Debates of June 11th, 2002

Health Care System

[Some hon. members]

Oh, oh.

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

Mr. Chairman, this is a serious question. Canadians want to know what commitments the minister can give to ensure that this report, when it is tabled in November, will be dealt with by the minister as soon as she receives it, that it will be tabled for all the public to see and that she will develop a plan of action as expeditiously as possible.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chairman, I can reassure the hon. member that I am the Minister of Health and I have one task and one task only, and that is to discharge my obligations as the Minister of Health. One of the most important obligations I have right now is to work with provinces, territories, members of the House, health care professionals and those who use the system to renew the health care system.

I would hope that the hon. member, with her sophisticated knowledge, and I mean this quite sincerely, of the health care system would not suggest that the renewal of this system is only about cash, because it is not. There is no one that I have talked to who has suggested that renewal is only about cash.

I will certainly make a commitment to the people of Canada and to the members of the House that the Romanow commission's report will be made public by Mr. Romanow. We will take up that report and we, as a government, will begin the development of our plan of action with the provinces, territories, and with those who choose to respond to that report, including I am sure the Standing Committee on Health.

[John Bryden, Liberal, Ancaster—Dundas—Flamborough—Aldershot, ON]

Mr. Chairman, renewal costs perhaps but also surely transparency. The minister will know that the health care providers in this country, the hospitals that are consuming billions of dollars, do not come under any kind of freedom of information legislation. They do not come under mandatory standards of corporate governance and transparency that are required of for profit corporations by the Canada Business Corporations Act. Is the minister, as part of her review, undertaking to study making the system of health care more transparent and accountable through proper legislative means?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chairman, accountability is an absolutely key issue here. When we talk to Canadians about health care, they want to see greater efficiency among other things. The other thing they talk about a lot is accountability. They want to know who they can hold accountable for the expenditure of their tax dollars. Is it the provincial minister of health, the federal Minister of Health, or the regional health authority? Is it the doctor from whom they have received a service? Who in fact is accountable in this system?

The hon. member raises an important point, which is that we need to do more together. That is why the provinces are moving in this area and certainly we will work with them to the greatest extent possible to ensure greater accountability and transparency in our health care system.

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

Mr. Chairman, I rise on a point of order. Could you ask for unanimous consent to allow a further 10 minutes for discussion and questions?

[The Chairman]

Following the question asked by the hon. member for Hochelaga—Maisonneuve, I must inform the House that, earlier today, the House unanimously passed a motion to allow only one type of requests for consent, that is to share time.

I am sorry, but the rules have been unanimously established earlier today in the House.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I agree with the minister and with most of the polls across this country that say that health care is the number one issue across this land.

It is also the number one concern of the electorate for sure who are responding to polls or talking in the coffee shops regarding the issues of the country. They value their health care system very much. It is important that they have at least the sense that their concerns are being dealt with as they wrestle with the problems as they see them because they are troubled. They are disheartened about some of the problems they are experiencing.

We can argue all evening about whether health care is in crisis or not. That is a fruitless argument. Some people say that just throwing more money at it will solve the problem. I disagree with that. Other people say that we should go for a complete overhaul of the system in some way. Then there are others who say that it is not in crisis at all and is just fine the way it is. The truth of the matter is that if we are one of those people on a waiting list or laying in a gurney in a hospital or laying in bed at home with our muscles atrophying because we cannot get into the system, it is in crisis today. We must recognize that.

It is important to Canadians and to the Canadian Alliance. We went on an extensive look at health care in this last year trying to discern exactly where Canadians were. We looked at our policy to see what Canadians were thinking and feeling about health care. We launched that last spring, revised our policy and it was accepted at the national assembly in April. We based our policy on four principles.

First, people want to get into a system in a timely way. They do not want to have their muscles atrophying while they are on a waiting list. That is unacceptable.

Second, when they get into the system they want it to be a quality system, one that they know can deal with the concerns that they have and is not second rate.

