Debates of March 11th, 2004

Supply

[The Deputy Speaker]

This is nothing more than the usual generosity of the Speaker, regardless of who is in the Chair.

The hon. member for Kamouraska—Rivière-du-Loup—Témiscouata—Les Basques.

[Paul Crête, Bloc, Kamouraska—Rivière-Du-Loup—Témiscouata—Les Basques, QC]

Mr. Speaker, I am pleased to speak to the motion brought forward by the Bloc Quebecois, acting as a spokesperson for Quebeckers and Canadians who want the federal government to further invest in health-care.

The current government and the Prime Minister claim that health care is their top priority, however there is a disconnect between what they say and what they do. This is why, through the motion I will read for the record, as it did before in other areas, the Bloc is urging the federal government to commit to significantly raising its contribution to health care.

The motion put forward by the hon. member for Joliette reads as follows:

That, as the federal government's 16%-contribution to health-care spending is clearly inadequate, this House urge the government to invest at least half the current year's surplus in health care, over and above the two billion dollars already promised, in order to achieve as rapidly as possible the stable 25% federal contribution called for by Quebec and the provinces.

Each and every one of the words in this motion is important, but I want to draw the attention of the House to the fact that Quebec and the provinces are all asking for the same thing in this particular file. This is not a debate spearheaded by a sovereignist government in Quebec City who could be seen as not wanting to play the federalist game. Right now, there is a Liberal federalist government in Quebec City, and in the other provinces there are governments who are promoting Canada.

However, we are faced with a federal government who refuses to return a sizeable portion of the taxes it raises and would rather continue raking in huge surpluses. In the meantime, the provinces and regions do not have enough money to adequately fund the health care system.

To see if a system is failing, we may look for certain clues. The first one is that all these governments that have been providing health care are saying that the federal government's current contribution is clearly insufficient. That is the first reality. They even paid for a series of ads on television and in the other media to ask the question: what is Ottawa's share in health funding? Four answers are suggested: 50%, 33%, 25% and 16%. Unfortunately, the right answer is 16%. The federal government only provides 16% of the money required to fund health care, which is totally unacceptable.

Thus, the first real reason why our health care systems are failing and may not be able to meet the demand is the federal government underfunding, which Quebec and the provinces have criticized.

There is another major clue that we saw, unfortunately, in the news last night. Some people have to resort to a collective action to get compensation, because the health care system did not allow them to receive timely treatment for serious illnesses. Yesterday, they were talking about women who have breast cancer. It was very sad to hear this piece of news, that is that, in our country, in Canada, in Quebec, some people cannot receive medical treatment within a reasonable time frame because of underfunding.

It has been said for a long time that health care services have to be reorganized. Provincial governments of all stripes have made efforts to this effect. However, today, even after making these efforts, we realize that an unacceptable situation such as this still exists. We must absolutely receive the money we need.

This is why we are sure to get the support of the vast majority of people, whether in Quebec or in the rest of Canada, for the motion put forward by the Bloc Quebecois. The only group we have not managed to convince yet is the federal government.

I hope the Liberal members who are here and who are aware of what is going on in their regions will understand that, instead of building an $8 billion surplus this year and using it all to reduce the debt, they could spend it on major needs in our ridings. The money could be used much more wisely, especially if we were to do as the Bloc so reasonably suggests and reinvest half of this year's surplus in health care.

With an $8 billion surplus, we could invest $4 billion in health care and spend the other $4 billion on planned expenditures. That would bring us back to the issue of balance which was raised before by the government during the election campaign when it talked about spending 50% of the surplus on debt reduction and 50% on other needs.

Unfortunately, there is a huge difference between what was promised to us during the election campaign and what we are faced with. Which is why our party, that wishes for adequate health care delivery, has made this call so that, at the end of the day, we can get the funding required to meet the needs of the health systems.

When the current Prime Minister was appointed finance minister in 1993-94, the federal contribution stood at 22%. It was that finance minister, our current Prime Minister, who slashed transfers to Quebec and the rest of the provinces. Cuts of $21 billion were made, one-third of which were made in the province of Quebec even though it only represents one-quarter of the population.

When we talk about billions of dollars, we tend to lose sense of what it really means. One has to wonder what impact the Bloc motion would have if it were passed and all that additional money were invested in health care.

There are regions, such as the one I represent, where small hospitals are always looking for money to buy basic equipment in order to provide adequate service to the public. In addition to helping those hospitals buy equipment, the adoption of this motion would, in a sense, provide more room to manoeuvre and ensure that enough personnel is hired. This way, people who go the emergency room for treatment and seniors requiring home care would receive completely adequate service.

It is important to understand this issue. Last week, I met with people in my riding who work in home care for seniors. They came to tell me they are very concerned about impending cuts by the Quebec government, because they sense that the tap has been turned off and there is no funding available for them. They asked me to make representations, even though I am a federal MP.

The first thing I told them was that I understand full well what they are going through. We want seniors to be able to live at home as long as possible. That is the best option in terms of quality of life. It is also a good decision financially speaking. In order for the Government of Quebec to provide this service, it needs to have the necessary funds.

A person living in Quebec, whose government is the Government of Quebec, expects that government to answer these questions. Nonetheless, one has to realize that, in this system, a substantial part of the funding comes from the federal government, even if its share is currently only 16%, whereas it should be 25%.

This portion of the funding would help increase these services and obtain, at the end of the day, results that would allow us to invest in prevention and stop the cycle of systematically increasing costs. If we could invest more in prevention, we would eventually have fewer difficulties or problems funding major expenses such as hospitalization and the like.

The federal government says that it understands that priority should be given to health care, but it does not act accordingly. We are only a few weeks, or rather a few days away from the tabling of the budget and we will have to pass judgment on how the government is responding to the wishes of the population in this area.

Today, during question period, it was a little disappointing to hear the newly appointed Minister of Health tell us that meetings would be held in the summer of 2004 with the premiers and the health ministers of the provinces to address this issue. This does not augur well. It might mean that there will be no additional money in the upcoming budget, while at the end of the current fiscal year the federal government would have the dollars available to lend a helping hand and make sure the much needed funds make their way into the system in Quebec and all the other provinces in Canada.

