, it is fine. You will tell the public that we know that funding is insufficient, but that we will put conditions on it”. Conditions are unacceptable to us. Under the Constitution, managing health care is a provincial responsibility. Then why have conditions?

Right now, the government wants to create a nationwide health care system. The Romanow report says that we must not end up with 13 different health care systems. This jeopardizes the existence of CLSCs and the universal system. CLSCs are the pride of Quebec's health care system. Other provinces come to see how our system works.

The Romanow report says essentially that the commissioners went to Quebec to see how the CLCS network works, and would like to implement such a system, but Quebec will have to step aside, because they want to do it their way. This is totally ridiculous.

Personally, I fail to see how creating new structures, imposing new standards and hiring public service employees will solve problems.

Putting the health care system in the hands of the federal government can only lead to disaster, and examples of mismanagement by the federal government abound. That is the point I want to make.

Just this week, the Auditor General tookd the federal government to task for wasting hundreds of thousands of dollars of taxpayers' money and for seriously crippling the delivery of several services. And this same government is telling Quebec and the other provinces what to do on health care. This is not very reassuring for the public.

Since this government took office, we have seen countless horror stories and major boondoggles. In the end, the current Prime Minister's record will be very poor, indeed.

For instance, in 1994, Revenue Canada had a huge deficit of $8 billion in unrecovered taxes. In 1995, $720 million was wasted in the construction of the bridge to Prince Edward Island. In 1996, harmonization of the GST in the Atlantic provinces cost $1 billion. In 1997, the Liberal government sold its air navigation system at a discount, when it could have sold it for $1 billion more. In 1998, there was the kerfuffle with the social insurance numbers. In 1999, the surplus in the employment insurance fund was ridiculously high; the Liberal government was going to use this surplus to finance its other activities. Need I add review of the employment insurance eligibility requirements to the list? In 2000, HRDC had its turn in the hot seat.

Last year, the Bloc Quebecois strongly condemned another despicable situation: the Liberals managed to save no less than $400 million at our senior citizens' expense. Are we to trust them with the health care system, our vested rights? Are we to expect the government to manage it properly? Those are the facts. I could go on. I had a lot more to say.

We cannot remain silent. We want this government to restore the money it cut, so that the provinces can run their health care systems properly. Since my time is running out, I would like to move an amendment.

I move:

That the motion be amended by adding after the words “health care”, at the very end of the motion, the following:

“according to the priorities they have established and to provide an accounting to their residents”.

[The Acting Speaker (Ms. Bakopanos)]

I declare the amendment in order.

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

Madam Speaker, I have a great deal of respect for the members for Hochelaga—Maisonneuve and for Drummond. I must, however, ask in all sincerity whether the Bloc Quebecois has really read Mr. Romanow's report. It seems to me that there is nothing in the Romanow report to support the ideas put forward by the Bloc Quebecois in today's motion.

It seems to me that there are three things that need to be acknowledged. Contrary to what the hon. member for Hochelaga—Maisonneuve said, Mr. Romanow recommended that the federal government's share of finfing for our health care system be 25%. That is a minimum. He really said that is a minimum. Will the hon. member acknowledge this fact?

There is one other thing. It seems to me that Mr. Romanow never said that there must be an autocratic or unilateral system—I do not know the exact terms—but instead called for a collaborative approach. He has presented a model of federalism that is along the line—

[An hon. member]

A centralist line.

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

No, not centralist. It is a model requiring participation by all players in our system. Clearly, Mr. Romanow has called for the government to participate in the renewal of our health system. He is therefore calling for funds and incentives to change our system, not to dictate to the provinces what they have to do. He is proposing changes to our system so that all Canadians can hope that our system is there to stay.

[Pauline Picard, Bloc, Drummond, QC]

Madam Speaker, I am tempted to say to my colleague that it depends on who is reading the report. I am well aware that Mr. Romanow is a former New Democratic premier.

In response to the 25% share, it says a minimum of 25%. That is the least it should be. Who will assure us that the federal government will go higher than 25%? In the beginning, when the program was created, it was 50%. It was not 25%. Currently, the federal government provides 14%. Now, the report proposes a minimum contribution of 25%. The government is beginning to look foolish, as I said earlier. It has always denied this. We asked many questions about this. Recently the Department of Health again said it was not true, that the figure was not 14%, but that it was now 32%. However, all of the provinces, all of the premiers, all of the health ministers, everyone who has assessed the situation and all those who have tabled reports have said that the funding is now 14 cents on the dollar, not 50 cents any more.

We should not be celebrating the fact that we have been offered a paltry 25% and have been told that this is a minimum. We know how things work around here. We are already being stretched thin at 25%. It would be very difficult to get the 50% that was promised at the outset, when the health care system was created.

As for the federal government's share of the funding, the Romanow report, from our reading of it, proposes increasing federal funding of health care services. However, these payments would be subject to certain administrative conditions set by Ottawa. That is the problem. Why attach strings to the money?

