Debates of Feb. 19th, 2002

Supply

[Bonnie Brown, Liberal, Oakville, ON]

Mr. Speaker, the member's suggestion has to a large degree been taken up by the government. About 15 months ago the premiers and the Prime Minister signed an agreement on health care funding that was to last five years.

This is another reason it is surprising that the premiers are suggesting they are not getting enough money. They agreed to a five year amount to be doled out on an annual basis. Now they are saying it is not enough. They say they need another $7 billion or so.

Long term sustainable funding is the goal of every program the Government of Canada administers, whether it is funding for the arts, the CBC or health care. Health care is the most important of all these. However as fiscal stewards of the nation's treasury the government must always be responsible. To go beyond five years would not be totally responsible.

[Bill Blaikie, NDP, Winnipeg—Transcona, MB]

Mr. Speaker, I am not sure what the bureaucrats are saying in their briefings to the Liberal backbenchers, but my understanding of agreements between the federal government and the provinces with respect to health care is that excepting the health accord of August 2000 the last agreement between the federal government and the provinces was when they went to EPF funding, Established Programs Financing, in 1977. In 1982 it was unilateral. In 1987 it was unilateral. The federal government has acted unilaterally all along the way, and to suggest that somehow this has been done by agreement is quite false.

The health accord of August 2000 is different, but even then it was a kind of take it or leave it. The money was put on the table and the provinces were told if they did not agree they would not get anything. I do not think any provincial premier could have done otherwise, but that does not take away from the fact that the federal government still has not put back into the system what it took out with those various unilateral actions over the years.

[Bonnie Brown, Liberal, Oakville, ON]

Mr. Speaker, I cannot be responsible for decisions made by the government during the 1980s. I do know that there was a moment in time when there was an agreement made for bloc funding. I believe the provinces asked for it so they would have more of a free hand in dispensing their moneys among their various human service programs. No matter what spin the member opposite puts on the recent agreement called the health accord, the premiers did sign it and emerged sounding quite pleased with the agreement they had made.

[Jeannot Castonguay, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, thank you for this opportunity to address the opposition's motion.

Canada's publicly funded health care system is a partnership between the Government of Canada and the provinces and territories. While the provinces and territories are responsible for the organization and delivery of health care services in their respective jurisdictions, the Government of Canada sets the national principles that provinces and territories must comply with to receive their full cash contributions under the Canada health and social transfer program. This shared role requires us to work in close co-operation with one another.

As members know, the federal health minister is the minister responsible for the administration of the Canada Health Act. This responsibility involves the monitoring of provincial and territorial health systems to ensure that they adhere to the criteria and principles of the Canada Health Act.

The Canada Health Act, passed by parliament in 1984, is the cornerstone of the Canadian health care system and forms the basis of medicare. This legislation affirms the Government of Canada's commitment to a universal, accessible, comprehensive, portable and publicly administered health insurance system. Canadians identify with Canada's health care system more than with any other social program in this country.

Health Canada's approach to resolving possible Canada Health Act non-compliance issues emphasizes transparency, consultation and dialogue. Our ultimate goal is to ensure that the underlying principles of our public health care system are protected for the benefit of all Canadians. In working with the provinces and territories, we are putting a much needed emphasis on making the health care system more accountable and responsive to Canadians.

In his 1999 report, the Auditor General of Canada recommended that Health Canada improve its capacity to monitor provincial and territorial compliance with the Canada Health Act. In response to this recommendation, Health Canada increased spending on the administration of the Canada Health Act by $4 million a year, up from $1.5 million a year. These additional resources have been targeted to enable the department to better monitor and assess provincial and territorial compliance with the act.

These resources are also being used to enhance the department's knowledge and understanding of provincial and territorial legislative frameworks for health insurance. To achieve these objectives, the Canada Health Act Division relies on the support of the six Health Canada regional offices.

Finally, these additional resources have been used to develop a new Canada Health Act Information System, which assists the department to better monitor and assess provincial and territorial compliance with the Canada Health Act.

I am glad to say that with the additional resources committed to improving the administration of the Canada Health Act, the Government of Canada's capacity to fulfill the expectations of Canadians has remained strong.

Under the Canada Health Act, all Canadians must have access to medically necessary health services on uniform terms and conditions. Canadians continue to attach a high importance to each of the five principles in the act.

The act itself comprises five criteria, two conditions, and two provisions. The five criteria of the Canada Health Act require that provincial and territorial health insurance plans be: universal, accessible, comprehensive, portable and publicly administered.

The Canada Health Act requires that the provinces and territories provide the necessary and required information to the Government of Canada for the purpose of bettering the administration of the act, and for reporting to parliament. Also provinces and territories are required to recognize the Government of Canada's contribution towards insured health services and extended health care services.

Finally, there are two additional provisions of the Canada Health Act. The first provision relates to extra billing by physicians. This provision prohibits direct charges to patients by physicians in addition to the amount they receive from the provincial or territorial health insurance plan for insured physician services. The second provision relates to user charges. Its purpose is to prohibit provinces and territories from allowing individuals to be charged for any other insured services.

The Canada Health Act serves as the Government of Canada's guarantee to Canadians that the health care system of this country will be safeguarded and secure. Canadians expect their government to continue to support and protect the values that they hold most dear.

As I mentioned earlier, the act is closely linked with the Canada health and social transfer payments. In order for the provinces and territories to qualify for a full cash contribution under the transfer, they and their health insurance plans must comply with the criteria, conditions and provisions set out in the act.

In September 2001, the Prime Minister announced a $18.9 billion increase in CHST cash transfers to the provinces and territories over the next five years, in support of health. For the fiscal year 2005-2006 alone, the sum total of CHST cash transfers will reach $21 billion, or an increase of about 35% above the current level.

It is through co-operative spirit and joint collaboration between the federal, provincial and territorial governments that the Government of Canada continues to be mindful and respectful of provincial and territorial governments, their mandates and our respective jurisdictional boundaries.

