Debates of June 11th, 2002

Health Care System

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

Mr. Chairman, I want to congratulate our colleague for his first speech in the House and wish him the best for the future. I have three short questions for him.

First, why does he think that it is the role of the federal government to give money directly to doctors? Would it not be better to increase transfers and let the provinces give the money?

Second, does he have ideas on the means to reduce the cost of medication?

Third, since he comes from the Atlantic provinces, is it true that Bernard Lord might be tempted by federal politics?

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

Mr. Chairman, with regard to prescription drugs there are a lot of Canadians who are financially unable to have a drug plan or are unable for whatever reasons to buy certain drugs for their medical condition. I deal with people in these circumstances on a continuous basis. As I mentioned in my speech tonight, I know of a woman who has spent $3,700 for medication. She is going to have to declare bankruptcy.

The federal government is going to have to make prescription drugs easily available for these exceptions, or the federal government and the provinces will need to work together to make sure that people have access to them. Sometimes provincial governments shift the blame and say it is a federal government problem. I have heard that many times. I spent 22 years fighting the provincial government on issues regarding health care. It always blamed the federal government for a shortage of money. We have to work together. We have to try something different. With a co-operative spirit we should be able to work these things out.

[The Chairman]

Before we resume debate, if that was the member's maiden speech, I congratulate the member for Gander--Grand Falls.

[Some hon. members]

Hear, hear.

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

Mr. Chairman, first I would like to thank the House leaders for agreeing to have this very important debate tonight and the Romanow commission for agreeing to meet with each of our caucuses. I think it is the proper role of members of parliament to be able to report in our homework in terms of what we have been hearing in this ever important policy process.

I would also like to thank my patients, who taught me pretty well all I know about health care and taught me the benefit of what informed patients who are prepared to use the system wisely can actually do to provide input into public policy. I would also like to thank the people of St. Paul's who show up in record numbers at the neighbourhood checkups that we hold and who were at the five town hall meetings that we have had over the past while on palliative care, on health care report cards, with Monique Bégin, with Peter Singer and on health care reform.

There is no question that these people have two overriding themes. One is that they want a strong federal role. They support the five principles of the Canada Health Act, but I think they are very aware that it is only the confidence Canadians have in their health care system that will indeed protect it, that if we erode the quality of care they will begin to demand to pay. We have to protect the quality and they need to know about accountability and transparency.

As we know, there has been a cottage industry of commissions and task forces looking at what we should be doing and there are some very clear consenses. One is the wellness initiatives, which virtually every commission has talked about. There are the ideas of some sort of pharmacare reform or community health groups that would do 24/7 care. There is the idea of the role for information technology and electronic medical records. There is the report card to the public, which again comes back to the competence issue. I would hope the report card would also compare us to international models. If people know that they are doing just as well with their heart attacks here as in California, they will begin to understand what indeed this spectacular health care system really has done.

The key to sustainability has to be prevention. We have to actually decrease the demand side. We have to avoid the Walkertons. We have to avoid the smog in July and August. We all know, from Marc Lalonde on, that poverty, violence and the environment are the most important things in terms of keeping Canadians well. I think most Canadians understand that at 10% of GDP we can have a fantastic health care system and with what we now have as a 70:30 private-public split we can again sustain the system.

We need to have more measurements in quality to provide incentives for good performance. I think we now know that there are two important roles for Canadians in the system. One is as knowledgeable and empowered patients who can drive the quality outcomes, and as well patients need to have the access to information with which they can make quality decisions. Clinical guidelines need to be available for patients so that they know why antibiotics are not appropriate for viral infections or why their ankle will not be x-rayed because it does not meet the criteria.

The most important thing I want to talk about tonight is the role of Canadians as citizens in this ongoing, fluid evolution of our health care system. On May 16 we had a round table at the University of Toronto with Janice Stein, where we brought together the people who know a lot about health care, a lot about governance and a lot about information technology. We were trying to figure out whether information technology, perhaps funded by the federal government, could help drive the reforms we want done.

The paper by Sholom Glouberman and Brenda Zimmerman on complex adaptive systems and the kinds of feedback loops we need was interesting. We in effect described a distributive model of power, where if the incentives are down as close to the ground as they can be, we can eventually have those feedback loops that end up with better quality and better cost effectiveness. What is important in a distributive model is a compelling purpose, a strong belief and an agreed upon process. We must agree upon a process by which the system will continue to renew itself. A few key principles will allow infinite diversity and yet coherence. We can be competing and co-operative at the same time. What we now believe is that a centralized control of an ecosystem is illogical, that equitable membership for members and voluntary co-operation are essential.