We might see a repeat of a situation that was all too familiar when the current Prime Minister was the Minister of Finance. In the fall, we were told that there was not much extra money, but suddenly, a few months later, as the the fiscal year is drawing to a close, and things are more certain, we learn that there were important surpluses and that they were put against the debt.

Of course the federal government has a responsibility to pay down the debt. It is important to do so. However, the government also has a responsibility to provide adequate services to the population. People need the health care system at times when they are much more vulnerable and without proper financial means.

I think the Bloc's motion will help our fellow citizens to better understand this intricate system by which we have to pay taxes to two governments, one in Quebec and one in Ottawa. The one in Ottawa should give back to the provinces a substantial portion of this tax money , but it does not, and this is why the Bloc Quebecois is now calling upon the public and the members of this House to urge the government to invest more in health care.

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

Mr. Speaker, I listened with interest to the hon. member as he talked about some concerns relating to health care in his province, particularly in relation to the cutbacks of funding from the federal government. The same thing is happening in my province, particularly when we look at the fact that Newfoundland and Labrador and Quebec have such large rural areas.

When we talk about health care delivery and when we talk about the fact that money is delivered to the provinces based upon population, it does not cut it that way. We have an aging population in my province. More young people are leaving, which means we have a smaller population. In fact I believe we are the only province in the country where we have a declining population, which means we get even fewer dollars each year to maintain the same plan. We cannot take out a hospital bed every time somebody leaves.

The geography over which we have to distribute that amount of money puts an extra burden on such provinces as Newfoundland and Quebec. I agree totally with what the member has said. However, does he feel that the government, in allocating funding to provinces such as ours, should take into consideration the aging population, more particular, the geography and that consideration should not be based only on population? I would like the members views on that.

[Paul Crête, Bloc, Kamouraska—Rivière-Du-Loup—Témiscouata—Les Basques, QC]

Mr. Speaker, I thank our colleague for his comments and question. I am indeed very sensitive to the situation in Newfoundland. In the part of Quebec where my riding is, a maritime, rural and remote region, we have problems similar to those the member has mentioned.

Over the past several years the federal government has provided us with various tools to help us. However, the current federal government has made systematic cuts, particularly in equalization payments, but also in the whole education and health care funding system. What we are seeing today is the result of these cuts.

A third measure has been very detrimental, that is cuts to the employment insurance. This means the current federal government made a choice: regional development was not an option for it; it is simply relying, at the most, on the market forces that are at play. People will go where the jobs are. It does not seem to be of any major concern that people, communities have opened new territories, lived in their natural environment, with their natural resources. That attitude has led to all kinds of actions and the cuts that were made.

The member says that young people are leaving his region, this is as a result of the government slashing funding for the provinces. Consequently, the provinces lack the necessary funds to support their health care system and they have to allocate an increasing part of their budget to health care, leaving less and less for the other expenses.

For example, it is said that health care expenses will increase from 38% of the provincial budgets in 2004-05 to 45% in 2019-20. Therefore, if the federal government keeps refusing to shoulder his share of the funding, the result will resemble what happened in Quebec at the last election. The party which was voted in said it would put energy and money in health care and education, but at the expense of the other areas.

That is what they said in their speeches, because it is important to make health care a priority, and they won the election on that platform. However, there is a financial reality. The current Quebec Minister of Finance, Mr. Séguin, says that the fiscal strangulation must stop because it is unacceptable to see seven out of ten provinces on the brink of deficit while the federal government shows accumulated surpluses of around $8 billion.

That is why the Bloc Quebecois is putting forward this motion today, requesting that half of these surpluses be invested in health care. I think this would address a very real and very definite public concern.

[Maria Minna, Liberal, Beaches—East York, ON]

Mr. Speaker, the opposition motion of the hon. member talks about a federal contribution of 16% to health care. In my view this is obviously not true. I think the hon. member knew that when he put forward the motion.

With respect to his arguments about the federal and provincial governments, the Government of Canada has made it clear that it is serious about setting a new tone and establishing a new working relationship with the provinces and territories built on respect, consultation and dialogue. This is very important to note. We hope the provincial and territorial governments will reciprocate.

Canadians have clearly told us that they are tired of seeing their governments fighting. As we approach a budget, the ongoing ads, after we recently committed $2 billion, are not in the spirit of what we are talking about here.

Canadians expect their governments to work together, not against one another, to address their pressing such as health care. The Prime Minister has said that he is committed to a new way of doing business. As prime minister designate, he met with premiers in Regina last November. Then as Prime Minister, he met with them again on January 30. At that meeting, all agreed that sustainability of the health care system was a top priority. The Prime Minister has committed to discuss this important issue at another federal-provincial ministers meeting this summer.

It is important that all governments focus on the desired outcome, a sustainable health care system. The meeting this summer will be about that. The Prime Minister has committed to that and we are moving toward that. We have been moving in that direction for some time.

The Government of Canada does not agree with the way the federal share of health care financing has been characterized. I think that is quite clear here today. A more accurate estimate of the current federal share of national public health spending is more than 40%, a share that will grow with the investments made under the 2003 health accord, which was not that long ago and for which $2 billion was recently paid out.

The Government of Canada's support for health care is substantial and growing. Last year the government committed to a five year $34.8 billion funding agreement. The Government of Canada has taken the necessary steps to ensure that an additional $2 billion will be available to the provinces for health care.

Cash transfers to the provinces will grow from $19.1 billion in 2002-03 to $28.1 billion in 2007-08. In fact cash transfers for health care and other social programs will grow at 8% annually on average over the five year period covered by the 2003 accord. This is substantially higher than the expected growth of federal government revenues over the same period.

If we were to look at a summary of increases in federal investments on health for the near future, it would look somewhat like this. The investment by the Government of Canada over the next three years will be $17.3 billion. Over the next four years, it will be $25.3 billion investment. Over the next five years, it will be $34.8 billion. Over the next eight years, the investment will be $70.1 billion.

In addition to that, as part of the 2003 accord, the Government of Canada, with the provinces, recently established a National Health Council to bring more accountability and transparency in the health care system across the country. The health accord took ideas from the Romanow report as well as from three provincial reports. This shows that the government looked at various ideas, and it listened to the provinces.