Once again, even though we have repeated it many times, health care services, or health care management, is the exclusive jurisdiction of the provinces. The federal government has no business poking its nose into it. What it should do is return the tax money collected from Quebeckers and Canadians. That is the priority right now. These returned tax dollars must go toward health.

[Serge Marcil, Liberal, Parliamentary Secretary to the Minister of Industry]

Madam Speaker, I will be sharing my time with my hon. colleague from Toronto—Danforth.

The health care system, which has helped make Canada one of the best countries in the world, must be revamped to accommodate the changing needs of Canadians and new health technologies.

In recent months, people from each province appeared before the Romanow commission. Many people attended the hearings, responded to the questions posed by the commission and participated in the forums organized by members of this House on the subject. They told us that they want to maintain the principle of a publicly funded system, and that all levels of governments need to act quickly to correct the problems identified and strengthen the positive aspects of the current public health care system.

They also stressed the importance of maintaining a universal health care system where access to care is based on need rather than on ability to pay. The Government of Canada shares these values and intends to defend them.

Individuals and groups appearing before the Clair commission, as before the Romanow commission, demonstrated a strong attachment to the values of social solidarity and equality, as well as to the the main principles of access, universality and free care that guided the development of our health care system.

In its report, the Clair commission recommended that all levels of government invest rapidly in sectors they considered priorities: frontline services, or primary care, home care, and updating the network in technological terms.

The Romanow commission reached these same conclusions, and also recommended significant investments in those sectors.

In the past few days, we have realized that the Commission on the Future of Health Care in Canada has correctly identified needs, and this has been validated by the main health care stakeholders and by political decision makers.

To meet these needs, Commissioner Romanow acknowledged that larger investments would be needed, above and beyond the $21.2 billion in additional health care funding announced in September 2000.

I would like to come back to the priorities mentioned earlier and make a few brief comments about primary care.

The prime concern of our fellow citizens is still access to frontline care, 24 hours a day, 7 days a week, wherever they live. Let us take, for instance, the family physician groups recently created in Quebec, as recommended by the Clair commission. These groups, made up of a dozen physicians working closely with nurses and other health and social services professionals, should help all Quebeckers have access to services and get the care they need, at all times.

This model should also help us ease the pressure on the emergency rooms and better prevent and detect health and social problems.

The money transferred to the provinces under the Health Transition Fund for Primary Care, set up pursuant to the agreement reached by the first ministers in September 2000, supports the development of such groups. The Government of Canada transferred around $133 million to Quebec to undertake the reforms identified by Quebeckers.

The family physician groups help ensure continuity of patient care, prevent diseases and injuries, and promote health, detection and early intervention, all of which are recommended in the Romanow report.

As for home care, this area has been identified as a priority by Quebec as well as by the other Canadian provinces. Moreover, considering the aging population and the fact that 20% of all older people have disabilities and need help in their daily activities, it is becoming urgent to take action, to provide home care for these people, and to provide the necessary support to their family and friends, so that these people can remain in their own environment for as long as possible.

Canadians tend to want to stay at home until the very end. The recommendation made in the Romanow report to support this priority should be explored.

Quebec, like the other provinces, is affected by a shortage of medical staff. The other major problem regarding human resources in the health sector is retaining medical staff in rural and remote areas.

An increase in the number of health professionals, a better distribution of staff, and an adjustment to the pay system are required. These recommendations were made by both the Romanow and Clair commissions.

Back in September 2000, the first ministers of Canada agreed to invest in medical equipment and in the health infrastructure. Quebec benefited from this and was in fact the first province to buy new equipment, partly with the $239 million provided by the federal government through the medical equipment fund.

New investments in diagnostic services, as recommended by Mr. Romanow, could improve access to these services and help reduce delays for treatment. This objective is shared by all the provinces.

Another element related to health technologies is undoubtedly the computerization of patients' files. In addition to ensuring the patients' security, these files will guarantee the best possible treatment. The Romanow and Clair commissions recognized the positive effect that such an investment could have in the long term. Computer files reduce the need to redo the same examinations when a patient is referred to another doctor.

Finally, everyone agrees that it is difficult to have an effective health care system without turning to advanced technologies that ensure, among other things, quicker and more accurate diagnosis, and without finding ways to effectively reach rural and remote populations, through projects such as telehealth.

All levels of government are unanimous in saying that they are accountable to the people they serve. Canadians expect such transparency.

In September 2000, the first ministers pledged to develop a series of performance indicators with respect to the health care system—this is nothing new—and the health of the population, all in the interests of transparency.

Quebec played a leadership role on the committee responsible for developing these indicators. The first comparative report resulting from this exercise helped identify the strengths and weaknesses of the various health care systems throughout Canada and will be used to put in place the required corrective measures.

All the provinces and territories agree with the five principles currently set out in the Canada Health Act, namely accessibility, universality, comprehensiveness, portability and public administration.

These principles guided the development of provincial legislation regarding public health care. Each province and each territory has reviewed and is in the process of improving health care. More than ever, our country is animated by a high level of energy that we must tap into in order to create a sound health care system that is driven by needs rather than by the ability to pay.