I believe it is unreasonable to think that Commissioner Romanow would be able to tell us exactly what our health care system should be, because it is going to continually change. I believe that what Commissioner Romanow should be telling us is to mandate a process by which Canadians will continue to always feel comfortable that their needs are being looked after.

The overall goal of priority setting must be legitimacy and fairness and citizens must be involved at every single step of that priority setting. It should not be a discussion about what should be funded but rather a discussion about how those decisions get made. It is clear that it has been impossible for us to define the term medically necessary, yet I think all of us, even with different values, still agree on how the priority setting should be done.

What is interesting is that in Peter Singer's National Post article entitled “Needed: An honest way to set priorities”, he cites the accountability for reasonableness framework developed by Norman Daniels and James Sabin. It provides guidance on how legitimate and fair priority setting decisions should be made.

First, we must have an inclusive decision where citizens are at the table. Second, that then must be communicated to everyone. Third, there must be grounds for appeal. Fourth, it then must be enforced. I believe that this could happen anywhere, from the very smallest health care organization in terms of a community health centre, to a regional health authority, to a ministry of health deciding on what goes on a formulary, to the highest level of the federal government.

Citizens now know that there needs to be democracy between elections. They need to have a place where their values get imposed at every decision. Ursula Franklin says that good governance is fair, transparent and takes people seriously and that if we do not do it in our small organizations no one can expect us to do it in the big picture.

What we need is a system. We have had a fantastic health care insurance plan. We now need a system. That means governance, and I believe that citizens have to be at the table in every decision. We can no longer have joint management boards where providers and bureaucrats sit behind closed doors and the bureaucrats save money if something comes off the list and the providers get to charge more if it is off the list. The citizens must be at that table. Citizens must be at the federal-provincial negotiating table. As Judith Maxwell said in this week's Canadian Medical Association Journal :

Citizens, as the owners and funders, also have something to offer to the construction of our health care edifice. What they offer is their core values about how the system should be financed, about what rules should determine who has access, and about the way the patient interacts with the system.

That gives us Peter Singer's legitimacy and fairness and Trudeau's social justice.

It is imperative that we look back to the social union framework agreement, where we and the provinces have already agreed that we would “ensure access for all Canadians, wherever they live or move in Canada, to essential social programs and services of reasonably comparable quality”. We have to be measuring that quality and we have to be doing what principle 3 in this social union framework states, which is that we would be informing Canadians in public accountability and transparency. Whether that has to be companion to the Canada Health Act or whether we just sit back and enforce what was agreed to in the social union framework agreement is left to be seen. The principle states that we must be ensuring “effective mechanisms for Canadians to participate in developing social priorities and reviewing outcomes”.

I am particularly intrigued with the model that Carolyn Tuohy and Colleen Flood presented to the Kirby report, which is concentric circles with the things that would be public in the centre, things with co-payments in the middle area and then the things that would be privately funded in the outer area. I believe that citizens should form a semi-permeable membrane by which things come in and out of there all the time based on the education by experts and by the information sharing and value systems that they would afford.

I believe we should not be making any decisions without citizens joining hands in terms of that educative function. I think if we look at that we can move it into all levels. I am particularly interested that citizens at those tables must have a responsibility for connecting back to their communities using strong associational networks.

The confidence that Canadians have in the system is the only thing we can count on in terms of protecting our system. Other countries like Australia and England have now mandated the importance of citizen engagement at all levels in decision making.

It is imperative that if we think of a national body that could look at pan-Canadian standards, could review the CIHI, could look at a national formulary, and could perhaps involve the citizens' council for health quality, we could start to look at the federal government as a provider, the fifth biggest provider, of the health care in this country, for aboriginals, soldiers, veterans and in corrections, and bring the federal government to the table in its joint project with all of the provinces on the delivery of health care.

We then need to share the best practices. We need to do the performance pool and reward the great things that are happening across the country. Then, I think, we can look forward to the system. Canadians are the solution to this system. They no longer want to be seated out of the project. I know they want to help us make it work and I know that they will be forever involved in this incredibly important--

[The Acting Chairman (Mr. Milliken)]

The hon. member's time has expired. Questions or comments, the hon. member for Hochelaga--Maisonneuve.