Third, they want it there not only for themselves but for their families, their grandchildren and for generations to come. They want it to be sustainable.

Finally, they want every Canadian to be able to access it regardless of the financial means.

That is how we must look at our system. That is what Canadians want. However, they want to change the focus from an institutional system to a patient driven system, one that they are paying for. They are the ones that the system should be concerned with. It should be focused around them rather than around the system.

Let us look at the legacy of the government over the last 10 years when it comes to health care. There has been a lack of importance put on the system. The government leads by polls and by spin. When it comes to health care that just does not work. We actually have to lead to drive health care and to sustain it into the future.

In the 1990s we saw the government pull $25 billion out of health care. The former finance minister is one individual who takes his share of the blame on this. What exactly happened to health care once that money was pulled out of it? This is a government that uses health care as a weapon going into an election, as a lever we might say.

This is not the first time we have seen a royal commission or an extensive commission on health care. The national forum on health in 1997, prior to an election, sits on a shelf collecting dust. There is absolutely very little, if anything, coming out of that forum that was implemented.

There are some things that the government does well, that is, study health care. It has put $242 million into studying health care in the last 10 years. That figure comes from a question we sent to the parliamentary library. It was not us who tallied the dollars. It was the Library of Parliament.

I would like to make mention of the September 2000 accord because it was a golden opportunity for renewing health care, if we want to use that word. It was a missed opportunity, just prior to the election I might add. There is $21 billion that does not go in right away. In fact, not a cent of that went in until April 1 of the following spring, except for the billion dollars that was mishandled and the other half a billion dollars that was for information technology.

If members want to look under a stone, just take a look at where that money went. It was probably treated very similarly to the billion dollars in technology that went toward floor scrubbers, steam cookers and lawn mowers. There was $486 million that was unaccounted for. This is almost two and a half years from the time that money was allocated.

There are major problems. What kind of a system do we have right now? We have waiting lists that are growing longer all the time. We have obsolete medical equipment. We have a critical shortage of medical professionals: 2,500 doctors are needed to stay in the system per year, and 110,000 new nurses are needed within the next eight to ten years just to keep up. Because of such a lack of health care professionals the system and the morale within our facilities are unbelievably disturbing.

The federal-provincial acrimony over health care and the Canada Health Act is something that should have been fixed many years ago. There was a promise in 1999 for a dispute settlement mechanism. We got that, but only after a gun was held to the head of the minister. Sadly there are too many other personal horror stories in health care.

What has happened? Canadians have lost their confidence when it comes to what is happening in health care. A Statistics Canada opinion poll released in January reported that the number of Canadians who felt the health care system was not meeting their needs rose 50% in the last four years. More than half of the respondents reported that health care problems led them not to pursue treatment in our health care system. That gives us an idea of how people are thinking.

Let us look ahead and take a look at what is coming if we are considering saving health care. The Canadian population is aging. The percentage of those who were over 65 in 1981 was 9.7% and 12.5% in 2000. It will be 14.6% by 2010 and by 2031, 23.6% of the population will be over the age of 65.

Why are we so concerned about that? It is because from age 45 to 65 we spend an average of $1,800 per patient. From 65 to 75 it is $4,000. That is over double within a 10 year span. From 75 to 85 it goes to $7,500. At 85 and over it is $14,000 a year. That is why we are concerned.

If we look ahead with the same system we have a problem coming. Coupled on top of that the kind of problems we have with obese children or unfit children, as I like to say, in our student population who will have heart and stroke problems at age 30 instead of 60 and 70, it will multiply that problem. Clearly we have a problem in health care.

What are some of the solutions? We should allow the federal government do what it can do and allow the provinces to do what they can do. The federal government can deal with the Canada Health Act. Canadians have bought into the Canada Health Act, although it has been compromised in all five principles in every one of the provinces. We really must do something with the Canada Health Act to make it a quality system. We must rejuvenate it and look at how we can deal with a health system that is going into the 21st century. It has not been looked at since 1984. It has to consider such things as quality, timeliness, sustainability and accountability. These new principles must be considered as we look into that.

