Mr. Speaker, today we are debating health care. I will talk about the motion in a moment, but I want to start by expressing my own view about the measure of success of a country.
Some would argue that it has something to do with economics. I would say the measure of success of a country is the measure of the health and well-being of its people. That is the true measure of success of a country.
The particular motion before us refers to private for profit delivery of health care. As I indicated earlier in my questions, I thought it lacked the clarity that was necessary for the House to really address it. However, the motion has brought us the opportunity to discuss some of the elements of our health care system, some of which is under the purview of the federal government, some of which is under the purview of the provincial government and some of which is the choice of Canadians who may choose to seek uninsured services from a health care provider.
The Canada Health Act has just celebrated its 20th anniversary for medically necessary insured services, and it passed unanimously in the House of Commons. I believe the existence of our publicly funded universal health care system is one of the most unifying elements that Canada has. It is that which we cherish so much, and most will agree that it is the most important asset we have in Canada, in terms of what is identified outside of Canada, is as one of our strongest points.
The health care system is very broad: obviously hospitals, doctors and nurses. However, these days health care for the public at large has been talked about in a much broader context than was ever envisaged or included in the Canada Health Act responsibilities. We now talk about pharmacare, the drug system. We now talk about home care, providing assistance to those who have had medical services and require care in the home for at least a point of time.
We also have dental care. That is a part of health care. Vision care is a part of health care. Psychiatric care is a part of health care. Not all these are included under the umbrella covered in the Canada Health Act. The Canada Health Act is for medically necessary insurance services.
The federal government has no responsibility to provide pharmacare. It has no responsibility to provide dental care. It has no responsibility to provide vision care, except if the need for that service is as a result of another occurrence, for instance, when someone needed dental care because the individual was in an accident. That would be covered. Normal, preventative and routine maintenance of dental care is not covered.
All of a sudden, in listening to the debate today, it is very clear to me that we are talking about health care in a much broader context than simply the responsibilities of the federal government. Having said that, there is no question in my mind that the public at large does not care to hear anything more about which jurisdiction is responsible.
Quite frankly, year after year, regardless of the issue, whether there are dual responsibilities or maybe even spread right down to a third level of government, Canadians do not care who is responsible. All they care about is that it is one taxpayer dollar. With regard to our health care system, all we really care about is that when medically necessary services are needed, they will be there on a reasonable basis and in accordance with the five principles of the Canada Health Act.
Those principles are: universality, which means it is available to all in Canada; accessibility, which means I can get it where I am, taking into account the geographic circumstances and the alternatives that would be necessary to qualify as providing accessible services; comprehensiveness, which means covering the full range of medically necessary services, not just providing a certain part of it in some areas but saying that it has to be comprehensive; portability, which means that regardless of where we live in Canada we would be able to get that service anywhere else in Canada; and finally, public administration, which is what most of this debate has been about in the context of private, for profit health care.
Private, for profit care has been talked about during this debate in two contexts. One has to do with a situation whereby an individual would go to a health care provider and pay for those services. Most Canadians would understand that to be private, for profit health care. It means that I go to a doctor and I want this and I want it now, and I am prepared to pay for it, so I can jump the queue. It might be, for instance, an MRI, magnetic resonance imaging.
There is another context in which private, for profit care has been discussed and I think it is the subtlety of this difference that is the important element of this discussion. This is private, for profit care in the context that the publicly funded system would acquire the services from a private, for profit institution, like a stand-alone clinic. Let us say, for instance, that someone went to the hospital after an auto accident and needed services. Let us say that the person had facial damage and had to have cosmetic surgery. That particular hospital may not have that particular service, so the public system would engage a private cosmetic surgeon. Cosmetic surgery is not an insured service unless it is as a result of, for instance, an accident. That means the health care system pays for it, not the individual.
There are two contexts here. I think it is important to understand that we are really trying to focus on the aspect of where the publicly funded or public administered system of our health care system would rely on services to be provided by those who are outside, who are not full time employees. They are in fact satellites out there that can provide those services for a fee, and there is a profit component. This is what this discussion and this debate have been swirling around. We have to make sure we are clear about the elements of which part we are talking about in terms of private, for profit health care.
Having said that, let me say that I spent almost 10 years on the board of the hospital in my own community. I learned a fair bit about the health care system. I have the ultimate respect for the primary care givers: the doctors and the nurses. These professions are extraordinary, and there are extraordinary credentials and extraordinary criteria, codes of ethics and guidelines for them.
In my own hospital in the 10 years I was on the board, the average length of stay of a patient in the hospital went down from about 7.2 days to about 4.7 days. That is a dramatic drop in the average length of stay. The reason it happened was that the health system is in its evolution, with the new technology, the new medicines, and the shift to an ambulatory system. One does not go to the hospital and prepare for a couple of days for surgery, have that surgery and recuperate for a couple of days. Now one can walk in and get same-day surgery and go home and recuperate there. It has totally changed the model of how health care is delivered.
I have a fundamental problem, though, with an ambulatory system. It is less invasive because of the technology, but what it does mean for people who are in the hospital and stay there for two or three or four days is that during that period of time when they have drugs required as a consequence of their surgery or their treatment, the cost of those drugs is covered by the publicly administered health care system. However, if one goes for ambulatory care treatment and it is day surgery, the cost of drugs required as a consequence of that surgery would be one's own cost. They would not be covered by the publicly administered health care system.