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

Mr. Chairman, I listened to the my colleague's speech from the lobby, where of course I drank a glass of juice and toasted your health.

I know that our colleague is quite familiar with the health and social services system. In the Romanow report, four options are being considered. I believe the member remembers that these are more privatization, increased public investment, the reorganization of services and a greater call on the consumer's purse.

Can the member tell us which option she supports? Does she agree that, even though the future of health services is not only a financial issue, the fact still remains that it this a prerequisite to any further discussion with the provinces?

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

Mr. Chairman, I am particularly interested in the reorganization. I think that from the Fyke commission on down, there is a view that if we actually could get an integrated, coherent system there probably would be a 30% saving in the system. I do not think there is a patient in Canada who has not had to have a test repeated because no one can find the results when the patient shows up for appointments. I believe that if we could make a primary investment in an information technology that would get us a real system, we could begin to think about what else might be necessary.

My primary goal is to develop a real system that is a reorganized, coherent, integrated, accountable and transparent system. I think that in order to get there we will need an infusion of money, particularly around the accountability and information technology framework. We have excellent evidence that user fees do not work. They are like some zombie that keeps coming back like a bad video game. People just continue to want to talk about them. As a physician I found it appalling that time and time again I would have to ask people what they could or could not afford. If I had wanted to talk about money all day I would have been an accountant.

It is extremely important to note the administration fee of trying to collect user fees, but also, user fees, in terms of asking for that extra, private part, are indeed a deterrent to the most vulnerable Canadians, like the fragile diabetic and the pregnant teenager. They are the people who do not seek help because of user fees and they are the people who will cost us buckets of money when they end up in an intensive care unit or the baby ends up in a neonatal intensive care unit.

I do not think there should be more private care in that sort of user fee way, but I do think that there are things in that model of core services, copayments or whatever, for which we have evidence that they do not work any more, that we should not be paying for out of the public purse.

I think that is a conversation to have with citizens: How we can get some of things that are core services now back out again? These are things such as the eighth ultrasound in a pregnancy to find out what the sex of the child is or cholesterol testing every three months because someone is obsessed by it when the person has had three normal cholesterol tests and the evidence shows the cholesterol only needs to be tested every couple of years. There are some things that can come out and if people really want them they can pay for them, but I also think this is a conversation that citizens are perfectly capable of having and we should not be making any of those decisions without them at the table.

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

Mr. Chairman, I congratulate the hon. member. I know she has tremendous practical experience in the area of health care. I listened to her remarks and I agree with much of what she discussed and the substance of what she said. I will be the first to admit that she is not a member of cabinet, although when her man is in place she may have a better shot at it.

I will preface my remarks by saying that this has been a good debate.

I do not want it to become overly partisan but I would ask the hon. member a question with all seriousness. When it comes to priority spending, the spending on new Challenger jets and the money that has gone awry with respect to contracts, it has not been consistent with Canadians' priorities. It has not been consistent with the needs that the member knows exist.

She spoke about new technology in the area of the practice of medicine, new x-ray machines, new ECG machines, medication itself, home care and the ability to have more personnel, nurses and doctors, actually working in the system.

How does she reconcile what she knows is so sorely lacking in the current system with her government's spending priorities and simple lack of spending and cuts that have been brought about during the tenure of the administration of which she is a part?

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

Mr. Chairman, there is no question that the member's earlier comments about stable funding is the most important thing in terms of planning for health care.

The deal the Prime Minister made with the provinces on September 11, 2000, was a commitment to that kind of stable funding with money targeted toward information technology, primary care and those types of things.

Some people feel that infusing money every time the opposition asks for it destabilizes the health care system. Some political scientists and observers feel that planning is more important to health care than just throwing money at it, which was the problem in the eighties. Monique Bégin said that we threw all the extra money at the system in the eighties with no appreciable increase in the quality.

We need to make sure we have a cost effective assessment of the dollars we spend, not a cost containment. The cost containment model ruined the system in the nineties. Province after province and regional health authority after regional health authority were not prepared to make the tough decisions to get rid of the stuff that did not work any more and continued to ask for more money. Instead of moving toward a more cost effective model they just cut.