That is why, in the event of provincial or territorial non-compliance with the Canada Health Act, the act identifies a process that the federal minister must follow to try to resolve the issue. Through this process, the federal Minister of Health and her counterpart in the province and/or territory begin discussions about the potential violation. If non-compliance is confirmed and a resolution cannot be achieved through these negotiations, the federal Minister of Health may opt to invoke either of the sanction mechanisms of the Canada Health Act.

It is very important to know that the purpose of the sanction mechanisms is not to impose penalties on the provinces and territories, but rather to achieve compliance to the principles of the act.

The two sanction mechanisms allowed for in the act are the mandatory and the discretionary sanctions.

The mandatory sanction requires dollar-for-dollar deductions to a province's or territory's allocation of the Canada health and social transfer. This dollar-for-dollar figure is based on the amount equal to the charges in extra billing or user fees that have been charged to patients.

The discretionary sanction is imposed if the federal Minister of Health is of the opinion that a province or territory has not complied with one of the five criteria or the two conditions of the Canada Health Act. This would result in a reduction in the amount of transfer payments depending upon the severity of the violation.

To date, the discretionary sanction has not been used by the Government of Canada, the objective of the government being to resolve outstanding issues in a co-operative and collaborative manner.

It is important to remember that the Canada Health Act is a legislative framework of broad principles and criteria, which allows for flexibility in its interpretation and application. This act differs from other legislative frameworks because it is accommodating to the evolving changes and trends which are occurring in the health sector.

Contrary to what some critics of the Canada Health Act may say, the act is not a straitjacket. This does not preclude provinces and territories from implementing appropriate reforms. The Canada Health Act is broad in its interpretation, application and scope. Its purpose is to preserve the values embedded in our health care system, those of equity, accessibility and quality.

In this new century, the dynamics of the health sector are changing every day. There have been many shifts in health care, and reform has occurred across the country with respect to the provision and delivery of health care services. Canadians expect the Government of Canada to lead in the discussion around new ideas and alternatives in its approach to their health.

That is why, on April 4, 2001, the Prime Minister announced the launch of the Commission on the Future of Health Care in Canada, led by Roy Romanow. The mandate of the commission is to engage Canadians in a national debate on the future of Canada's health care system. This task is an important one in light of increasing complexities in the system coupled with the rising expectations of Canadians.

Canadians expect the Government of Canada to protect health care in this country as a symbol of their national identity. Work is continuing on monitoring, compliance assessment and reporting on the Canada Health Act. Health Canada and the provinces and territories are working diligently in developing a Canada Health Act dispute avoidance and resolution process.

The Government of Canada is committed to the principles and conditions of the Canada Health Act. Through renewed spirit and collective co-operation between the two levels of government in this country, Canadians can be assured that the Government of Canada will continue to sustain and strengthen their medicare system.

[Benoît Sauvageau, Bloc, Repentigny, QC]

Mr. Speaker, I listened carefully to the speech delivered by the Parliamentary Secretary to the Minister of Health. As interesting as it was, I think it was made during the wrong debate. The motion before the House deals with the government withdrawing from health care funding, but I think the member deliberately chose not to address this issue.

As the Parliamentary Secretary to the Minister of Health, the member is probably more knowledgeable than many others. So, I would like to put to him some more pointed questions, which he should be able to answer.

The motion brought forward by my hon. colleague from Hochelaga—Maisonneuve condemns the government for withdrawing from health care funding. It condemns the government—rightly or wrongly, that would be up to the parliamentary secretary to tell us—for no longer shouldering more than 14% of the costs of health care. It reminds the House that, in 1993-94, when the Liberal Party took over, the federal contribution stood at 22.4%. So, this represents a drop of around 10%.

I have a question for the parliamentary secretary, who will probably vote against the motion, about the government no longer shouldering more than 14% of health care funding. If my colleague does not agree with this figure, could he tell the House what percentage of health care funding his government is shouldering? As the Parliamentary Secretary to the Minister of Health, could he answer this question?

[Jeannot Castonguay, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, the Government of Canada has clearly demonstrated that it has not withdrawn from the Canadian health care system.

First, in September 2000, a five year agreement was reached with the provinces and territories to maintain stability and meet the demand in order to have a longer term vision of what the funding would be.

Then, last fall, the Romanow commission, in co-operation with all the provinces working on this issue, looked at ways of renewing and improving our health care system.

I do not see that as a withdrawal. On the contrary, I think the government is totally committed to ensuring that the system is there for the next 25 or 30 years. We know full well that the system needs to be improved and fine tuned to meet the needs of all Canadians, from all provinces, including Quebec.

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

Mr. Speaker, I would like to repeat the question just posed by my colleague from the Bloc about actual figures from the government for cash transfers by the federal government to provincial governments. That is the critical question here today.

We have heard clear figures from the Bloc and we know from the provincial premiers their assessment of the situation, yet the government continues to refuse to address specifically the critical question at hand. What is, from the government's own estimates, the federal share in cash transfer dollars to the provincial governments for health care? That is one question.

The second question relates to the response of the parliamentary secretary just now when he said in effect “don't worry, be happy”, the system will be here 25 years from now. The fact of the matter is it will not be here even one year from now if the federal government does not make some immediate moves. As the share stays at below 15%, or whatever number the government will finally admit to, provincial governments like those of Alberta and British Columbia are taking very drastic measures that fundamentally alter the nature of health care in Canada today and actually bring us very close to that point of crisis, after which there is no point of return.

Therefore my other question for the parliamentary secretary is this: What is the current government thinking in terms of emergency transitional funds to assure provinces that as Romanow proceeds with his dialogue, discussions and public hearings there will be some assistance to help bridge the gap and ensure that these fundamental transformative changes to health care are not undertaken in Canada today?

[Jeannot Castonguay, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I will start by answering the second part of the question asked by my colleague.

The provinces will continue to wait at the door to try to obtain more funding. It is human nature, and we know that. Let us not forget that all the provinces are receiving funding every year under the agreement signed by all of them in September 2000, and that funding will continue to increase each year over the next three years.

We can debate the figures and say that it is 14%, 18% or 20%, but the 14% figure refers only to the portion paid under the Canada health and social transfer. We know full well that the CHST accounts for only 41% of total health transfers.

