Debates of June 11th, 2002

Health Care System

[The Chairman]

As usual, the hon. member for Hochélaga--Maisonneuve is a very wise man.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Mr. Chairman, I keep hearing from the hon. member that there was a promise to do everything on a 50:50 basis. In 1970, when medicare began, the promise was only for hospital and physician services.

Following 1970, provinces began to add on a basket of services outside of the hospital, such as home care, long term care, palliative care and community care. They have added on a whole other basket of services outside of physician services.

This is what we are talking about when we say that it is like comparing apples and oranges. If we divide the amount of money the federal government is funding into that whole new large basket, which is not part of the Canada Health Act and not part of the agreement, then obviously we would come up with the kind of skewed numbers that the member has talked about.

The member should consider that if the provinces want the federal government to fund some of the services that it is not required to fund, such as hospital and physician services, then negotiations may have to be opened up. The federal government will not just drop money into an open hole in the ground. It will have to decide how it can form a partnership with the provinces in order to fund some of the new and many ancillary services that have been added on since 1970.

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

Mr. Chairman, I know we cannot use documents, but I would like to quote, if I may, from the Romanow commission's interim report, in connection with the 50-50. Commissioner Romanow is not a man who could be suspected of sovereignist tendencies, but he says the following:

The first step toward universal public coverage began with the introduction of hospitalization insurance in Saskatchewan in 1947. In 1957, the federal government committed to sharing the costs of hospitalization insurance with the provinces.

This is the historical review given by the Romanow commission, and that is what we were talking about. It has always been a question of 50-50 responsibility for the federal government.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, if we look back to what actually happened in 1997, after an exhaustive two year study by the National Forum on Health which cost $12 million, we see that the study was used as a lever going into an election to give the impression and allow the electorate to hope, after the money was pulled out of health care, that the government was actually doing something for health care.

Why would we expect the Romanow commission to be treated any differently than the other study which sat on a shelf collecting dust. The Romanow commission will be treated exactly the same.

Human nature is funny. When I go stream fishing and I catch some fish in a certain pool, when I go back I am often drawn to the same pool where I had good luck fishing. I think the government has the same human nature trait when it comes to health care. It had success in one election going with the National Forum on Health. It had success in another election by throwing this supposedly big pool of money at it. I believe it will use the same kind of political trick with the Romanow commission.

I would like my hon. colleague's comment on that. Does he see the same pattern coming forward again as the government plays politics with the most important issue to the Canadian electorate, health care?

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

Mr. Chairman, a few months ago I asked the Library to prepare a chart of what had been accomplished: the National Forum on Health recommendations, and then what action had been taken.

I would not be honest if I said no action was taken. Out of the 12 recommendations, 8 have been followed up in the budget, not always to the extent the forum wanted to see, but it would not be honest if I said that nothing had been done.

I do, however, think that two key recommendations need to be looked at.

First, the recommendation for Canada-wide pharmacare. As hon. members may know, Quebec has set an example in this ever since Pauline Marois set up its prescription drug insurance plan.

Second, what is interesting about the National Forum on Health, is that it made the following recommendation, which I shall read, knowing your thirst for knowledge:

—explicit acknowledgment of the health and social impacts of economic policies, and action to help individuals who are trying to enter the workforce.

In conclusion, a federal government that does the harm that it has with EI reform cannot expect people to be in good health.

Real health requires social policies that respect people's dignity, and the federal government has a woeful record in that respect.

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

Mr. Chairman, I listened with great interest to my learned colleague opposite, whom I appreciate very much since I work with him on the Standing Committee on Health.

He mentioned, among other things, that health care needs to be rethought. Having practised medicine for a number of years, I absolutely agree with that. Indeed we have seen a significant increase in the demand for home care, palliative care, and so on.

In light of this need and in light of the importance of this commission, does the member think that this debate on the future of health care is futile? Does he think that we should not be doing this? I would like him to comment on this.

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

Mr. Chairman, what I am saying is simple. Yes, health care needs to be rethought for all the reasons that were mentioned and that I will not repeat.

However, who delivers health care? It is definitely not the federal government. The federal government is responsible for health services to aboriginal people and veterans, for drug licensing and for issues related to epidemics and quarantines.

In Canada, epidemics and quarantines are rare. The federal government has no other constitutional responsibility. I think that the provinces are the ones that should reflect on this, and they have done what they had to do.