In deciding where we want the money, I would like more money to go into accountability, transparency and information technology to create a real system. It may be an infusion in terms of what we described. Sharon Sholzberg-Gray and maybe the Fyke commission have said that we might need $6 billion to fund the secretariat or whatever would actually help us design an information technology system for the whole country with the feedback loops around quality and accountability. Just giving money to provinces that goes for strikes and labour disruptions has not been effective up until now.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I agree with a lot of my hon. colleague's presentation but I am a little astounded. Her government has been in power for almost a decade and now the member is coming up with some of the things that we have been suggesting for many years. I appreciate hearing that.

My specific question relates to the fact that my hon. colleague is a physician. I have talked to many physicians who tell me that they could save the system $2,000 or $3,000 a week if there was an appropriate incentive.

I do know whether I blame physicians for this but I think one of their main concerns is with their liability as physicians. I wonder if there is something that might assist the system regarding liability. Could she comment on that?

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

Mr. Chairman, maybe it would work for politicians too.

In terms of liability, we have been looking for a new way to do risk management and risk assessment in health care. It would be in much the same way as it is for airline pilots. They do not lose their licence for making a mistake. They lose their licence for failing to report a mistake.

In the learning culture of a real health care system we would want to know about collective mistakes because in this college system we have no place for system wide errors. We have a college of nurses, a college of doctors and a college for all of these things. Quality councils might be able to feed back the learning episode instead of it being a gotcha litigated model and, like so many things, we just want to get the lawyers out.

[Werner Schmidt, Canadian Alliance, Kelowna, BC]

Mr. Chairman, it is good to see you in the chair and wonderful to have you out tonight. I also want to recognize my hon. colleague from across the way. I think she delivered a very significant set of comments.

I want to address my comments to a particular segment of our society and their relationship to health care, seniors. Since 2000, it has been my responsibility for the Canadian Alliance to look at the issues for seniors. The major issue for seniors, whether they were in British Columbia, in Saskatchewan, in Nova Scotia or in New Brunswick, was the issue of health care.

Our consultations were informal and we ended up talking to real people about real problems and where they existed on the day to day experience. The viewpoints expressed by these people were not those of learned scholars. They were the viewpoints of people who were suffering and people who were experiencing difficulty with the health care system.

The idea was to have organizations and groups of seniors work together to make things better. These organizations and many of the frontline caregivers struggle under a health care system that is too often inadequate and underfunded.

Through these visits, I came to realize that my main objective was not to sell a particular political idea but rather to be a voice for these people in the Parliament of Canada where the important decisions are made. That is what I intend to do here tonight.

It is the same perspective that will become increasingly important because of the demographic shift that has taken place in Canada. By the year 2040, roughly 25% of our population will reach the age of 65 or older. The implications of that are very serious for the health care system. We also need to recognize that the greatest proportion of the money spent on health care is for people between age of 85 and older, particularly women. Older seniors, the majority of them women living alone, need more and more health care. Will the health care system and health care services meet that growing demand? Where will we get the final funding to support home care and long term care? Will the specialty services required for older seniors be there when they are needed? How can we ensure that the cost of prescription drugs will be reasonable and affordable?

Only a few months ago the Canadian Medical Association charged the federal government with systematically underfunding the health care system, in particular, specialty care. What does the federal government intend to do with the CMA's charge that it is systematically underfunding the health care system?

Those are some of the questions that the seniors asked as we talked to them about their problems and concerns with health care.

Let me read into the record what some of the seniors specifically said. I want to be very careful to read this exactly the way they said it. I do not have all of them but we have some.

The comments are as follows: Health care spending is wasted; too many services have been cut and there is a lack of facilities; hospitals, emergency units and intensive care facilities are being closed, forcing families to be transferred greater and greater distances away from family support; the cost of drugs is too high and more affordable generic drugs take too long to come to market; federal health care funding must be restored; the federal-provincial governments must work together to resolve health care issues; the cost of covering diseases such a Alzheimer's and diabetes are insurmountably high for seniors; user fees for emergency rooms might alleviate crowding and unnecessary use; nursing homes are understaffed; a better understanding of the care needed for seniors could mean that not all health care providers need be doctors, nurses or specialists; organizations that care for seniors could do a better job of co-ordinating activities to avoid duplication; there is a lack of monitoring of quality and standards of institutionalized care; governments could lower or remove taxes to offset the cost of living at home; prevention and a lifelong promotion of good health could reduce health care costs.

