Debates of May 13th, 2003

Supply

[The Assistant Deputy Chair]

On a point of order, the hon. member for St. Albert.

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, I was not rising on a point of order. I just wanted to commend the Minister of Health for the leadership she has provided to this country and also for running 10K races as the member said.

I do enjoy the friendship I have with the Minister of Health and the conversations I have with her. I would hope that we can get on with questions and answers. That is what it is all about.

We have an hour and a half left. We have wasted so much time. I hope our critics for health care--

[The Assistant Deputy Chair]

Order, please. The hon. member for Winnipeg North Centre.

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

Madam Chair, I am pleased to have a chance to participate in this historic debate, an in-depth look at the estimates for the Department of Health.

Five hours is a big improvement over the hour we might have had in the past in committee. I commend the minister for being here. I should let her know, though, that five hours falls far short of the 50 hours or so that we used to grill the minister of health in Manitoba. She may live to regret the day that we have opened up this door.

Let me start by asking about the Romanow report. The first question I obviously have is, why have the minister and the government failed to implement the Romanow report as a blueprint for the future of health care?

I know that is a broad general question but Canadians everywhere are asking us that question. Why would the government spend millions of dollars on an independent commission, spend a great deal of time with Canadians investigating their feelings about health care, ensure that a blueprint evolved from that process, and then end up not doing anything about it?

Canadians are asking us, why did this happen? How did we have this huge process, the expenditure of time, an in-depth look at values, and then a blueprint basically ignored by the government of the day?

Is there an intention on the part of the government to recognize the Romanow Commission report as a blueprint and to begin to implement it at least on a piece by piece basis? If it is not prepared at this point to give whole hearted support for the report, will the government give us an indication of how it views the Romanow blueprint and what it intends to do with it?

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, I thank the hon. member for her questions. Even though she is no longer my health critic I thank her very much for her ongoing interest and commitment in the area of health and health care.

I must disagree with the hon. member. Mr. Romanow's report provided much of the guidance in terms of the first ministers accord that ultimately was reached on February 4. It will continue to inspire many of the actions, and form many of the actions that we take and other governments take as we move forward in the months and years ahead. But just to give some specific examples, Mr. Romanow talked about the importance of primary health care reform. He talked about the importance of home care. We must start to look at our health care system as a continuum of care and home care needs to be included as an insured service.

What are we doing? We are starting with post acute home care and palliative home care. We are starting to develop that continuum of health care and expanding the basket of things that are covered by provincial health plans. We are looking at the area of catastrophic drug coverage. Mr. Romanow talked about that as did Senator Kirby. It has been identified for us by a lot of Canadians.

Many of the breakthrough drugs and therapies can cost thousands of dollars a month. That is just too much for some families. As we said 50 years or 40 years ago about the fact that we should not have to sell our home or give up our entire life savings to be able to access an acute care hospital, we should not have to mortgage a home, give it up or sell all our life savings to be able to afford something like a $10,000 a month arthritis therapy, for example.

That is why we are moving on catastrophic drug coverage with the provinces and the territories. The Romanow Commission formed the health accord to a very significant degree. We are moving on the health council. The health council is only one example of the broader principle of accountability which everybody agrees is absolutely key. We are building on the work of CIHI and PIRC, the predictions indicators project.

We will create a health council and expand our prediction indicators. There will be expanded reporting and annual reporting in relation to important aspects of the health accord. It will provide Canadians with the information they need to be able to compare how their health care system is performing in their city, with another city in their province, or a city across the country.

We are reaching a point, based on the good work that is done at the provincial and territorial level, and our own level, where we can now actually compare apples and apples in the health care system. That is really important.

Mr. Romanow also talked about the importance of high end diagnostic equipment. We are still, in relation to some areas, a little bit below the OECD average, but because of what we did in September 2000 we are much closer to that OECD average as it relates to high end diagnostics. We have created a medical equipment fund that responds to that need but also has greater flexibility.

If we talk to a health minister from a province like Prince Edward Island, he would say there are MRIs for 100,000 people and there is no need for another MRI, but that there is a need for beds and basic x-ray machines. That is why we have expanded the medical equipment fund to accommodate those legitimate real needs on the front lines of health care. We have also expanded that fund to permit training because even in well off provinces like my own, Alberta, the health minister would say that there are enough MRIs, but that they are not run to the maximum utility because there are not enough trained technicians and radiologists to maximize the utility. We have increased the flexibility to permit training for either new technicians or radiologists and to retrain existing technicians and radiologists.