Tomorrow, December 6, all the health ministers at the federal, provincial and territorial levels will meet to map out the broad lines of the plan to renew the health care system. It will be the first of these meetings. This discussion will certainly reflect the federal government's commitment with regard to the future of Canada's health care system and the delivery of high quality health care. The plan will be based on the appropriate use of public funds because, to maintain a high quality health care system, we must ensure that it will deliver good results at an affordable cost. That is one of the commitments made by our government.

Early in 2003, first ministers will meet to discuss Mr. Romanow's recommendations and to agree on an overall plan for modernizing the health care system in order to ensure its sustainability.

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

Madam Speaker, I would like to thank my hon. colleague for his speech. Once again, I feel the need to provide a few biographical elements about my colleague and to remind this House that he was not only a member of the National Assembly of Quebec, but also a minister.

He will correct me if I am wrong, but I believe that he was responsible for manpower and training in the final years of the Bourassa government. Moreover, I believe that Ms. Harel was his critic for a short time. This goes to show that, throughout his political life, there will always be someone from Hochelaga—Maisonneuve looking over his shoulder.

With this in mind, I have two short questions for him. As the former minister responsible for manpower, does he agree that it is not the federal government's responsibility to become involved in manpower planning and the conditions under which health care professionals must work?

Second, as a former minister and former member of the National Assembly of Quebec, how important is it to him that the National Assembly reach consensus? When Jean Charest, Mario Dumont and Bernard Landry speak on behalf of the 125 MNAs who represent seven million Quebeckers and say no to Romanow, does he think this is significant?

[Serge Marcil, Liberal, Beauharnois—Salaberry, QC]

Madam Speaker, I would like to thank my colleague for both of his questions.

In politics, it is unusual to give very direct answers, but I will give one now. Yes, there is health legislation that provides a Canadian framework where the five basic principles regarding health care that all of the provinces must respect are laid out. Everyone agrees on this, including the provinces.

We all acknowledge, and the Minister of Health has also said, that it is the provinces' responsibility and jurisdiction to administer the health care system, based on the needs of each of the provinces. There is no debate on this. However, the motion moved here needs to recognize some things.

In response to his second question, if I had been an MNA, I would have at least asked my leader not to support a motion with this wording.

There is constant talk of unconditional transfer. Yet there are many examples of highly successful federal-provincial negotiations. Take, for example, the immigration agreement between Quebec and the Government of Canada. There were negotiations, an agreement, fund transfers. There was a manpower training agreement for a total of $600 million annually, with negotiations and an agreement. Areas of jurisdiction were respected.

Hon. members need to recall the latest agreement, from September 2000, when Mr. Bouchard, the Premier of Quebec at the time, negotiated, signed on and accepted funds—some of which were listed just now—for primary care services and medical equipment purchases. There was an agreement. Quebec was told there was money available and asked “Do you want some?”. They said yes, and signed the agreement.

Are you admitting in the resolution that Quebec's premier is weak for not wanting to negotiate? You are saying “Transfer the money to us without conditions” but that is not how things are done. The Government of Canada is not a bank. It does not give out money.

There is agreement on major principles and then together we sign an agreement. We share responsibilities and allocate the money according to the frameworks on which agreement has been reached.

Mr. Bouchard never made demands along the lines of “Transfer the money to us without any conditions”. What he said was “I am a negotiator and I am going to sit down at the table and we will negotiate”. They reached an agreement and it was signed, for a total of $21.2 billion. That is not peanuts, it is a considerable amount.

I am convinced that the Government of Quebec will take part in this conference. I am convinced that all provinces and the Government of Canada are gong to reach an agreement.

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

Mr. Speaker, following our colleague's speech, the people who are listening to us should know that Mr. Bouchard rejected the social union. All the premiers asked for unconditional funds. I think that our colleague must recognize this. He should stand up in this House and recognize that Lucien Bouchard rejected the social union. Come on.

[Serge Marcil, Liberal, Beauharnois—Salaberry, QC]

Mr. Speaker, I do not know if we are talking about the same thing. Mr. Bouchard signed the health agreement, the agreement in place since September 2000, in which the Government of Canada provided $21.2 billion to be used for medical equipment and for home care and primary care.

Thus, as far as I know, all the premiers of Canada signed the agreement. I am not making this up. There is a document with the signatures.

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

Mr. Speaker, I would like to say to the Bloc member for Hochelaga--Maisonneuve that I will not be supporting this motion today.

I will not be supporting this motion because my vision of how this country should be run is totally different from the Bloc Quebecois. My feeling on what the Government of Canada's responsibility should be in relation to the whole health care debate is totally different from the Bloc Quebecois. The Bloc Quebecois, for the last number of years, has worked assiduously in ripping the guts out of this place, promoting separation, devolving and dismantling Government of Canada instruments which help keep this nation together. It has been too effective at times in allowing that to happen.