What is expected of the federal government is that it honour its past commitments and restore the 50-50 funding formula for hospital insurance, which, unfortunately, it has not done since 1993.

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

Mr. Chairman, I want to deal with the issue of the 50-50 cost sharing we have been hearing about ad nauseam over the last few weeks.

We must recognize that when you were talking about the 1947 agreement providing for the 50-50 sharing, we were talking about hospitalization insurance. If we add all health care and other programs, will my colleague agree that, in the end, it was not at all a 50-50 cost sharing that had been agreed upon, at the beginning, in terms of hospitalization insurance? It was a totally different formula.

It is clear that if we add all the other components, the cost sharing is no longer on a 50-50 basis. I would like to hear my colleague's comments on this point.

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

Mr. Chairman, John Diefenbaker mandated a judge to review the hospital insurance issue and, between 1947 and 1972, all the provinces, from Newfoundland to British Columbia, set up a hospital insurance program.

In Quebec, this was done under Mr. Bourassa and Mr. Castonguay. Who knows, perhaps the latter is related to the hon. parliamentary secretary?

We are asking, as regards everything relating to hospital insurance, including all upstream and downstream services, that the federal government fulfill past commitments and that federal funding be provided.

At the last first ministers conference, the federal contribution was evaluated at 14 cents per dollar spent. That is not in line with past commitments. I say to my colleagues opposite that their government did not fulfill its historical responsibilities and that they must make good on the commitments they made to their province.

This is what the debate is all about.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, we can talk about the past but the past is the past and there is not much we can do about that. I am more concerned about how we are going to sustain health care into the future.

What proposals would my hon. colleague's party put forward that would solve the crisis that is looming, if it is not already here, in health care? What solutions would he put forward?

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

Mr. Chairman, I will get straight to the point. There is the establishment of transfer payments, the review of the whole drug certification process, and respect of the provinces' autonomy. These are our proposals and we believe that they are all very constructive.

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

Mr. Chairman, we are here today to focus on the work of the commission on the future of health care in Canada, arguably the most important national discussion about the character of our nation since the last constitutional debate. No issue is more universal than life and death. The work of the commission will impact on the life of every Canadian. It is very appropriate, therefore, that we address the commission's work in this place.

When the commission was announced a little more than a year ago, the reaction of many Canadians was why. Why just four years after spending $10 million on the National Forum on Health would the government embark on yet another study? Why would it not act on what it already knew?

Some speculated that the government did not get the pro-corporate answers it wanted from the national forum and would keep spawning studies until it did. Others pegged it as the all too typical Liberal misuse of a royal commission to take the heat off a government on a controversial issue: its appalling record on health care.

Most Canadians, desperate for some action to save their health care system, quickly set aside their cynicism and embraced the Romanow commission with their hopes for getting medicare back on track. The degree to which Canadians are pinning their hopes on the commission has become apparent as the work has progressed. Commissioner Romanow has even expressed concern at being able to live up to the high expectations being placed on him to solve our current problems.

The intense pressure is not just on Mr. Romanow and the commission. It is shared by all of us as members of parliament. Canadians are watching closely to see what measures will be taken by the government to act on the commission's recommendations once the final report has been tabled.

This is a test not only of Commissioner Romanow but of our entire parliamentary system as the vehicle to respond to the vital needs and concerns of Canadians. The debate around the future of health care has become a microcosm for the debate over the relevance and capacity of our parliamentary institutions.

Why is this commission so important to so many Canadians? Why have thousands of people invested the time and effort to respond to the commission's questionnaire, to write or call the commission with comments, to submit briefs, to come out to public hearings and follow the issue debates in the media? We know that Canadians value their public health care system. That is not even disputed by those who would like to drastically change it.

We know that some people have been affected more than others by successes and shortcomings of the system and want to advocate for improvements in specific areas but it is more than that. Canadians understand that what is taking place around the Romanow commission is an epic struggle for power, for control.

At play are two distinct views on the nature of health care and the nature of government. One side sees health care as so fundamental to our well-being that it deserves unique status outside the play of market forces where decisions are health based alone. The other side views health care as a commodity similar to other service industries.

It is a struggle as well between two opposing views on the role of government in health care. One sees government as an accountable active agent for the public interest. The other sees government as a facilitator and partner in the development of private corporate interests.

