Debates of June 11th, 2002

Health Care System

[Wayne Easter, Liberal, Malpeque, PE]

Mr. Chairman, I thank my colleague for the question. I believe they should be targeted to health. I talked about accountability and knowing where the dollars are spent. It is partly for that reason that the money should be targeted toward the health care system. In that way we can check if the efficiencies are being made that ought to be made through the public spending of health care dollars.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, we could continue the numbers game but I do not necessarily want to do that. We have exhausted that. He can throw his numbers and I can throw my numbers and we will go nowhere. I am more concerned with where we are going with health care into the 21st century. I am most frustrated with what I see as a system that is focused on itself. Over the last number of years anyone who wanted to be able to talk about health care as a politician was slain at the polls. Would the hon. member and I agree on one thing, that the system must change to be patient driven rather than system driven?

[Wayne Easter, Liberal, Malpeque, PE]

Mr. Chairman, the system can always be improved. That is why the Romanow commission was set up. That is why we are having this debate tonight. I am strongly in favour of a public health care system in which governments are accountable and responsible for the funding toward that public health care system and in which Canadians regardless of their status, income, stage in life or where they live have the opportunity to be able to receive universal health care services.

[Richard Marceau, Bloc, Charlesbourg—Jacques-Cartier, QC]

Mr. Chairman, I came to lend a helping hand to my friend and colleague, the member for Hochelaga—Maisonneuve.

It is a pleasure to participate in this extremely important take note debate on the future of our health care system, and more specifically on what we commonly call the Romanow commission.

First, I would like to stress the fact that, whenever the government decides to create a commission, it chooses with great care the person who will chair that commission. The government knows that the philosophy and the ideology of that person will naturally play an important role in the findings of the commission.

The Prime Minister has chosen Mr. Romanow, a New Democrat as we know, and a former Premier of Saskatchewan. We know and we often see, in the House, that the NDP strongly supports centralizing social powers in Canada; it is keen on national standards and believes that “Ottawa knows best”. The ideology of that party is one of centralization. The New Democratic culture has been left its mark on Mr. Romanow. That was my first point.

Second, Mr. Romanow, as we know—and incidentally, this happened 20 years ago this year, the anniversary was celebrated very well—, was a major player in the recent history of Quebec and Canada, when he schemed with his friend, the current Prime Minister, in the kitchen of the Chateau Laurier, to patriate the Constitution in spite of Quebec, in spite of what Quebec wanted.

These two elements demonstrate Mr. Romanow's vision: first with respect to the place of Quebec, in particular, but also to the role of the provinces in the Canadian federation.

Mr. Romanow published an preliminary report, as has been said many times in the House. From the outset, Mr. Romanow stated that Canadians do not want a 10-tiered system. He was alluding to the provinces and to Quebec.

Clearly, his philosophy is that there should only be one system in Canada, and that this system must be managed in Ottawa, this system, the philosophy, the elements, and that decisions must be made in Ottawa instead of being left to the provinces.

This also demonstrates the vision whereby there can only be one vision. This is the Canadian vision, which scorns any different ways that the other provinces, and obviously Quebec in particular, may want to proceed.

In its preliminary report, the commission completely disregarded Quebec's jurisdiction. This is something we know and we must repeat over and over. As sovereignists, it becomes tiring to have to repeat it to people who should know their constitution, since they claim to be defending it. Health is under the jurisdiction of the provinces. Health is under Quebec's jurisdiction.

How can we accept this vision of one single health care system where everything would be decided here in Ottawa? In fact, and I quote from page 43 of the report:

—governments may need to step back fromtheir traditional perspectives, decide what is in the best interests of the healthsystem overall—

This is code for saying that the provinces should abandon any hopes of autonomy and any hopes for specificity in order to fit a mould that will be cast in Ottawa. This is what this passage means.

In the preliminary report of the Romanow commission, it is already clear what direction he is headed in and what his philosophy is. We see the desire to build a uniform Canada, one that is increasingly centralized and standardized.

The preliminary report of the Romanow commission also sets out and recognizes the problem of the instability of health funding and opens the door to partial privatization of health services. It proposes a framework which assumes the standardization of health care systems in Canada and clearly tackles issues which come under the exclusive constitutional jurisdiction of Quebec.

As members know, the Government of Quebec quite rightly boycotted the proceedings of the Romanow commission because it thought it pointless. Quebec has already held its own commission to study health care and social services, the Clair commission, which tabled its report in January 2001. This report proposed tangible, specific solutions adapted to the needs of Quebec and Quebecers and it respects their health care needs.

Speaking of needs, this is an opportunity to uncover what could be seen as a bit of bad faith on the part of the federal government. Federal funding to Quebec for health care, through the Canada health and social transfer, stands at 14%. This means that for every dollar spent in Quebec today, 86 cents come from the Government of Quebec and only 14 cents come from the federal government. This contribution was slated to drop to less than 13% in 2005-06.

I hope that the minister will ask me some questions about this. I would be delighted to provide explanations and I hope that she will listen closely, as she can do.

In 2000-01, federal transfers represented only 16% of Quebec's revenues, dropping from over 28% in 1983-84.

The additional federal health transfers deposited in trust also pose many problems. The federal government boasts that it has transferred money in trust to the provinces. But it is requiring that the monies transferred be used for specific purposes. They are one-time payments and Quebec does not necessarily have the resources to hire the staff needed to use the medical equipment.

This one-shot payment in trust is not working well. This serious fiscal problem which has the Government of Quebec and, through it, all Quebec taxpayers in a stranglehold is so real that, in 2010-11, it is estimated that about 85% of Quebec's program spending will go the education, health care and social services.

What does that leave for the environment, culture, foreign affairs and recreation? When 85% of a budget goes to these basic items, it does not leave much leeway. The federal government is deliberately applying this fiscal stranglehold on the provinces.

In this two-fronted attack on Quebec's autonomy, the first front being the fiscal imbalance—and I will come back to that—and the second being the administrative centralization required by the social union agreement signed in 1999 by all provinces, except Quebec of course, and the federal government, how can the latter justify such blackmail with regard to the funding it provides, when its share of health care costs has shrunk to 13% and its share of education costs has shrunk to 8%?