When we talk about the Bloc motion on health care we must go back not just to the work of Romanow but to the work of Senator Kirby. We must understand that the work of Kirby and Romanow was not their private work, their private thoughts or their private meditations on how we should approach the renewal and reinvigoration of the health care system. These exercises were about listening to Canadians from coast to coast, from all walks of life, such as health experts, ordinary Canadians, and men and women who sell services to the health care system.

When we talk today about Kirby and Romanow we are not talking about what they said as individuals but about what Canadians have said. Canadians have said they want the Government of Canada to reaffirm that we must have a universal health care system. Canadians have said they do not want any kind of privatization in the health care system. The privatization campaign that has been running rampant around here for the last seven or eight years must stop. It is totally out of control.

The number one issue for Canadians and in particular, young Canadians, is that foreign ownership has gone too far. It is close to 40% right now. Young Canadians are saying stop, enough. If we were to allow a single province to do any privatizing of any part of this health care system under the North American free trade agreement, our entire system would be vulnerable, and it would be the end of our health care system which makes our country unique. Canadians have spoken through Kirby and Romanow and they have said no to privatization.

Canadians have said they want the Government of Canada to stop being so devolutionary in its thought process and actions. They want the Government of Canada to reaffirm its activism. We are not a cheque writing machine up here in Ottawa. We have a responsibility to the men and women who elect us to get involved. This is not about micromanaging how hospitals are run on a day to day basis. If we are transferring billions of dollars to various provinces for health care, it is normal that we have some kind of a collaborative understanding on how those dollars are spent.

Mr. Romanow's recommendation that the Government of Canada be more active in the relationship with the provinces on health care is a good suggestion. That is not what I think, and it is not what Kirby or Romanow thinks. It is what Canadians have said over the last two years. This is what Canadians want.

My colleague from Pickering—Ajax—Uxbridge has spent many years of his parliamentary life in the whole area of drug patent concerns and drug costs in this country. He has led the way for us in this chamber. Bloc members have told the Government of Canada not to interfere with their province. They have said to stay back, send the province the cheque and not to interfere. My colleague reminded me about the clutch that brand name pharmaceutical drug companies have around the throat of the legislature in Quebec and how they want to have the patent laws extended even further.

They are the most profitable companies in the world. They make more money than banks and countries, and the Bloc asks us to stand back and let these pharmaceutical guys do what they want. I do not get it. However, it will not happen, because Canadians are telling the Government of Canada that it has devolved too much. We have allowed too much foreign ownership, as Liberals, in the last number of years. Some $500 billion dollars from Canadian companies has gone into the hands of foreign ownership in the last eight years. It is awful.

What happens with foreign ownership? The CEOs of this country essentially sit there and they get their e-mails from headquarters, wherever those headquarters are now in whatever part of the world, it does not matter. Those messages indicate to them how they will run their business, how much research they will do, how much money they will put into new plant and machinery, and how they will vote and how they will influence legislators on the health care system in Canada.

On this issue, the Bloc has it all wrong. Anyone in the House, I do not care what side of the House they are from, who continues to pussyfoot and be grey around whether we should or should not get involved after listening to Canadians, through Romanow and Kirby, is at great peril if Canadians are ignored. If that happens the country will just dissolve.

I would even go so far as to tell the Prime Minister the provinces want to walk on this whole issue of how to reinvigorate health care after listening to Canadians, because that is what Romanow and Kirby are all about. The provinces want to put it to our head, and sometimes they can do that. I would go so far as to tell the Prime Minister, “Let us go to the people. Let us have an election on it”. I will tell everyone what would happen. The Prime Minister would be returned for a fourth term, even with all our faults, because Canadians do not want us to devolve any more of our national government responsibility to the provinces.

They are scared silly that if we were to devolve any more, if we let the provinces do what they want in this area, that there would be a possibility of privatization which would be the beginning of the end of our universal health care system. The chamber must fight that possibility with everything we have in our hearts and in our minds. We must, in a goodwill way, ensure that never happens on our watch.

[Rick Casson, Canadian Alliance, Lethbridge, AB]

Mr. Speaker, the member's government at every opportunity has hindered the provinces from being creative in how they deliver health care. It is a province's mandate to do that. The government has gone so far as to hold back transfer payments with all kinds of threats.

What would be wrong with letting my home province of Alberta for example try some alternative methods of delivering health care to see if they work? If it is as the member has said, that he does not think it will work, then let us call Alberta's bluff and let Alberta have a go at it and see how it does.

I would also like the member to comment on the fact that many in the country believe that our health care system is not sustainable as it exists. If we cannot sustain the services that we are presently supplying, how are we ever going to expand those services into other areas if we cannot come up with more creative ways of delivering health care?

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

Mr. Speaker, I have immense respect for the member for Lethbridge. I sincerely appreciate both those questions.

On the first question allowing for ingenuity is a great thing. Ingenuity is something we have been short on in this place in the last number of years.

The problem that we have has to do with chapter 11 of NAFTA. The minute we open up the door to any kind of privatization in our health care system, it essentially creates a situation where the whole country is exposed to people coming in and privatizing our health care system. It is chapter 11. I have talked to some of the best trade lawyers in the world, Mr. Peter Appleton who wrote the book Navigating NAFTA and Michael Rachlis, who is one our best health care experts.