Hopefully, the National Health Council will also be addressing the reform issues that deal with problems of human resources, technicians, nurses, doctors. These issues also have to do with provincial reform and changes. I can speak of one example in Ontario, for instance, where we have over a thousand doctors with foreign credentials who are not practising, yet we have a shortage of doctors. There are other professionals who are unable to practise. These are provincial issues as well as federal and we must work on these things together. Therefore, accountability will be part and parcel in moving forward.

To continue to speak about the issue of income financing, no one speaks very clearly about the tax points. There is a great deal of myth about the tax points and what they mean. They are real cash. The value of the Canada health and social transfer tax points cannot be ignored since half the cash under the cost sharing regime was converted into tax points in 1977 by mutual consent. The provinces asked that they be given less cash and more space in tax points, which was done in 1977.

Now, of course, they want to forget that because they do not use that money, however they use it, and now increase the cash anyway, which we are doing absolutely. But at the same time we cannot leave out of the equation the whole tax point system and the amount of money that they represent because it is money that nonetheless goes from the government even if it is through tax points and deferred taxation.

The other is equalization payments the provinces received from the federal government. Again, this is not put into the equation very clearly. Equalization payments do not have a clear direction. They do not tell the provinces how to use the money but I would suspect a big chunk of that does go into health care. Again, that is an aspect of the finances that is not dealt with very clearly.

They also are not accounting for other federal contributions to the total public health spending, which is estimated at approximately $5 billion in 2003-04. These areas can include things such as the first nations health, veterans' health, health protection services, disease prevention, health information and health related research.

As well, through the tax system, the federal government provides support worth about $1 billion a year which includes such things as credits for medical expenses, disability, caregivers and infirmed dependants. This is not something that is very light. There are a lot of expenses beyond what is transferred directly to the provinces or in addition to that. Cash transfers to the provinces will grow from $19.1 billion in 2002-03, as I said earlier.

There are other issues. The issue of health care reform is something that was also discussed at the last meeting of the Prime Minister and the provinces and will be discussed again. Health and finance ministers were tasked to meet and to look at issues surrounding the sustainability of the health system leading up to a first ministers meeting this summer. They have been asked to work on these issues.

All agree that sustainability is not just about money but about reforming the system as well, and this is very important to look at. I believe that reform is a fundamental piece of the puzzle in the sustainability of our health care system. The fee for service system we have now, for instance, is too costly and does not provide a holistic approach which includes preventive health care.

In Beaches—East York, I am proud to say that we have a very successful community health care centre where doctors are paid a salary. They are on call 24 hours a day, 7 days a week, helping to keep people out of our crowded hospital emergency rooms. The centre staff also includes a nurse practitioner and a nutritionist.

This rounded approach to the delivery of primary health care will mean a much healthier society and a more sustainable system in the long term. While delivery of health care falls within provincial jurisdiction, we must work together to ensure that reform takes place in order to guarantee a sustainable healthy public and a universally accessible system.

All agree that sustainability is not just money. It is important to look at all aspects of health care. If we do not do that, we will not be able to address the issues.

First ministers committed in the accord to reforms in the areas of primary health care, home care and catastrophic drug coverage. First ministers also committed to enhancing access to publicly funded diagnostic and medical equipment and to the development of an electronic health accord.

Those are areas that the ministers, when they met with the Prime Minister last time, agreed to work together on and to report next summer as part of the package that was agreed upon to reform the health care system in an overall context.

Let us talk about home care. If we are looking to the future we can clearly see that the demand for home care services will increase and not decrease. Many families will want to care for their loved ones at home to maintain their quality of life and dignity. Addressing these shortages of home care will go a long way to alleviating the stress in hospitals and emergency rooms, as well as the costs associated with long term acute and palliative care.

Equally important, the stress levels and demands experienced by caregivers themselves will soon be approaching critical levels and will create even more stress on the health care system as the existing caregivers grow older or develop health problems of their own. In effect, home care should not be seen as a separate category of care but as a key part of the health care system.

To gain the most from home care services, we need to ensure the natural continuum of care. We need to move ahead with concrete actions for a truly national program. This should include the recognition and appropriate compensation for our home care workers and support and incentives for families who provide the necessary care. This is a whole area of services on which, as we understand it, ministers are supposed to be meeting to discuss in order to prepare for the summit this summer.

First ministers directed health ministers to work on additional reform initiatives in such areas as patient safety, health human resources, technology assessment and innovation and research. These are very critical areas that we must look at.

Finally, the Government of Canada, in addition to spending in the various areas that I have just mentioned, has other programs in the area of public health. As we know, the Prime Minister recently appointed a minister responsible for public health, a position that did not exist before. She has been mandated to establish the Canada public health agency that will address public health risks and coordinate a national response to health crises. She has also been mandated to appoint the chief public health officer for Canada.

Other programs that the Government of Canada funds are tied to the issue of health care as well. Early learning was flagged by the prime minister's health forum of 1994-95 I think, and to the health cost of the future. If a child between the ages of zero to six receives proper nutrition, we will have a healthier child and a healthy child is a well adjusted child. The government and I fought very hard to increase the child tax benefit to ensure that child poverty would be eliminated in our country. We also wanted early learning for children, stimulation and well-adjusted children. This is an area that does go to assisting and bringing down the costs of the health care system, as well as looking at the whole issue of physical activity, which is part of the new public health minister's responsibility.

We have heard on the news lately of the problem of overweight children and society in general, the issue of physical activity and nutrition is very critical. It is part of our responsibility, together with the provinces, to ensure that we have a healthier society in the long term.

Funding for the national crime prevention program that the government funds also goes to the same long term savings in the health care system. Preventive care is very important. We cannot just look at primary care that is needed now and is very important, but also long term care.

The national pharmacare program is something that I understand the ministers will be looking at and discussing this summer when they get together to look at the sustainability of the health care system, the catastrophic cost of drugs and to assist Canadians with the cost of drugs. I believe the Canada Health Act, as such, should cover the cost of drugs, especially catastrophic drug costs.