The other thing is the dollars and cents. How will we pay for the system? The Canadian Alliance strongly believes that never again should a government be able to pull those moneys out of the health care system and balance the books of the nation on the back of health care. Therefore we added a sixth principle. We say that we should have stable five year funding at a minimum for health care to be able to sustain it into the future.

However more money is not the only solution. Every one of the reports from the provinces, whether it is Fyke, Mazankowski, Kirby and even the Romanow commission, will all say that more money is not the only solution. We must do more than that.

When we look at some of the serious considerations of our health care system and the number one driver of costs we understand that it is drugs. We must do something about that. Not only must we do something about the cost of drugs and the availability of them, we must do more than that. We must look at the safety of drugs. We have problems in drugs that are unbelievable. Approximately $15.5 billion was spent on drugs in 2001, up 8.6%. That is a serious problem.

We must also umbrella everything that we talk about under health care promotion and look at more than crisis management. We have crisis managed health care for the last three or four decades. We must look beyond that. We must look at it as health promotion and wellness. We must look upstream much further than that if we are going to sustain the system into the future.

We have great challenges in health care. We have great opportunities as well. We need greater accountability and transparency, more stability of funding, more flexibility and innovation, more co-operation with the provinces and more honest and open debate.

[Judi Longfield, Liberal, Whitby—Ajax, ON]

Mr. Chairman, I listened with great interest to the hon. member opposite. One thing struck me. He talked about a report he asked the Library of Parliament to produce for him that claimed we were spending an enormous amount of money to study health.

First, did the Library of Parliament provide you with the details of where we were spending the money? If we spent as much as you say perhaps you could tell us how it was spent.

Second, you talked about the rising--

[The Chairman]

I know committee of the whole is slightly different but I strongly encourage all members to make their interventions through the Chair and not directly to one another across the floor. It might be helpful if I need to come in at some time.

Let us start from the beginning. The hon. member for Whitby--Ajax.

[Judi Longfield, Liberal, Whitby—Ajax, ON]

Mr. Chairman, could the hon. member opposite comment on the notion that while drug costs are rising it may be a more cost efficient way of treating the illnesses facing Canadians?

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Thank you very much for the question. I can certainly give you the report from the library. I do not have it with me but it is in my office and I would be more than pleased to give it to you.

[The Chairman]

Again, we are at the beginning. Do not forget us up here. You might want us someday, so please make sure you go through the Chair. Right now it is nice and cool but that could change.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I am sorry but it was a very cordial dialogue. We will do our best to make sure it stays that way.

I would be more than happy to table the report either to the Chair or to the hon. member tomorrow. It is certainly not anything I keep secret. Nor is it something I developed. It is there and the figures are real.

The real issue the hon. member wanted to talk about was drug safety and the reason drug costs are going up. Not only is the cost of drugs going up. We are using more drugs. That is fine. Canadians are big users of drugs and will continue to be.

However we must look in perspective at the downfalls of this. As we use more drugs we are also misusing many drugs. This is causing tremendous concern. Statistics coming into my office suggest 30% of seniors are addicted to benzodiazepines, a very addictive line of drugs. That is 20% of the general population. The addiction is often worse than the illness the drugs were prescribed for. They are not being used as intended by Health Canada. The rules say they should be taken for 7 to 10 days at a time. Some people have been on them for 7 to 10 years.

We have a major problem that needs to be addressed. Before we open the avenue for more drugs let us deal with the safety of the drugs we have.

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

Mr. Speaker, my question is for my colleague who sits on the same committee as I.

In 1984, when the then Minister of Health, Monique Bégin, tabled the Canada health legislation in this parliament, she did so in a rather unconstitutional way.

We know that, regarding the division of powers, the federal government has power over drug certification, quarantine, Indians and national defence. The Minister of Health used the federal spending power to impose standards that would normally never have seen the light of day under a strict division of powers.