Since my time is running out, I will conclude by saying that the fiscal imbalance that undermines the autonomy of the provinces and of Quebec, and this is a deliberate decision on the part of the federal government, is jeopardizing the social and economic choices of Quebecers. In the end, all the decisions could be made in Ottawa. This is the danger that Quebec is facing. This nation building process undermines the desire of Quebecers to be different, to do things their way, to have their own culture and their own identity.

The shortfall in Quebec is estimated at $50 million a week, or $2 billion a year. If this fiscal imbalance were corrected, Quebec alone could hire over 3,000 physicians and 5,000 nurses.

For the people of Charlesbourg—Jacques-Cartier, these sums represent $24 million for the current fiscal year alone and $78 million by the end of fiscal 2004-05.

These are practical measures, and this is what the federal government should work toward instead of listening to what the Romanow commission wants, which is a uniform health care system across Canada.

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

Mr. Chairman, a few years ago, in Quebec, the provincial government decided to offer pensions to doctors who agreed to retire.

This evening, the hon. member is talking about the need to recruit 3,000 doctors, and I am trying to reconcile all this. Some years ago—but this is still relatively recent—that same government decided that there were too many doctors and offered them early retirement. Surprisingly, many more doctors than anticipated took the government up on its offer.

How can we reconcile the fact that, today, they are saying that if they had more money, they would recruit more doctors with the fact that they offered early retirement to doctors a few years ago?

[Richard Marceau, Bloc, Charlesbourg—Jacques-Cartier, QC]

Mr. Chairman, I am somewhat disappointed in the parliamentary secretary not being on top of the news. First, he should know that, following an agreement with the Collège des médecins, enrollments in Quebec's medical schools has increased significantly.

Second, I said that if the tax imbalance issue were solved, Quebec would be able to hire an additional 3,000 doctors and 5,000 nurses. That is what I said. The parliamentary secretary and the minister cannot deny that.

Getting back to these figures, the Séguin commission used a study from the Conference Board of Canada, which is definitely not a haven for separatists, nor is it a PQ office or a branch of the Mouvement national des Québécoises et des Québécois. It is a completely independent organization with a federalist tendency, and it makes no bones about it.

The fact is that the needs are glaring and that the shortfall, the tax imbalance is of the order of $50 million per week, or $2 billion annually, which means $24 million for the riding of Charlesbourg—Jacques-Cartier. These are concrete figures.

And how many problems could have been solved by simply settling the tax imbalance issue?

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

Mr. Chairman, everyone in the House knows that the minister of health is a constitutionalist.

I would ask my colleague this: if he had to correct the health minister's exam and found that she had answered a question by saying that a national health act as we have at present was justified, would our colleague have written a note to remind our constitutionalist health minister of which powers relating to health, according to the very terms of the constitutions of 1867 and 1982, are federal and which belong to Quebec?

Perhaps for the sake of our colleagues, that distinction needs to be made.

[Richard Marceau, Bloc, Charlesbourg—Jacques-Cartier, QC]

Mr. Chairman, I see that the minister is very eager to hear the explanation.

The member for Hochelaga—Maisonneuve is spending a lot of time in law schools these days, which means that his legal and constitutional knowledge is really up to date. I know that the Minister of Health will appreciate the importance given to the legal profession by the member for Hochelaga—Maisonneuve.

Of course, according to the division of powers, health is a provincial responsibility. The tool used by the federal government to interfere in the area of health care is the spending power.

Very recently, I had a most interesting conversation with Eugénie Brouillet, a doctoral student in constitutional law at Laval University who specializes in Canadian federalism. She explained to us how the spending power theory undermined the very principle of federalism because it prevented or removed any real separation between the various levels of government.

We know that a federation is defined by the distribution of powers among different levels of government. By introducing the spending power theory, the Canadian federation has undermined the very principle of federalism. As a result, Canadian federalism has lost many of the elements that are usually the trademark of a federation.

We could take other examples. The most recent is the social union agreement. It is the latest example of this distorted vision of Canadian federalism that the federal government has.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, I want to do something that is unheard of in the House. I want to take politics away from this discussion and talk about the substance of this debate tonight.

Mr. Romanow talked about four themes when he presented his interim report: values, sustainability in funding, quality and access, and leadership collaboration and responsibility. I would like to deal with those four issues in the order in which they come.

The first is values. Mr. Romanow talked about how the Canada Health Act reflects the values of Canadians today. When the Canada Health Act was first written and medicare's inception began in the late 1960s and 1970s Canadians believed in certain values. The question he is asking is are those values still as valid today?

We have been to town hall meetings and talked with our constituents in roundtable discussions. We have listened to the public, to patients and even the provinces at the first ministers conference on health reform in 2000. All agreed that those values are unchanged. The values that we espouse under the five principles of medicare: public administration, comprehensiveness, universality, portability and accessibility are all still as real for us as Canadians today as they were in 1969.

However let us ask ourselves, what has changed? Why is it that even though we still espouse these values we are having this debate? Why are we discussing medicare right now? The thing is that since 1969 our country has changed. There are so many pressures that have been placed on what was inherently at one time a good system.

One of the most important things that we must remember about the system is that it started as a system that would ensure that when Canadians became ill they would not be bankrupted or have to sell their homes to be able to take care of their families when they became ill. That was the basic principle behind this medicare system as we have come to know it today.

At that time we were looking at whether or not we would only deliver care. This medicare system decided we would deliver care in hospitals only and that it would be for physicians only. It began as a physician and a hospital centred service. What has changed since then is that we are delivering care everywhere. Not only are we delivering care in hospitals, but in homes, long term care centres, palliative care institutions and in the community. That has changed.

We are coming to realize that physicians are not the only people who can deliver care to people when they are in need and when they are ill. We know that we have nurses and nurse practitioners. We have chiropractors. We have many health care professionals who are capable of delivering certain types of care as required when patients become ill. The whole concept has changed and we have seemed fixed into this area.

This is what the federal government does when it transfers payment for health care. It transfers payment under the concept of paying its share for physicians and hospital service only. As time went on and as provinces that deliver service realized that they had to take care of all these other places where services were delivered, all the other types of services that were required, we began to find that there began to be pressures in the system.

The provinces began to focus on paying for health care, for services and programs that were outside those two original areas. This was a second area where pressure began. Therefore the question is, if we still believe in those values how do we deal with those questions?