When we look at all the various commitments and partnerships that exist between the provinces, the territories and the Government of Canada in all areas of public health, such as aboriginal health and all the various funding mechanisms that exist within our country, the picture is not as clear as everybody would like to make it.

We are talking about a very complex area, an area where we must work together to ensure that our system is sustainable. I strongly believe that our primary health care has to be reformed. We need to look at home care because that will free up a lot of space in hospitals and also ensure that people have dignity at times of need in their lives.

The provincial and territorial premiers, as well as the Prime Minister, have been mandated to discuss those things now to get ready for this summer.

The summit was held and two other meetings have been held since then. We have transferred $2 billion. Yes, a budget is coming up but we have not addressed the reform issues which will be addressed this summer. Once that is done I presume we will have an additional accord that will take us the distance in the long term.

However we must address those issues before we start talking and, to some degree, being blackmailed by ads just because there is a budget coming up. Negotiations should not be done in that way. That is not the spirit in which the Prime Minister started his discussions with the premiers.

[Paul Crête, Bloc, Kamouraska—Rivière-Du-Loup—Témiscouata—Les Basques, QC]

Mr. Speaker, I listened carefully to what my hon. colleague had to say, but we are faced with quite a problem. On one hand, we have all the premiers, including the Premier of Quebec, the opposition parties and the provinces asking themselves in an ad campaign: what is Ottawa's contribution to health care? Is it 50%, 33%, 25% or 16%? The answer is 16%.

They also tell us that, despite a recent increase, the federal contribution stands at 16%, while it was initially at 50%, which means that the provinces and the territories must pay 84% of the costs.

Our constituents have to deal with two different versions of reality. On one hand, the premiers and the opposition parties all agree that the federal government is not doing its part to fund health care in Canada. This is warranted criticism since the Prime Minister of Canada did say that he would make health care his top priority. But increasing health care spending was not the first thing he did.

Why is it that the federal government has dropped from 50% to 16% of the funding? For the current government, that is enough, so much so that it is said negotiations will take place next summer. By then we will have had a budget and possibly an election, and they can start negotiations next year, although this year there will be a surplus of about $8 billion.

Would it not be much more reasonable to agree with the Bloc's position and say that half of this surplus should go to health care? In that way we could stop the downward spiral of underfunding.

I will ask my question and I hope that the hon. member will not reply that federal government funding is about 40%. When she says that, she is neglecting to say that she is including in the system the transfer programs, the whole business of equalization, and the transfer of tax points. These are entirely different categories of expenditures. When an income tax point transfer is made, it is because of a particular, real situation. Nevertheless, since 1993, when the current Prime Minister became finance minister, there has been a draconian shrinkage in the federal government's funding for health care.

Would the hon. member not admit that it would be high time, in the next budget, to have a commitment on the table from the federal government to invest 50% of the surplus this year, and to renew this commitment in coming years? Would that not be the duty of the current government, rather than continuing the fiscal strangulation we are now suffering? Could we not take this to mean that if it continues in the same way, it is simply to try to take control over this area that is within provincial jurisdiction?

The provinces are doing their best. Could the federal government not make an effort, exceed the $2 billion that was committed by Mr. Chrétien and then announced again? What is needed is new money to enable the provinces to satisfy their needs. Is it not the premiers who are telling the truth in their ad? Is it not them that the Bloc Quebecois is supporting today to ensure that adequate funding for health care will be coming from the federal government?

[Maria Minna, Liberal, Beaches—East York, ON]

Mr. Speaker, first of all, I would hope that we are here today to support Canadian citizens who need health care, not necessarily the premiers or any other individual government structure. The people of Canada need to be supported and assured that they get quality universally accessible health care, including Quebeckers. That is number one.

Number two, yes, I have seen the ads from the premiers. Of course, they are everywhere. How could one possibly miss them? That does not mean to say that they are correct.

We had ads before from Ontario, specifically from Mr. Harris who had ads all the time. There are ads in Toronto, in case the hon. member has not noticed, from the board of trade which say to tape over everything that is broken and needs to be fixed in terms of infrastructure in Ontario because it is true, we have a major problem in areas such as transportation, affordable housing and so on.

We have lots of ads because we know there is a budget coming up and there is talk of an election. That does not mean that the ads are correct and it does not mean that the environment in which the premiers have chosen to negotiate with the Government of Canada is proper either.

As I said, the Prime Minister met twice with his provincial counterparts. There was an accord in 2003. It was agreed that an additional $2 billion would flow this year and it has. The Government of Canada has committed the $2 billion.

The other commitment made was for the premiers and the Prime Minister to meet to look at reforming the system. This would save additional dollars. In addition to that, I am sure that at that point there would be other money on the table.

Those kinds of things are happening as we speak and they should happen before we settle down to a long term allocation of funds, but at the same time we have not stood still. The Government of Canada has established a health council to look at accountability. There is a public health officer and so on, and a minister responsible for public health.

Again, preventive health is just as important. There is money being invested there.

When the hon. member tells me that the tax points have to do with other categories, with all due respect, that is not true. The tax points were part of the health and social transfers at the time for social services and health.

The provinces said that instead of all cash, they wanted the cash cut and more tax room. We have to count the tax points as part of the cash as well. Otherwise, if we keep making block transfers in tax points, as the provinces have already asked for in previous discussions, we will keep passing down the taxation powers but the provinces do not recognize the responsibility that comes with it.

They committed to spend their money on social programs and health care. They cannot have it both ways. The tax points and equalization dollars are block funded, and they are part of the equation.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, it is good to hear that part of the debate is talking about prevention because when we look at our dollars, the investment in certain practices can certainly lead to the reduction in health care costs and the wellness of our society.

One of the problems we have with the government is the lack of action on things that do not even cost money but set an example that could improve people's health.

I have a question for the hon. member. How does she reconcile the duplicity in the government by not getting these types of things off the books and one of them is the Canada pension plan? It has invested in big tobacco.

We know that the tobacco industry and the cancer issue costs us a lot of money in our health care system and at the same time we profit through our pension plan. How does the government reconcile that? How does it reconcile the fact that it has not acted with anything on trans fats? We know the cost of that. It could ban that and work on legislation that would remove that from our system for the wellness of people, or it could have labelling.