Does the Canadian Alliance member not think that the principles put forward in the Canada Health Act infringe somewhat upon provincial prerogatives and go against his constitutional agenda?

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I thank the hon. member for his question. It is a good point. As I said in my dialogue earlier, the five principles of the Canada Health Act are compromised in every province. It depends on where and how we want to draw the line. Are they compromised because we have misused or abused them? Perhaps they are.

Let us look at the pattern of the government over the last decade. Every time the provinces have been innovative in trying to deal with the deficits inflicted on them by the federal government's withdrawal of money, in came the health minister of the day with a big sword saying “Do not touch that. Do not do that.” It was a double sin. Not only were the provinces asked to deal with an untenable position in terms of lack of funding. They had to do it with their hands tied behind their backs.

I was in the system at the time. I worked on the floor in policy development. I wrestled with the issue of how to make health care sustainable. It is something that absolutely cannot happen again. I hope the new minister takes a more collaborative approach than ever before to the respective roles of the federal and provincial governments. If we are to save health care we need to do that.

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

Mr. Chairman, I have often been critical of the federal government when it comes to health policy. However when it comes to the Alliance policy I find some of its proposals outright frightening.

During the last election the Alliance was on record as supporting two-tier health care. It has come out as being opposed to strict enforcement of the Canada Health Act. It has given credence to shifting more costs onto individuals through medical savings accounts or user fees. It voted down a bill in the House that would have banned private hospitals. Last week an Alliance member told the Romanow commission the Alliance would favour private, for profit health service delivery and private pay options to offer more choices to Canadians.

Members can see our concern and the concern of Canadians. It is incumbent on the Alliance health critic to clarify his party's position and indicate whether he is prepared to join Canadians in the fight for non-profit public health care.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I thank the hon. member for her questions. They are misleading at least, and a blatant lie or misinformation if not--

[Some hon. members]

Oh, oh.

[The Chairman]

Order, please. I would ask the hon. member to withdraw the word lie.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

I withdraw.

[The Chairman]

Is there still a point of order from the hon. member for Peterborough?

[Peter Adams, Liberal, Peterborough, ON]

Mr. Chairman, I withdraw my point of order.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chairman, I will inform the hon. member and Canadians of our policy and what we did. First, it is not the case that we support two-tier health care. In the last election we ran on absolutely the opposite. We said no to two-tier health care.

The hon. member quoted a newspaper article from last week in which one of my colleagues who is a doctor expressed his own personal view. I clarified in the same article that this was not our party policy. I said we believed in a federally run system based on the Canada Health Act, not the parallel system she so blatantly says we believe in.

I do not know what it would take to clarify the misconceptions of my hon. colleague. That is not where we are at. If she has read the rest of the article she knows it full well. If she has not read it I encourage her to go back and do so.

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

Mr. Chairman, they could not have chosen a better moment to discuss those issues. The Bloc Quebecois received with great skepticism the interim report of the Commission on the Future of Health Carein Canada.

Why were we so skeptic? Try to imagine the situation we are in. I hope the minister will make the effort and try to understand our situation.

Since coming to power in 1993-94, the Liberals have reduced transfer payments to the provinces by nearly $30 billion. They have literally, deliberately weakened the provincial health care systems.

The federal government has never been in a better position financially, its revenue increasing by more than 6.5% a year.

The federal government has some gall to come to us now and say “We want to think about the future of health care”.

Between 1947 and 1972, each province created its own hospital insurance plan. It is impossible for the federal government not to know that the provinces developed their own plan with their own public funds during those years.

At the time, the Liberal governments were committed to 50-50 funding. This was a cost-shared program in which half of the money was to come from the federal government and half from the provinces.

Today—and this must be a source of embarrassment to the minister—fourteen cents of every health dollar spent in Quebec comes from the federal government. I think there is no possibility of dialogue with the provinces. I see the minister is getting all agitated, and I would challenge him to stand up and tell us that is wrong. There is no possibility of dialogue with the provinces if we do not put the federal share back where it was supposed to be, at 50 cents of each dollar spent.