Those are only a few of the comments that were made but they cover a full range of issues. They refer to almost every aspect of health care, from home care to drug costs.

Seniors are aware of the deficiencies of the health care system. If I could summarize in one statement what seniors fear most about the state of the current health care system it would be this: They feel their ability to receive timely and affordable care in the setting of their choice is being compromised. This is the kind of health care seniors want: timely, affordable, and in the setting of their choice. If we can offer seniors a health care system that provides these three things we will have gone a long way to addressing the most pressing problems.

What does timely mean? When seniors ask for health care that is timely they are seeking services that are available where and when they need them. Seniors need to have access to services, particularly those of specialists, without delay. If they need to be cared for in a hospital they do not want to wait until a bed becomes available. Nor do they want to drive miles and miles to get treatment. If resources and services were more readily available at the community level the desire for timely care would be satisfied.

Seniors want health care to be affordable. When seniors ask for affordable health care they mean services that are within their means. This is particularly true of seniors living on fixed incomes. Seniors have told me that living on a fixed income presents a challenge in terms of both meeting current costs and planning for inevitable cost increases in the future.

As provincial governments try to deal with deficits and decreased funding from the federal government, services for seniors are too often hit with cutbacks. Seniors are expected to absorb increased costs to the provinces in such areas as medical services, drug plans, community and care services, transportation, income supplements and housing. In some cases seniors have said they were forced into financial distress and into a position where they had to choose between food or medicine. If on top of that they are faced with a long term illness, what do they do? Affordability is critical to the health and well-being of seniors.

Seniors want to have care in the setting of their choice. This is probably the most important aspect of health care for seniors. Without question their preferred choice is to remain at home. Yet they are faced with uncertainty. I do a daily scan of newspapers for stories related to seniors. Overwhelmingly, by a ratio of about three to one, the issue of cutbacks to home care is the big issue.

Not only are cuts to home care in direct opposition to what seniors want. They deny seniors independence, something they consider their most valuable asset. Seniors argue that the lack of good home care puts direct pressure on other housing options. Seniors have been quick to tell me that neither low income housing nor institutional care options meet the demands of persons facing the prospect of leaving their homes.

Seniors are not only talking about their problems and concerns. They are talking about solutions. I do not want to oversimplify the issues, but I believe seniors could achieve timely and affordable health care in a setting of their choice if two things happened: First, we need to develop and maintain a harmonious relationship between the provinces, territories and federal government. In January the Minister of Health said:

The provinces...deliver health care, they are on the front lines of health care every day, and therefore what I want to do is work with them cooperatively to renew the system they largely run in this country.

This kind of comment is encouraging to Canadian seniors. They like that kind of co-operative spirit.

Second, we need stable funding. We are not alone in this. The Romanow commission agrees it is the case.

We could achieve solutions to our health care problems by establishing harmonious relationships and stable funding. I would argue, as our party has from time to time, that this should become the sixth principle of the Canada Health Act. We could call it a guide or a requirement. In any event, stable funding should be a legislated requirement under the Canada Health Act. It can be done. I would challenge the government to do so at the earliest possible opportunity.

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

Mr. Chairman, I appreciate what my colleague had to say. Since I will soon join the ranks of those who are 65 and older, I must think about my welfare also.

I am well aware of the problem that exists throughout the country. People say “We have lived many years in our community and would really like to be taken care of at home”. I believe they are right. This is part of the challenge that we face.

We have difficulty keeping medical and nursing staff in the regions, close to these people. In New Brunswick, I looked for all kinds of ways to get financial incentives and, frankly, after a few years, people say “We do not need them anymore and we will move on”.

Do you have any ideas on how to keep these health care workers close to those people, where there are real needs?

The answer is not necessarily easy, and I do not have it.

[Werner Schmidt, Canadian Alliance, Kelowna, BC]

Mr. Chairman, it would be presumptuous on my part to say I have all the answers. I do not. However there are some principles we could address to help us deal with the problem at least in part. First, we could recognize that not all health services and procedures need to be provided by highly trained doctors, specialists or even nurses. Other people could perform them because a lot of health care services are the vested interest of certain professional groups.

Second, we could provide and allow for a system that permits home care. Many patients would be far healthier at home or in a setting of their choice than in an institution. Providing this kind of care would help a lot.

