Mr. Speaker, the Prime Minister remembers with pride the debates around the table with his father, a strong supporter of Prime Minister Pearson's initiative. Our Liberal roots on medicare run very deep. The tools for ensuring the five principles of medicare, which is the Canada Health Act, again under a Liberal minister of health, Monique Bégin, and under a Liberal prime minister, Pierre Elliott Trudeau, was passed exactly 20 years ago.
Pretty clear principles were set up in the Canada Health Act. They are accessibility, comprehensiveness, universality, public administration, and portability.
The hon. member's motion pertaining to not for profit private care is kind of cute by far. She knows that this is prohibited under the same Canada Health Act that we brought in and to which we continue to reiterate our commitment, as recently as the first ministers meeting on the health care accord in 2003. In fact the hon. health minister in 1995, a Liberal minister, actually enforced the Canada Health Act by withholding transfer of health payments to Alberta for the very infringement of private for profit clinics that were charging user fees and allowing preferential treatment to those who could afford to pay for medically necessary services. Let me explain so the political semantics can be laid to rest.
The key words here are “medically necessary”. In theory anyone has always been able to buy an ankle X-ray even if he or she never injured the ankle, and could even have an X-ray taken every day for a week, although I have no idea why anyone would want to do that. If that same person actually injured the ankle, and after examination by a physician it was felt that an X-ray was needed, then the X-ray would be paid for by medicare, even if the person could afford to pay for it, and that person would not be allowed preferential queue-jumping rights. That is the clear understanding of what we mean by delivery of medically necessary services under the Canada Health Act and medicare.
The system is intended and supported by law to provide the services that Canadians need when they need them, not what they want when they want them. Indeed there is no system that could ever provide that, either public or private.
I want to expose another little bit of wordplay in the words private care, et cetera. The key principle in the Canada Health Act refers to public administration, not public ownership. It seems to me the NDP members have a little ideological blind spot that can account for the confusion, since we know that they want public ownership of every government institution while the Conservatives want to privatize all of them.
In fact since the inception of medicare, many of those who deliver services have been private contractors. Ask a doctor who runs a private practice, pays her own rent and staff, purchases her own equipment and tools, and delivers care under contract to the province, the private administrator under a clear set of rules and the legislative authority of the Canada Health Act.
Where do we go for our X-rays and tests? Most of us go to clinics run by private contractors to the government, operating under the Canada Health Act. Indeed most hospitals are not publicly owned. They contract services to the provincial government under the Canada Health Act.
The issue is not where services are delivered or by whom, but whether the principles of medicare are held as articulated in the Canada Health Act and are enforced as such.
There are two important provisions in the Canada Health Act. The first provision relates to extra billing by physicians. This provision prohibits direct charges to patients by physicians in addition to the amount they receive from the provincial or territorial health insurance plan for insured physician services. The second provision refers to user charges for hospital services and the purpose is to remove financial barriers that could preclude or impede reasonable access to insured services.
Dragging out all these trite, politically motivated arguments is actually useless and it does not add to the debate. What we should be doing is talking about ways in which we in Parliament can make medicare sustainable for future generations; how to deliver quality care in a timely manner to Canadians when they need it; how to make the system more accountable and transparent so that it ceases to be the finger pointing federal-provincial forum that it now is; how to deliver services outside of the hospital system and in the home and community, remembering that when the Canada Health Act was designed, the federal government was only committed to transferring payments for physician and hospital services only.
Since then, medically necessary care can be delivered in a variety of settings: at home, in the community, et cetera. We need to move on and to be progressive in how we ensure that we as the federal government, which delivers funding, make sure we have a say in things such as home care and community care.
We need to ask how to get the health care providers we need. We need to ask how to get enough physicians, nurses and other health care providers to ensure that there is timely access to health care.
We need to ask how to prevent the 60% of illnesses that are lifestyle related and therefore preventable.
We need to ask how to deal with public health crises, how to promote healthy environments, how to operate the system with appropriate funding, how much funding is needed and how to spend that money in an effective manner with outcomes that are measurable.
The government asked those questions. In the Romanow commission, we got our answers. It had a set of recommendations that we have listened to. As a result, and for accountability and transparency, we have set up the health council. We have increased funding. We are delivering $25 billion over five years, including a direct health transfer of $16 million to look at issues such as home care, pharmacare and health reform.