We also find that the technology has changed. We have technology that can tell us anything we want to know about diagnostics, about care and treatment. People are living longer so the chronic degenerative diseases that we never used to see in the old days are now there. We spend a lot of the money in medicare at the last stages of life and in the latter years of life as well as in the early years of life. We are finding that we can deliver babies earlier and that they can survive earlier. So we have all of this technology coming into play.

Finally, as a result of all of this new knowledge, we find that patients are beginning to expect more of their system. Patient expectation is also a huge pressure that is driving the system.

I remember I once had a friend who said to me “I think today because of so much technology and all the things we know that everyone thinks that death is an option”. Therefore, we want to plug into every single thing that we can to ensure we have what we need when we want it.

I use the word “want” and that is another pressure on our system. Canadians have come to expect that they can have what they want, when they want it. The medicare system is designed to give Canadians quality care when they need it, in a timely, accessible and cost effective manner. This is where we have to start focusing our debate.

That then moves me into the second theme and that is sustainability and funding.

How do we sustain a system that has evolved so rapidly and that will not take another 30 years to evolve? It is evolving as I stand here right now. There are changes. There is fluidity in the system. Evolution is occurring and something new is being discovered every day. We are debating new reproductive technology. We are debating all kinds of new things. We have a new armamentarium of tricks up our sleeve to diagnose and to keep people living for a longer period of time.

We will not have to find an answer to the question today, but we will have to find an answer that is flexible and that can evolve as this evolution continues. That is one way to look at sustainability.

Funding is a huge issue. I think we have all bought into the 70:30 split in public funding/private. However there is a bigger question because of the variability of opinion. Some people say that because we have the 70:30 split we should have a private system and those who can afford to pay can use it. They say that this will take the pressure off the public system, it will solve the problem and everything will be fine.

However that goes against the values. Let us not forget that these five themes are interconnected. The values tell us that we do not believe that anyone should be bankrupt when they need care or that anyone should be denied care when they are ill because of a lack of ability to pay. Therefore, in that very concept we have accepted the fact that we will never have two classes of citizens, one class that can afford to be well and one class that cannot afford to be well. We have already bought into that concept, so let us not even debate that.

What happens when a system is developed where one class of people can pay and the other class cannot, whether it be full pay or a user fee or all those other things that are suggested? Having practised family medicine for 23 years and having delivered a thousand babies, some people who cannot afford to pay will not care. They will accept charity and get those services free while others will have to pay. That is wrong.

So many of my patients who were low income people had a sense of pride. They did not want some sort of charity. They wanted to pay their way. There are families of working poor with three children for whom a $5 user fee for each child is a huge amount of money. Therefore user fees already create a barrier to one of our principles and that is accessibility.

Then we have people who say that we should look at those who can afford to buy premiums or that we should have an escape valve and people can buy different kinds of premiums for different kinds of things from private insurers.

Many people do not speak about one of the five principles of medicare and I would like to touch on that. It is called universality. What people do not know is that universality means that there should be no pre-existing conditions considered in medicare. There is no insurance service anywhere else in the world that does not consider pre-existing conditions.

The fact is no matter how rich people are, if they suddenly develop a long term chronic disease, their first year will be fine. In the second year in a private insurance company their premiums will go up. In the third year they will become completely uninsurable and no matter how wealthy they are they will end up selling their houses to get care. That is not what we want.

We have to deal with this in a different way. We have to look at the issues of leadership and collaboration. We have to talk about how we get it. We have to talk with the provinces. We have to get away from this blame and pointing finger attitude that it is their fault or our fault. Let us talk about how we can sustain a system that we know must be there for Canadians.

Let us talk about how we define what is medically necessary so that we give people the health care they need when they need it, and what they want they can buy. The need and the want are two very important things, so let us redefine what we mean by medically required services.

Let us not do this in an arbitrary way. Let us do it by looking clearly at what we call clinical guidelines and evidence based care. We have that information today. Let us put aside the rhetoric and the politics and talk about something that is so important to all of us and to all Canadians. Let us decide that we will share the responsibility as a federal government and as provinces. Let us work together in a collaborative manner to find solutions not just for certain Canadians and certain provinces but for all Canadians no matter where they live or work, whether it be in rural, isolated or urban Canada or on the east or west coasts.

In closing, perhaps one of the ways to do this is to bring forth some sort of commission that can take away the politics occasionally, that can give us the evidence, the outcomes and the results, that talk about funding and that give us the statistics so that--

[The Acting Chairman (Mr. Milliken)]

I regret to inform the hon. member but her time has expired.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, my questions are quite simple when it comes down to it. When we look at health care, we see some major problems. There is no question of that.

My hon. colleague talked about the Canada Health Act and the values of it. I think we bought into that as a nation and that is fine. However those five principles were set up in 1983-84 and the health care system has changed significantly since that time. We have a system now where the technologies have changed, drug therapies have changed and who delivers health care has changed. That act was set up really for primary care and only for primary care. The system has evolved so much more since then.

The obvious question is this. Does the Canada Health Act, which contains the five principles, need to be freshened up and does it cover all the bases to sustain a system that is affordable for everyone, regardless of their financial means, and that moves us ahead into the 21st century? Does it deal with time limits? Does it deal with accountabilities? Does it deal with quality of care and some of the things that we cherish and want to have in our health care system? This is why we are saying that the system must change from being system driven to patient driven.

Would my colleague like to comment on the areas of the Canada Health Act that need to be spruced up? Perhaps she could comment as well on the sustainability of the system as well as the funding as one of the principles.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, that is an interesting question because originally when we looked at the Canada Health Act, which was going to pay for physicians and hospital services, it was not only primary care, it was also for secondary and tertiary care, whatever care was needed in a hospital setting.

As many people said in the House, that has changed. We need to now look at the Canada Health Act differently. If the Canada Health Act is the instrument that will serve whatever it is we wish to do with our medicare system, our health sustainability and broader areas, we will have to talk about what we mean by delivery of care. Where is the care delivered? We are not only going to talk about hospitals. These are questions we need to ask.

Should the Canada Health Act therefore look at home care, long term care, palliative care and community care? If so, how would the provinces come on side and collaborate with the federal government so that we could enter that domain? If we do enter that domain and decide that we would like to fund those areas, which right now are not in our jurisdiction, then that would be an excellent idea. However the question then would be, what things would we have to do in terms of the accountability? The member asked about that. What would be required of the provinces? What would be required of that new funding? Then we would have to talk about how we would judge outcomes, how we would look at national standards for home care, long term care, palliative care and community care?