Third, it is absolutely imperative that our institutions of higher learning address the problem of insufficient numbers of people being trained in the various health fields.

Fourth, we must address the issue of attitude. All professionals including myself should make service rather than money our number one concern. Let us look at the recent situation in British Columbia. It seems the most important issue to the doctors, particularly physicians, has been money rather than people.

That is wrong. The health care profession is a service profession. Its practitioners are there to help and heal people. They are healers in the first instance. Sure, we want to pay them well. We want them to have a good standard of living. However when greed takes precedence over service we have a serious problem.

We need to move on all four of these areas.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I listened intently to my hon. colleague's remarks, particularly with regard to seniors. He made mention of the fact that demographics are having an impact on Canadian society in terms of its health care system. The same can be said of countries around the world but particularly of Canada.

In the last decade we have been adrift in terms of health care. We have only been able to get away with it because the impact of the demographics has not yet hit. In the next decade we will see the percentage of people 65 and older increase. The amount of health care dollars they will consume, especially given the new technologies and drug therapies impacting our system, will also increase.

Is my hon. colleague as fearful as I am that the Liberal government that will play politics with health care again? As brilliant as the Romanow commission might be, is my hon. colleague afraid it may be used as a lever to win political gain rather than a way to sustain our health care system into the 21st century, which is what Canadians expect and deserve?

[Werner Schmidt, Canadian Alliance, Kelowna, BC]

Mr. Chairman, my hon. colleague has put his finger on what is probably the most interesting, controversial and devastating aspect of the whole health care system.

I talked earlier about greed versus service. Perhaps health has become politicized to the point where politics have become more important than providing service to people. Politics is the system of determining who gets what, when and how much. That is why I am so concerned about having stable funding legislated. We could then predict what would happen. Provinces, institutions and health organizations must plan ahead. When health becomes a political football planning goes out the window. That is significant.

My hon. colleague also mentioned the demographic shift. It is not just that a larger proportion of people in our society are getting older. People are also living longer. As a consequence demands on the health care system are increasing. It is a double whammy that complicates the issue.

To politicize all this stuff is to suggest politics can decide what the facts of life are. I do not know of any politician yet who has affected the law of gravity. It exists regardless. We must become realistic. We must ask ourselves what the issues are and deal with them on that basis. We cannot simply say “I am a Liberal and I solve problems that way”, “I am a Canadian Alliance and I solve problems that way”, or “I am a Conservative and I solve problems that way.”

[Wayne Easter, Liberal, Malpeque, PE]

The Conservatives do not solve problems.

[Werner Schmidt, Canadian Alliance, Kelowna, BC]

With all due respect, I am not quite sure the hon. member is implying that the Liberals solve problems. They have created problems.

We must get down to grips and ask what we are doing. We have given the government some good suggestions. I wish the hon. member would take them seriously.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, my hon. colleague briefly mentioned some of my concerns with regard to the way health care has been treated in the last decade. There is no question that seniors are fearful as they look ahead to discern whether health care will be there for them at the most vulnerable stage of their lives when they need and rely on it the most.

My observation over the last decade has been that if there is a political party in the House that should throw fear into Canadians with respect to health care it is the Liberals. Since they have been in power they have pulled money out of health care and watched it drift into crisis. We now have problem after problem. We have waiting lists and people who cannot get into the system. People are stuck on waiting lists while their muscles atrophy and their conditions worsen. Some people die while on the lists.

An interesting study was done in the United States recently about private hospitals. We should have a study in Canada about how many people die before they get to hospital.

Could my hon. colleague could comment on the crisis? Which party is throwing fear into seniors?

[Werner Schmidt, Canadian Alliance, Kelowna, BC]

Mr. Chairman, I do not know who is throwing the greatest fear into whose heart. However the hon. member opposite commented that in the last while the Liberals have seemed to be systematically taking money out of the health care system.

I would remind the hon. member opposite that although the Liberals put money back into the budget last year and the year before that they are still a billion dollars short of what they took out eight years ago. It is therefore not an unfounded accusation.

The biggest concern of both seniors and young people is stability and the need to feel secure and safe in our society. This is what I heard from seniors across Canada. They said they want to feel secure and safe. They want to be treated at home to the degree that it is possible. They want the services they need when they need them. They want to be able to afford the medicines they need despite being on fixed incomes.