There are obviously other amounts that are transferred in support of health, but the opposition has a tendency to ignore them.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, it is a privilege to speak on this issue. It is an issue of great passion for most Canadians and I am passionate about it myself.

I would like to split my time with the member for Okanagan--Coquihalla.

I will pick up the debate where we left off, speaking about the number of dollars spent in health care. I applaud the hon. members of the Bloc who brought forward the motion, which talks about the dollars, the provincial jurisdiction and the Romanow report. I support the hon. members, although I would put a caveat on their suggestion that the Romanow report may not open debate. I think that debate is what we need in the country and I think the Romanow commission will help fuel some of that debate. I hope it is a healthy debate, although even the greatest report coming from Mr. Romanow would probably be used as a political pawn, as we have seen happen with health care. I will explain.

Health care is the top priority for all Canadians. The latest poll, on December 7, showed that 82% of Canadians had health care as the number one issue on their minds. It continues to be the number one concern for people.

A government that is supposed to respond to the people it serves has failed them, I would argue, in not addressing the problems in health care. Let us take a look at health care funding since 1993-94. Where did the CHST cash transfers go? They were at $18.8 billion in 1993-94. By the way they are not there now because since that time we have seen a massive unilateral withdrawal. In 1995 there was a massive $3.8 billion reduction in funding transfers with the CHST dropping to $14.7 billion in one year. Two years later the CHST fell to $12.5 billion. This slash and burn approach of the federal finance minister was great for his bottom line but it was absolute devastation for health care.

I was made part of the health care crisis because I was on a regional health authority and actually was at one of the first Alberta round tables brought together to try to deal with the crisis of a $900 million reduction in one year while still sustaining the health care system. The federal Liberal government actually put this burden on the backs of the provinces. In turn, the provinces, with 82% of health care budgets being spent on human resources and actual frontline staff, had to impose a penalty on those people.

This had a ripple effect that absolutely crippled our system. There were enormous consequences. There were massive layoffs of thousands of health care workers and professionals. If that is not bad enough, when those numbers of people are laid off and it is done in that way there is a drop in morale. In fact eight years later stats show that the most dangerous places to work in Canada are our health care facilities. Morale is lower and the number of sick days higher than in any other workforce in Canada. As well, enrolment in medical and nursing schools was cut back and now we are into a massive crisis where we have no doctors to look after the people of the country and no nurses to work in our facilities.

Yesterday it was interesting to ask the Minister of Health about the 1,500 new frontline doctors who are supposed to fan out across the country to train our doctors at our facilities on how to work and deal with bioterrorism attacks. They cannot even find a dozen in the country.

Another issue is new medical technology. New medical technologies were promised to upgrade obsolete equipment. Absolutely nothing was found. The government said it put in $1 billion for that. I did a little research and asked where the $1 billion went. I asked the Canadian Medical Association and it is asking the same question because it still sees medical equipment that is broken down. Hopefully we will be able to find some specific answers. We will follow it up.

Over the last eight years $25 billion has been removed from the federal responsibility for health care in the country. That is in light of an 8% increase in the population. In 1993 there were 28.7 million people in Canada and today we have 31.1 million people. This is a massive number of people we are looking after. Not only that, we have the increase in inflation. Just the cost of doing business in the country has risen 13% since 1993.

Today what are the fruits of this shortsightedness? Wait lists, as I said, are a plague on the system. They grow longer and people on the waiting lists are dying. There is the shortage of nurses and doctors. According to a survey done by the College of Physicians and Surgeons, two-thirds of the physicians in the country are refusing to accept more patients and we are asking them to actually do more work. They are saying they are stretched to the maximum and cannot even take on new patients.

The confidence of Canadians in our health care system has plummeted and why would it not? What more could we expect? This kind of damage is not cured overnight.

To take the opportunity to undo some of the damage by putting more money into the system, the government came up with an accord in September 2000, but that money will happen over a five year period. It is like offering someone who has just walked through the desert a cup of water. The provinces had no choice but to accept it. It was a sort of unilateral decision, just prior to an election, by the way.

What a golden opportunity it was for the federal government and what a missed opportunity. If it wanted to show real leadership on health care and to help out with some of the crises happening in its reign, the government should have followed the dollars with some conditions. It should have led the provinces and showed them how to protect health care and sustain it over the long term. Instead of that, this was just an election ploy with no leadership. The accord was just something that had to be signed so the government could appease its conscience somewhat through this next period of time by just throwing money into the system.

The federal government's responsibility used to be part of a 50:50 arrangement. Now it is down to 14% and in some provinces it is less than that; in Alberta I think it is at 12%. Clearly health care is not a priority of the government. We saw that as recently as the last budget. At least the government could have brought this up to the 1993-94 level by adding another $500 million as a token to say it is with the provinces and realizes there is a problem. Not one penny has come forward. We have seen 6.5% annual increases in health care costs over the last four years. That is purely not sustainable and every province knows it. Every premier is yelling and saying that something has to be done and that they will move forward.

We need to come up with new approaches to rein in the escalating drug costs. We need to find new, efficient ways of delivering health care. We need to ensure greater accountability among the users and providers of health care to eliminate some of the waste in the system. We need to promote more responsible use of health care dollars even within that system. We need to place a greater emphasis on prevention and keep people healthier in the first place to avoid the cost crisis management approach we have seen from the government.

Up to now I have just talked about the dollars and the crisis of the dollars, but health care is a two-pronged problem. Not only did the government pull all the money out of health care, it held the provinces in a straitjacket so they could not be innovative in their approach to delivery. Every time we saw one of the provinces being innovative we would see the Minister of Health ride in with his sword, shake it at the provinces and say “don't you dare” and fly off within minutes before he could be questioned.

The social union framework in 1999 was supposed to appease some of that. What did we get? There was supposed to be a dispute settlement mechanism for any challenges to the Canada Health Act and we are still waiting for that today. I am wondering where the Minister of Health has been in coming up with a dispute settlement mechanism that is fair and takes provincial as well as federal interests into consideration.

