Mr. Chairman, I want to do something that is unheard of in the House. I want to take politics away from this discussion and talk about the substance of this debate tonight.
Mr. Romanow talked about four themes when he presented his interim report: values, sustainability in funding, quality and access, and leadership collaboration and responsibility. I would like to deal with those four issues in the order in which they come.
The first is values. Mr. Romanow talked about how the Canada Health Act reflects the values of Canadians today. When the Canada Health Act was first written and medicare's inception began in the late 1960s and 1970s Canadians believed in certain values. The question he is asking is are those values still as valid today?
We have been to town hall meetings and talked with our constituents in roundtable discussions. We have listened to the public, to patients and even the provinces at the first ministers conference on health reform in 2000. All agreed that those values are unchanged. The values that we espouse under the five principles of medicare: public administration, comprehensiveness, universality, portability and accessibility are all still as real for us as Canadians today as they were in 1969.
However let us ask ourselves, what has changed? Why is it that even though we still espouse these values we are having this debate? Why are we discussing medicare right now? The thing is that since 1969 our country has changed. There are so many pressures that have been placed on what was inherently at one time a good system.
One of the most important things that we must remember about the system is that it started as a system that would ensure that when Canadians became ill they would not be bankrupted or have to sell their homes to be able to take care of their families when they became ill. That was the basic principle behind this medicare system as we have come to know it today.
At that time we were looking at whether or not we would only deliver care. This medicare system decided we would deliver care in hospitals only and that it would be for physicians only. It began as a physician and a hospital centred service. What has changed since then is that we are delivering care everywhere. Not only are we delivering care in hospitals, but in homes, long term care centres, palliative care institutions and in the community. That has changed.
We are coming to realize that physicians are not the only people who can deliver care to people when they are in need and when they are ill. We know that we have nurses and nurse practitioners. We have chiropractors. We have many health care professionals who are capable of delivering certain types of care as required when patients become ill. The whole concept has changed and we have seemed fixed into this area.
This is what the federal government does when it transfers payment for health care. It transfers payment under the concept of paying its share for physicians and hospital service only. As time went on and as provinces that deliver service realized that they had to take care of all these other places where services were delivered, all the other types of services that were required, we began to find that there began to be pressures in the system.
The provinces began to focus on paying for health care, for services and programs that were outside those two original areas. This was a second area where pressure began. Therefore the question is, if we still believe in those values how do we deal with those questions?
We also find that the technology has changed. We have technology that can tell us anything we want to know about diagnostics, about care and treatment. People are living longer so the chronic degenerative diseases that we never used to see in the old days are now there. We spend a lot of the money in medicare at the last stages of life and in the latter years of life as well as in the early years of life. We are finding that we can deliver babies earlier and that they can survive earlier. So we have all of this technology coming into play.
Finally, as a result of all of this new knowledge, we find that patients are beginning to expect more of their system. Patient expectation is also a huge pressure that is driving the system.
I remember I once had a friend who said to me “I think today because of so much technology and all the things we know that everyone thinks that death is an option”. Therefore, we want to plug into every single thing that we can to ensure we have what we need when we want it.
I use the word “want” and that is another pressure on our system. Canadians have come to expect that they can have what they want, when they want it. The medicare system is designed to give Canadians quality care when they need it, in a timely, accessible and cost effective manner. This is where we have to start focusing our debate.
That then moves me into the second theme and that is sustainability and funding.
How do we sustain a system that has evolved so rapidly and that will not take another 30 years to evolve? It is evolving as I stand here right now. There are changes. There is fluidity in the system. Evolution is occurring and something new is being discovered every day. We are debating new reproductive technology. We are debating all kinds of new things. We have a new armamentarium of tricks up our sleeve to diagnose and to keep people living for a longer period of time.
We will not have to find an answer to the question today, but we will have to find an answer that is flexible and that can evolve as this evolution continues. That is one way to look at sustainability.
Funding is a huge issue. I think we have all bought into the 70:30 split in public funding/private. However there is a bigger question because of the variability of opinion. Some people say that because we have the 70:30 split we should have a private system and those who can afford to pay can use it. They say that this will take the pressure off the public system, it will solve the problem and everything will be fine.
However that goes against the values. Let us not forget that these five themes are interconnected. The values tell us that we do not believe that anyone should be bankrupt when they need care or that anyone should be denied care when they are ill because of a lack of ability to pay. Therefore, in that very concept we have accepted the fact that we will never have two classes of citizens, one class that can afford to be well and one class that cannot afford to be well. We have already bought into that concept, so let us not even debate that.
What happens when a system is developed where one class of people can pay and the other class cannot, whether it be full pay or a user fee or all those other things that are suggested? Having practised family medicine for 23 years and having delivered a thousand babies, some people who cannot afford to pay will not care. They will accept charity and get those services free while others will have to pay. That is wrong.
So many of my patients who were low income people had a sense of pride. They did not want some sort of charity. They wanted to pay their way. There are families of working poor with three children for whom a $5 user fee for each child is a huge amount of money. Therefore user fees already create a barrier to one of our principles and that is accessibility.
Then we have people who say that we should look at those who can afford to buy premiums or that we should have an escape valve and people can buy different kinds of premiums for different kinds of things from private insurers.
Many people do not speak about one of the five principles of medicare and I would like to touch on that. It is called universality. What people do not know is that universality means that there should be no pre-existing conditions considered in medicare. There is no insurance service anywhere else in the world that does not consider pre-existing conditions.
The fact is no matter how rich people are, if they suddenly develop a long term chronic disease, their first year will be fine. In the second year in a private insurance company their premiums will go up. In the third year they will become completely uninsurable and no matter how wealthy they are they will end up selling their houses to get care. That is not what we want.
We have to deal with this in a different way. We have to look at the issues of leadership and collaboration. We have to talk about how we get it. We have to talk with the provinces. We have to get away from this blame and pointing finger attitude that it is their fault or our fault. Let us talk about how we can sustain a system that we know must be there for Canadians.
Let us talk about how we define what is medically necessary so that we give people the health care they need when they need it, and what they want they can buy. The need and the want are two very important things, so let us redefine what we mean by medically required services.
Let us not do this in an arbitrary way. Let us do it by looking clearly at what we call clinical guidelines and evidence based care. We have that information today. Let us put aside the rhetoric and the politics and talk about something that is so important to all of us and to all Canadians. Let us decide that we will share the responsibility as a federal government and as provinces. Let us work together in a collaborative manner to find solutions not just for certain Canadians and certain provinces but for all Canadians no matter where they live or work, whether it be in rural, isolated or urban Canada or on the east or west coasts.
In closing, perhaps one of the ways to do this is to bring forth some sort of commission that can take away the politics occasionally, that can give us the evidence, the outcomes and the results, that talk about funding and that give us the statistics so that--