I am not here to suggest to the hon. member we accept--

[The Assistant Deputy Chair]

Order, please. The hon. member for St. Albert.

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, the point is that we do need more MRIs. That is the issue about health care today.

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

Madam Chair, I appreciate the answer from the minister, however, the facts do not make her case.

Looking at the budget there is a huge gap between what is in the budget for health care and what Romanow recommended. I would simply like an acknowledgement that there is a Romanow gap in terms of the funding of health care. The provinces have said the Romanow gap is $5.1 billion or $5.2 billion. Does the minister accept that figure and agree with it, yes or no?

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, there are many, including probably some provinces who would not accept Mr. Romanow's numbers because they do not think it is enough. The numbers game is not really that useful to us in terms of understanding what we want our health care system to be; what are our objectives for our health care system; how do we reach those objectives; what do we need to do; what is the money required to achieve those objectives?

People can argue about whether we have exactly the right amount of money or whether it is too little. My guess is very few people would argue that it is too much, except maybe some in the Alliance Party, I do not know. I take the point that there are very few who would argue that it is too much.

Having said that, we think $34.8 billion is an awful lot of money, new money over the next five years. Money is not the only answer. There would never be enough money for health care without structural change. What we have to do is ensure structural change to make the changes that are necessary to sustain the system. There will come a point when Canadians ask if we have put enough money into the health care system. What percentage of GDP should a province or a nation be providing for health care? Those are legitimate questions. It is not only about the money.

We have put a lot of new money in over the next five years. Let us see what we get for that. I think that is the question Canadians are asking. The Canadians I talk to ask me “How much money was put in? How much money do we spend? Are we getting better health outcomes and if not, why not?”

I do not think it is about more money. Canadians are very skeptical about whether we need to put more money into the system. They want to know how the money presently in the system is being used and what they get for it. Those are really important questions. They want to know whether there is waste and inefficiency and what we can do to restructure the system before they put more of their hard-earned dollars into the system. Those are the questions we should be asking.

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

Madam Chair, in the budget there is a funding gap in terms of Romanow's recommendations. There is also an accountability gap. We are certainly not suggesting all of the debate on health care is about money but that is an important part considering the government of the day is responsible for significant cuts in the health care system over the last number of years.

My simple straightforward question for the minister should be answered with a yes or no. What is the amount of new money in this budget for health care in terms of the first ministers' agreement for the year 2003-04, the amount of new money in terms of sustaining our health care system?

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, looking quickly at my FMM accord funding chart, the total funding increases are $4.238 billion in 2003-04. It includes the CHST increase, the CHST supplement in this year. It includes the health reform fund; the diagnostic equipment fund; the information technology fund; research hospitals; dollars for governance and accountability. Then we have first nations health at 180 million new dollars this year and we have 312 million new dollars for other aspects of health and health care.

I want the hon. member to understand these are not all transfer dollars to the provinces because we do not accept the fact that the only dollars to be counted in terms of new money for health and health care are dollars directly transferred to the provinces. As I am looking at my FMM accord, the total amount for this year for health and the health care system is $4.238 billion.

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

Madam Chair, it is important to distinguish between global new funding for health care and transfers to the provinces since that is so fundamental to our ability to sustain a national system. It is important for the minister to acknowledge the fact that according to her own records and provincial analyses of her departmental budget, only $2.5 billion is being allocated as new money to the provinces for the year 2003-04.

We have to understand this whole debate. When the minister talks about this huge amount of 34-plus billion dollars going to health care, Canadians know that is a camouflage. We are here today to try to get the facts about what the government is actually spending in terms of new dollars on health care. Let the record show that for the year 2003-04 there is $2.5 billion going to the provinces as new money. If the minister wants to challenge those figures, she certainly is welcome to.

Let me ask her specifically a question that I tried to raise at the finance committee. I assumed I would get a straightforward answer on this question but failed to do so. Let me put it to the health minister.

What is the value of the cash transfer to the provinces today? What is the percentage share of the federal government in terms of financing our health care system? I would like a percentage calculation based on cash transfers to the provinces, not tax points, not equalization, strictly cash transfers.