So now we have two situations. The hospital saves money and in fact closes beds, and indeed, in this particular hospital it went down from 650 to 400 beds, but it still could claim that it serviced more people with less beds because it was having a lot of day surgery. So suddenly not only were we downloading the cost of drugs to people, we were also downloading the recuperative care to families and to home care. That home care is not covered under medically necessary and insured services. That is provincial. The existence of home care and the extent to which it is provided is a provincial decision. It is not covered under medically necessary insured services under the Canada Health Act. Thus, over time, things have changed on what our view of health care is. It is much different today from what it was 20 years ago when the Canada Health Act came in.
In this morning's National Post there is what I think is a very good article written by Ms. Jane Brody on women and reproduction. It is an excellent piece. One of the things commented on is the fact that societally women are waiting a little longer before they have their families. It states, “Biologically speaking, the ideal age at which to have a baby is between 18 and 20”.
We know that is not happening very often now. In fact, people are waiting until their thirties before they have children. But the article also goes on to say that older women are more likely to suffer pregnancy complications: genetic abnormalities are more common in their fetuses and the miscarriage rate rises as the fertility rate falls.
Here is an example of how even societally how we live our lives is in fact changing the demands on our health care system. We have decided that we are going to wait longer to get married and longer to have children. As a consequence, however, it means that the costs to the health care system are also increasing, so there are other dynamics.
The point is that for the health care system as it was discussed and debated 20 years ago this past April 17--and in Parliament the Canada Health Act was passed unanimously--it was talking about hospitals and doctors and about what was medically necessary.
Today, “medically necessary” is not a defined term in the Canada Health Act, and it should be. We should define it. I would even refer it to the Standing Committee on Health. Let us talk and let us have some experts come and talk about what is medically necessary. As many of the people who have participated in this debate have already said, health care to them is what the people think health care is. Health care is not just the doctors, nurses and hospitals. Health care is community clinics. Health care is pharmacare and home care. It is the health and well-being of the person, the whole thing.
When we consider that we now get pharmacare, dental care and vision care, we suddenly are talking about a much different health care system and health care need that Canadians have focused on than what Parliament was talking about some 20 years ago.
When I was elected for the first time, in 1993, one of the first major tasks the government initiated was the National Forum on Health. It engaged some of the top medical professionals and administrators from right across the country. It spent two years studying our health care system. It provided interim reports and had consultations with Canadians. I can remember the booklets we had. I can remember the interim reports and the final report.
If members will hearken back to that period, the National Forum on Health concluded that there was enough money in the health care system. The problem was that we were not spending it wisely. That was the principal conclusion of the National Forum on Health, an independent public consultation with all of the expertise that was available. It concluded that there was enough money in the system.
We have now had another round with the Romanow commission. It consulted again all across Canada. Suddenly Mr. Romanow did a favour for us, I think, by telling us that we have to start thinking about our health care system in much broader terms than we contemplated back 20 years ago. We have to start talking about the health and well-being of Canadians in terms of what they need so that their health and well-being can be rated “high”. Because the higher the rating of the health and well-being of people, it is the measure of success of a country.
We have not yet finished the debate. I think that members would agree that pharmacare is a very important element, but drug costs now, in terms of the cost of medical services or medical expenses, are equal to what we spend on doctors. This is the result of change in the cost of medications.
This is not to say that on a blanket basis the pharmaceutical industry is somehow taking advantage of the health care system. The technology has changed. The drugs have changed. People are living longer. We only have to look at the average life expectancy of people these days. There is a significant increase in the length of our lives.
Members should also know this, which is one of the first things I remember from when the officials from the health department came before us back in 1993, at the first committee meeting I ever went to. The officials said that we spend 75% of our health care dollars fixing problems and only 25% preventing them. They said that this model we had back in 1993 was unsustainable. They also said that a dollar spent on prevention was far more productive than a dollar spent on curative or remedial health care spending.
So things have changed, Mr. Speaker. Things have changed dramatically in the health care system. Parliamentarians, with a motivation that I hope is beyond the political, are now seized with an opportunity to talk about what the people need. I think there is agreement that our health care system should be there for us when we need it, not because we can afford to pay.
One of the facts we in the health committee also found out early in my career was that about 75% of the health care costs in a person's lifetime will be incurred in the last two years of a person's life. Let us imagine that: 75% of the health care costs in our lifetime are spent in the last two years of our lives.
Why would that be? The reason is that we are talking about more life-threatening types of situations as we age. This means that the types of interventions, the specialists, the more expensive drugs and the equipment are all some of the most sophisticated equipment possible. It means that the resource intensity that is being used for life threatening situations goes up. That is why the health care cost is so high at the end.
We can all imagine that we have a system where we are now faced not only with defining what health care is and what is medically necessary, but we are also looking at an aging society and what demands that will make. The urgency is now.
I will conclude with what I believe is a fair assessment of my position on for profit health care delivery. To the extent that private for profit health care exists, the public health care system must be disadvantaged. The reason is not because of costs. It is because we are taking resources out of the public health care system and feeding the human resources into a private system. That means that the public system must be diminished. In my view, private for profit health care should not be an option in Canada.