When it comes to the Romanow commission, I believe he will do the best job he knows how to do. There will be 18 days of hearings, 7 expert focus groups, 9 partner events, 5 regional sessions, 1 workbook and 1 national conference. It sounds like the 12 days of Christmas. That is the kind of debate that will go on.

The government is great at studying. It has spent some $242 million on studies since it came to power, yet there has been no leadership. I believe Mr. Romanow will do a great job, and the best job that he can, but the government will use it as political positioning for the next election, which is unfortunate for Mr. Romanow and for the health care of Canadians.

[Peter Stoffer, NDP, Sackville—Musquodoboit Valley—Eastern Shore, NS]

Mr. Speaker, as the hon. member should know, pharmaceutical drugs are the major cost implication when it comes to health care. Since the Conservatives, under Brian Mulroney, brought in the drug patent legislation, drug prices have tripled to the point where we now pay more for pills than we do for doctors' fees.

Quite clearly the most expensive system within the health care system is controlled by the private sector. With the over 20 year patent protection that the drug companies have and with the escalating cost of drugs for people, what would the member's party specifically recommend to control drug costs across the country? What would he do to help the generic companies offset those costs so that Canadians can have better access to cheaper drugs in their long term health care?

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, the hon. member's question is a good one. He is absolutely right. The number one driver of health care costs in the last year was the 9.1% increase in drug costs. When we really break that down does it mean the cost of drugs have risen higher or that utilization has gone up?

I believe the utilization, unquestionably, is the number one reason that the costs have risen. Will that change in the coming years? I would suggest that it probably will not because more drugs in the chain now are about to be approved than we have ever seen before.

I do not believe we can stop it that way. We cannot hold back the tide of new drugs. However we can add efficiencies within the system and we can put in place a regulatory body so that those drugs that are being used are not misused. I see a bigger problem in the misuse of drugs. We must address the issue of the number of individuals who are addicted to prescription drugs.

The drug problem is multi-pronged and there are many different areas we can go on that. The member is absolutely right when he says that it is one of the big problems we have to tackle. I see absolutely no leadership on that from the government,.

[Peter Stoffer, NDP, Sackville—Musquodoboit Valley—Eastern Shore, NS]

Mr. Speaker, to follow up on that, would he support or at least look at the possibility of a national pharmacare program adjacent to our national health care program that would especially assist our seniors? The population is getting older and more seniors are relying on these pharmaceuticals. Would the hon. member support a national pharmacare program in order to offset the additional costs that seniors will have to face in the near future?

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, we have to understand that when it comes to costs in health care, the money comes out of the jeans of the working men and women. Whether we pay for it through a pharmacare program or through different insurance programs, we must be careful not to just mask the real cost of the system.

A pharmacare program is something that has been talked about a lot but I am not convinced that it is the way to go to reduce the cost to the actual working people walking the streets and paying the bill. As passionate as we like to be when it comes to dealing with seniors' expenses for pharmaceuticals, which will just increase, I am not convinced that a pharmacare program is necessarily the way to go.

Maybe we need to examine and debate pharmacare but I believe we must do what is most efficient in order to deliver health care. We should put our energies into focusing on the misuse of drugs and on getting the best drugs instead of wondering how we will actually pay for those drugs, because we are competing with many different interests.

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

Mr. Speaker, in relation to that same question, I am interested in the question and in the response from the member.

To go back to one of the five principles of the Canada Health Act, which is universality, we should keep that in context with prescription services. There are so many jurisdictions in Canada. We have 10 provinces but some of those provinces do provide that service. What does that tell us about the universality of the Canada health system? There is a very disjointed and patchwork quilt approach to it. Maybe the member could comment on that.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Speaker, the hon. member is right. I believe every one of the five principles are compromised in every one of the provinces and we do have a patchwork. The provinces are saying that they need a dispute mechanism on the Canada Health Act because the interpretation is being compromised in every area. We need to identify what the interpretation is so the provinces can get on with delivering health care instead of this adversarial approach that we have seen by this government.

[Stockwell Day, Canadian Alliance, Okanagan—Coquihalla, BC]

Mr. Speaker, I rise today to speak in favour of the Bloc Quebecois supply day motion on health care.

I am pleased to rise today in the House to support the motion on health that was moved by the Bloc Quebecois.

The motion puts the problem precisely right. The Liberal government has withdrawn its support from Canada's health care system. It has hacked and slashed support levels for health care through the transfer payments but, at the same time, has continued to invade and erode provincial jurisdiction over health care services. Most recently it has told the provinces, which are facing a health care crisis due to the federal funding cuts, that they must wait until the federal Romanow commission files its report before beginning vital health care reforms. In other words, the Liberals no longer pay the piper but they still want to call the tune.

As a former finance minister, each time I tabled a budget I warned of the increasing percentage of the budget that was being consumed by health care costs. This is true right across the country. It should not be a surprise to us that this happens because the system itself defies the most basic laws of supply and demand. A quality product and a quality service is being provided at no apparent cost to the consumer. Unchecked the costs can only continue to rise.

I want to address the areas of funding and jurisdiction as both increased and stable federal financing for health care and allowing innovation and flexibility within the provincial systems. These are two of the necessary remedies for the system's current maladies that they face.

To make the problem worse, between 1995 and 2000 the government ripped some $25 billion out of the health care system compared to previous transfer levels. Even with the agreement reached right on the eve of the last election, which was interesting in terms of the timing, health care funding in nominal, non-inflation adjusted dollars is still not what it was seven years ago.

In the meantime, health costs keep rising. While federal transfers were slashed, the provinces tried to manage a health care system for an older population and a system requiring new technologies and increasingly expensive medication.

Liberals now tell us that the health care cuts of the mid-1990s were a necessary evil to reduce the threat of a deficit. What they did not tell us was how they went about reducing that deficit. More than half of the deficit pay down was done through raising taxes. That is a no-brainer. Of the spending cuts that were implemented, the federal government cut health care spending six times as much as it cut its own federal programs. Its pet political programs were left largely untouched while health care was ravaged. Even now the federal government has not clearly restored the status quo. Federal funding for health care as a percentage of health care spending is at its lowest level ever, around 14%.