That is why we have to be so careful. We can allow creativity within the hospitals but we cannot allow it through the private sector.

On the second point which has to do with the sustainability of our health care system, the member is absolutely right. We have a huge problem right now. Kirby of course recognized that and it was tough stuff.

We have not done our part in the House of Commons on the whole area of prevention. I chaired the sport committee in the House of Commons. All members came together and unanimously said that we should put $250 million over five years into getting Canadians to exercise half an hour each day. Only 29% of Canadians exercise half an hour a day. If we could increase that to 39%, we could save $5 billion a year on our health care system. Those are huge numbers but it means a little investment.

I went to the Minister of Finance four years ago and begged him to put aside $250 million over five years so kids and parents could get involved and exercise. If we invested that we could save $5 billion a year. I got nowhere.

I am pretty sure in the not too distant future we will start working on prevention. That will save billions of dollars in our health care system.

[Antoine Dubé, Bloc, Lévis-Et-Chutes-De-La-Chaudière, QC]

Mr. Speaker, I listened carefully to the member's speech. We see in the Romanow report an attempt to extend the scope of the Canadian legislation, particularly concerning diagnostic services and home care. It seeks to add the principle of accountability .

Every year, the Auditor General finds shortcomings, such as the $1 billion missing in the budget of the Department of Human Resources Development and the cost of gun control, which is now $1 billion. How can such an ineffective government still want to intrude into areas that are outside its jurisdiction?

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

Mr. Speaker, I think the Auditor General does fantastic work for Canadians. If I ever became prime minister I would have five auditors general. I have said this before. The problem with this place is that the elected culture is no longer running things; it is the unelected officials who are running things around here.

In my own city of Toronto where we spend $22.5 billion a year, I have been trying for a year to find out where that whole $22.5 billion goes and I still cannot get the answer. They only want to let me know where half of it goes. The problem is that the provinces have the same problem in dealing with unelected officials.

As elected members of Parliament we should not walk away from the challenge of finding out where our Canadian dollars are going. To continue to allow the same system of just writing cheques and letting people do what they want, whether they are federal bureaucrats or provincial bureaucrats, is wrong. It is time to get the elected people back in the business of knowing where the tax dollars are going.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, it is a pleasure to speak to this important issue at a time in the history of Canada when we are engaged in the debate on health care. We have an opportunity now to come to a decision. Decisions should have been made years ago and actually they were, but they were made in the wrong way. There is a potential to make those wrong decisions again.

In this upcoming year of debate ahead of us, we have an opportunity to decide to go down a road of sustainability for health care, or not. We have an opportunity to cooperate with the provinces, or not. We have to put the patients first or lose them into the system like we have seen in the last decade, or even further back to the last three or four decades. The patient has become secondary to the system itself.

Health care reform has been left on the back burner for far too long by the government. There are critical cracks in the system. They are so wide and unbelievable that the patient, the ordinary person on the street, has the sense that the system is not sustainable.

We could argue about whether the system is in crisis or not. It really does not matter because it depends upon whether a person is one of the million on the waiting lists trying to get access to the services that we love and hold near and dear. With one million people on the waiting lists, with critical shortages of doctors, nurses and technicians, and I could go right down a very long list, there are acute problems with our health care system that need to be addressed. They should have been addressed long before now.

The problem is so large. When we compare Canada to other OECD nations, we rank 18th when it comes to access to MRIs, 17th in access to CT scanners and eighth for radiology equipment. One thing which is even worse is that the World Health Organization rates us 30th when it comes to our health care system. Our health care system is rated 30th, in a country that is rated number one as far as the best place in the world in which to live.

Something is wrong with our health care system because it does not match the rest of the ratings that Canada gets. That is absolutely true. Patients and ordinary Canadians understand that full well. That is why they are engaged in this debate like never before.

The federal government has been asked to make a decision on health care and that decision is long overdue. It can embrace one track or another track. It will be interesting to see which track the government will hang its hat on.

My guess is it will hang its hat on the $50 million report of Commissioner Romanow, the government's golden boy as far as health care and the future of health care are concerned. If that happens we will have squandered an opportunity to innovate and drive the health care system into the 21st century in a sustainable way. We will have entrenched the status quo for more money and a broken system.

The easiest thing to do in politics when running into a problem is to throw money at it. I would urge the government not to do that but to open its eyes, look forward into the 21st century and look at some of the initiatives that need to take place to sustain health care.

The report done by the Romanow commission is a centralist bureaucratic vision of the future of Canadian health care. It is no real surprise that those on the extreme left are the most supportive of that report.

We criticized the commission when it first started, first because of the two year delay before the government actually came to a decision as it needed to make a decision on health care long before that, and second because of the idealistic bias of the individual who was running the commission. We said that this delay would retard the amount of health care reforms that needed to take place. We realized that the terms of reference of the commission had a limited scope for reforms to the publicly funded health care system.