We cannot understand why we still cannot get labelling on alcohol products for women who are pregnant to warn them that the consumption of it could lead to some health impacts during their pregnancy and could impact also on their child. These are preventive things that do not cost money.

Also, providing consumers with choice for genetically altered foods, and allowing people to see what they are consuming and making educated decisions, these are things that do not cost a lot of money but could have a benefit for human health. How does the member reconcile the duplicity?

[Maria Minna, Liberal, Beaches—East York, ON]

Mr. Speaker, the hon. member will recognize that on this side of the House we have many different views. We work together and come to the same thing at times; however, as the hon. member knows, when his party put forward the motion with respect to the Canada pension plan and ethical investments, I voted with him because I thought it made eminent sense.

A good many of my colleagues on this side of the House voted for that motion. That was a message we sent to the government, and to the Canada pension plan, that this was an issue that needed to be addressed.

I do not think that the member will get any argument from me on that one. When it comes to other issues like trans fats and whatever, I would ban the trans fats, quite frankly, if I could, never mind labelling them.

The hon. member will receive no argument from me with respect to public health and preventive health care. I was talking about that earlier and it is why we now have a minister responsible for those things.

[Benoît Sauvageau, Bloc, Repentigny, QC]

Thank you, Mr. Speaker. First, I would like to ask a question to the hon. member, then I will move on to my remarks.

The hon. member is suggesting that the federal share of health care costs is 40% and not 16%. Let us assume we are wrong and the Liberals are right. The Romanow report says that the federal government's share should increase from 16% to 25%. If the federal contribution is 40%, as she suggests, why is the Liberal government's position not to cut health transfers by 15%? It is paying way too much.

It is obvious that nothing in the Liberal government's position can be taken seriously.

[One hon. member]

There are the tax points.

[Benoît Sauvageau, Bloc, Repentigny, QC]

An hon. member opposite is shouting that there are the tax points. If my daughter were to ask me for money to go out and I told her, “I have already given you money. I bought you a sweater and a pair of jeans, and glasses and other things”, she still would not have any money to go out.

It is obvious that they have been spouting nonsense all day long. Enough with this nonsense. I will leave this to members opposite.

The motion reads:

That, as the federal government's 16% contribution to health care spending is clearly inadequate, this House urge the government to invest—

[Some hon. members]

Oh, oh.

[The Deputy Speaker]

Order, please. I realize that the House is dealing with a very important issue. As usual, there are differences of view. However, since there is not much time left—approximately an hour—to deal with such an important issue, perhaps we could focus on the speeches and remarks that will be made during the next hour, always through the Chair, of course.

The hon. member for Repentigny.

[Benoît Sauvageau, Bloc, Repentigny, QC]

Mr. Speaker, I thank you for having brought the House to order. I remind you that I will be splitting my time with the member for Argenteuil—Papineau—Mirabel.

The motion reads as follows:

That, as the federal government's 16% contribution to health care spending is clearly inadequate, this House urge the government to invest at least half the current year's surplus in health care, over and above the $2 billion already promised, in order to achieve as rapidly as possible the stable 25%—

This was one of the recommendations made by the Romanow commission and the provincial premiers, while the Liberals claim they currently contribute 40%.

—federal contribution called for by Quebec and the provinces.

We will try to explain a little what the motion means in financial and fiscal terms.

The motion demands that at least half of the federal surplus, in addition to the $2 billion already promised, be invested in health. For 2003-04, we estimate that there will be an $8 billion surplus. From this amount, we must subtract the $2 billion already promised—so far, so good—, leaving $6 billion. Of this, $3 billion will go to health and $3 billion to paying down the debt, as the federal government likes to do with the surplus.

If it is true that health is the priority of this Liberal government, now is the time to prove it. It need only take part of the surplus. The Liberals do not have to cut into already existing programs or the sponsorship programs or the national unity fund or the CIO or the Canadian Unity Council or the Prime Minister's discretionary budget. They can use half the surplus to increase the federal contribution to health.

Some people could say that the Bloc's motion proposes a one-time injection of funds into health care. Despite everything, this is not what we are proposing, but it is a first step to ensuring a stable federal contribution of 25% of program spending for Quebec and the provinces.

What have the premiers of Quebec and the provinces said about this? We have said this many times, but the Bloc Quebecois is not alone. The premiers of the provinces and territories are saying the same thing. I quote from the press release that was issued after the council of the federation met in Vancouver on February 23 and 24, 2004:

Provinces currently pay 84% of the costs of health care in this country, while Ottawa only pays 16%. This is clearly not enough. Canadians agree with the Premiers that the federal cash share of funding must rise over time to total at least 25% of provincial expenditures.

This is an excerpt from a press release by the provincial and territorial premiers.

Later, they published an ad asking what Ottawa's contribution to health care funding is. The Premiers' Council is teaching Canadians about health, and it reaches the same conclusion: the federal government pays 16%.

We are told that it is not 16% because we have to add all the other numbers. It is as if I allocated money to offset a budget item in my office, but took the total budget into account to say that, with this total budget, I will be able to offset that item. The government is mixing apples and oranges. It is mixing all sorts of things.

The federal government is telling us that there is equalization. If it were true that equalization is a transfer for health care, a proposal we could make to the government would be to call it by the right name. Take out this word and say that it is a complement to the health transfer and that it will be higher. If it is not called a health transfer, it is because it is not one. Equalization is equalization.

First, let us remind the House that the purpose of the equalization program is to reduce economic inequalities between the provinces by increasing the revenues of the poorer provinces. Thus, federal payments are to allow these provinces to provide public services that are relatively comparable, without them having to considerably increase their taxes. Therefore, this is clearly not a health transfer.

We are also told about tax points. If tax points are a health transfer, why are they not called a health transfer? A chair is called a chair. A cat is called a cat. A health transfer should be called a health transfer.

Tax points are not a federal government expenditure. Indeed, they are not listed in Canada's public accounts. Incidentally, the Canadian unity fund is not there either. Indeed, this is a transfer that was made in 1977. The federal government transferred tax points at that time. It does not do so every year. If tax points were a federal expenditure, we would find the item “tax points” in the section relating to provincial transfers. However, it is not the case.