We have heard from the party of the member opposite that it intends to set up publicly owned pharmaceutical companies and pharmacare. Is that party going to bully and run roughshod over the provinces and territories to do this? Is it not committed, as the government is, to building a partnership? Our Prime Minister has said very clearly that this summer he intends to sit down with the provinces and territories and forge a very real partnership, not just a transfer of money but a real say in the innovations and in the changing of the system as defined by the Romanow commission.
We need to talk about those things. We need to move forward together to deliver on them. We need to set up that health council, an independent body, so that we can take away the acrimony and political rhetoric among federal-provincial governments, which continue to dog what we do with health care.
We need to look at outcomes. We need to look at how we use very clear evidence based measurements to measure the outcomes: not what we think is being delivered but really what is being delivered.
We need to look at getting research to say what is the exact amount of money that is appropriate, because we know that apparently this country spends $112 billion on health care. That is 9.7% of the gross domestic product.
There are other countries such as the United States, which spends 25% on health care and does not have any better outcomes. In fact, 30 million people are still not covered. We need to ask ourselves, is money the only answer? How do we change the system? We are committed to doing that. We are committed to building partnerships. We are committed to looking at evidence based care. We are committed to health promotion and disease prevention.
We have just set up and had a commission that reported on how to set up a public health agency. That agency is not supposed to look only at SARS and other crises. It needs to talk about health promotion and disease prevention. It needs to look at population health and research and to deal with some of the things that create disease in our society and that we can in fact prevent. It needs to look at issues such as safety, security, and environmental issues like our water and how safe it is.
That is the kind of stuff we need to be talking about. We need to talk about how we develop health human resources to provide for the long term so that we can have the right health care providers. We just provided $90 million to do exactly that, to work with nurses and physicians, and not only to deal with the shortage now but to provide a long term plan so we can have health care providers, not only the ones we need in the tertiary care units but the ones we need anywhere else in Canada, the ones we need in the rural areas, for example, so that there can be timeliness and access and people can live in Sudbury and be able to find family doctors and specialists when they need them.
These are the kinds of things we should be talking about. How do we use incentives to help people get their services delivered to where they live? These are some of the things that we need to talk about. We need to talk about private, not for profit health care. This government is not committed to that. It never has been, but it has already said that currently health care services are being delivered by private contractors.
I have already reiterated that hospitals are privately owned. The individual doctor is running a small business. A lot of places where we go for our health care are privately owned, but we need to keep the Canada Health Act as a strong piece of legislation that will set the guidelines and the principles which will tell us how we can deliver that health care to everyone under the five principles of medicare.
How do we move out of the hospital based system and look at home care? How do we deal with pharmacare? How do we deal with the cost of drugs? What are the real things we can do so that we can continue to administer a strong public health system?
To confuse the issue, as is being done here, makes it very difficult for Canadians to understand, so we knee-jerk to something that is not really what we are talking about. We are talking about not delivering for profit care. We are talking about making sure that no Canadian who needs care will have to pay for it. No Canadian will lose care because they do not have any money.
We are talking about those issues. We are continuing to expound on the five principles of medicare. This government has never moved away from that. What we need to deal with is not the little bits of rhetoric. We need to deal with the real changes we need to make.
Mr. Romanow, in his commission report, gave us a very clear blueprint. We have started to move on that blueprint in all of the smaller areas. We need assistance from the opposition members across the way to move that agenda forward and to build strong alliances and relationships, to put medicare and the health of Canadians first because they want it to be first. We do not need to bandy about this sort of little argument that we continue to do: just before we think there is going to be an election, we start playing little games with something as important as medicare.
Let us talk about what we need to do to make health care sustainable so that our grandchildren will have access to care regardless of where they live in this country and regardless of how much money they have. That is what we are talking about. We are talking about timeliness of access.
I always love the argument about how we need more MRI units. Yes, we do, but how many? An MRI unit is on every corner in the United States and yet 30 million people cannot have access to them.
There is a private delivery system and a public delivery system in the United States. A lot of people cannot have access to even the public delivery system and many people cannot afford the private delivery system. That is not where we want to go. That is absolutely contrary to everything that this government has stood for over the years and that we have put into place time after time and have been committed to. I am here to tell--