Does this mean that no thought must be given to how services are going to be organized? It must, and this is so much the case that thought must also be given to the fact that the very good government of Quebec, led by Bernard Landry, he who provides very good government to the people of Quebec, has set up the Clair commission.

Seven other provinces have followed Quebec's lead, and now there are eight task forces that have made recommendations on the future of health care.

What has changed in health care? Today, the issue is no longer senior citizens. For example, if she does not smoke too much, goes to the gym regularly and has good determinants of health, the minister should live to be 86 years old. Incidentally, we wish her a long life, not in politics, but in real life.

This is why we are no longer talking about the old, but the very old. This means that governments must plan health care in co-operation with the communities. People no longer want to be kept in the health care system. They no longer want to stay in hospital for too long. This is why we must rethink the whole issue. The two spectra of life are forcing us to rethink our health care approach. People live longer and they live longer in their communities. We must rethink palliative care and home care.

If we do not want people to go to hospital, it means that frontline services must be available. In Quebec, which is a model for Canada and several other countries, we have local community service centres, better known as CLSCs. The challenge for lawmakers is to find ways to provide proximity services in people's natural environment. We looked at the changes.

I would be curious to know. I asked the Library of Parliament—I am an intellectual, I read all the time—to see what had become of the various measures announced in the National Forum on Health.

First, is there anyone in the House who thinks that the Romanow commission is going to tell us anything other than what we learned from the National Forum on Health?

From 1995 to 1997, the Prime Minister, the member for Saint-Maurice, chaired the National Forum on Health. We saw the forum's report. The government invested $300 million in the Health Transition Fund. We now know what the major changes in the health care system will be. We are no longer listing the changes and receiving information about them. The provinces have completed this exercise, as did the federal government with the National Forum on Health.

Now, we must make sure that our budgets will be up to the challenge. Whatever our political stripe—to the left of the New Democratic Party or to the right of the Canadian Alliance—one fact is inevitable. Whoever the federal Minister of Health is, one fact is inevitable. For example, if Quebec wants to provide exactly the same health care and services, and no more, it is going to have to increase its funding by 5%. This will be true up until 2010.

I could add that at the first ministers' conference, they looked at possible resources. It is not possible that the Minister of Health does not know this. In 1994-95, when the Liberals were in power, the provinces invested $48 billion in the health care system. In 2002, they invested $67 billion. In 2010, they will be investing $88 billion.

Considering the present fiscal situation, provinces are unable to meet the demand. This is why, regardless of their political stripes, Premier Bernard Lord, Premier Campbell in British Columbia, New Democrats in Saskatchewan and Conservatives in Ontario have unanimously asked the federal government not to reflect, not to tell provinces what to do or use an authoritarian approach to reorganize what is a provincial jurisdiction, but to loosen its purse strings.

This will be the challenge for the federal government in the years to come: assume historical responsibilities. I would be very disappointed if the minister, who no doubt has very finequalities, was not very vocal about this issue in cabinet and did not show herself to be a staunch ally.

We cannot count on the Prime Minister to be an ally of the provinces. As we know, he is a stubborn and insensitive person and we cannot count on him to become an ally of the provinces. We can, however, rely on the minister, who has a sweeter disposition and a more conciliatory attitude, to recognize that without a substantial increase in resources, provinces will never be able to meet the demands of the various health systems.

I will conclude by mentioning that in September I will move a motion in the standing committee on health, for which I hope to gain the support of all my colleagues. There is one thing the federal government could do, and it is to ensure that when new drugs are registered, they have new therapeutic value.

The Patented Medicine Price Review Board has noticed that 80% of new drugs on the market are actually not new. The Senate of Canada has estimated that when a new drug comes on the market, pressure for its use occur during the first 12 months.

The standing committee on health and the federal government could review the whole question of the introduction of new drugs on the market and ensure that they have new therapeutic value.

Mr. Speaker, I see that my time is up. Even if the minister is asking me to go on, I will yield to your authority and answer questions.