So, one cannot argue that it is tax points. One cannot argue that it is equalization. Nor can one argue that these are transfers for social services. Everyone recognizes that the federal contribution is at 16%.

We are told that the government is acting in good faith and that there is a change of tone. Earlier, when he replied to the hon. member for Joliette, the Minister of Health repeated that there is a change of tone. It is true that there is a change of tone. When the former Prime Minister would ignore us, he did so bluntly. The Minister of Health is doing it politely. However, when we are being ignored, whether it is politely or not, we are still being ignored. The change of tone is only at that level.

We are told that there is a problem and that everyone recognizes that. The government wants to negotiate. It wants to do so by claiming that it is already contributing 40% and by asking us to prove that it is only giving 16%.

The Liberal Party says that it wants to negotiate and set up a negotiating committee. The people who are lying on stretchers and those whose names are on waiting lists do not want a committee. This reminds me of an article written in Le Devoir by Jean Dion, whom I really like. He said that God created the universe in six days. Then he set up a committee and five billion years later a man and a woman appeared. We can set up a committee, but when will we get its response? In 5, 10 or 25 years, since we are told that it will be after the election.

The Romanow report told us that the federal contribution should be 25%, but that it is currently 16%. The surpluses do exist.

I will conclude by urging Liberal members to show some openness and to look at the real figures on health transfer. If they are with it and if they are serious when they say that their government is giving 40%, while the recommendation is 25%, they might as well tell us in the same breath that they want to cut us off and that everyone else is wrong.

[Monique Guay, Bloc, Laurentides, QC]

Mr. Speaker, I want to commend my hon. colleague from Repentigny for his speech. He managed to clearly explain the difference between health transfers, equalization payments and tax points, and we now understand that they are three very different things.

I wonder why, each time we talk about the needs in health care, we have to remind people that the government is only funding 16% of health care even though our federal tax rate is much higher.

Why is it always so long and painful for the provinces to get money for health care? We heard about the $2 billion for more than a year before we finally got it. We knew there would be surpluses. We always know in advance when a surplus is to be expected. They could have helped the provinces a lot sooner. They chose not to do so, although the help was long overdue.

They now say that they will set up committees and sit down with the provinces. Our motion is quite clear and simple. We urge the government to fund 25% of the costs the provinces are faced with. We need to act now.

I only have to look at the situation in the Saint-Jérôme hospital, in my area. Last week, the emergency room was so crowded that, for at least 48 hours, patients were turned away and redirected to Joliette of all places. We are faced with a serious problem. We do not have the time to sit on a committee to look for solutions we already have.

It is a way for the government to buy time, to make us waste time, and to avoid spending the surpluses on things that are really worth it. It is our top priority.

I would like the hon. member to maybe elaborate a bit further on this issue.

[Benoît Sauvageau, Bloc, Repentigny, QC]

Mr. Speaker, I thank my colleague for her question. I was looking for the table with the federal government's five points for health.

My colleague is perfectly correct. The federal government is saying, “Health care is our priority”. However, what are its health care responsibilities? It administers veterans' hospitals. There are perhaps a dozen of them in Canada; I do not know the number by heart. It also administers hospitals on reserves and that is all.

Health Canada has 5,000, 6,000 or 10,000 employees—I do not know exactly—and it only is responsible for 22 hospitals. However, the federal government says, “Health is our priority”.

Other than ensuring the universality of care and the five national principles of health care, the federal government has a responsibility with regard to the Canadian Food Inspection Agency and public health in general.

Yet, when we are told in a trembling voice that we are “sensitive to the reality facing Canadians”, as the Prime Minister would say, and that “health is our priority”, we could politely respond, “give us our money and mind your own business. Your priority is collecting taxes and you should give this money back to us”.

Who administers the waiting rooms? Who administers the hospitals? Who administers long term care? It is not the federal government; it is the provinces. Now we are told that there will be discussions with the provinces to resolve the problem in health care.

The only thing that the federal government needs to discuss is transferring money for health care, that is all. It should stop making speeches and saying, “We will ensure shorter hospital wait times”. This is none of its business. I say this very politely. In more parliamentary terms, this is not part of its jurisdiction. This is an area of provincial jurisdiction.

Consequently, to respond to my colleague, we want to create committees. We want discussions but about what? Waiting lists? Operating rooms? The number of doctors in the regions? I am sorry. The federal government should mind its own business. What we are asking the government to do is re-establish adequate funding to allow the provinces and territories to provide adequate health care to the public.

I think that this is not very hard to understand.

[The Deputy Speaker]

Before we continue, it is my duty, pursuant to Standing Order 38, to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Pictou—Antigonish—Guysborough, Terrorism; the hon. member for Renfrew—Nipissing—Pembroke, The Sponsorship Program.

[Mario Laframboise, Bloc, Argenteuil—Papineau—Mirabel, QC]

Mr. Speaker, you will understand that it is a pleasure for me to speak to the Bloc Quebecois motion calling upon the federal government to follow up on the provinces' request.

The motion is simple and I am not going to read it. It is echoed by the question that Canadians and Quebeckers often hear in the media these days as to the level to which the federal government is contributing to health care spending and the objective that the provinces would like the federal government to reach. The government is currently contributing 16%; I think this is what the Romanow report says.

We will recall that in Quebec, the current Liberal provincial Minister of Finance, Yves Séguin, had been hired by the Parti Quebecois government to prepare the well-known Séguin report. I do not think that the Parti Quebecois can be accused of being biased in this regard. Mr. Séguin was hired to analyze the famous fiscal imbalance and he is the one who found the figures which were corroborated by the Romanow report.

Except for the Liberal government, nobody in civil society is denying that the federal government is paying only 16% of the bill. The goal is 25%. Incidentally, I would like to stress the fact that the health care issue is part of the Canadian federation problem.

Why? Because the federal government does not provide any direct service to the general public. Other than for aboriginals and, obviously, veterans, no health service is provided by the federal government. The provinces and other entities, under the Constitution, have well-defined responsibilities.

It is not the federal government that incurs the costs. I would say that is for the best. When we look at the gun registry program that was supposed to cost $2 million, but cost $2 billion, if the federal government had to take care of health we would have a serious problem on our hands. The Constitution defined the responsibilities very well and every province is responsible for health.

