Mr. Speaker, I am pleased to speak on the motion moved by our colleagues in the New Democratic Party, and I will have an opportunity to answer the question the Minister of Health put to me earlier.
I must say that I was taken aback by his remarks, which struck me as somewhat petty and vicious, since there is no question of taking responsibility away from anyone, or playing partisan politics with the health care system. I think it was beneath him, as a minister, to say what he said. Since he became one the 24 lieutenants in Quebec for the Liberals—it is hard to tell who is in charge—the higher his hierarchical standing, the more demagogic he becomes.
That said, what is important to recall is that, by the end of the 1970s, the provinces were spending $11 billion on their respective health systems. Since 2000, they have been spending $56 billion, and it is estimated that, in 2010, which is really not too far in the future, they will be spending $85 billion.
It must be remembered that, when hospital insurance was first introduced back in 1957, the federal government had made the commitment to cover 50% of health care costs.
There is no doubt that the system has evolved in such a way that, currently, many services are no longer provided in a hospital setting. The fact remains that the so-called medically necessary and medically insured services account for a major portion of the services provided by the health care system.
If there is a single example of the federal government's ability to cause fiscal instability in the provinces—justifying ultimately the need for the people of Quebec to achieve sovereignty—the health care system is the best example.
When Jean Chrétien's government was sworn in in October 1993 et assumed responsibility for the nation's business, the CHST was $18.7 billion. Today, as we know, this transfer has been divided; since April 2004, there is a dedicated health transfer and a dedicated social transfer.
In the early budgets presented by the current Prime Minister, the ceiling dropped to a rather disturbing $12.5 billion. Thus, in 1996, 1997, 1998, 1999, 2000, 2001, 2002 and 2003, the provinces obviously had to continue providing health services in a profoundly altered environment. We know that people are living longer, and living with debilitating diseases, and they want to remain in their own communities longer. Still, throughout all these years the federal government was decreasing funding, there was never any consultation.
Just now, the Minister of Health showed he has a lot of nerve. He has the nerve of a herd of wild bulls to rise in this House, his hand to his heart, with his soft little philosopher's voice, and tell us that in the summer of 2004, there will be a first ministers health conference, as if the government itself were not responsible for the mess in the health care system.
I have seen and I have read—I will mention it later as well—the speech that the Minister of Health gave in Toronto, talking about a new partnership and new conditions.
The Minister of Health talked about four requirements for the health care system. But they are responsible for the mess in the health system. And here I can make the connection to the New Democratic Party motion. In fact, if our fellow citizens have turned increasingly to the health care system, it is not because they believe in it philosophically; it is because of the federal government's cuts to health. Health transfers have declined from $18.7 billion to $12.5 billion, which means that the ability of the provinces to provide adequate health care has been seriously cut.
I would like to answer the health minister's question. He can act innocent, and resort to philosophy and rhetoric, but he will fool no one. The provinces are asking for one thing. The provinces have made common cause, something that is very rare in federal-provincial diplomacy. In 1999, 2000 and 2001, all the premiers—whether New Democrats, Conservatives, Liberals or, of course, the premier of the excellent Parti Quebecois government, when they were at the helm in Quebec—were part of this consensus. They mobilized their civil servants. They submitted a report to the health minister and the Prime Minister of the day about the evolution of the health care system.
The premiers documented this report with econometric models with which the member for Joliette is familiar. In the years to come, even before offering any new services, all provinces will have to invest an additional 5% in health if they want to continue to offer just the same services, without adding even one more.
In the meantime, the federal government has disengaged, disinvested in health services. People wondered how it could be that the systems were working so badly, why there were waiting lists, and why people did not have immediate access to the health system they wanted. What were the consequences of this? The irresponsible actions by the federal government have increased the private sector's part in the system in all provinces. It was not that certain health services were no longer insured, but rather that people who could afford it wanted to have faster access to a system that was slowing down because the federal government had not met its responsibilities.
Before speaking about Quebec's Arpin report on the private health system, I would just like to remind hon. members of three figures. Even with the February 2003 agreement signed by the premiers, the federal government's contribution to health system funding—and I hope the hon. member for Shefford realizes this—will, after hitting its ceiling in 2005-06 with cash transfers of $24 billion, be no more than about 15%.
It is unbelievable, when we know that the government's commitment, when the first joint federal-provincial programs were signed in the 1950s, was to contribute 50%.
Secondly, for 2004-05, that is for next year, there is a cumulative shortfall. Looking at the 2004-05 level for the Canada health and social transfers in comparison with their initial level in 1994-95, and taking inflation into account, we will see that $14.7 billion is needed to bring these transfers up to where they ought to have been based on the initial 1994-95 levels. This is dramatic. Once again, it must be kept in mind that the provinces continue to be under pressure to deliver services to their populations.
In 2004-05, Quebec will be receiving a mere $200 million more in CHST payments than it did in 1994-95. That is absolutely ridiculous, especially considering the fact that Quebec has had to increase its spending on health, education and social programs by $9 billion. Meanwhile, the federal contribution is a meagre $200 million, or 2% of the additional costs.