The position of the New Democratic Party in this titanic struggle is clear. Our vision is grounded in an approach based on need not on ability to pay. It is reflected in the five principles of the Canada Health Act. It involves the collaboration of all levels of government anchored on stable and adequate funding. It looks beyond treatment to the economic and social conditions that contribute to ill health. It demands government independence in assessing health protection needs. It is a vision unequivocal in its support for a public non-profit health system.

New Democrats see a positive future for public health care. We believe it can be realized through increased public funding, yes, but also more efficient, co-ordinated and comprehensive approaches that include drug costs and home care, a more appropriate use of health professionals, greater public access to the benefits of research and health information and a proactive approach to preventing illness by investing in the social determinates of health.

This requires a strong leadership role for the federal government in rallying the collaboration of all levels of government. This is a vision that my colleagues in the NDP have fought so long and hard for in the past. It is a very different vision from positions held by other political parties. We have had some of that debate already tonight

I am sure the Minister of Health is paying attention. The Liberal Party vision is in our view a hologram of health. It depends how or when it is looked at. Election campaigns produce promises of home care programs, national pharmacare programs, drug patent reform and going to the barricades in the defence of public health care. However when it forms the government, that vision is replaced by a starkly different reality of underfunding and inaction.

I have already touched on the confusion and concerns we have with respect to the Alliance position. I do not need to elaborate any more. I am sure the member will have questions for me at the end of my speech.

As Commissioner Romanow has said, this is a time for choices about competing values. Thankfully Mr. Romanow, unlike his corporate shadow from that other place, Senator Kirby, has adopted an evidence based approach to his work. That is good news for Canadians.

For example, let us look at the claim that the health care system is in crisis. New Democrats, along with many Canadians, challenge this cornerstone of the case for more for profit care repeated by corporate promoters. When we look at the evidence, the so-called crisis vanishes like a mirage. The Romanow commission heard from Dr. Wally Temple of the University of Calgary who has said that although the Alberta government has been shouting crisis, total per person health costs in Alberta over the past 20 years have barely kept pace with inflation. Public health spending actually dropped by 33%.

The Parkland Institute told Romanow that the crisis claim, repeated in the Mazankowski report, was “based upon some of the shoddiest use of statistics and some of the most flagrant misrepresentation of data ever foisted upon a commission”. Public health spending as a percentage of gross domestic product was virtually the same in 2000 as it was in 1989.

The claims that for profit care is cheaper and better than public care do not fare any better under public scrutiny. Evidence brought before the commission overwhelmingly concluded that the claim that for profit care was a way of saving health dollars was bogus.

Looking to the American system for evidence, the prestigious New England Journal of Medicine concluded that “No peer-review study has found that for profit hospitals are less expensive. For profit hospitals cost more to operate, charge higher prices, spend far more in administration and often provide poorer services than non-profit and public hospitals”. No sound evidence has been presented to prove that for profit care, whether in hospitals or other areas of health care, can deliver care cheaper than non-profit.

Neither is there evidence to back up the myth that private care is better care. It is just the opposite. A major study out of McMaster University last month showed that patients were more likely to die in U.S. private for profit hospitals than in not for profit hospitals. Similarly, studies of U.S. for profit nursing homes and kidney dialysis facilities show a poorer quality of care in relation to comparable non-profit facilities.

Those are my comments on some of the bogus arguments that are presented to the public and have to be dealt with by Romanow.

What the commission has received at the hearings has been the heartfelt testimony of hundreds of Canadians about their experience and the values they want to see reflected in its recommendations. Whether young people like grade eight students, Kyla Weinman and Laura Wilson, or the several seniors and pensioners associations, Canadians of all ages continue to present the commission with an extraordinary wealth of experience and expertise to consider.

Many innovative suggestions have been made for improving the public health system, ideas like a national health council to improve accountability as suggested by the Canadian Labour Congress and others. The Canadian Medical Association has suggested a health charter and a health care covenant has been suggested by the Canadian Council of Churches.

As well as innovation, there has been widespread agreement in traditional areas of concern to New Democrats: a national drug program, a national home care program, a national health human resources strategy, multi-professional teams and a concerted effort to address the economic and social conditions that undermine health.

New Democrats have also continued to call for a priority attention to first nations health, an area of exclusive federal jurisdiction.

