House of Commons Hansard #52 of the 37th Parliament, 3rd Session. (The original version is on Parliament's site.) The word of the day was services.

Topics

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3:30 p.m.

NDP

Peter Stoffer NDP Sackville—Musquodoboit Valley—Eastern Shore, NS

Mr. Speaker, on two points, actually it was about six months ago and I had it at Cobequid hospital, a publicly run, publicly delivered facility.

For the information of the hon. member, for whom I have great respect, every 56 days or thereabouts I go to the Canadian Blood Services clinic to donate blood. My blood is severely tested right there for the presence of any diseases.

The hon. member talked about her platform and that of the Prime Minister. I challenge her to rise again in the House and tell us that in the Liberal Party platform in the upcoming election we will see the words “publicly delivered, publicly funded, not for profit health care”. Is she prepared to stand in the House and tell us that is the Liberal position in their platform for the next federal election?

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3:30 p.m.

NDP

Bev Desjarlais NDP Churchill, MB

Mr. Speaker, a colleague was chattering behind me saying “sports, sports”. Therefore, I say to my colleague, it has been mentioned that the involvement of young people and certainly all people in physical activity does improve their health.

I am the seniors critic. I am someone who has met with a number of seniors and quite frankly, I am someone who is on that doorstep, but I am not quite there. I actually do agree that it is crucially important that seniors and others have the opportunity for recreational activity. There is a severe lack of facilities for seniors in our system. It is crucially important that more infrastructure dollars go toward that. I would like the hon. member's comments on the recreational opportunities for seniors.

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3:30 p.m.

NDP

Peter Stoffer NDP Sackville—Musquodoboit Valley—Eastern Shore, NS

It is not just for seniors, Mr. Speaker, but for families right across the country. The NDP introduced Bill C-210, which would offer people the opportunity, when they sign up for physical activity or sports, to claim the registration fees as a tax deduction similar to that of a charitable donation.

Seniors who are in the lawn bowling clubs and dance clubs and families who put their kids in hockey, soccer or whatever, the fees that they pay should be tax deductible. That would encourage more and more people to become physically active in our society.

If a person is physically active, the chances of the person using the health care system are greatly reduced. Physically active Canadians are healthier citizens. A healthy body and a healthy mind mean a person makes healthy choices.

For the investment on the tax deduction for people who participate in sports and physical activities, we would save tremendous amounts of money on the tail end of the health care services. If we provided proper recreational facilities for our youth, families and seniors, we would prevent the health care system from being overused and we also would prevent a lot of social injustice issues in the very near future.

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3:30 p.m.

NDP

Lorne Nystrom NDP Regina—Qu'Appelle, SK

Mr. Speaker, I want to ask my colleague from Nova Scotia about the Conservative Party. I notice here in the Toronto Star there is statement from the Conservative Party calling for more privatization of health care in response to Roy Romanow.

The Conservatives have a record with Brian Mulroney. Brian Mulroney was their leader for years. Members, like the member for Saskatoon—Wanuskewin, are big Brian Mulroney fans, being a former leader of that party. Grant Devine was one of the leaders in Saskatchewan.

I want to know why the Brian Mulroney-Grant Devine party is now calling for more privatization of health care according to the current leader. Members of that party get very sensitive when I talk about their former leader. In Moncton he endorsed with great enthusiasm the current leader.

I wonder if the member could talk about what he thinks about this privatization move being pushed by the Mulroney-Devine-Mike Harris Conservatives to my right.

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3:35 p.m.

NDP

Peter Stoffer NDP Sackville—Musquodoboit Valley—Eastern Shore, NS

Mr. Speaker, the three scariest names in this country are Brian Mulroney, Mike Harris and Grant Devine. Each one of them promotes in some way the privatization of our health care system. That is the Conservative agenda. The Conservative agenda very clearly says government should get the hell out of the way and let the private sector take over. That is what we will be saying on the doorsteps.

Can any Conservative stand up in the House and say very clearly that the platform of the Conservative Party will be a not for profit, publicly delivered and publicly funded health care system? Will they be able to say that?

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3:35 p.m.

Vancouver Centre B.C.

Liberal

Hedy Fry LiberalParliamentary Secretary to the Minister of Citizenship and Immigration

Mr. Speaker, I rise to speak to the motion proposed by the hon. member for Churchill. I have always had a problem with politicizing an issue as complex as health care with simplistic statements as the motion on the floor proposes to do, because it tends to create disinformation, anxiety and confusion and fuels a false debate on an issue of critical importance to Canadians.

The hon. member knows that the government and the Prime Minister have reiterated over and over their commitment to medicare in word and in deed. Let me quote:

Any discussion of this government's priorities must begin with health care for there is no other issue of such vital and visceral importance to Canadians. Nowhere does government interact with people in a more meaningful and consequential way.

That was said by the right hon. Paul Martin.

The government is proud of its historic credentials on medicare. While the idea began with Tommy Douglas in Saskatchewan with public hospital insurance, and let us give him credit where it is due, this idea became a concrete national medicare plan under a Liberal prime minister, Lester Pearson. It took two years to get all the provinces onside. Our Prime Minister, Mr. Martin, remembers with pride the debates around the dinner table--

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3:35 p.m.