In the last election the Canadian Alliance acknowledged the need for secure health care funding for the provinces. We committed that we would have increased health care funding back to these 1994-95 levels. We committed ourselves to adding a sixth principle to the Canada Health Act, stability of funding by statute. That would give the provinces the stability they need to plan for the future.

In a letter to the Prime Minister and the premiers, I also suggested that federal funding in the longer term could move away from the current system of cash transfers toward a greater use of tax points, especially to those provinces that wanted to and were willing to pursue that. That would be a situation where the federal government would agree to lower its taxes to give the provinces room to increase theirs where they wanted to but with no net tax increase to their citizens.

These tax points, which could be equalized so that they would benefit poorer provinces as much as richer ones, would increase in value as the economy grows. Moving to tax points would have a built in growth factor in funding over time as opposed to provinces continuing to come back every year or two to beg the federal government for more funding.

The main Liberal objection to that idea is that the federal government would lose its stick, its threat of penalizing provinces by cutting their transfers. That attitude, which was expressed by the Prime Minister and the then minister of health, was an expression of contempt for the provinces.

The Liberals seem to believe that only they can protect medicare. They believe that the provinces, whose representatives are democratically elected by the same people who elect representatives of the federal government, somehow do not care about the health care of its citizens. That is absurd.

Liberals believe the provinces, which have the day to day experience of running hospitals, clinics and health boards as opposed to just carping from the sidelines as the federal Liberals do, somehow do not know enough about health care to manage their own systems. This is what the federal government suggests. It says that only the threat of father knows best Ottawa of cutting off the provinces' allowance can be trusted to keep provinces and their citizens in line. That attitude is absurd but it is widely shared by federal Liberals.

Unfortunately, I think it goes a long way to explaining why federal Liberals have never sat down and negotiated a dispute settlement mechanism for health care as they promised in the social union accord which was reached in 1999. They still have not fulfilled that promise.

I was part of the negotiations which led to the social union agreement as Alberta's social services minister and later finance minister. I know how much the provinces were relying on an impartial dispute settlement mechanism that would set the parameters within which the provinces could innovate in health care and in other social services. Unfortunately, the federal Liberals liked being the judge, the jury and the executioner over the provinces. They like that role too much to allow a joint federal-provincial body or some other kind of acceptable impartial panel to judge the provinces' adherence to the Canada Health Act.

The federal government must let go of this stubborn behaviour and finally allow the provinces more flexibility when it comes to renewal of the health system.

If provinces want to experiment with greater use of private clinics, including overnight stays or hospitals built and managed by public-private partnerships, or medical savings accounts which promote individual accountability for health care costs, then the federal government should allow that innovation to proceed. Instead we see a government which ran attack ads against a provincial initiative in the last election campaign. An attempt to even introduce modest health care reforms was attacked by the federal Liberals.

The provinces must have the flexibility to innovate within the framework of a publicly funded universal health insurance system. As long as no one is denied necessary services because of ability to pay there should be no ideological barriers to the provision of health care services. Patients do not care whether their wounds are being dressed with a private or public sector bandage, as long as they get the care that is there when they need it and without financial barriers. These waiting lists continue to grow and the demand for services increases exponentially. All the minister can counsel is more waiting.

Two years ago the previous minister of health stated:

Now I started by saying that the status quo is not an option. We have to change, we have to improve Medicare....On many of these practical issues we've had enough studies, we've had enough reports, we've had enough commissions. We're now at the stage where by working together we can move from recommendation to action.

Bold words indeed. What did the government do after the election? It appointed another commission and asked the provinces to stick to the status quo for a few more years.

The provinces cannot wait, should not wait and will not wait. They will go their own way following the recommendations of the Fyke commission in Saskatchewan, the Clair commission in Quebec and the Mazankowski commission in Alberta. These commissions recommended positive steps for reform and now it is time to implement them.

I met with doctors and nurses in a hospital in my constituency in Penticton, I met with health care advisers in Merritt, and I talked to residents of Summerland who are at risk of losing their hospital services. People are losing supplementary services and it is clear we cannot wait. Rather than standing in the way, the federal government should encourage provinces to innovate.

I urge the minister and Mr. Romanow to dedicate their reforming zeal to achieve these two goals: more stable funding, including the approach of tax points for provinces; and a dispute settlement mechanism, an impartial body respected by the provinces, which can lay down clear parameters to both levels of government. Individual provinces should be allowed to reform their own health care services.

The supply day motion is useful to remind the government to fulfill its end of the health care bargain before it begins telling underfunded, overburdened provinces how they should do their job. It instructs the government on its responsibility both to ensure stable funding and to allow the provinces the flexibility they need to reform the system. This is the way we can move ahead and we challenge the government to move in this direction.

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

Mr. Speaker, I thank our colleague for supporting the motion. I would like to ask him three short questions.

He is quite right in saying that the provinces have already thought for a very long time about the form that the health system should take. I am willing to share with him a document that proves that seven provinces out of ten have had working groups between 1997 and now. That is my first comment. If I understood his speech correctly, he wishes to give the provinces as much autonomy as possible.

Second, would he agree that there would be a danger in implementing a conflict resolution scheme between the federal government and the provinces, because this would imply that the federal government can intervene beyond what the constitution allows it to do? The constitution allows the federal government to intervene in health issues concerning aboriginals, epidemics, quarantines and military personnel services.

Does the member share my view that a federal-provincial conflict resolution scheme could lead the government to intervene in a way we cannot wish for if we really want to abide by the letter of the constitution?

[Stockwell Day, Canadian Alliance, Okanagan—Coquihalla, BC]

Mr. Speaker, I thank the hon. member for his question and for his offer to consult this document together.

Yes, I think there may be some danger when provinces wish to have an agreement with the federal government. On a number of occasions in our history, when the federal government got involved in areas of provincial jurisdiction, problems have cropped up.

In this case, however, before signing anything whatsoever in order to resolve the problems, if all provinces agree, if all provinces are in agreement with the federal government, I think it is not so dangerous.