We can point the finger forever and say it is the fault of the Liberals, the Conservatives or the provinces. However it is the fault of all of us if we do nothing about it.

One of the reasons I am here tonight is to draw attention to the fact that there are solutions. Will the government take it on itself to introduce stable funding into the health care system, something it has refused to do for the last eight years? The government has played around with the system. It has added money and taken money away. The end result is that it is still short of where it was in 1993.

[Wayne Easter, Liberal, Malpeque, PE]

Mr. Chairman, before I start my speech, I was a little worried that we had a bit of a problem in the House. The member for Yellowhead seems to be hallucinating in terms of the numbers.

I am pleased to take part in tonight's take note debate on health care as we look toward the completion of the Romanow commission. Mr. Romanow stated:

Canadians themselves are the ultimate custodians of medicare. Not politicians. Not royal commissions. Canadians.

I agree with the statement made by Commissioner Romanow. I also agree that our role is very important. I will focus my remarks to give some voice to the residents of my riding who support a very strong federal role in the health care system.

The Romanow commission is about options. It is about discussing with the public, health care professionals, patients and the full cross-section of stakeholders what kind of health care system Canadians want and are committed to support.

In this debate we have seen some facts. Yes, we will disagree, sometimes along partisan political lines, sometimes on principle. However, this debate is starting to come up with some ideas to give us focus.

What direction do we want to go in? In my view, there has been a drift toward a two tier health care system. The one which ultimately sees a United States model imposed upon the Canadian landscape is one direction most Canadians are opposed to, and one which has been expressed to the Romanow commission. In terms of wanting a strong, federally funded system let us look at the facts. Why is the opposition moving toward the United States model?

The United States spends 14% of GDP on health care. Canada on the other hand spends 9.3% of GDP on health care. The cost per person for health care in the United States is $3,701 U.S. The cost per person for health care in Canada is $2,050 U.S. There are 43 million Americans who have no coverage at all while millions more are not adequately covered. Every Canadian is covered. One study found that in 1997 Canadians paid $270 U.S. per person for health care administration and overhead. Americans paid $615 U.S. per person.

I lay out those facts to relay that the solutions some people are proposing in terms of moving to the United States system of health care is not the way we ought to be going.

Alllow me to give a perspective from a resident of my riding. Joyce Taylor, who wrote me on June 4 stated:

I wish to add my voice, as one who has experienced non-medical coverage for many years in the long distant past, consequently I would not like my grandchildren to suffer my experiences of anxiety and worry over the health of their children.

She explained the difficulty her family faced. She also explained what happened when she and her husband were in Florida recently and a man collapsed in front of them. She said:

My husband suspected the man was having either a heart attack or angina. He attempted to help him and asked me to run and call an ambulance, the man begged me not [to] call any medical aid for him because he was worried about the expense. His condition certainly was not helped by worrying about paying his medical bills.

She went on to say:

I believe as many Canadians do, that health care should be universal and not be commercialized for profit.

We cannot talk about the other place but I am worried about some of the statements made by the chair of the committee over there that is looking at health care in terms of moving us toward a privatized health care system.

Where do we go from here? The former minister of health talked about a report card. That is absolutely essential. Before we can deal with a problem or spend money, we have to understand where the money is going. It is amazing that with all the money we spend on health care in Canada we do not have comparisons. We do not know where every dollar is going.

If we had that kind of report card, a comparison could be done between rural and urban areas and we could see where the problems are. We could do a comparison between one province and another. Maybe one province is doing something right and another is doing something wrong. We could compare one hospital to another. We have to have greater accountability. We have to know where every dollar is going in the health care system.

Greater effort must be placed on caregivers themselves, in particular nurses, the people who work on the hospital floors. With the financial crunch the health care system is facing, the lives of nurses have been made more difficult.

A wing has been closed at the QEH hospital in Charlottetown. I find it amazingly strange that in that wing I now see offices and more managers. I do not see more people who do the actual work on the floor. As one nurse told me tonight “Any important event is not important because you are a nurse”. She made that statement because nurses are finding it extremely difficult to get the quality of life they require.

I would also like to speak to drug costs. The greatest increase in costs the health care system is facing now is the cost of drugs. We have to seriously look at the patented medicines regulations. What is wrong with them? The automatic 24 month injunction under the patented medicines regulations of Canada's Patent Act allows brand name pharmaceutical companies to prolong their market monopolies by simply alleging patent infringement against generic manufacturers. That adds substantially to our costs.