The problem with the Canadian federation is that the government collects 60% in taxes and pays only 16% of health costs, which, in Quebec, account for 40% of the entire budget for the province.

There is a problem. I can appreciate that people want us to change our tone, but the Parti Quebecois government was the first to run ads in the media.

Consequently, the Liberal Party of Quebec must join the other provinces today to do the same thing the Parti Quebecois government and the Harris government in Ontario did when they published similar ads telling people to stop being lulled by the federal government.

That is the problem with the federation. The federal government, which writes a cheque and pays only 16% of the bill, can dictate the standard to the provinces, yet the provinces are responsible and have to suffer the wrath of the people using the system. When users have a problem they take it out on those who provide the service. They take it out on the provinces, which is normal.

In Quebec, the Government of Quebec is blamed and held responsible. During the last provincial election, the Liberal government made health an issue and promised to reduce overcrowding in emergency rooms once it came to power. Almost a year has gone by and nothing has changed. Mr. Couillard, the Minister of Health and Social Services, had to confess this week that it would be another two or three years before anything could be done about overcrowded emergency rooms.

Why? Because he does not have the money. There is nothing tricky about it. Health is a question of money and the money is in federal pockets. What we are saying today is that there will be a surplus of around $8 billion, give or take. We are near the end of the fiscal year. All sorts of experts are making pronouncements. Still, in recent years, the Bloc Quebecois has only been off by 4% in its predictions. So, it will be close to $8 billion.

The government has already pledged that $2 billion of this surplus will be given to the provinces. It has already done that, and is doing so this one time, even though it knew very well when it met with the provincial premiers and health ministers that, quarter after quarter, it would be having billion-dollar surpluses. It effectively said, “I promise you $2 billion but it is just for this one year only”.

How can the provincial health ministers manage the problem of emergency rooms if they cannot count on stable funding?

They cannot hire any staff. Quebec's Minister of Health and Social Services, Mr. Couillard, openly announced that he would buy equipment with the $2 billion because he cannot invest it in personnel, not knowing if the funding will be ongoing.

Of course, I wish for the sake of all Quebeckers that in the next federal budget that will be brought down in a week or so, all provinces will be told that the $2 billion already promised will be recurring funding. That is how the Liberal government operates. It is simple. They announce something and then announce it again and again. It is that simple.

Therefore the sum of $2 billion has been announced on a one time only basis, and probably the second time, they will announce that this amount will be recurring. They want to remind the public, the people who work hard to pay their taxes, the people who do not always have the time to follow all this, that they have just announced another $2 billion. No, it is still the same $2 billion that they promised for one year and it will probably continue. They will promise the provincial premiers and health ministers that they will be giving it regularly in coming years. I hope so.

What would be even more terrible is if, each year, the federal government were to announce to provincial premiers, to health ministers, to people, to Quebeckers, that, now it depends, it does not know, it may provide them with some money this year. Imagine how we could manage such a system. We cannot manage our personal savings if we are not sure about our income. So I have difficulty seeing how we can manage or develop health systems if we cannot have guaranteed revenues.

The Bloc Quebecois motion, supported by all parties in this House, except the Liberal Party, is simple. It says that, out of this year's $8 billion surplus, $2 billion is going to health care. There is $6 billion remaining. Half of it would be returned to health care in order to achieve as rapidly as possible the objective established by all the provincial premiers. Let us be clear that it is not the Bloc Quebecois that established this objective. It is each of the provincial premiers, following the Romanow report, following the Séguin report in Quebec. They said they had to achieve as rapidly as possible the 25% federal contribution in the health system.

I think that it is reasonable for the Bloc Quebecois to propose this solution, since there is a surplus. Of course, in our proposal, we say that, each year, half of the surplus would go to health care. I say half because, year in year out, 40% of provincial government spending goes to health. The health budget will increased by 5% each year. This is the reality, and it is supported by all the experts.

Of course, you will have understood that we do not want Canada to have a deficit and we do not want to put anyone in trouble and in dire straits. All we want is for half of the federal government surplus to go to health care, in order to achieve the 25% federal contribution as rapidly as possible, as called for by the health ministers and the premiers of each of the provinces.

What bothers us particularly is to hear today from the Liberal members that it is not 16%. According to them, Romanow, Séguin and the premiers are all wrong. The Liberal member told us earlier that what the premiers were saying was not true. She said, “Harris also lied during his last election campaign”. That is what she said. She argued that it was not so, it was not true.

Leaving the premiers out of it, not one analyst or expert in Canada questioned the 16%. It is incredible. The Liberals seem to believe they are the only ones in this House to know about such things and they maintain that they are funding 40% of health care. Now, I have to agree with my hon. colleague here. If they are paying 40%, they are 15 percentage points over and above the 25% contribution Romanow called for.

Do you see how unbelievable this is? Why can they not spend the money on health care on the eve of an election? Because, with a $6 billion surplus, they can make a lot of announcements and hand out a lot of gifts. I think we are now at the point where Quebeckers and Canadians alike want the government to stop handing out gifts. They have heard about the gifts handed out these last few years. They just want the money to be spent on health care. This is the top priority of our constituents.

I hope the members of this House will realize that the Bloc motion is aimed at improving the health care system across Quebec and Canada.

[Benoît Sauvageau, Bloc, Repentigny, QC]

Mr. Speaker, I had an idea while listening to my colleague, the member for Argenteuil—Papineau—Mirabel, and I would like to know what he thinks about it.

The ads published by the Premiers' Council on Canadian Health Awareness cover all the provinces. I would like the Liberal member who gave a speech earlier and who wanted to be the first member of my fan club to listen carefully to what is going on.

She said that Mike Harris told lies during the election campaign. I am not a sharp political analyst, but I think that in February 2004, last month, Mike Harris was no longer the Premier of Ontario. I think that the Premier of Ontario is now a Liberal. If I remember well, the Premier of Quebec is no longer Bernard Landry. The Premier is not a péquiste any more. As far as I know, and for your information, the Premier of Quebec is also a Liberal.