[Bill Blaikie, NDP, Winnipeg—Transcona, MB]

Mr. Speaker, my question for the hon. member from the Alliance who just spoke has to do with the Canada Health Act. The member talked about provincial flexibility and jurisdiction. Could the member tell the House whether he views the Canada Health Act as an acceptable form of setting boundaries on what provinces can and cannot do with respect to health care?

Clearly this is what the Canada Health Act is. The act sets out five basic principles. It also sets out two different practices as unacceptable to the federal government, extra billing by physicians and user fees. These are grounds on which the federal government can withdraw its own money from receiving provinces.

Could the member be clearer with respect to his own view of the Canada Health Act? Does he believe that the setting of these kinds of boundaries as represented by the Canada Health Act are unacceptable? If he was in a position to do so would he seek to get rid of the Canada Health Act? Everything he says points in that direction.

[Stockwell Day, Canadian Alliance, Okanagan—Coquihalla, BC]

Mr. Speaker, the hon. member was not listening clearly. The Alliance Party has been clear on this, even in the last election. The Canadian Alliance supports the Canada Health Act. We have been asking that a sixth principle of stable funding be added by statute so that we could never again see what the federal Liberals did in terms of slashing the transfer payments to provinces. Within the Canada Health Act Canadians expect they would be able to receive insured necessary health services without any financial impediment and without having to pay. That is something that has to be maintained.

The types of flexibility I am talking about can be handled within the Canada Health Act. If there is a discussion on the Canada Health Act in terms of being improved, then let us look at it. That would obviously have to happen with the full agreement of the provinces and the federal government. The type of reforms we are talking about can happen within the present system, as long as there is a federal government that is willing to work in a co-operative way, respect areas of provincial jurisdiction and keep the federal nose out of provincial jurisdiction.

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

Mr. Speaker, I will be splitting my time with the member for Winnipeg--Transcona. I am pleased with the opportunity to participate in this debate.

I will start by thanking the hon. member for Hochelaga—Maisonneuve and his Bloc Quebecois colleagues for having presented us with this motion. This is a very important subject. It is a priority for Canadians. It is time the House of Commons addressed this very important matter.

It is important for this debate to happen now. As soon as the House came back on January 28 we tried to have an emergency debate in the House. This requires our urgent attention given the developments in the area of health care over the last number of weeks and months. This is our first opportunity to have a lengthy debate to hold the federal government accountable for its inaction on this very important file.

We should all be reminded of the need for federal action having heard the two speakers from the Alliance Party. If ever there were a reason or a case to be made for the government to get busy and deal with the issues at hand, it is clearer today than ever before. The Alliance is determined to support privatization and to allow for a patchwork of health care systems across the country, and to gut federal responsibility in this area. That is not what we need today. We need federal leadership, action, and a commitment to preserve the Canada Health Act and the principles of medicare.

The Bloc motion is important in terms of its condemnation of the federal government and its reduced level of funding for provincial health care systems. We have no quarrel with that part of the resolution. We strongly believe that the present government is negligent and not prepared to live up to its mandate and responsibilities on the health care front.

We take umbrage and have some concern with the Bloc resolution when it comes to the whole question of jurisdiction and the suggestion that the federal government should not be rethinking its role in terms of expanding the provision of health care services because of the fear that it would invade provincial jurisdiction.

We are at a critical point in the history of medicare. We cannot let jurisdiction cause us to become immobilized. We must be creative and find co-operative solutions. There is a willingness on the part of all provincial governments across the country to work with the federal government to be creative and to restructure medicare so that it can meet the needs of the current population and of future generations to come.

The most curious part about the Bloc resolution is the suggestion that we should condemn the federal government for attempting to invade provincial areas of jurisdiction by using the preliminary report of the Romanow commission to impose its own vision of health care. Our biggest concern is that the government has not done a thing. It is sitting back, letting things happen, refusing to take charge, refusing to enforce the Canada Health Act, refusing to address the funding issue and refusing to prevent the slippage that is so rampant all around us.

The best evidence of that has been the recent statement by the new Minister of Health who said this past weekend that she would appreciate it if the provinces would not take major actions in terms of health care and would not introduce transformative changes to health care in Canada today.

We have gone from the old minister of health who is really the minister of unfinished business and who really must bear responsibility for the dilemma we are in today to a new Minister of Health who is just tiptoeing around. She is so worried about offending the provinces that she has become immobilized and is not showing any necessary leadership in terms of the real threats to health care.

Therefore we have what the Alliance wants. British Columbia is introducing measures to drastically alter medicare as we know it by de-listing vital services such as chiropractic services and increasing premiums by 50%, which would clearly have an impact on those who are least able to afford that kind of increase. The Alberta government under Ralph Klein is institutionalizing a private hospital in that province. Those changes are transformative.

These moves are major and are not merely tinkering with the system. They are a serious threat to medicare as we know it. We need only to look at the impact of free trade agreements in other areas to understand just how much Canada will be prevented from moving forward with innovations in health care if Ralph Klein and the premier of British Columbia are allowed to dismantle and fundamentally alter health care.

We have tried to raise over and over again in the House our concern regarding the federal government's intransigence and refusal to carry its fair share of funding when it comes to health care. We heard from the parliamentary secretary. The government refuses to acknowledge what the federal share of health care spending is.

The federal government refuses to acknowledge something that the premiers, health ministers and finance ministers of Canada have said over and over again, that the federal share of health care funding has dropped to the abysmal amount of 14%. We are talking about a 14% federal share and an 86% provincial share. That fact has to be recognized.

One thing Roy Romanow said to which we should all listen at this very moment is that there is no advantage to be gained by involving ourselves in jurisdictional wrangling and jurisdictions sniping at one another across the bow. The way to get out of that jurisdictional wrangling is for the federal government simply to acknowledge what has taken place, for right or for wrong, and to say “That is the position we are at and here is the dilemma”. Let us simply start with that basic assertion and build on that point.

Why does the government continue to hide behind the rhetoric about tax points and the money it put on the table in the September accord? Why does it continue to ignore the fundamental issue, which is a responsible, meaningful share by the federal government in health care? If we only could get that kind of understanding and statement, we could begin to rebuild our health care system.