When I talk to Canadians, they do not particularly care who pays and what level of government is responsible for what. They just want to know that when they are sick or their families are ill that they can go wherever they are and get the quality care they need.

The time has come for us to make the federation work, to really talk about Canadians as people who need their levels of government to come together. It is time we talk about how we open up the Canada Health Act and look at ways in which we can redefine where we deliver that care? Who are the people who will deliver that care because it will not only be physicians? Who are these people? How will we move in and collaborate in some of these areas? How do we define what is medically necessary? We need to use an evidence base to do that and not arbitrary measures like age, where people live or any such thing. What are the evidence base guidelines that we know would dictate necessary care?

We need to talk about those kinds of things when we talk about the Canada Health Act. Obviously we have to look at the Canada Health Act in a completely new way and see it as a tool to define where we want to go. However we have to decide where we want to go and how we want to do that, then let the Canada Health Act serve as the legislative tool for helping us to deliver the system we want.

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

Mr. Chairman, since the member for Vancouver Centre earlier questioned the accuracy of statements that medicare was originally funded on a 50:50 cost shared basis, and since like all Liberals tonight she is dodging the questions about the federal role in financing health care, I want to put to her a recent statement by the hon. Monique Bégin, under whose ministry the Canada Health Act was established, and ask her if she agrees.

Monique Bégin said last February:

This legislative federal transfer [CHST] mechanism should be rescinded and a new Act written that would cover only health financing. The whole contentious issue of the value, and of the very fact, of tax points’ transfer to the provinces should be put to rest once and for all...Tax points transfers are a taxation capacity lost forever and they carry no enforcement power whatsoever. So let us stop talking about them. For both accountability purposes and for good governance, we should revert back to the spirit of a 50-50 cost-shared arrangement, block-funded by cash transfers established in multi-year blocks.

Will the member for Vancouver Centre indicate if she supports this approach?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, that is an excellent question which deals with what we are debating here. No one has yet been able to come up with a decision on where we want to go, how we want to fund and what the sustainability of the funding is. The federal government does not have within its jurisdiction the ability to do this on its own. Where we go and how we fund is something that has to be decided on with the provinces.

People have been knocking the CHST and that block funding. It was based on some fairly sound policy principles that may or may not, at the end of the day, have been proven to work in terms of their implementation. However the concept was that if the health of a person was dependent upon things other than just disease or the lack thereof, and upon issues like poverty, the environment, et cetera, that if we gave funding to a province which had within it social, health and education components, then it allowed the provinces to use this to influence some of the determinants of health and other areas which would have an impact on the health of the individual.

We must ask: Is that a viable thought? Should we go with that or should we fund health care as a simple block piece for health only? If we mean that, are we talking only about medicare or are we talking about prevention and promotion? Are we talking about rehabilitation and palliative services? Are we talking about research and development? Are we talking about infrastructure? What are we talking about?

This is not a simple question. It is a nice and simple statement to make but inherent in that statement are huge and complex issues that we must talk about. That is part of what we are doing here today. I do not think we are here today to come up with definitive answers and I will not stand here and say that I have the answers at all. What we are trying to do is exchange ideas, hopefully in a manner which at the end of the day will benefit Canadians.

There is merit to some of that but it must be examined under a microscope. We must look at what it means. It certainly is not something that the federal government can do on its own.

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

Mr. Chairman, I would like to begin by thanking my colleague for her excellent presentation, especially when she mentioned that she had tried to make her speech non-political.

I think that all of us often have a collective responsibility for the expectations that we have created in the public by speaking about free care. The result has been that, very often, people demand services based much more on what they want than on what they need, as my colleague mentioned.

I would like to know what her ideas are. How could we reverse this trend and redirect it towards the availability of services based on needs?

At one point, my colleague spoke of a commission. I would like her to elaborate and comment on this.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, as my hon. colleague would know because he is a physician himself, there has been a lot of work done over the last 10 or 15 years in terms of looking at clinical guidelines. We now know that there are clear clinical guidelines, for instance, on how to know whether an ankle that is twisted and swollen is sprained or broken. Therefore inherent in that question would be some clear guidelines as to whether to do an x-ray or not, because an x-ray is an extra cost to the system.

If we have some of these guidelines it is something we can use. It means that governments should collaborate and work in close partnership with health care professionals and the people who are doing that kind of research.

At the end of the day if we had some sort of health commission it could look at outcomes and stop the finger pointing and the idea that it is the fault of the federal or provincial governments. It could look at clinical guidelines that were set by various health care associations, bodies or colleges. It could decide whether the outcomes are good, whether the quality is being achieved, and whether there are cost savings.

We know that to spend a day in an acute care hospital costs anywhere between $800 to $1,200 a day, yet the cost for a person getting home care or care in the community could be anywhere from $120 to $200 a day. We need to have people who do not have political stripes on them in any way to look at that.

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

Mr. Chairman, this is an interesting evening as we enter this health care debate. Members from all sides of the House have been expressing their views on this important issue.

What can we do to satisfy the health needs of Canadians? It is an important issue to many of the constituents in all of our ridings. Many Canadians have expressed to all of us individually as members of parliament their concerns about the state of our health care system and where it is going.

I was interested in the health minister's comments tonight as we started off debate. She indicated that Canadians are concerned about timely access to quality care. Tonight she started off by saying she wanted to address values. What should be covered? How should we pay? How should we provide the services? What values do Canadians want to see in their health care system and what values are needed?

My colleague from Yellowhead mentioned that in our consultations with Canadians we learned quickly that Canadians are concerned about timely, quality, accessible care and they want care available to all Canadians. My colleague from Kelowna spoke tonight. He mentioned that seniors are particularly concerned about the setting of their preference, in addition to timely, quality, and accessible care.

We are now over $102 billion in health care spending. Why are we doing so poorly in outcomes? Why do we have such long waiting lists, shortages of personnel and why are outcomes so poor when we are spending so much?

I heard the minister say earlier that Canadians are tired of seeing their valued health care system sliding away while politicians argue and blame each other over funding, jurisdiction and their visions. Could it be that we are spending a lot of money for a high cost system that delivers what has become a low value product? I am one who believes we are spending enough money on health care. We could do a lot better if we perhaps spent it in a different way. A lot of Canadians would share that perspective.