Let me conclude by saying in the days ahead we urge that those who have not yet taken advantage of this unique opportunity to contact the commission to express their views. We know that they and the countless others who have been following the commission's work will be anxiously awaiting the final report in November and the government strategy to act on its recommendations. It will be an unfortunate day for public health care and for Canadian politics if this tremendous project of hope and commitment has been for naught.

[Elsie Wayne, Progressive Conservative, Saint John, NB]

Mr. Chairman, I want to thank my hon. colleague for her presentation. I had the distinct honour of making a presentation to the Romanow commission just a week ago. Something I have noticed, and I have noticed it in the House as well, is when we discuss health care no one brings up the subject of veterans hospitals and the need for that to be addressed like never before.

We have been travelling across the country to look at our veterans hospitals. The Ste. Anne's Hospital in Montreal, which is still under the jurisdiction of the federal government, is in excellent condition. The treatment our veterans receive there is wonderful, and rightfully so. However all our veterans hospitals should be at the same standard. Instead of that, unbeknown I am sure to the majority of members sitting in the House of Commons, many of them have been closed or knocked down.

In my riding, the most beautiful DVA hospital was closed and a tiny hospital was opened to replaced it. Hundreds of veterans were in need of beds and help. The hospital was expanded by 48 beds but every one of those beds were for people with Alzheimer's.

Why does no one address that issue anymore except for us? I raised it before the Romanow commission and I noticed that the chairman started to take a lot of notes, which told me that no one had raised that before with him and his committee. What does my colleague think? Does she honestly feel as strongly as I do that money needs to be put into the health care system for veterans and for all walks of life?

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

Mr. Chairman, I appreciate the question from the member for Saint John. She raises a very important issue for this health care debate. It is a concern that I share and one that I have raised as well with the Minister of Veterans Affairs. That is the question of national standards when it comes to hospitals for veterans and continuing care generally for those who fought so long and hard in wars and sacrificed so much.

The issue here is one of support for our veterans. It is also one about an appropriate role for the federal government. The question of national standards is surely an area which begs for action. Whether we are talking about veterans hospitals and care for our elderly or whether we are talking about approval of drug therapies or a human resource strategy, there is a desperate need for the federal government to present national standards in collaboration and co-operation with the provinces. That would make a difference.

Finally, the member raises a very important point about the aging population. I want to use this opportunity to use the evidence which has been presented by many experts in the field. Those who suggest that our aging population is causing a crisis in the health care system are wrong. It is a bogus argument and must be debunked. If we care for our elderly, the seniors of this country who make a very important contribution to our society, and ensure that the appropriate services are in place for them, we end up saving money for our health care system.

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

Mr. Chairman, I would like to ask my socialist colleague a question.

I am very surprised to see her strong stance in favour of centralization.

Would she not agree that we must ensure that those who know our fellow citizens' needs are the ones who are in the best position to provide the services? It is the provinces that have the expertise. In some cases, it is even the municipalities. But it is definitely not the federal government.

How, in the year 2002, can the hon. member still be talking about national standards when everyone knows that the management process must be at a much more local level? With all due respect, does she not think that her views are somewhat outdated?

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

Mr. Chairman, I appreciate the question because it is a fundamental issue that has to be debated in the whole discussion on the future of health care.

I want to say first that I very much worry about our national health care system and our medicare model being dissolved into a patchwork system for which their is lack of portability and continuity.

I think we can achieve the desired changes in our health care system through national leadership, national goals and national funding without forsaking the important role of the provincial and local governments in the delivery and provision of health care services.

The recent health ministers conference is a case in point. Health ministers came together and agreed to establish a national system to review new drugs coming on to the market so that they could pursue a co-ordinated approach thereby saving the system money. They did that because the federal government abdicated its responsibility. It refused to do what it had long promised to do, which was to establish a national pharmacare program and to reduce patent protection for brand name pharmaceutical drugs.

There is a need for national standards but I think it could be done in a way the member would agree with. It could be done in collaboration with provincial governments, with delivery at the local level, with the advice of experts in the field and with the involvement of citizens in the decision making process.

[Loyola Hearn, Progressive Conservative, St. John's West, NL]

Mr. Chairman, I would like to ask the hon. member a question about home care.

One of the best bargains any government has in relation to caring for the elderly or the sick is the provision of home care, proper care within a patient's own home, which is where older people want to stay. Very few of them want to leave home to go to boarding homes, nursing homes, hospitals or whatever.