This commission cost $50 million. Imagine how many MRI machines that would buy. There is rumoured to be an overrun of perhaps up to $26 million. We are going to use an Access to Information Act request to find out how many dollars Mr. Romanow did spend. It is true to what the government normally does with overruns. We could look at gun control or perhaps the blank cheque on Kyoto. Canadians get nervous when they look at some of these issues.

The government does one thing well. It studies. It studied health care to death. In fact there have been $243 million worth of studies since the government came to power in 1993. There was $12 million for a National Forum on Health study which now sits nicely on a shelf. That was a two year, very intense study similar to the Romanow commission.

Senator Kirby just finished his study. It was the most efficient one as far as numbers of dollars spent. It was very comprehensive over a two year timeframe.

It appears that the fix was in from the very beginning on the Romanow commission. Let us look at that report. He is calling for a massive infusion of cash, $15 billion over a three year period, and then carrying on from that with up to a 25% ceiling for the percentage of cost into health care.

We agreed with money going into health care. The system is collapsing around itself and the injection of more cash was something we had called for as far back as 1997.

Provinces are shouldering much of the cost as 40% of their budget is used up in health care. We see only 14¢ to 18¢ on every dollar from the federal government, depending on the numbers one uses. That goes into the fuzzy money the federal government has injected into health care. The money goes into the CHST, the Canadian health and social transfer, which adds education and social services into the health care budget. The Auditor General even said that this is inappropriate because we cannot tell how many dollars the government is actually putting into health care. Clearing that up is something that is long overdue.

Clearly the federal government is not paying its fair share on health care. It has not got its priorities straight when it comes to the number one priority of Canadians which is health care. It is time that happened.

It is interesting to look back at the September 2000 accord and the number of dollars put into health care. The government brags about how much money it has injected. Not one cent of that money for health care reform or primary care went into the system until the April after the September accord. It was more about an election promise and trying to win an election than it was about health care reform. In fact, there are still three years left on that money to go into the system.

If it was the number one priority of the government, it should have been a much more aggressive injection of dollars. Instead we are now just up to the 1993-94 level of dollars into health care from the federal government.

Mr. Romanow said that we should be taking all the money, the $15 billion, out of the projected surplus. Projected surpluses can be there or they cannot be there. All it would take would be a little recession. If we signed the Kyoto accord within the next, I would suggest that the surplus would evaporate before our eyes. We had better recalculate the surpluses that are proposed to be there.

The situation is that the government does not have the appropriate priorities. If health care is to be the number one priority of the Canadians whom it represents, then it had better get its priorities straight.

The motion before us today is very important in the sense that it talks about dollars coming from the federal government with no strings attached. The reason it is there is that Mr. Romanow is suggesting that there be lots of strings attached. In fact, there are five areas: rural and remote access to funding; diagnostic services; primary care transfers; home care transfers; and catastrophic drug transfers. All have strings attached and they open up the system into many more boutique services and programs in health care than were there before.

It is irresponsible to suggest that new dollars would be tied in any way to force the provinces to provide some expanded services. The commissioner was sent to talk to Canadians and to all the professionals to decide how to fix the problems in the existing health care system. Instead of fixing the existing problems, he came back with a report that said to expand it, make it bigger and to tie dollars to the provinces to force them to put those dollars into certain areas.

I do not have a problem with home care. If the catastrophic drug plans address the principle that a person should not lose their home or income or all the money in an RSP because of a catastrophic illness, that is a principle Canadians hold near and dear and we should be protecting it.

We need to work with the provinces when we target dollars. The provinces should be given more flexibility for the new funds that are being injected. The provinces are on the front line of health care delivery. The heavy hand of the federal government is not a way to deal with that.

We should be asking the provinces and holding them accountable for the dollars they need to spend with the ultimate goal of obtaining measurable results on where the dollars will be spent in order to sustain the system in the long run.

We have seen an example of exactly what we are headed into just recently in the 2000 accord with $1 billion in the equipment fund. What happened with the fund when we followed it through was that some of the money was not spent on where it was intended. Some of it was spent on floor scrubbers, lawn mowers and ice cube machines because in certain areas they did not need the high technology equipment and in other areas they did not get it. When we have the blunt instrument of the federal government putting conditions on, we cannot hit the nail on the head as far as where the problems really lie. It only interferes in the provincial jurisdiction which has the mandate to deliver on health care reforms.

When it comes to the motion, we are saying that these measurable outcomes are something that absolutely have to be there. We would have a problem with it except that the Bloc has seen fit to amend it and to add, according to the priorities that it has determined, that it should be accountable to its population. I believe the key is that we need accountability in the system. The provinces need to be accountable for the money that the federal government is injecting. That is fair enough, and I think the provinces all agree with that. From that perspective, I think the motion is now worthy of consideration. We need this cooperative approach if we are going to save health care in the long run.

Let us talk about some of the disappointments we have seen in the Romanow report. One of the most disappointing is in regard to the private provision of health care services. Romanow said that he would like to see an end to any private provision of health care. It is really interesting because 30% of the system is private right now. I wonder if he will roll back every doctor's clinic that is out there and pay them differently. I do not understand exactly where he is with that. He says “not now, not ever” as far as any kind of private delivery.