This subject has been studied and studied. In British Columbia the Justice Emmett Hall study was done in 1979. In 1997, just prior to the last election, there was a National Forum on Health which spent about $12 million. We have had provincial studies: the Fyke commission in Saskatchewan and the Clair commission in Quebec. We have had the Kirby Senate reports that are ongoing on health care and the Mazankowski report recently tabled in Alberta. Now we are waiting for the Romanow study to be completed in the next few months. That is another $15 million of taxpayers' money going into a study. What will we do to fix this situation?

My colleague from Yellowhead indicated earlier tonight that researchers from the Library of Parliament studying this said that the federal Liberals have spent $242 million studying the health care system. We do like to study health care.

One I did not hear mention tonight is hot of the press and sure to add fuel to the fire of discussion. It is the Canadian Medical Association document “Prescription for Sustainability” that was just released on June 6. Its prescription is on behalf of more than 53,000 physicians. I am sure there will be valuable and interesting suggestions and no doubt will add to the debate in the days to come.

I want to address a few major concerns. One of them is the cost of drugs and the effect of drugs. Health Canada has received in the vicinity of 7,400 domestic reports of suspected adverse reaction to health products in 2001. These were reported for the most part by health professionals either directly to Health Canada or indirectly through another source. It is unknown how many cases go unreported. According to the government's own data doctors report less than 10% of all reactions.

About 51% of Canadians have taken more than one prescription or non-prescription medication on the same day. Yet 61% of the same people do not always check with their doctor or pharmacist about possible interaction, according to a Pollara study. The need for mandatory reporting of drug reactions is something that needs to be addressed. The high number of casualties from iatrogenic causes, that is doctor caused, or inappropriate use of medications, is a terrific cost driver and a mortality driver and a serious concern for Canadians.

Another issue is independent drug approval for children. Children are routinely given lower doses of drugs than are approved for adults and yet they are at a greater risk than adults for developing a severe reaction. Drug research is not currently performed on children, and without a more reliable regulatory body the safety of adult drug use in children is unknown.

Emphasis needs to be placed on the differences in the pathogenesis of adverse reactions between children and adults. A recent study indicated that physicians are notoriously bad at mathematics when it comes to deciding what a dose should be for a child. This was responsible for overdose situations for children in a large number of cases. Nurses are a bit better with a pencil. This is a serious concern and something that needs to be addressed.

In addition, we have problems with drugs being imported, ordered by mail or on the Internet and mailed into Canada. I am speaking of drugs that are not available in Canada such as Prepulsid that Vanessa Young died from. Drugs coming across the border are a serious issue and we have no means of controlling it.

The increased cost of drugs is a huge problem for seniors as well as their safety. My colleague mentioned that about 30% of seniors are addicted to prescription drugs and with questionable clinical outcomes. The amount that we are currently spending on drugs is about $15.5 billion of that $102 billion.

Another serious issue involves aboriginal communities. In the Regina Leader Post on May 13, Dr. Henry Haddad, president of the Canadian Medical Association said, “Aboriginal health is a national tragedy and a national shame”. That is in spite of $2.3 billion in federal spending for aboriginal health.

Diabetes is three to five times more prevalent in aboriginal communities as it is in the general population, according to Health Canada. It is increasing at a rapid rate among aboriginal people. Before 1945 diabetes was almost unknown in aboriginal communities. If it goes unchecked at the current rate it is expected that 27% of all aboriginal people in Canada will have diabetes. Even aboriginal children are now being diagnosed with type II diabetes which was generally associated with older people.

What is happening to our aboriginal people? In coastal aboriginal communities in my area there is a saying, a philosophy, which is called Hish Tukish T's Awalk . It literally means “everything is one”. We are part of nature and nature is a part of us.

I want to address this issue on a different angle. Health is not something that is here one day and gone the next. Health is built over time by the choices we make, including lifestyle choices: what we eat, what we drink, the quality of air and the quality of water that we drink. All of these are part of building healthy bodies.

Exercise is also an important part. Exercise is promoted in cancer therapy for breast cancer and there are higher survival rates for those who actually pursue physical exercise such as the dragon boats that are popular with breast cancer survivors and even those undergoing treatment. Building healthy bodies ought to be a focus for Health Canada, and indeed it is a focus for many Canadians.

Many Canadians find that if they look after their physical, mental and spiritual well-being they will not get sick. They find that they do not get sick as often and if they do they recover more quickly. Building healthy bodies ought to be as much a concern for the health department as it is for Canadians. That has been my vocation for quite a while. I have spent some 25 years as a health care provider trying to build healthy bodies.

We need to address effectiveness and cost effectiveness. The system needs to become more patient focused rather than system focused. A lot can be said about manpower shortage as mentioned earlier tonight. Nurse practitioners could play a large role by helping out doctors with the care they have trouble providing. According to some studies perhaps 80% of what a physician does could be done by nurse practitioners.

Low back pain is a major factor in our society and also a major cost driver. A study was done by Dr. Pranlal Manga, a health care economist at the University of Ottawa, on the effectiveness and cost effectiveness of chiropractic treatment of low back pain.

Hundreds of millions of dollars could be saved provincially and on the national scale up to $2 billion by simply sending the patients preferentially to a treatment that works better than drugs or surgery. Why is it that there are financial disincentives when people choose another form of health care?

Simple nutritional supplements can make a big difference in a person's outcome. Why is it a substance like chromium picolinate which is very helpful and necessary in the management of blood sugar and necessary for the glucose tolerance factor is on a restricted list with Health Canada? These questions and others are ones that Canadians ask me. Why is Health Canada not more interested in promoting health than in continuing to fund a system that focuses so much on illness?

With these questions I add to the others that have been raised tonight and with my colleagues submit them for consideration as part of the dialogue. We are looking for answers. I believe there are more cost effective ways to deliver health care to Canadians and that is what we are looking for.

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

Mr. Chairman, I certainly appreciate the suggestions made by the Alliance member on how to renew, strengthen and reform our health care system. Most of those suggestions I agree with.

I am really curious about where the Alliance stands when it comes to the issues of management, funding and support of our health care system. Earlier when I raised questions about the Alliance position of support for two tier health care or support for such things as user fees and medical savings accounts, the health critic for the Alliance reacted vehemently and left the impression that the Alliance position had changed.