Time and time again the provincial governments have said to the federal government that they are in a very difficult position because of the refusal by the federal government to provide anything more than the 14% share that is on the table now. In August 2001 they said “Restoration of federal funding through the CHST to at least 18% is our priority”. That was in August 2001 yet the federal government is trying to suggest that it is at 18% now. It would help to have a little honesty and straightforward discussion in the debate.

Again in January the premiers said very clearly that they are not able to deal with the growing pressures on the health care system because the federal government refuses to address the critical situation of funding and refuses to commit to more than a 14% share.

We are now at a critical crossroads. The federal government is refusing to budge. It is refusing to acknowledge its meagre share and its meagre position in terms of funding health care. The provincial governments are saying they cannot go on like this and they will have to take drastic action. We have to deal with this impasse immediately or medicare will be lost.

Our plea today is for the federal government to acknowledge the difficulty, to accept responsibility for its cuts over the years, and acknowledge this at least by putting transitional funds on the table to help the provinces through this difficult period before Roy Romanow reports in November. That is the only position left if we are truly serious about saving medicare and about building for the future.

The government has to move today. We simply cannot sit back and ask the provinces not to take any major steps until Mr. Romanow reports. We cannot do that. The pressures are building. We see it every day in terms of waiting lists, people who need drug coverage, people who are desperate for support, people who care for family members who are elderly or who have disabilities. We see it every single day. This is urgent. There must be action today.

I commend the Bloc for bringing the issue forward. I cannot support the motion in full but we appreciate having this debate.

Perhaps today the new Minister of Health will make a clear statement as to the federal government's priorities when it comes to Canada's number one issue, the state of health care in Canada today.

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

Mr. Speaker, the hon. member has been a friend of mine for many years. We sit together on the Standing Committee on Health. I can understand that she supports our position in part, but I am a bit disappointed, because it seems to me that she is not being consistent, and may even be contradicting herself.

There is not a politician alive who would object to the federal government restoring transfer payments to the level they were in 1993-94 and increasing its contribution to 18% of health care costs.

What surprises me about the hon. member's position is that she sincerely believes that the federal government knows better than the provinces how the health system should be modernized. For instance I do not see what the Romanow commission could tell us that we do not already know.

The House will recall that I asked that the work already done by provincial task forces be assessed. Seven out of ten provinces have had task forces since 1996. Quebec had the Clair commission and Alberta, the Mazankowski commission. All the provinces except Manitoba have had them.

However, I would caution the member against an approach which, because it is too centralist, would suggest that there is any help coming from the federal government when, as parliamentarians, that is not our responsibility.

It is up to each of the provincial governments to provide care directly to the public. The role of the federal government is to contribute funding, as agreed to in the 1960s, when medicare was introduced.

I would like our colleague to consider this and comment.

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

Mr. Speaker, we obviously agree on one very important issue, which is the way in which the federal government has unilaterally cut significant amounts from health care transfers over the years. We could cite chapter and verse the number of steps the federal government has taken. It began with the Mulroney Conservatives in the late 1980s and was carried on by the Liberal government when it was elected in 1993.

It got to the point where cash transfers for health care were to drop to a miniscule amount, even zero, unless action was taken. Through a lot of pressure we managed to stabilize that system of funding. However we are still in the terribly difficult position of having such an imbalance federally and provincially in terms of Canada's most fundamental program, our medicare system.

We part company with respect to the role of the federal government in transforming and restructuring our health care system. We believe there has to be a national presence, national standards, national funding and national programs in order to have one system that responds to the needs of all Canadians from one end of the country to the other.

We do not in any way support the concept advocated by the Alliance for 13 separate provincial health care systems. That kind of patchwork system, that kind of mixed response to very fundamental issues is detrimental to Canadians. It is contrary to the vision our forefathers and foremothers had of health care.

We believe that through provincial-federal co-operation we can restructure medicare. We can move our system from a costly institutional medical model to one that is preventive, holistic and rooted in the community. Through incentives from the federal government, through funding, through standards and through programs, we can shape our health care system to respond to the needs of families in their homes and communities. We can adapt and innovate medicare so it goes beyond the institutional model and looks at meeting the needs of people wherever they live in whatever region.

I suppose we have to simply agree to disagree on this one. We know that the Bloc has a fundamental issue around its own political requirements and the separatist agenda.

Let us be clear. If we are truly serious about a national vision for health care and transforming the idea that Tommy Douglas had so many years ago into something that is relevant for today, we have to do it on a national basis with more than just funding. We have to do it with some leadership from the federal government. We have to do it on a co-operative basis. We have to do it together so that we have one health care system that meets the needs of all Canadians, regardless of how much they make, where they live and whatever their background.

[Bill Blaikie, NDP, Winnipeg—Transcona, MB]

Mr. Speaker, today we are debating a very strange motion.

I do not know how to say weird in French, but what we have here is a motion in which the Bloc finds itself in strange alliance with both the government and the Alliance. It has given the Liberals far too much credit by suggesting that the Liberals have a national vision of health care which they want to impose on the rest of the country--and here is where it gets really strange--through the preliminary report of the Romanow commission.

I have not read it from cover to cover but it seems to me what I remember of the Romanow commission report was that it laid out a bunch of options for dealing with the problems in health care. How laying out options can be construed as imposing a particular vision on the provinces is strange to me.

The other aspect of the strange situation I think the Bloc members find themselves in is that the Alliance supports their motion. It would seem to me that the Alliance vision of health care is a far cry from the more social democratic view of how health care should be provided that we find in Quebec and which presumably the Bloc in some way or another supports.

If I were the Bloc mover of the motion, I would go back to the drawing board and ask myself how it is that I could have devised a motion which gave so much credit to the Liberals and which drew so much support from the Alliance. However, enough of that.

Today we have the opportunity to debate future health care in this country. There are a few things I would like to say; in fact, there are many things I would like to say but I will not have time for them all.

The fundamental thing that is being overlooked by the government is its own culpability in terms of not living up to the commitment the federal government made at the time of the establishment of medicare. It was federal money that was the midwife, that gave birth to medicare in Canada. It was the federal spending power which said to various provinces, even those that were ideologically reluctant, that it would offer the spending of 50 cent dollars on health care if they would agree to become part of the national medicare system.