As the regulations stand, no generic drug can be approved by Health Canada until any claim of alleged patent infringement is decided in court. The regulations withhold Health Canada approval not when a patent is actually infringed but when the brand name company says it might be. Clearly this provides enormous financial incentive to brand name companies to allege patent infringement regardless of the possible outcome of the litigation.

Even when the generic manufacturer wins, which has happened in about 80% of the cases since the last amendments were made to the regulations in 1998, the generic drug is still kept off the market through lengthy and costly litigation often for years past the expiry of the original patent. We must deal with that and try to get the cheaper generic drugs on the market.

The pharmaceutical industry has found a way through the use of patents and legal means to abuse the intent of the patent regulations. That definitely must be addressed.

There is a lot of rhetoric around the health care issue. We heard it a moment ago when the member for Yellowhead talked about spending. The fact is that the federal government has increased spending for health care. In 1997 CHST transfers to Prince Edward Island stood at only $118 million. As a direct result of the government's sound financial management in the year 2002-03, transfers to Prince Edward Island will reach $158 million. That is a substantial increase.

The point I want to make, and others have made it before me, is that it is not just a question of more money. We have seen reports this week in the press stating that the extra money the federal government has extended to the provinces for health care equipment was not necessarily spent on health care. Coming back to my point earlier on report cards and accountability, it is important that the federal dollars that go into the health care system be accounted for and used for what they were intended.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I listened very closely to my hon. colleague's comments. I am a little confused. He suggested some numbers that may have been thrown around. If he wants to play the numbers game, let us play the numbers game.

The percentage of the health care dollars that comes from the federal government is only 14%. In some provinces it is less than that. It is down to as low as 12%. Some health ministers will say it is even less than that in some provinces. From the provincial side, it is up to 42% in some provinces. Looking ahead over the next five years, it will get to 50% and beyond. That is if we move things out to the next four or five years.

When it comes to responsibility from one jurisdiction to another, let us get serious about who is supporting health care. Is it the provincial governments or is it the federal government?

If the federal government is serious about doing what it says and recognizing that health care is the number one priority for Canadians, then it is time to put its money where its mouth is and to do something when it comes to putting dollars back into health care, but not just dollars because dollars alone in a dark hole will just evaporate. That is what we are discussing this evening. Even Mr. Romanow has suggested that we need to do more than just put dollars back in. This is a golden opportunity to sustain the health care system into the 21st century.

Where has the member been for the last 10 years as the government has run health care just about into the ground?

[Wayne Easter, Liberal, Malpeque, PE]

Mr. Chairman, I said earlier that I was worried the member for Yellowhead was hallucinating but now I am sure. He obviously believes, and that is his right to do so, this 14¢ myth that has been portrayed by the provinces.

It is true the provinces do claim that the federal share of their health care spending is now only about 14¢ on the dollar. To come up with the 14¢ figure, provinces are comparing only the cash portion of the Canada health and social transfer.

When we went to the Canada health and social transfer a few years ago, the tax points were increasing and the cash portion was lessening. As a result the federal government had less ability to ensure that the provinces maintained the principles of medicare. We went to the CHST to try to keep the cash portion high enough to have the leverage because the best leverage is the spending leverage. The member is only talking about the cash portion, which is indeed 14¢, but we have to add the transfer for the tax points as well.

Direct federal spending for health care currently amounts to about $4 billion a year. This is for first nations health, veterans health, health protection, disease prevention, health information and health related research. As well through the tax system we provide support worth about $1 billion a year. This includes credits for medical expenses, disability, caregivers and infirm dependants. When we add the $5 billion in direct spending and tax credits to the $24 billion in transfers, we are spending about $29 billion a year, or close to 36% of all public spending on health care in Canada. The 14% does not have merit. It is actually about 36%.

We can debate the numbers but certainly jointly between the federal and provincial governments, we have to ensure that the stable funding is indeed there to get the job done. We must ensure that we have the kind of public health care system that Canadians want.

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

Mr. Chairman, I would like to ask a question to my colleague, who has been here for a number of years already. With regard to the current provincial transfer formula, does he think that we could look at whether the money transferred for health care does in fact go to health care? I would like to hear his comments on this. Could this be a way to ensure that we know exactly where our investments in provincial transfers are going?