The Acting Speaker (Mr. Bélair)

I am sorry to interrupt, but the member has used the Prime Minister's name instead of his position twice already. Please refrain from doing so.

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3:35 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

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--

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3:45 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Your party destroyed it.

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3:45 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, if we want to put a simple question, we will get a simple answer.

We want to continue to strengthen the system of medicare that we brought in many years ago, based on the good idea of Tommy Douglas. We want to continue with that. We want to strengthen the Canada Health Act. We want to ensure we have a system that is here for the 21st century needs of patients so they can get care when they need it. That means taking the infrastructure of the system and working to build it in a different way.

It does not just mean money. We continue to talk about money. We continue to focus on one of the small factors involved. It is like people who suggest that if I do not eat trans fats in foods I will lose weight and never get heart disease. Trans fats are only one small factor in the whole issue of lowering cholesterol, having a healthy heart and living a healthy lifestyle. There are many other things involved.

We need to talk about those other things, all the pieces that come together to make up that continuum of care that we need to deliver, knowing that as a federal government we do not have the ability to deliver those services. We have to work with the provinces. We have to set up a true partnership. We cannot be a cash cow anymore, where we hand over money with no strings attached and it goes into general revenue and we do not know where it goes. We do not want to do that anymore. We want to build a relationship based on trust and on mutual objectives.

Our Prime Minister has committed to that. He intends to do that at the first ministers meeting in the summer. He wants to build some real partnerships for the provinces and the federal government to work together in the best interests of Canadians.

I want to be clear on this issue. I think I gave a clear answer to the motion. For us, it is a huge and complex issue and we want to go into every area and do what we need to do as a government to ensure that this system is here not only for our children but for our grandchildren as well.

We want to ensure that the outcomes will be measurable and will increase the health status of Canadians. We want to ensure that the system will be there for them at all times when they need it, especially in the first few years of life and the last few years of life when health care services are most needed. We want to be creating healthy populations. We also want to deal with sectors that have specifically low health status and very difficult problems, such as the aboriginal sector. We have committed new moneys to that. We continue to work with the aboriginal people to improve their health status and give them access to care when they need it.

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3:50 p.m.

NDP

Bev Desjarlais NDP Churchill, MB

Mr. Speaker, I am going to respond to a number of comments my colleague has made.

First, she mentioned clinics where anyone can go any day and get an X-ray on their leg if they need it, but if there is an accident the doctor can order it and it is covered. I would suggest that she has just explained the loophole that is out there for people to queue-jump. All the doctor has to say is “this is not medically necessary” and someone can go to that other clinic and get the service provided ahead of time. That is a serious issue that has been brought forth as a result of loopholes in the system, just with a doctor writing “not medically necessary” so they can queue-jump.

I believe the member made the statement that not all the hospitals are publicly owned because the provincial governments run them. In my view, provincial governments are still public. They have been for some time.

I also want to comment on her indication about the Romanow report and following along what Romanow did. Let me quote from a section of the Romanow report written in response to private, for profit delivery. It states:

--in effect, these facilities “cream off” those services that can be easily and more inexpensively provided on a volume basis, such as cataract surgery or hernia repair. This leaves the public system to provide the more complicated and expensive services for which it is more difficult to control cost per case.

But if something goes wrong with a patient after discharge from a private facility--as a result, for example, of a post-operative infection or medical error--then the patient will likely have to be returned to a public hospital for treatment as private facilities generally do not have the capacity--

A number of issues have come forth, and I believe it is questions and comments, Mr. Speaker, so unless I am restricted in making a certain length of comments, I also want to mention this. The member said the government is opposed to for profit delivery, but I would say to her that the reason this is an issue is what the minister said at the health committee:

The minister was remarkably blunt in his response. He said that, in fact, the Canada Health Act does not prohibit private sector delivery of medicare services...“If some provinces want to experiment with the private delivery option, my view is that as long as they respect the single-payer, public payer--

They should be allowed to go ahead, said the minister.

So we have an issue here. We want to hear the Prime Minister and the health minister say they will not allow for profit delivery. They cannot say they are against for profit if they are not putting enough dollars into the system. I cannot say I do not want a hole in the roof of my house because I do not want the rain to come through and then not fix the hole.

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3:55 p.m.

The Acting Speaker (Mr. Bélair)

The member is not necessarily restricted in the time she uses, but I also have to give the chance to someone else to ask questions or make comments.

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3:55 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, I think the comments and the questions of the hon. member point so much to a complete and total lack of understanding of first, the Canada Health Act, and second, the system. For starters, if she quoted--

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3:55 p.m.

NDP

Bev Desjarlais NDP Churchill, MB

The health minister said--

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3:55 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, may I be allowed to answer the question? I would like the opportunity to answer the question.

The statement made by the hon. member is that the public does not get the difference between public ownership and public administration. The hospital is not owned by the government, but the services are administered by the government under the Canada Health Act and according to a clear contract that follows the rules of the Canada Health Act.

