Mr. Speaker, I want to talk about health care.
Let me say first that I received an e-mail this morning which I found quite saddening. Members may have seen it. The five year old son of the member for Châteauguay, our colleague, has passed away. I want to note that, and I am sure that all members would agree that our hearts are with the family at this very difficult time.
I do not believe that the measure of the success of a country is its economic success. Rather, I believe that the measure is the health and well-being of its people. Health care has been the number one issue on the agenda of the Parliament of Canada and the Government of Canada ever since I can remember.
When I came here as a member in 1993, one of the first important initiatives undertaken was the establishment of the National Forum on Health. This process went on for a substantial amount of time. The best people, the best resources in the country, were consulting with Canadians, with the experts and with those who were familiar with the system as it existed and with the options and opportunities as they presented themselves in regard to continuing to improve our health care system in Canada.
I am very careful to remember that the ultimate position or opinion of the National Forum on Health was that there was enough money in the system. It did not say that we needed to have more money pumped in; it said that we were not spending it wisely, that we were not being efficient in using it. This led to a whole new range of thinking about how to get the resources that are within our health care system dedicated and focused to being flexible or responsive enough for the needs of Canadians.
That leads, then, to this whole discussion about federal and provincial responsibility and jurisdiction. The member for Hochelaga—Maisonneuve raised it, I think, and he often talks about the provincial responsibilities and how the federal government seems to be just getting in the way. But there are certain things that transcend jurisdictional responsibilities. There are certain things that transcend partisanship. I believe that health care is one of those matters. As far as Canadians are concerned, there is only one payer of taxes, and that taxpayer does not care which level of government collects tax dollars. What they care about is that those dollars are being used wisely and effectively to provide the services that Canadians require.
As I mentioned earlier in a question and comment session, it is under the Canada Health Act that the principal responsibilities of the Government of Canada lie in terms of protecting and defending the principles of our health care system. Very briefly, I will describe them.
There is universality. This means that health care is going to be available to all in Canada regardless of whether they are citizens or have landed status or, indeed, are refugees. People who are on our shores are going to have accessibility. Health care is going to be universally available to all those who are in Canada. That is our value.
Comprehensiveness is the next item. This means that the full range of medically necessary services is going to be there for all those in Canada.
Finally, there is portability. This is an area that I have some concern about. Portability says that no matter where one is in Canada, no matter which province or territory, one will get health care service. I think that is very important.
Health care that is publicly funded and administered is the next principle. It means that in Canada we do not get an invoice every time we get health care services. It means that as we pay our taxes we are putting into the resources of the country so as to be able to sustain a health care system to provide for the needs of Canadians, or so we will have it when we need it.
As an example, 75% of the health care costs in the average person's lifetime will be incurred in the last two years of life. Imagine if we had a system which said that when we go for health care, we pay. If we are healthy throughout life, we are not going to incur many health care costs, but every one of us is going to eventually get to that point where we hit what is called the “resource intensity” requirements: the best specialists, the best medication and the best equipment. That is when expensive health care kicks in. It is usually in the last couple of years of life.
Who could afford it? It would bankrupt most people. That is exactly what happens in the United States for millions of Americans who do not have health insurance. They go bankrupt at that time when there are high resource intensity waits for the services required. The costs are prohibitive, sometimes as much as $20,000 or $30,000 a month in terms of the effective value of that service.
Having health care publicly funded means that the costs are smoothed out. It basically insulates all of us from the big hit of paying those costs for health care when we need it. It is there and is accessible.
The final point is accessibility. A country like ours is very diverse. We have a high population concentration in urban centres and a very high concentration of our population within 100 kilometres of the American border, but all Canadians do not live in urban centres and in proximity to the American border. Every Canadian must have reasonable accessibility.
I know that one of the biggest problems we have with the Canada Health Act right now is that some of the definitions are so broad and general. I really think that they have to be looked at. We need to define what is medically necessary and to have it understood. “Medically necessary” is not a defined term under the Canada Health Act--that I am aware of--but it should be so that Canadians' expectations with regard to what they get from the health care system are in there.
Members have heard and Canadians are aware that in certain provinces pharmaceuticals are being delisted. They are not being covered by pharmacare. In certain jurisdictions, medical and vision care are both being provided generally under health care to low income seniors, but in other communities they are not.
In New Brunswick and, I believe, in Labrador, seniors cannot get pharmacare unless they are collecting the guaranteed income supplement, which means they are the poorest of the poor.
That is not universal. That is not accessible. It certainly would not represent portability. I do not understand--and I guess we as parliamentarians have to ask these questions--how it is that these principles have been manipulated by some provinces in terms of trying to balance priorities on an individual basis.
When I came to Parliament, we had transfers to the provinces under two main envelopes. One was under the established program financing, which covered health care and post-secondary education. The second aspect was on the social programs under the Canada assistance plan, the CAP program, which was our contribution of 50¢ on the dollar with regard to matters such as welfare and social assistance.
That system was getting to be onerous. The funding amounts were provided in two forms. One was cash and one was what is called tax points. There are very few people in Canada and, I suspect, very few people in the House who totally understand tax points, other than the concept being that it is the taxing authority that has been transferred from the federal government to other jurisdictions to make up the cash.