In the two most populated provinces, it was Liberals who signed the press release saying that more money was needed to reach 25%. It was not Mike Harris or Bernard Landry.

Now that I have confirmed that reality for the member who spoke earlier, could my colleague, the member for Argenteuil—Papineau—Mirabel, tell us if that idea is only a creation of the minds of separatists and Tories in Canada or if it is shared by almost everybody except one political party?

[Mario Laframboise, Bloc, Argenteuil—Papineau—Mirabel, QC]

Mr. Speaker, I thank the hon. member for Repentigny for his question.

What my colleague mentioned is very important. At the beginning of my speech I said that health is a major problem in the Canadian federation, and I would go so far as to say that attitudes such as that of the Liberals right now are what will destroy that federation. If the federal Liberals keep denying the obvious, which is recognized by all of civil and economic society, because they are fully aware that the federal government is not paying its fair share in health, the Liberals themselves will destroy the Canadian federation. This is the reality.

There is a reason why a number of Quebeckers would rather manage their taxes by themselves. Why? Because they want to be able to solve health-related issues. It is simple and easy to understand.

The more federal Liberals deny that there is a fiscal imbalance, or the more they deny the statement made by the provincial premiers to the effect that, as the hon. member pointed out, the federal government is only investing 16% in health when it should contribute 25%, the more they themselves will undermine the Canadian federation.

They are well on their way to achieving that result. I would encourage them to keep working at it. However, in the meantime, there are Quebeckers who are suffering and who never get treated in emergency wards. And the Bloc Quebecois can never accept that.

[David Kilgour, Liberal, Edmonton Southeast, AB]

Mr. Speaker, I must begin with an apology to my colleagues in the Bloc who are greatly interested in this matter, but I am going to speak in English. My sources for the figures come from the Department of Finance. If they do not agree with my numbers, I trust that my colleagues, the Bloc included, will correct me.

Let me speak first to the repeated provincial claims that the federal share of health spending is in the 14¢ to 16¢ range. To arrive at this figure the provinces, and I believe the Bloc, divide the cash portion of the Canada health and social transfer, the CHST, by all of their social spending in the social domain, not just their health care spending. They include also social services and primary, secondary and post-secondary education in their calculation.

It seems to me that it is misleading to use the total amount of provincial social spending to calculate the federal share of provincial health care spending. Total provincial health spending is actually $77 billion compared to $143 billion for social spending.

It is also misleading for the provinces to ignore the $17 billion in CHST tax points provided by the federal government and the more than $10 billion transferred to provinces through the equalization programs. These amounts are available for health care spending and the choice is up to the provinces.

The CHST is a block fund which provides flexibility to the provinces to allocate the funding according to their own priorities. In short, they can spend as much of the CHST on health as they choose. Under the CHST there is no share of federal transfers earmarked for health care, none. Provinces have full flexibility to spend all or any part of the CHST and equalization on health care.

It was by mutual agreement that cost sharing of specific provincial expenditures on health and post-secondary education were changed to block funding. This gave all of the provinces much greater flexibility on how they would allocate federal transfers.

The provinces have complained that cost sharing distorted provincial spending decisions and favoured better off provinces since they could afford to spend more and so attract more federal dollars than the less well off provinces. Effective April 1 of this year the federal government will create a new Canada health transfer to improve transparency and accountability of federal transfer support for health.

What exactly is the federal contribution to health spending? We have all asked ourselves that question. The federal government contributes to provincial health spending through the CHST, both cash and tax points, and equalization and makes substantial and direct contributions to health care and health research.

Let us look for a moment at the CHST, that is, cash and tax points, which amount to almost $38 billion in 2003-04 including the $1 billion CHST supplement. The current CHST supports health, post-secondary education, social assistance, social services including early childhood development and early learning and child care services. I wonder how many members of the House accept this.

Since health spending represents about 62% of the total that the provinces spend in these attended areas, it is reasonable to assume that they spend 62% of the CHST, on average, on health annually. That is more than $23 billion of the annual CHST transfer. Adding the $1 billion in support from the new health reform fund increases the amount to over $24 billion. This total of over $24 billion is an amount equal to 32% of provincial health care spending of $77 billion.

What is the additional federal contribution to provincial health spending through equalization? The federal government provides eight of the ten provinces with equalization and they are free to allocate as much of that money as they choose to health. On average, provinces are spending about 38% of their program budgets on health care. I thought it was higher than that, but the finance department insists that it is only 38%.

It is reasonable to assume that 38% of the annual equalization goes to health, which means that more than $3 billion a year for health care. Added to the more than $24 billion in federal support through the CHST, the health reform fund which I mentioned, this brings the federal contribution to approximately $28 billion or 36%. I would suggest that we are getting a long way from 16% of provincial health care funding.

Finally, what about direct federal contributions to total public health spending? The federal government's direct spending for health care is estimated at approximately $5 billion in 2003-04 and that is for first nations health, veterans health, health protection, disease prevention, health information and health related research. As well, through the tax system, the federal government provides support worth about $1 billion a year. That includes credits for medical expenses, disability caregivers and infirm dependents.

It is not much of a secret where I am going. When we add the over $6 billion in direct spending and tax credits to the $28 billion in transfers to the provinces, the federal government is currently providing about $34 billion a year, or more than 40% of all national public spending on health care in Canada. We all hope this amount will continue to grow, and of course following recent investments outlined in the budget of 2003.

In summary, health care makes up 62% on average of what the provinces spend on social programs covered by the CHST. As I have said, that makes it reasonable to infer that probably 62% of the CHST is spent on health. If we add the federal support to the health reform fund, and that came to $24 billion, I do not think I need to repeat what I have just said.

In short, the federal government's contributions would strongly appear to be more than 40% of all national public spending on health care in our country.

[The Deputy Speaker]

Before proceeding to questions or comments, could the hon. member for Edmonton Southeast assist the Chair as to whether he might have been splitting his time with a colleague?

[David Kilgour, Liberal, Edmonton Southeast, AB]

Mr. Speaker, that was the arrangement with the parliamentary secretary.

[The Deputy Speaker]

In terms of the length of questions or comments, we will have five minutes of questions or comments.

The hon. member for Argenteuil—Papineau—Mirabel.