My question for the member is does the Alliance Party support public not for profit health care? As part of that question, does he agree that it does matter who delivers health care and who controls the corporate structure of a hospital, a health care clinic or any other facility?

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

Mr. Chairman, I know the hon. member has a passion for health care and for seeing people well and for finding answers for sustainable health care.

As stated in our policy, “ensuring timely, quality and sustainable health care is available to every Canadian regardless of financial means” is part of our policy. We are looking for answers so that Canadians can receive value. Value is something we mentioned. We want to talk about Canadian values tonight. It is value in health care delivery that we are actually interested in pursuing.

On the issue of sustainable funding, we would add another principle to the Canada Health Act and that is sustained funding. We would ensure that the federal government cannot unilaterally withdraw funding from the provinces and leave them hanging out to dry in the delivery of the services.

We believe that sustainable and predictable funding so that health care budgeting is possible is really important. In the management of health care it is finding value, and that is effectiveness and cost effectiveness. That is something we need to pursue. It is something we are interested in pursuing, giving Canadians a choice in services they receive and making sure that they get value.

That is something in which the federal government can play a positive role. Nearly $1 billion in health care research funding is available to us. The federal government, rather than telling the provinces what they should and should not deliver, should be providing a leadership role in making sure that if there is another way of doing business, another way of delivering effective care to Canadians that it will put research dollars into checking it out. It must make sure that Canadians are getting cost effectiveness and value for their health care dollars.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, I was interested in the hon. member's presentation. There are a couple of words that the hon. member used. Value as defined by Mr. Romanow had to do with how we felt about the principles of medicare, et cetera.

On quality care, how does the member propose that we define quality care? For me, and from the Canadian Medical Association document which the hon. member referred to, quality care will obviously be defined by evidence based analysis, by looking at outcomes. When defining how a person is getting their health care, value is not necessarily a word in that case. It would be how we define quality accessible care.

I would be interested in knowing how the member would define quality care. Does he believe it is important to have evidence based outcome analysis? Does he believe it should be done by a third party as suggested by the Canadian Medical Association and the Canadian commission on health?

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

Mr. Chairman, quality care is certainly an interesting concept but how do we make sure that we are getting quality? For the dollars we spend we have to look at outcomes. Are we actually delivering the product that we are purporting to deliver when we undertake a procedure?

The hon. member for St. Paul's who is also a physician mentioned that politicians lack the courage to address the issue of many outdated procedures that are not actually delivering value. She made a very good point. Where do we get the idea that if a physician orders every test in the book that it is good medicine? Frankly many tests are performed that actually are not needed.

I asked a surgeon that very question recently. I know it is not how he was trained. The hon. member opposite was trained in clinical and differential diagnosis so she could determine which tests were more likely to be necessary rather than just testing everything. The physician was not too happy with the question but his response was that there are two drivers.

One driver is patient expectation. Somehow patients expect that if they take every test in the book and it takes three weeks, six weeks or 10 weeks to do it, that this is good medicine. One of the problems is the patient has no idea what these tests cost. Worse yet, the physician has no idea whether they cost $300 or $3,000 or $30,000. That is a major concern.

The other driver is that nobody has been sued for taking too many tests. That is a major driver in our system as well. When we are talking about quality care we have to make sure that we are actually getting value for what we are doing rather than just doing procedures for the sake of doing them.

[Paddy Torsney, Liberal, Burlington, ON]

Mr. Chairman, I truly appreciate the opportunity this debate offers to join with our colleagues in reinforcing the government's commitment to quality health care. It has become a fundamental part of our national values and heritage.

I wish to focus my remarks on two issues this evening, the federal government's monetary contribution to health care and the need for new services which are important to my constituents, including home care and end of life care. I would have preferred to focus my speech primarily on those two issues, but the level of misinformation and hyperbole around federal spending on health care clouds the debate so completely that I am compelled to set the record straight.

There is no question that people are deeply concerned about the challenges, especially regarding financing, that confront our system. However, our government has a priority that is clear and concrete and that is to work through partnership with all levels of government and all stakeholders to provide Canadians in every region with the public health care system they need and rely on. It is not rhetoric. We have backed this priority with real action and with bottom line results. Almost 70% of all the new federal spending initiatives that we have undertaken since balancing the books have been in just three areas: health care, education and innovation.

Indeed, since the 1999 budget the federal government has announced increases in funding to the provinces under the CHST alone totalling $35 billion. These funds are available to the provinces to use as they see fit on health care, post-secondary education, social programs and early childhood development. Moreover, when we look at major federal cash transfers to the provinces, both the CHST and equalization money is expected to increase more than three times faster than the growth in federal revenues over the next five years.

Let us look at the facts for a second. The first ministers agreement of September 2000 on health care renewal and early childhood development provided $23.4 billion in increased funding to provinces and territories over five years: $21.1 billion for the Canada health and social transfer; and $2.3 billion for new targeted investments in medical equipment, primary care reform and new health information technologies. These investments in particular will lead to innovations in health care, increased support for doctors and nurses, the availability of new MRI machines and other medical equipment. By 2005-06, CHST cash will reach $21 billion, a $5.5 billion or 35% increase over last year's levels.

The cash transfers are only part of the story. It is only fair to include in the CHST calculation the value of the tax points that we ceded to the provinces at their request in 1977. This year the value of these tax points will reach an estimated $16.6 billion. If we take the two numbers together it means that the total value of the CHST to provinces this year, cash and tax points, amounts to $35 billion. Again, that is only part of the federal health care story. The federal government provides eight of the 10 provinces with equalization payments which they are free to allocate as they choose. Currently those payments exceed $10 billion.

Added together, federal transfers currently cover one-third of all provincial health care costs. We have to recognize that federal support for health care extends beyond transfers. This debate is not just about money. My constituents are concerned about what basket of services we are funding.

As part of her work with the provinces, I encourage the minister to work on improving what those services are that are available across the country. Home care and end of life care are of critical importance to my constituents.

On the home care front, anecdotal evidence shows that a lack of home care is definitely forcing people into hospitals, is straining families and is causing harm. I had a constituent who recently came to me. He had his two hours of home care per week cut. He needed help recently, but rather than having access to a home care nurse he was told to call an ambulance to deal with his nose bleed. He spent several days in hospital and cost everyone a lot of money. Frankly, I agree with his concern that a few hours per week would have prevented a whole series of other costs within our system and would have had a better impact on his quality of life.