Because of a lack of government involvement and proper funding especially for home care workers who get paid very low wages, the seniors, the elderly and the sick people are forced to go into homes which quite often are a considerable distance from their own homes. This puts an increased burden on them, at a cost which is several times what it would cost to fund home care for them.

It does not seem to make any sense. We seem to be penny wise and pound foolish in this case. I would like the member to comment on what she sees happening in this area.

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

Mr. Chairman, the member has raised a very important issue, a case in point of how we can renew and revitalize our health care system and in the end make sure that our non-profit public model is sustainable and actually saves money.

With respect to home care, it has been well documented that an investment in that kind of approach would save money for the system as a whole and would sustain medicare for the future.

As the hon. member may well know, the 1997 National Forum on Health, after an extensive study, concluded that home care should be considered an integral part of publicly funded health services. In 1997 the federal Liberals promised a national home care program. Do we have it? No.

In 1998 at the national home care conference the former minister of health said in his speech that the most urgent element of modernizing and enhancing medicare is home care. It should not be an add on. Do we have it? No.

We have been through another election, the 2000 general election. We heard some more promises. Do we have it? No.

This is the issue and the matter before us. How do we convince the government to move on its promises? They are so necessary and vital for ensuring quality health care services to all Canadians and they are so important for the future sustainability of our system.

[Peter MacKay, Progressive Conservative, Pictou—Antigonish—Guysborough, NS]

Mr. Chairman, I commend the member for her very articulate and informed speech.

The member spoke of the necessity for funding. The Progressive Conservative Party and other parties as well had advocated an injection of the sixth principle of health care, namely stable funding.

Does the hon. member agree that we have to be innovative, and Mr. Romanow I am sure is prepared to do so, to look at ways to ensure the stability of that funding? I suggest one would be a model similar to the employment insurance plan in which money is specifically earmarked and designated for health. Would the member agree that this is the direction in which we must go? Health care is so important it would justify making that designation.

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

Mr. Chairman, I am not sure if one needs to add a sixth principle to accomplish what the member is suggesting. What it requires is political will on the part of the federal government to live up to its commitments, to restore cash payments and to move us back steadily toward the 50:50 partnership which was a reality at the beginning of medicare in Canada.

I would suggest, and I am sure Mr. Romanow is doing this, that we look at the way in which health care is funded today and think about revamping the formula. The CHST has failed Canadians. There are no conditions attached to the funding. We have lost the ability to move our system forward because of the way we fund health care.

I for one would be prepared to recommend that we scrap the CHST. We should put in place a health investment fund where the dollars would be tied directly to health care needs and the provinces and the federal government would collaborate on how to move our system forward.

[Rex Barnes, Progressive Conservative, Gander—Grand Falls, NL]

Mr. Chairman, I appreciate the opportunity to speak on behalf of my constituents in Gander--Grand Falls.

The Canadian health care system is in crisis. This idea is demonstrated by the true failure of the health care system faced by all Canadians, particularly those living in rural Canada. In Newfoundland and Labrador the number of rural physicians fell by 12.3% between 1996 and 2000. Any solution that is sought for this problem must address the issue of providing adequate, sustainable, stable funding for those that administer health in this country.

The position of adding a sixth principle to the Canada Health Act has been long advocated by the Progressive Conservative Party. The provinces must be able to rely on the federal government so they can put in place long term plans to effectively deliver health care without having to look over their shoulders wondering when the next round of cuts will come to this essential service.

Prior to being elected as the MP for Gander--Grand Falls last month, I worked directly in the health care field as a paramedic for 22 years. I can say that morale in the health care field is at an all time low. Health care workers are discouraged by the lack of support, the lack of leadership and the lack of compassion the federal government has shown toward patient care. Health care workers do not have the tools or the personnel to do the job for which they were trained and so desperately need to do.

It is from this perspective as a frontline worker in the health care system that I talk to the House today. I have seen this crisis firsthand. In Grand Falls-Windsor where I worked, as of April 26 there were 10 physician vacancies. On January 10 it was also posted that the region has two more openings in clinics for family physicians. In Gander three permanent positions for family physicians were posted on April 8 as available immediately. Prior to that announcement two other vacancies had already been posted on March 28.