What we are saying is that we do not really care who delivers as long as the payer is the public, that it is from the public purse and that it is a single payer option. Our health card should be able to access services any place in the country and who delivers the service is not something that Canadians are all that concerned about. We have to leave some options open to enable the provinces to follow through on their mandate to do that.

The title of Mr. Romanow's report is “The Future of Health Care in Canada”, but if it were implemented it would not be the future he would be talking about, it would be the 1960s and 1970s model with twice the mandate and half the money. It would be destined to failure. Five years from now we would be sitting in this place wondering where all the money went, saying that the system is unsustainable, as the baby boomer bubble hits it and the weight is lowered down onto the system, as new technologies and the costs of them come forward and we are trapped into a model that cannot be sustainable in the future. We have an opportunity to do something about that system now and we had better seize that opportunity.

Canadians need, and should expect, timely services. It does not matter who provides those services but they absolutely have to be able to get to the place where they can access the services.

We have the five principles of the Canada Health Act. I suggest that most people in Canada have no idea what those five principles are. I suggest most people in the House would have a difficult time reciting the five principles. I certainly know there is no one here who can define the five principles because no one really has.

However that is not really important because when most Canadians walk into a health care facility they do not look up and say “I wonder whether this complies or not”. They are saying three things. They are saying, “Make me better when I am sick”. They are saying, “Don't make me wait to get better. They are saying “Don't make me pay to the point that I will lose my home or my life savings for an illness when I do get sick”. Those are, in very simple terms, where we are going with health care and what Canadians so dearly love and want in their health care system. That is very simple and straightforward but it seems to be missed in Mr. Romanow's report.

This brings me to the other issue that he so blatantly missed, which is a patient guarantee. We had talked a few minutes ago about the Kirby report. Mr. Kirby is one individual who said that at least there should be patient guarantees, that patients and the public are putting $102 billion into health care right now which will go up another $15 billion a year at least.

Will we get anything for that? Will we remove the one million people on waiting lists? The CMA, Canadian Medical Association, is saying the same thing and so are we when we talk about timely access. It should be there but Romanow rejects all of that as being unworkable. It is not unworkable. It just does not fit into his ideology.

What good is it if we create the best system in the world but we cannot access it? That kind of system does not do anyone any good.

Mr. Romanow has missed a few other things in his report. One of the things is the setting up of the health council or the watchdog over health care. If we have to set up another watchdog, what is the federal Minister of Health doing? What are the provincial ministers of health doing? Is it not their responsibility to deliver on the money Canadians pay in taxes and who expect their money to be spent reasonably and efficiently on their behalf? That is their area of jurisdiction. We would only need a watchdog if they were not doing their jobs.

The other thing is the human resources shortages that we have in the country. I talked about that earlier in my speech. I said that we have a massive problem that will not go away very quickly and that has been totally ignored by this report. If we do not deal with the waiting lists so that Canadians can expect timely delivery of services when they are ill, and if we do not deal with the human resources problems that really cause a lot of that problem, then we have missed the boat on health care reform.

There are some things that we actually like about his report. He has talked about splitting up this fuzzy money, the CHST, and dedicating it. We are saying that the Auditor General agrees with that. She came out with a report a few weeks ago saying that was what happened in the early 1990s. Money was pulled back under the guise of the CHST. We do not even know how many dollars are going into the federal coffers. If we split that up, we would at least have some accountability. Some degree of accountability is absolutely needed.

With regard to stable funding, we agree with stable funding. In fact, we fought the last election on stable funding for health care. Canadians need to know that. If we are going to deal with the system of health care, we had better have secure dollars so we can count on those dollars moving ahead.

We agree with the independent drug safety agency because we have a massive problem when it comes to drugs in this country. A pharmaceutical program, opening up more pharmaceuticals to the people, might be a noble thought but we had better fix the abuse problem before we ever go down that road.

Canadians believe in timely access to high quality health care regardless of their ability to pay. We support the province's effort to use alternative service deliveries within the public system as a way to improve patient care and increase efficiencies in encouraging greater investments.

We oppose big government solutions which too often ignore the health of Canadians. Tomorrow the minister is heading into a meeting with provincial counterparts. It will be really interesting to see whether she will be dealing with them collaboratively or whether she will use the big stick approach that the government has used over the last nine years.

We must work cooperatively with the provinces now. The government must not use the Romanow report to turn back the clock on real health care reform. What a terrible error and missed opportunity that would be if that were to happen.

We become very nervous when we hear Liberal backbenchers say that their whole caucus would like to hug Romanow. She also went on to say that they did not have time to look at any other report. I would say that the time has come for real health care reforms in this country. The public is way ahead of the politicians. This room needs to catch up. Reforms that place the patient first and not the system is where we have to go.

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

Mr. Speaker, I first want to comment on the position taken by the member for Yellowhead. I am certainly one of those members who can assure the member that most Canadians understand the five principles and have understood them for many years.