On the hospice front, in Burlington we are extremely fortunate to have a wonderful new facility, the Carpenter Hospice, which recently opened its doors. It will provide terminally ill people with better end of life care than would ever be possible in a hospital. Our community identified a need, raised the funds, found the volunteers, found the donated land and built a truly beautiful facility, where I am confident excellent care will dramatically improve the lives of patients and their families.

Unfortunately, provincial health care dollars are not provided in these facilities and our national system did not plan for this kind of expenditure.

In our area, a recent Maclean's annual health report identified that the Mississauga-Brampton-Burlington area ranked in the top four communities in Canada offering the best health care services. It is not news to me or to the people of Burlington. Our Joseph Brant Memorial Hospital offers exemplary service and medical care, yet it faces the same challenges and struggles all hospitals face, exacerbated by a critical shortage of primary care physicians. Far too many families in my constituency do not have a family doctor. We have a physician recruitment team in my community. Northern and rural communities face this issue to an even larger extent.

Canadians want to know that the federal government is looking forward, that we are providing funding and support for all types of medical research. We need to advance research into AIDS, cancer, diabetes, ALS, Parkinson's and multiple sclerosis, to name just a few. The new CIHR system is funding, in unprecedented ways, research into these illnesses and others, and our new reproductive health legislation will ensure we are able to participate in important stem cell and genetic research to help unlock the mysteries of these diseases.

Finally, as chair of the Special Committee on Non-Medical Use of Drugs, I must say that we must do more to ensure that we are providing Canadians with education and health promotion so that they can make informed choices about risks related to occupations and recreations, about drugs and about participating in healthy activities. As well, I believe we need to ensure that there is available across this country much more treatment for those who are addicted to drugs and alcohol.

Canadians support the fundamental values of the Canada Health Act, the values of universality, portability and accessibility. The Romanow commission and its public consultations are very important to ensure that we find realistic solutions to the health care challenges that face us, that we have the flexibility in how and where health services are available, and that Canadians have decisions made that are realistic, rational and reflective of the reality of their lives. They want governments to show openness to new ideas and alternative delivery.

This debate and the work of our Minister of Health and her parliamentary secretary will ensure that we get the services and the products that all Canadians have come to know and love.

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

Mr. Chairman, first I would like to thank my colleague for her excellent presentation. She was particularly good at explaining how the Government of Canada makes contributions to the provinces, and that it is not simply transferring cash, but that there are also tax points and equalization payments. Very often, the provinces try to tell the public that they only receive cash transfers. It is important that Canadians understand how it works.

I would like to know what she thinks about the formula currently being used to calculate transfers. Should we not target the money we transfer specifically for health, rather than the current formula, which includes health funding with education and social programs? I would like her opinion on the matter. Does she believe it would be better to target certain amounts for health specifically?

[Paddy Torsney, Liberal, Burlington, ON]

Mr. Chairman, as the parliamentary secretary will know, we in fact responded in our first mandate in office to a desire from the provinces to have more flexibility in investing in the areas they thought were important. The problem with that, of course, is that then we leave ourselves open to this attack that we are not funding the things that they thought we were supposed to be funding or that we have somehow restricted them. I do not think that is very fair.

I think that if there were more honesty and accountability and perhaps tied funding, as we have done with the equipment funding, Canadians would actually be able to track those dollars and see the benefits of their federal spending as well as of the provincial spending.

We do have to make sure that we have some flexibility in what is important. With the drug committee we have been to the Vancouver east side. There they are asking for different kinds of treatment in health interventions which would not necessarily be appropriate for my community or other communities across the country.

We have to make sure that the provinces have flexibility, but I do think we are going to have to look at tying some moneys to specific needs, as we did with the medical equipment fund and as I think we are going to have to do with treatment dollars, so that there is no excuse and Canadians looking for those services can find them in their own provinces.

That is another thing I am sure the parliamentary secretary has heard from constituents in his riding and other places. We need to separate the myth from the reality. All kinds of people have come to see me about health care but they have not had an intervention lately. By and large, the people who are having issues and who are receiving health care are extremely satisfied with the level of care, with the innovation that is taking place at the local level. By and large, they are extremely pleased.

Of course there are some people who have had difficult situations and they need to be addressed, but the people who seem to be most concerned or fearful that it has all gone to hell in a handbasket or that we need to introduce a private health care system are people who have not actually had any interaction with the health care system and in fact have bought into some of the myths.

I think the parliamentary secretary has hit on an important issue and that we perhaps very much do need to look at reconstructing those dollars and at tying the money to the services that Canadians have told us are important.

[Irwin Cotler, Liberal, Mount Royal, QC]

Mr. Chairman, this take note debate on health care comes at a most important and propitious time, for wherever I go in my constituency of Mount Royal, if not in the country as a whole, Canada's health care system is held out as the litmus test of society, defining who we are and what we aspire to be, a caring, sharing, responsive and compassionate people.

The federal-provincial-territorial agreement of 2000 was an important step forward as a comprehensive, sustainable and renewable health care system for the 21st century wherein, inter alia, the federal government is investing more than $21.1 billion over five years through the Canada health and social transfer agreement.

The agreement should not be measured in dollars and cents alone, however crucial the infusion of monetary resources. Most important, apart from the re-commitment to protect the integrity of the five basic principles of Canada Health Act, is the commitment to a sustainable vision of a renewed and revitalized health care system, including a commitment to work together on eight specific health care priorities, which are as follows.

One: increasing the supply of doctors, nurses and other health professionals in order to better meet current and emerging demands for health services.

Two: improving primary care, the first point of contact for Canadians with the health system, so that they can have access to the right care, by the right provider, when and where they need it.

Three: strengthening home and community care in order to relieve pressure in the more than one in five Canadian families currently caring for a sick or elderly family member at home.

Four: co-ordinating efforts to manage rising costs for pharmaceutical products, the fastest growing cost component of our health care system.

Five: supporting the development of common indicators and monitoring so that we can measure, report and improve health system performance.

Six: harnessing the potential offered by recent advances in information, Internet and communications technologies to enhance access to and better integrate the delivery of health services and electronic patient records.

Seven: investing in new and more advanced health equipment, like MRIs and CAT scans, to reduce wait times for diagnostic and treatment services and improve the quality of care.