The rural crisis grows each month as health care professionals choose to go elsewhere because the system as it stands now simply does not work. What is needed more than talk and debate is leadership in finding solutions. Any solution will only be found in direction from the federal government in finding co-operative solutions with the provinces. Clearly, the answers do not lie in a private health care system. The answers lie in co-operation and leadership. The very fabric of this country is universal access for all Canadians no matter where they live.

Our party understands that throwing money at problems does not automatically result in a solution. Funding must address the real needs of the people. What is needed is a plan. Strategic spending of financial resources will result in direct benefits at the local level.

One thing I think we can all agree on tonight is that the fundamental pillar of universality is in doubt. Certain provinces are able to pay their health care professionals more than other provinces can. Last year Alberta offered its nurses more than its neighbouring province of British Columbia offered its nurses. Some provinces may have the financial ability to match this challenge. Newfoundland and Labrador cannot.

This does not mean that health care workers in other provinces should have their wages limited. Rather, the federal government must work with the other provinces to ensure that all provinces have an equal opportunity to acquire the resources required to meet their needs. The federal government must put an end to the ongoing bidding war for the ever shrinking pool of trained health care professionals.

Doctors are not taking on new patients in regions of the country, especially in Gander--Grand Falls and in rural Canada in particular. The biggest problem is that doctors are leaving because their working conditions are unacceptable. Health care professionals leave rural Canada because they do not have the tools to fulfill the professional code of care they have been sworn to uphold. Doctors are faced with a lack of adequate staff, the absence of proper medical equipment required to do their jobs and the prospect of better financial compensation elsewhere.

There are several ways to address these problems. The issue is not just how to entice doctors to rural Canada but also how to encourage them to stay.

The first step is to provide the means for those medical students who come from rural Canada to return. This can be accomplished through loan programs that provide students with the opportunity to acquire their medical education debt free with the agreement that they will spend the length of time they have spent in their studies in rural areas. The idea here is not to trap people in rural Canada. It is to provide encouragement.

We need to think outside the box. Instead of chaining students debt to the obligation to practice in rural Canada, the federal government should provide income tax breaks for those who take up the profession in Canada's less populated regions. For example, those who work in rural areas should be free from income tax for the first five years after graduation. This is not unlike the cost of living tax breaks offered to Canadians who live in the far north.

In addition to this, with an eye to a more permanent solution, for every five years that doctors work in rural Canada they should be rewarded with a year free from income tax. This would have the added benefit of freeing up dollars for health care professionals who would most likely spend it in the local economy.

First year enrolment in Canadian faculties of medicine continues to drop meaning that the problem will only get worse before we find a solution to start making it better. One solution to this problem is to make it easier for foreign trained health care professionals to practice in Canada. Canada is a country that boasts about its immigration policies, and then we prevent these new Canadians from using their skills and knowledge when they come to our country.

At a time when we are producing fewer doctors, I would ask the government: Why is it not tapping into this obvious resource talent? The federal government should take the lead by bringing together professional associations and provincial governments to resolve this problem immediately.

The lack of federal leadership is continually demonstrated by the fact that moneys allocated to health care are not going where they are needed. In my riding of Gander--Grand Falls there is a lack of health care equipment. The federal government must sit down with the provinces in good faith with the idea of ensuring that the money that is allocated nationally gets to the local places where it is needed.

The committee from the other place on social affairs, science and technology stated that it was concerned that:

--there are apparently no mechanisms for ensuring accountability on the part of the provinces and territories as to exactly where money targeted towards purchasing new equipment is actually spent..

Such occurrences stem directly from the lack of co-operation between governments, responsibility for which lies directly at the federal level.

Our aging population means increasing demands on our system. What is easily overlooked is that our health care professionals are also aging. This will lead to even further future demands on our system. An aging population also means a reassessment of the needs of our health care system. We must redesign and refocus our health care system to address where the population bulge is now found.

In my election campaign I met a woman who had spent $3,700 a month on prescription drugs. Her options were pretty limited, bankruptcy or illness so severe that it would undermine her quality of life. No Canadian citizen should be faced with this dilemma

There is no commitment, no vision by the federal government to even improve the time limits for drug approval that would result in lower costs for Canadians. We all know that unless people are able to have access to prescription medication that they will only end up institutionalized, further compounding our problems.