I ask this question because it is important for the future of our health care system. It is the glue that holds our system together. I raise it because, as Roy Romanow and others have said time and again, what is important is the actual transfer of cash to the provinces. I want to quote from his report where he said:

While a tax transfer theoretically should provide stability and predictability, the actual history of tax transfers for health indicates they are quickly ignored and discounted by the jurisdictions that receive them. In addition, there is no guarantee that the revenue generated from tax points will be used for health care. Finally, and most importantly, however, tax point transfers eliminate any possibility of the federal government facilitating future expectations or expansions of medicare or helping to safeguard the fundamental principles underpinning the system.

My question is what is the role at the financial level of the federal government in funding our health care system? What is the actual amount of the cash transfer and the percentage involvement by the federal government?

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, for 2003-04 the actual cash transfer is $19.8 billion.

I completely reject the argument, whether Mr. Romanow makes it or anyone else, that we do not include tax points, which in fact lead to a calculation. If we include $19.8 billion cash, tax points of $17.5 billion, plus an additional $1 billion coming out of our health reform fund for this year, a total of $38.3 billion in 2003-04 are transferred to the provinces.

Those tax points are important. It is up to the provinces to decide what they use the money raised through those tax points on. That is why they were given to the provinces, to provide them with that kind of flexibility in terms of planning. It is up to their voters to keep those provincial governments accountable. If the provincial voters want the value in cash of those tax points spent on health care, they should be making that case. If they do not, then I would suggest that is a really important public accountability issue in relation to what the value in cash of those tax points is being used for in provinces across the country.

We know there is $19.8 billion in cash, $17.5 billion in tax points and an additional $1 billion in new money from the health reform fund to begin the structural changes that we talk about in the health accord. That is $38.3 billion in this year as it relates to cash and tax transfers and the health reform fund. Most Canadians would say that is a pretty hefty chunk of change on top of what the provinces spend.

Canadians are asking “What do I get for that in my health care system? Am I healthier than I was and if not, why not? Am I as healthy as the people who live in the province next door and if not, why not?” Those are all really important questions around accountability and it is not all about more money.

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

Madam Chair, it is certainly not only about more money, but it is important for the federal government to be involved at a reasonable level in the funding of our health care system. Roy Romanow's recommendation, which follows many others, was simply to convince the government in the short term to get the federal share of funding of our health care system up to 25%.

The government's budget and the first ministers agreement do not accomplish that. That is a problem. It may be up to 20% when all is said and done, but it is still a long way from the fifty-fifty partnership that built medicare and it is not close to the 25% recommended by Roy Romanow. That is important for holding the provinces to account and for the federal government to have a say in sustaining, building and creating a national health care system.

I would love to stay on this topic, but I want to change topics very briefly and ask the minister a question that is very important to me in terms of the work I have done in Parliament. It has to do with fetal alcohol syndrome. I am seeking direction from the minister on her intentions to finally implement the motion that was almost unanimously passed by Parliament two years ago to require warning labels on all alcoholic beverage containers indicating to women that drinking during pregnancy could cause harm to the fetus.

When will the minister finally respect the wishes of Parliament? When will she acknowledge the sentiment of Canadians everywhere and take this tiny measure toward helping address the problem of fetal alcohol syndrome? It is not the be all and end all. It is not the final solution. It is part of a solution. It has been recommended for years. It is supported by Canadians. I would like to know today if the minister will give us a date by which she will ensure that the motion is acted on and labels become a reality and that we have some additional tool at our disposal to deal with the very serious problem of fetal alcohol syndrome.

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, I cannot give the hon. member a date, but I applaud her for her work in this area. We all acknowledge, as we did earlier, that FAS-FAE is a very serious concern. We are trying to determine what are the most effective interventions. If after our analysis, our work with experts, our research of what other countries are doing, we come to the conclusion that it is an effective intervention, then we will do it.

[Hélène Scherrer, Liberal, Louis-Hébert, QC]

Madam Chair, first, I want to inform you that I will be sharing my time with my colleague, the member for Oakville.

Indeed, I will take a few minutes tonight to share my passion, my interests and my concerns regarding an important aspect of our health care system, of which, I am sure, the minister is totally aware.