It is those 50 cent dollars that are absent today. It is the absence of those 50 cent dollars that gives the provinces, even those which are lacking in any other moral high ground, a certain kind of fiscal high ground when they are talking to the federal government about health care. I am thinking in particular of Alberta. It has a point, as do all the other provinces, about federal dilution of its commitment to cost sharing health care.

I find it passing strange, and it points to the ideological dimension of this debate, that it is the province of Alberta which claims that it is under such pressure that it has to experiment and innovate even before the Romanow commission reports. Is it just a coincidence that all the experimenting and the innovation points toward the corporate sector and the private sector being more involved in health care? Why is it that Alberta feels so much pressure? Alberta does not even have a sales tax. Alberta has oil. Alberta has 100 different reasons that it does not have to feel the kind of pressure it claims to feel.

Poorer provinces like Manitoba, Saskatchewan and the maritime provinces are the ones that are under pressure. However because they are more committed ideologically than Alberta is to the principles of medicare, and appropriately so because so are the Canadian people, they are trying to make do with what they have.

It is the height of hypocrisy for Alberta to say “We are under pressure. We have to involve the private sector. We have to have more private clinics. We have to have more patient participation. We have to have this; we have to have that”. The fact is Alberta is the province most capable of sustaining the cost of health care in the province and it is unwilling to do so.

The Alberta government's real agenda is not fairness between the federal government and the provincial government, or having the federal government live up to its commitment that was established at the beginning of medicare, or anything like that.

Its real agenda is ideological. In the end it wants to turn over the health care system to the private sector so it can become another place where people make money, so that health care can become a commodity like oil. That is what is really going on here. That is totally contrary to the principles of medicare.

That is exactly what the people who fought for medicare in this country were against; the commodification of health care, the reduction of the provision of health care to a commodity in the marketplace like any other commodity. I believe that is the underlying agenda of Premier Klein and others like him.

However the problem is that they will not just do that in Alberta. If they succeed in doing it in Alberta, given the nature of the North American Free Trade Agreement and given the possible nature of the general agreement on trades and services that is being negotiated now at the WTO, it may well be that they could set precedents for private sector involvement in health care that will be binding on all other provinces.

What gives Alberta the right to do this to the rest of the country? We heard the former leader of the Alliance Party, the ghost of Alliance past and perhaps maybe the ghost of Alliance future, we do not know we will find out in March or April, talking about the horrible federal government imposing national standards on provinces. Yet he does not seem to be offended at all by the notion that by acting alone and by involving the corporate sector, particularly if that corporate sector comes to be American owned and therefore would have rights under chapter 11 of the NAFTA, Alberta might, by doing what I have just described, be imposing a burden on the rest of the country. That does not bother him at all.

I find it much more morally and politically offensive that Alberta should decide on its own to walk through this trade related minefield and at some point might step on something that will blow up not just in the face of Alberta, but in the face of the whole country.

I share the view, only I wish the federal government would express it more strongly, that at the very least the provinces, and in particular Alberta, should wait until the report of the Romanow commission before acting. Let us see what Mr. Romanow has to say before going any further. But one thing that has to be preserved, Romanow commission or not, is the basic principle at the heart of the Canada Health Act. That is, any kind of patient participation at the moment when someone is sick and in need of treatment is unacceptable.

Before the Canada Health Act, we had the Medical Care Act which laid out the five principles. Sometimes when we listen to the debate we think that the five principles of medicare were only established with the Canada Health Act. They go back further than that. What the Canada Health Act did was establish two new things. The practice of extra billing by physicians and the charging of user fees by provincial health care systems would be practices that would be sanctioned by the federal government by virtue of withdrawing from federal transfer payments to provinces the equivalent of what was being charged to patients in those provinces through the imposition of user fees or extra billing by physicians.

What is unacceptable about these two things is that it is a form of patient participation; that is when a person is sick the doctor has to be paid or a user fee has to be paid. One of the things that jumps off the page at me, and which the former leader of the Alliance seemed to be recommending, is these individual medical accounts where people have so much that they can spend and beyond that they might have to spend some more of their own money. That is a form of patient participation when someone is sick. That is a form of having to pay because one is sick. That cannot be advocated and at the same time say what the former leader of the Alliance said when he said he was against having any financial barriers to being treated. That is a contradiction. Both of those things cannot be done.

Whatever comes out of this debate, the notion that there should not be any form of patient participation on the basis of sickness or disease or need of treatment is the thing that has to be preserved if the principles of the Canada Health Act are to be preserved.

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

Mr. Speaker, I am very surprised by the hon. member's comments. With all due respect to him, there seems to be a lot of confusion in his remarks.

This is unbelievable. The hon. member does not realize that if he wants to talk about how the provinces should set up the health system, he is simply in the wrong legislature. He is surprised that there is a growing consensus in the House that the role of the federal government, based on its resources, is to restore transfer payments to the 1993-94 level.

What we have here is a centralizing vision that is backward and outdated. I do not understand how a political party can be so insensitive to what the provinces want. This is unbelievable.

Their party, which supported Pierre Elliott Trudeau for years, is even more centralizing than the late Prime Minister. Thank goodness there are in the House parties such as the Bloc Quebecois which care about the regions. Imagine for a moment what it would be like if this parliament was left to the Liberals and the NDP; we would find ourselves in a most unacceptable centralizing process.

Again, I am telling the hon. member in all friendship that if he wants to decide for the provinces how health care should be organized, he is in the wrong legislature.

I believe that such centralization is totally out of date. No one, except the NDP, believes in it. Could the hon. member name a single premier who asked that the Romanow commission rule on how health care should be set up? I am extremely disappointed.

Incidentally, I attended the NDP convention. They even adopted a motion to create a department of urban affairs. Denis Marion had asked me to attend and I spent the whole weekend there. I followed the work being done. I am telling NDP members that such centralization is unacceptable; they are offbeat and are living in a world which no one wants, and certainly not Quebecers.