This is the background of the situation we are facing: underinvestment by the federal government; a minister who puts on a philosopher's air and suggests, in a charming tone, that the government has taken its responsibilities, when in fact it has acted totally irresponsibly; provinces whose ability to provide our fellow citizens with services has been strangled.
Again, I refer to the motion by the NDP, our neo-Bolshevik friends, as we like them to be. In Quebec, a commission was struck which produced the Arpin report. It makes for interesting reading. I would like to quote two excerpts.
From 1982-83 to 1998-99, cuts in federal health transfers totalled $16 billion, or nearly two-thirds of the cuts in federal transfers in Quebec.
I spoke earlier of the 1995 to 1999 period.
For the period between 1995-96 and 1998-99 alone, the shortfall in health funding for Quebec totalled $8.2 billion.
The federal government reduced transfer payments from 1995 to 1999, while major changes were taking place in the health care system. It is not the Bloc Quebecois, the Parti Quebecois or the NDP, but the scientists behind the Arpin report who reported an $8.2 billion shortfall. That is one comment.
I have a second, very interesting one to make, which, in my opinion, captures the quintessence of the Arpin report. I want to stress that point. It reads as follows:
It was observed that, between 1989 and 1998, the increase in the relative share of private health care spending does not originate in the categories of services funded mainly through public programs, but essentially in categories of expenditures that are mostly the responsibility of individuals, including seeking treatment from institutions other than hospitals, buying medicine and consulting practitioners other than medical doctors.
What does that mean? That means that in the mid-1990s, after Alberta, 30% of health spending in Quebec occurred in the private sector. I am not talking about private insurance, which was not a factor because the services were not insurable. That is not what we are talking about. It is not because there were fewer services in the hospitals. Of course the services had slowed down and the waiting lists were longer, that is for sure, since the government had made cavalier cuts to health transfers.
The reason private services increased in Quebec is twofold. First, more people consulted health professionals not practising in hospitals. Second—and my colleagues will not be surprised to hear me say this—the biggest reason is the whole drug issue.
I would like to quote the Arpin report again:
Private spending on drugs has increased from 32.3% in 1989 to 34.2% in 1998. This increase can be attributed in part to the significant increase in the price of drugs and in part to the increase in rates for pharmaceutical services—
Now, we really must talk. Hon. members know that of all the budget items for health, the one that has grown the fastest is for drugs, prescription drugs in particular.
What does that mean? That means that the federal government acted irresponsibly, in a cavalier manner and with obvious contempt for the basic principles of federalism.
When I was studying political science and the topic was federalism, we were told that a certain number of conditions were required in order for there to be federalism. There are two levels of government that are sovereign in their respective spheres. Obviously, there cannot be federalism if a government, namely the federal government, can destabilize provincial public funding without any consultation or any warning.
The fact is that there needs to be extremely serious reflection on the issue of drugs. At the Standing Committee on Health I tabled an order of reference with four very specific proposals. The first is on the entire issue of drug advertising.
We know that direct consumer advertising is not allowed under the Food and Drugs Act. There can be no connection made between a drug and a particular condition, no claims made in TV advertising that a product will cure this or that disease or disability.
The Department of Health has not been able to gain compliance with the Food and Drugs Act. Television ads contain more and more direct links between products and conditions.
I do not know, Mr. Speaker, whether you have ever paid any attention to the Viagra ads. Who does not get the message, when someone is depicted as leaping with joy first thing in the morning, that he has had a great night. Imagine if there were a court challenge on this, it would not have been easily settled.
The federal government has not been able to enforce its own legislation. More and more, we are finding direct consumer advertising on television and in print. We know that advertising of this type is allowed in the United States, and it has certainly increased the tendency to take medication.
The second thing the Standing Committee on Health will have to consider is the issue of renewing patents. We in the Bloc Quebecois believe in intellectual property. We know that if a company, on the West Island of Montreal, or anywhere in Quebec—in Laval, for example, because there is a very strong biotechnology development there—spends $800 million to bring a drug to market, we agree that the company should earn a return on its investment. The problem, however, is that some pharmaceutical companies, when a patent expires, renew the patent without any real therapeutic innovation in the medication. Without questioning our international obligations under the TRIPS agreement, we must look at the way we deal with this reality.
Thirdly, the generic companies must be subject to regulation by the Patented Medicine Prices Review Board. There cannot be a double standard. We cannot say that we will examine the expenses of the innovative companies while allowing the generic companies onto the field without having to be accountable.
Those are the proposals my representative took to the Standing Committee on Health.
I could also talk about the whole phenomenon of Internet pharmacies. That is a very worrisome thing.
My conclusion, since time is flying, will be this. The best way to keep our fellow citizens safe from privatized health care is for public investment to be sufficient. On that matter, we have no praise for the federal government, which has withdrawn from this sector in a cavalier manner. What we are going to ask during the election campaign is for the government to assume its responsibilities, for it to contribute 25% of the funds in the health transfers to provinces, in order to provide and keep viable the public health system, which we in the Bloc Quebecois believe in.