First, it is important to state certain facts to be able to ask questions and see if the required amounts have been adequately invested in prevention. I am obviously talking about healthy lifestyles and prevention, an issue of particular interest to me.

Many things have led to the inclusion of healthy lifestyles in the priorities of Health Canada and of the Government of Canada.

A growing body of evidence from various countries shows that the human, social, economic and medical costs of avoidable chronic diseases that are non contagious, such as cardiovascular and respiratory diseases, diabetes and certain types of cancer, are significant and growing in various countries, including Canada.

The total economic cost of diseases, disabilities and deaths related to chronic diseases in Canada presently exceeds $80 billion.

According to the World Health Organization, more than 90% of type II diabetes and 80% of coronary heart disease could be prevented or delayed by eating healthily, exercising regularly, not smoking and effectively managing stress.

Allow me to quote some instructive statistics. It is estimated that 90% of lung cancers and 30% of all other cancer-related deaths in Canada could be prevented in a tobacco-free society.

We know that health is not just about treating disease. We must now look into how to redirect our efforts. We must—and I am sure the hon. minister is well aware of this—invest upstream, that is, in the health/disease continuum, to have a positive influence on the quality of life of Canadians.

Naturally, there are, among other upstream investments, integrated and cooperative approaches to health promotion, disease and injury prevention, as well as a complete range of public health activities designed to alleviate the burden of chronic disease on the health system.

As hon. members know, during their September 2001 meeting, the Minister of Health and her provincial and territorial counterparts agreed—I am happy about that—to work together on Canada-wide strategies for the short, medium and long term in terms of healthy lifestyles with a focus on eating habits and physical activity and their relationship with a healthy weight.

They also agreed to organize a national symposium on healthy lifestyles, bringing together government and non-government health organizations, among others. Health specialists, representatives of the first nations and the business community, as well as other stakeholders, will also be invited to participate.

I was also pleased to see that the federal government made a commitment to healthy lifestyles in its September 2002 Speech from the Throne. Furthermore, the 2003 first ministers agreement on the renewal of health care urged health ministers to focus on strategies and healthy lifestyles.

A number of territories and provinces have implemented or are about to implement integrated strategies combining healthy eating, physical activity, preventing chronic disease as well as preventing and fighting diabetes and smoking.

It is absolutely necessary, however, to take a coordinated, Canada-wide approach—

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Madam Chair, I rise on a point of order. My colleague from St. Albert has actually made this point before. I would like to reiterate it. If there is a question we would like to hear it, so that the minister can actually deal with the estimates. This is an issue that has limited time. We only have half an hour left. It is very important that we get in all the questions we possibly can. It is absolutely absurd for an individual to come in here, give a speech that has been previously prepared and not deal with questions to the minister. It is valuable time and we would like to see this happen.

[The Assistant Deputy Chair]

I appreciate that the hon. member is trying to enlighten the Chair, but I want to repeat what I said earlier. I am not taking any more points of order unless they are on another subject, because the fact is, I did make the point. It can be raised by any member at any time with the Speaker or even with the Standing Committee on Procedure and House Affairs. If there has to be clarification, that is the place where the clarification has to take place.

I will not allow another member to again eat into the time that the hon. member has because we have exactly half an hour remaining and we have yet to hear one more member from another party who also has to be given the time allotted to that political party.

[Hélène Scherrer, Liberal, Louis-Hébert, QC]

These are very important points and it is important to be able to discuss them this evening. This involves a large part of the population and one whole issue we have not yet touched upon this evening. I think it is important to look at the statistics, at how we can address it, and ensure that there is the necessary funding for it as well.

Another equally important aspect of the lifestyle strategy consists in addressing the basic causes of the precarious health status of certain segments of the population, such as the aboriginal peoples, families living in poverty, the disabled, and those in rural and isolated areas.

Integration is an important theme of the strategy. It consists of grouping together the fragmented and isolated approaches for health promotion and the prevention of illness and injury. As well, it involves establishing common groups of risk factors relating to chronic diseases, monitoring the factors that determine individuals' quality of health, and finding new ways of managing promotion and prevention efforts where people live, work, study and play.

It also involves measures to encourage the participation of partners from all areas of knowledge in the health care system and in other sectors and systems that affect health.