Eight: renewing performance standards and expanding the use of standards.

It is not surprising, therefore, that the Romanow interim report asserted that “for many Canadians the concept of Medicare, as expressed by the Canada Health Act, is a defining aspect of their citizenship”. Accordingly, what I would like to do now is share with the House briefly 12 principles that would underpin an equitable, universally accessible, responsive and sustainable publicly funded health system and one that, as the Romanow interim report put it, would offer “quality services to Canadians and would strike an appropriate balance between investments in prevention and health maintenance and those directed to care and treatment”.

Principle number one is health and human rights, the right to health as a fundamental human right. Recently we commemorated the 20th anniversary of the Canadian Charter of Rights and Freedoms, the centrepiece for the promotion and protection of human rights in the country. While there was a good deal of discussion about fundamental freedoms such as freedom of religion, expression and association or about legal rights such as the right to protection against arbitrary arrest and detention, or economic, social and cultural rights, we heard very little about health and human rights despite the critical link between the two.

Simply put, we tend to ignore that there is a universally recognized, though not universally publicized, human right to health. As set forth in article 12 of the international covenant on economic, social and cultural rights, it recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.

Accordingly, those engaged in the struggle for human rights must always remember that the right to health care must be a fundamental goal, that the right to health is not just one right among many but is at the core of the human rights edifice, that it is the foundation of autonomy as autonomy is the foundation of humanity, and that when we struggle for the rights of the poor, the rights of women, the rights of the minorities and the rights of the oppressed, one must always remember that without the right to health, all other rights become a mere chimera. This is particularly true with the struggle of many in the developing world for the most basic rudiments of a healthy life, if not life itself: clean water, immunizations and AIDS prevention, just to mention a few.

Principle number two is health care and Canadian values. An equitable and universally acceptable, responsive and sustainable publicly funded health system would reflect basic Canadian values, apart from the five principles of the Canada Health Act, including: ensuring access to health services on the basis of health need and not on the basis of the ability to pay; a shared risk approach to the provision of health services, which is necessary to ensure an equitable access to health services; the public governance and accountability of health services; and the whole question of the integration of economic performance and health services.

Principle number three is sustainability, debunking the myths. A network of myths has developed around the Canadian health care system. Despite the popularity of the Canadian health care system among Canadians and the international respect that it enjoys, it is being dismissed by critics as old fashioned, unsustainable, economically unfeasible and otherwise out of step with the new globalization.

In particular, some 10 myths have been propagated and passed as conventional wisdom when the evidence indicates otherwise. These myths include the myth that the aging population will overwhelm the health care system, the myth that Canadian health care spending is out of control, the myth that health care is an ordinary market good, the myth of Canada as socialized medicine, the myth that Canada has the most publicly funded system internationally, the myth of medical savings accounts, the myth of user fees, the myth of strengthening the public system by freeing up resources, the myth of the federal government's limited contributory role, the myth of affordability and requiring more private money, and the myth that a two tiered system is inevitable and desirable.

That brings me to principle number four, toward a strategy of cross commitment, the interplay of health determinates. Simply put, a comprehensive response to an equitable and publicly funded system may require not only the eight national strategic priorities that I cited above but must also address the oft ignored health determinates: the struggle against poverty, discrimination, poor housing, poor working conditions, poor education and a lack of civic literacy in health and the like.

As my colleague, the member for St. Paul's put it, “investing in air quality is preferable to more puffers and respirators”.

Principle number five is the imperative of prevention. It is more cost effective, more value added and just easier to prevent and pre-empt illness than to treat it once it has arisen. Accordingly, there is a clear role for all the stakeholders in the system in promoting wellness, a healthy diet, exercise, lifestyle and preventive medicare checks and the like.

Principle number six is the integrity of the patient. The health care system must treat patients as individuals to be treated with dignity, with concern for the psychological and emotional impact of illness and treatment, not just the physical and medical effects, and an appreciation of the distinction and diversity of the patient population having a regard to culture, gender, religion, the whole and increasingly multicultural society.

Principle number seven is the imperative of aboriginal health care. My colleague, the member for Nanaimo--Alberni, has discussed this so I will simply say that particular care must be given to ensuring that aboriginal populations are properly and sensitively served by the health care system.

Principle number eight is stable and predictable funding. Stakeholders must know years in advance the resources they will have available to ensure proper planning and the delivery of services.

Principle number nine is that we must protect the health system in international trade negotiations. The challenge here is to find a balance between protecting our health system from unfettered international private sector funding and delivery while at the same time enabling public-private Canadian health partnerships to have exposure on the world market.

Principle number ten is respect for all stakeholders. The stakeholders in the health care system are not just those who use its services but also those who provide them. Nurses, doctors and all health professionals have a right to work in a health care system that treats them with respect and attentiveness, that values them in their work and that recognizes the commitments they make.

Principle number eleven is the critical importance of human resource issues. These human resource issues are not the only major cost factors in the health delivery system. For example, 70% to 80% of health organizations' budgets are allocated to staff. However there is a current and projected global shortage of providers and an uneven distribution of people and skills across Canada, not only between regions but within regions. These issues involve not only physicians and nurses, but also social workers, pharmacists, therapists, medical and laboratory technologists and the like. We need to develop a cross-Canada human resource framework and strategy.

Principle number twelve is embracing an appropriate system change. I would like to make reference to the importance of the particular reference that was made in the report of the Canadian Health Care Association in a response to a sustainable and publicly funded health care system in Canada, The Art of the Possible. The report refers to the importance of implementing primary health care reform; of encompassing home, community and long term care; and of strengthening all components of the health care system; in other words, providing more resources and attention to public health programs, emergency medical services, mental health services, palliative care services and the reorganization of pharmacare.

Several provincial governments have released studies on their health care systems. These studies contain several similar recommendations, including, as I mentioned earlier, the importance of wellness and prevention initiatives; improved waiting list management; and the importance of community health centres, such as the CLSs in Quebec which have two principal benefits. They reduce the stress on health care professionals by creating interdisciplinary teams who care for a pool of patients and provide 24 hour clinics where people can get the care they need so that only the most ill patients need to use the more costly emergency rooms.

Finally, as Mr. Romanow put it, “Everything is on the table except the status quo”. What is at stake is defining who we are and what we aspire to be as a people.