Short of the current difficulty we find ourselves in, we, and certainly the people who I spoke to over the weekend who carry no bias, political or otherwise, certainly agree with the Romanow committee report and are very much in favour of a system that provides a comprehensive plan to attack what many see to be serious deficiencies in the system, notwithstanding the strains that have encompassed it over the last little while.

Could the hon. member tell me whether the CMA supports the general thrust of Romanow? Concerns have been raised about the NAFTA investor privilege found in section 11 of NAFTA, an exemption that was tried before. From a U.S. study that was done some 11 years ago, does he not see that the public way of delivering medicare is much better and more affordable than the private system that he has proposed? Does he not see that Romanow would be the right way to proceed on this, notwithstanding the objections that he has just raised?

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, my hon. colleague has it so wrong when says that we want a private system. Where he comes up with that is amazing to me.

We are saying that the provinces should be allowed to follow their mandate to give alternative delivery options. If the private sector can provide the service as efficiently as and cheaper than the public system, then fair enough. It can be contracted. What we are saying is that all people will need is their health care card to access services in the country.

The Canada Health Act, if we want to talk about it, does not necessarily restrict the ability of private delivery options, but Mr. Romanow has, and the government in this place has certainly been putting the boots to any kind of an attempt to allow any private delivery options, as we have seen over the last decade in the way it has treated the provinces. In fact, it is such an adversarial role that I would say it is almost dysfunctional at this stage.

Let us get it straight about where we stand on private delivery options within a public system. What we are saying is that within a public system we need to have some competition to be able to know that we can deliver the system as affordable as we possibly can. If the private sector can do it, then we should not be so alarmed at that, we should embrace it. However that is not up to us, it is up to the provinces. It is a provincial jurisdiction.

All we are saying is that since the provinces are asking for the opportunity to deliver health care to their patients as efficiently as they possibly can, we should be open to it and encourage them. The government should take its eyes off the system, get over the phobias that I hear and start thinking about the patients and curing the ills of those patients as its number one priority.

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

Mr. Speaker, it is good to be debating health care in the House again today. We have heard some interesting discussions this morning.

When I hear some members talking about a private system and other members suggesting that the system will collapse if there is private involvement, have they failed to recognize that 30% of our health care spending already is outside of the public system?

The problem we have with our single public system is that it is inefficient, ineffective and it has no competition.

As an example of that, just recently there was a big article about the cancer care unit in Toronto. The private system comes in during the evening to run the equipment because the cancer unit cannot find people in the public system to work those hours. The private clinic runs the equipment in the evening and is able to treat 1,000 patients for cancer therapy with the same equipment for the same cost that the public system would treat 600.

We are talking about innovation. I wonder if my colleague would expand again on the importance of giving the provinces the opportunity to innovate in health care.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, my colleague makes a very good point with regard to the amount of private funding in the health care system now. Actually a little over 31% right now is private. Yet we do not have a NAFTA challenge. We do not have naysayers saying that it will destroy the system if there is any privatization of our system. Our system is 30% there already. That truly is false and it truly is trying to fearmonger and add phobias.

However, all of that is falling on deaf ears because Canadians are so much further ahead. What Canadians really care about is having a system that is there for them when they are ill. We have to realize that this becomes the focus. There is no question about that. So when we are asked questions about alternate delivery and following the mandate, that is what has to happen. We have to stop the adversarial roles. We have to draw clear distinctions between the role of the federal government and how it supports the health care system in Canada and the role of the provincial governments in delivering health care services to their constituents. We have to realize what that role is.

When we respect those roles, then we will be much more able to collectively do what Canadians expect us to do. As we realize, the same people support the federal government and the provincial governments with the same tax dollars. It comes from the same pocket. It is the same money.

Taxpayers do not like the differences we have had, the adversarial conditions that have been set up in Canada. Canadians want health care when they need it. This is what we had better focus on.

[Gérard Asselin, Bloc, Charlevoix, QC]

Mr. Speaker, I am pleased today to congratulate the hon. member for Hochelaga—Maisonneuve for his motion and the hon. member for Drummond for her amendment.

The hon. member who just spoke will doubtless agree with me that the money is in Ottawa, but the needs are in the provinces. Yesterday, in answer to a question from the Bloc Québécois, the Prime Minister said that he did not want money from the federal government to be used to pay for collective agreements, but to go solely towards purchasing equipment.

In my opinion, each province knows best what its health care needs are. Emergency services are a priority. Home care for the elderly is a priority. Investing in equipment is dangerous. The same thing will happen that happened in education with the millennium scholarships. We know that the federal government wants to be visible when it comes to equipment. No visibility, no equipment. We risk finding Canadian flags etched onto computers, while emergency services have serious problems, and we need to invest directly in patient care.

Will the hon. member agree with me that those best placed to determine health care priorities are none other than the provinces? We are asking the federal government to give back the money it cut in transfer payments to the provinces and let the provinces decide how to invest it. This is Quebec's main demand.