If we can succeed in integrating three important areas, policy, research and public health intervention, we will be able to increase the real value of what we are now accomplishing. What this means, in other words, is better value in managing priority health care issues.

The minister no doubt knows that if the country finds a way to manage the resources in our health care system, Canadians will be healthier. Obviously, we are also talking about managing financial resources more efficiently and more effectively.

We all know that an approach based on prevention that seeks to change people's behaviour without addressing their standard of living is not likely to lead to lasting results. One of the fundamental elements of the strategy, and a major challenge, is to recognize and predict links between life choices and health determinants, such as social, economic and environmental influences.

To that end, we need to promote vertical participation of partners within the health care system, but also horizontal participation in other sectors and systems that influence health.

Consistent with this line of thought, as you know, the Romanow report recommended putting more emphasis on prevention and well-being as part of an overall strategy to improve the delivery of front-line health care services in Canada, and providing new funding for research on health determinants.

The report backed strategies to fight sedentary lifestyles, obesity and smoking. Incidentally, just this morning, a French-language paper published alarming figures on obesity among young people and said that more money was needed to fight this problem that is having a major impact on young people.

[John Williams, Canadian Alliance, St. Albert, AB]

Madam Chair, I rise on a point of order. I find it rather unfortunate that I continue to interrupt this debate, Madam Chair, but I have taken a look at the report of the Special Committee on the Modernization and Improvement of the Procedures of the House of Commons, dated June 2001, of which the Deputy Speaker was the chair. Item number 36 states:

We propose that the Leader of the Opposition consult with the leaders of other opposition parties, and that he or she could select two items from the Main Estimates per year, which would each be considered in Committee of the Whole--

Which we are considered to be. It continues:

...for up to five hours. We would expect that this examination would take place in the evening, after the conclusion of the regular sittings of the House, and would be completed by the recess in May of each year. The regular rules regarding Committee of the Whole would apply.

But it also goes on to state:

Such a procedure would permit a meaningful examination of certain Estimates; it would facilitate the participation of Members who are interested in the department or agency whose Estimates were being considered; and by being conducted in the Chamber and televised--

The procedure “would permit the meaningful examination of certain Estimates”.

Madam Chair, it is the intention that we have a meaningful examination of the estimates of the Department of Health tonight and we have the minister here for five hours to answer on behalf of her department. That is the intent of this debate. It is not for speeches by backbenchers of either side of the House. It is for a meaningful examination of the estimates and I say that we should have questions on the estimates and the minister should be responding, or else the member who is speaking should be ruled out of order, because that is the intent of the rule.

[The Assistant Deputy Chair]

I would like to thank the hon. member for St. Albert. I will repeat again what I said earlier, but first, on a point of order, the hon. parliamentary secretary to the government House leader.

[Geoff Regan, Liberal, Halifax West, NS]

Madam Chair, the hon. member knows full well what the rules are that were established by the committee that was struck. He is referring to when it began, but the point is, he knows the rules. He has been to other occasions like this before. He knows members are entitled to speak if they wish to. They can use their time as they wish.

He has had all kinds of time all evening to question the minister. She has answered him ad nauseam. He has questioned her ad nauseam all night long, but if he wants to have a process whereby he interrupts our speakers constantly and we interrupt his questions all night, I am more than happy to have that go on. But I implore you, Madam Chair, not to allow the same points of order to go on. In fact, it seems to me that you have been exceptionally patient in allowing him to raise the same point of order again and again when he has abused his rights and privileges in the House to rise on points of order.

Madam Chair, I implore you not to allow any more of these specious, waste of time points of order from this member anymore this evening.

[The Assistant Deputy Chair]

I will not hear any more points of order, but if I have been lenient it is exactly for the reasons the hon. member for St. Albert has raised. I think there is a need for clarification in terms and I will put that on the record, but that is not the role of the Chair tonight. I think it is the role of standing committee on procedure, or of the modernization committee, to be precise. I would direct the hon. member for St. Albert to speak to his House leader in order to raise the same points that he is raising in the House.

We will take no more points of order.

[Hélène Scherrer, Liberal, Louis-Hébert, QC]

Madam Chair, how much time do I have left?

[The Assistant Deputy Chair]

You have seven and a half minutes.

No, excuse me, you are finished because you were sharing your time, but I will give you one minute to conclude.