In Canada, towns with a population under 10,000 people amount to 22.2% of the population, and yet they are served by only 10.1% of our Canadian physicians. Any solution to the health care crisis must address the problem facing rural Canada exemplified by what is happening in my riding of Gander--Grand Falls.

Ultimately, the system cannot fail because the federal government and the provinces cannot work things out. Someone must take the lead.

[Peter Adams, Liberal, Peterborough, ON]

Mr. Chairman, I enjoyed hearing what the member had to say. I was particularly interested in what he had to say about health care professionals and working in rural areas. He is absolutely right.

There seems to be a gulf in health care between the large communities and our rural areas. If we look at the health standards of individuals living in rural areas they are below the norm of urban areas. At the same time we have a situation in which the number of health care professionals and the other services which are available to treat those people whose health standards are lower are fewer than in the urban areas. It is a particularly large problem.

The member gave a number of examples of things that could be done but I would like him to talk to us a little more about that. At the medical school at Queen's University in Kingston this year I am told that only one of the graduates will be going into family practice. All the others will be going into a specialty of some sort, which means that the chances, no matter what we paid them or what the incentives were, of those graduates going to a rural area are very slim.

I know there will be two new medical schools, one in northern Ontario and one in northern British Columbia. That is a step in the right direction. Does the member have any other ideas about what we can do to persuade the students who are already in the medical schools to, first, go into family practice and then, to practise in rural areas?

[Rex Barnes, Progressive Conservative, Gander—Grand Falls, NL]

Mr. Chairman, I spoke to several students who were in the process of getting their degree to practise medicine. Many of them have told me that they cannot afford to stay in Newfoundland and Labrador to practise as family physicians because of the large debt load they must pay back. Some will leave the province because the money and working conditions are better.

The province from to time designates so many doctors to cover for MCP in certain areas and as a result will not hire more. There is no incentive for them to go to rural Newfoundland and Labrador. If the province would give them incentives they would probably go there. Some have said why should they go down into rural Newfoundland and Labrador and spend 10 years of their life trying to accommodate the province when it will not give them anything back? They are forced to go to Upper Canada, as they say, to make more money so they can pay off their debt load much quicker.

Some people do return after 10 or 15 years, but the problem then is where do they go? The doctors who are there are probably younger and will not be leaving because they made a commitment. Tax incentives to persuade doctors to stay there is a good idea. It is something that the federal government should look at.

Just prior to announcing that I was running in the election I spoke to three interns. They told me that if the government could take care of their debt they would give a commitment to the people of the province and go to rural Newfoundland and Labrador.

They know the need is there and they know they need the expertise there to make health care better out on the coast. That is why in rural Newfoundland and Labrador they are training nurse practitioners to take on the workload. Some of the nurse practitioners are able to do it and some are not able to do it because of family concerns and family problems and commitments. If there was an incentive program to work with they would do it.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I listened intently to my hon. colleague's comments and his answers to the last questions. He spent the majority of his presentation talking about the shortage of human resources in health care.

There is no question that one of the most acute problems we have in this country is the fact that two-thirds of our medical practitioners refuse to take on any new patients. We have a critical problem across Canada. However it is a problem that we have known about. It is a problem that the government has known about and was told about a decade ago. Money was pulled out of health care and the number of placements in universities and teaching facilities was cut. This was a recipe for disaster. We knew it would happen and here we are.

It takes 10 years to train doctors. We have a major problem dealing with this. We have a problem not so much with them staying in Canada and going from province to province but we have a problem with them going from Canada to the United States. There is a shortage of doctors around the world. A great number of physicians come from South Africa and Cuba.

Has the member thought about more than just the tax incentive? Being in close proximity to the problem in rural Alberta my experience in dealing with this issue is that it is much more than just money that keeps physicians at home. I would be interested in the member's comments on that.

[Rex Barnes, Progressive Conservative, Gander—Grand Falls, NL]

Mr. Chairman, there are no new ideas out there. We hear the same rhetoric about what should be happening and telling the federal government what it is or is not doing. We need to start a new program for health care with new ideas.

The incentive program is something that should be looked at and considered. If the federal government were really concerned about health care as a unit, it would return the health care dollars it took back in 1993 or bring health care back to the 1993 level. That is a starting point in taking steps to providing a better health care system.

If the government is not willing to do that, then we must come up with new ideas. The federal government should be listening. I hope the Romanow commission will look at these incentives seriously to ensure we have a new health care system that will work for Canadians.