What was happening when I became a member of Parliament was that the cash component was starting to shrink in terms of transfers. Let us look at what happens if the government does not have any cash, or if the taxing authority is basically transferring all of what is necessary. For instance, I think that in Quebec at the time the health care transfer with regard to the tax points actually was getting to the point where no cash had to be transferred. If the federal government has no cash to withhold in the event that a province would not respect the five principles of the Canada Health Act, which has happened from time to time, then there is no lever for the federal government to use to compel a province to provide the medically necessary services that are expected under the principles of the Canada Health Act.
That is when we changed to what is now called the Canada health and social transfer. I must admit there was a lot of confusion when we arrived at that point. Everyone said that it had been calculated a certain way in the first place. Now we have the Canada health and social transfer, and it is not three parcels but one. One has to wonder why that happened.
I remember looking at it somewhat carefully. It appeared to me that the principal advantage of bundling the transfers to provinces under one computation was that the cash transfer for post-secondary education and the Canada assistance plan components for social services was available to be withheld under the whole umbrella. Basically we could absolutely ensure that the federal government had cash that it could withhold in the event that the Canada Health Act was not being respected. It was a very interesting change in the policy.
Since then we have continued to debate about the existence or the non-existence of tax points and whether they are real. Some have even gone so far as to say that they have no value or they should not be included or that the federal government is only transferring so much cash, and why not just reverse it. I have a feeling many people would argue that the whole point of transferring tax points to the provinces was probably not one of the federal government's finest hours. This has led to a lot of confusion.
Notwithstanding that, we now find ourselves in a situation where health care continues to be the number one priority of Canadians, and Canadians should know it is the number one priority of their government.
Health care has been in every budget since I first came here in 1993. Every budget cannot deal with every aspect of each subject, but this has been a building situation. When we look at what has happened in terms of funding, whether it be one time specific in certain areas, such as MRI machines or for other specific purposes, the question again comes up about federal and provincial responsibility. I often wonder if we will ever get out of this dialogue about whether someone is encroaching in someone else's jurisdiction. I understand what the responsibilities of the provinces are under the Constitution. Now we have to ask ourselves if we are making some significant shifts in terms of the activities of the Government of Canada.
When we look at something we started right back in 1994, moneys from the federal government were put together in partnership with provincial and regional governments to do infrastructure programs such as sewers, bridges, roadways and the like. This was not federal jurisdiction per say.
If the country's infrastructure is eroding, a number of consequential and detrimental things will occur. If the economy is not good, then generally people are not working. If people are not working, chances are that is affecting the safety and security of their communities. Chances are that is affecting their ability to have a job.
In our society everything we do plays a role. I would argue, as I said at the beginning of my speech, that the measure of success of a country is not the measure of success economically. Rather it is the measure of the health and well-being of its people. Any government has to look at the condition of its people, particularly as it relates to their health.
Now we are talking about conditional funding. For instance, if the federal government were to inject another $2 billion, which is the number suggested, that is conditional funding. Two areas have come up with regard to this, and that is pharmacare and home care.
I recently did some work on a seniors project. I tabled 17 motions in the House on February 2 dealing with seniors. The most startling one to some was my proposal for a guaranteed annual income for seniors. Seniors' poverty is an important issue that has not been given the priority or attention it should be given.
Among the other motions I put forward, two had to do with pharmacare and home care. On the pharmacare side, as I mentioned earlier, there is an inconsistency across the country in the availability and accessibility of pharmaceuticals. This is so important. If we put it in context, we spend as much in health care costs on pharmaceuticals as we do on doctors and nurses. Doctors and nurses and drugs in our health system are the same. That is how our health care system has moved. Therefore, we have to reassess as we get these dramatic shifts.
I know it is extremely important that people understand how much it costs with regard to pharmaceuticals and whether there is a system in place to ensure that the pharmaceutical industry is meeting the needs and that we are getting, as the Auditor General reminds us of, value for money. I am not so sure sometimes when I see the new and improved or the change in a formula which has basically no effective change in the value of a drug.
The other part has to do with home care. I am really concerned about the situation that many families find themselves in these days under the umbrella of our health care system delivered by the provinces. It has to do with home care, specifically from the standpoint that we understand people have circumstances where they do not need full nursing home care, medical care and attention on a constant basis, but that it might be limited to as little as a couple of hours a day.
When we think about it, it is either full time care in a nursing home, which can cost somewhere around $2,000 to $3,000 a month to be in a regulated nursing home environment, as opposed to a couple of hours a day. What happens to all the people who need more than two hours a day, who have supervisory requirements where they can get themselves in trouble or they need help to do some basic things but it is not constant? There is an enormous hole in the middle of the home care system which can only be filled by who? By family members. It usually turns out that it is family members and it is more often than not women versus men. Women are being required to withdraw from the paid labour force to provide care for an infirm or disabled elderly loved one.
How is it that we can provide important subsidies to the nursing home industry, yet we cannot provide the same effective level of subsidies to care givers?
About three or four years ago Motion No. 30 passed in this place to establish a care giver tax credit. That was my motion. It was only a modest amount of about $500, but we now have in the Income Tax Act a care giver benefit.
I believe an important contribution we can make to the health and well-being of Canadians, particularly our seniors, is to look seriously at enhancing and enriching the care giver credit so our seniors will be able to have the care, if necessary, beyond what home care can provide. At the same time we cannot continue to shift the burden on to families to provide the care that they need.
What we have to do is look very carefully at our home care model and in fact tie some funding to home care so we can provide some flexible options for families in that middle, between full time nursing home care and a couple of ours a day.