I would ask the member to ask family physicians if they are not sitting in a private practice paying their own rent, running their own show, but under the Canada Health Act they are bound by clear rules and they must be under a contract to the public administration which is the province. There is a real difference between ownership and administration which the hon. member does not get.

As I said, the bottom line here is that her political party wants to own everything. No wonder those members muddy the waters between ownership and administration.

The hon. member talked about cataract surgery and hernia repair being done as a private for profit service. These are medically required and medically necessary services. Under the Canada Health Act they have to be delivered according to the principles of medicare under the act. This is absolutely clear. As I said before, in 1995 the health minister enforced the Canada Health Act for exactly that reason in Alberta and withheld transfer of payments as articulated in the act following the act to the letter.

Finally, the hon. member of Parliament did not understand what I said when I talked about the X-ray. It was not if the person needed, she used the word “needed”. I said, if the X-ray was needed because of very clear clinical guidelines and clinical evaluation, not because somebody dreamed it up one day or walked down the street and said they thought this was because a trained health provider was following clear clinical guidelines and decided this was a medically necessary service. That falls under the Canada Health Act.

That is all I was trying to explain to the patient, but I guess it is pretty difficult to understand it if one is sitting facing ideology all the time.

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3:55 p.m.

NDP

Libby Davies NDP Vancouver East, BC

Mr. Speaker, we are not fools in the House and after what we have just heard, is it any wonder that Canadians are totally confused about where the Liberal Party actually stands in terms of dealing with private for profit health care delivery?

Having heard the member for Vancouver Centre, I think she knows very well that we are not debating and talking about private physicians, or private dentists as she talked about yesterday on a CPAC panel. We are talking about the private for profit delivery of health care and how this has mushroomed under the Liberal watch. There is no escaping that reality.

There is just one very simple question. Does the Liberal government support privatized for profit health care services in Canada or not? If it does not, why have we now gone through a decade of seeing these services escalate across the country? The Liberal government has not taken any action to prevent this from happening. Why is that the case?

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4 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, I thought I said that very clearly earlier on in my remarks. This government does not support private for profit delivery, private for profit administration or any such thing. We are committed clearly to the high principles of medicare. We are committed to the Canada Health Act which was brought in by a Liberal government 20 years ago. We continue to be committed to those things.

We intend to strengthen the system, to make it sustainable and deliverable to our grandchildren. We will provide timely access of quality care to Canadians when they need it and we intend to do so under all those high principles of medicare. I do not know how I can say that any stronger than that.

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4 p.m.

NDP

Peter Stoffer NDP Sackville—Musquodoboit Valley—Eastern Shore, NS

Mr. Speaker, my question to the hon. member is a very simple one to answer. Does she believe in a publicly funded, publicly delivered, not for profit health care system in this country?

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4 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, I seem to be answering the same question over and over, and the simple answer is, yes. There are five clear principles of medicare. There is a Canada Health Act that supports those clear principles, and we absolutely support that.

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4 p.m.

NDP

Lorne Nystrom NDP Regina—Qu'Appelle, SK

Mr. Speaker, I wonder if the member across the way, being a so called progressive Liberal, is embarrassed by the fact that her government has cut back on cash funding to the provinces. It used to be 50% years ago when the NDP forced the federal Liberals under Pearson to bring in national health care, and now it has gone down to 16%.

Years ago, the Liberals fought against national health care. In Saskatchewan the Liberal leader, Ross Thatcher, actually kicked the doors of the legislature when the CCF, Tommy Douglas and Woodrow Lloyd brought in health care. The Liberals were really opposed to health care and then it came in at a fifty-fifty cost sharing basis. Now the federal government only funds about 16%. Does that embarrass her as a Liberal?

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4 p.m.

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Mr. Speaker, I wonder if maybe I should turn the tables on the hon. member and ask him if he can explain why the hon. Premier of Saskatchewan had premiums in his budget this last spring? Surely that contradicts everything that his political party says it stands for.

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4 p.m.

Bloc

Christiane Gagnon Bloc Québec, QC

Mr. Speaker, today's NDP motion on the private for-profit delivery of health care services the government has encouraged since 1993, leads us to reflect on the reasons the private sector has grown so much in the provincial health care field. I have decided to speak today because of the many hospitals in my riding. There are many seniors in my riding, as well as a very high percentage of people living just around the poverty line. There is heavy demand for health care and home care.

This afternoon, I have heard some strange remarks from the member for Vancouver Centre in connection with the government's wish list. She seems not to realize what her government has done since 1993. I have noted some of the objectives she has mentioned: disease prevention, environmental improvement, ensuring that no one is denied the health services he or she requires. What I see is that, since 1993, the government's objectives for health have been quite different.

Who was finance minister after the 1993 election? Who could decide what funds to allocate to health? None other than our Prime Minister, who is about to embark on an election campaign.

I watched her list all of the government's good intentions, to be achieved by trampling on provincial jurisdictions. Just on the eve of an election, it smells like electioneering.

In this afternoon's debate on health care, I would like to split my time with the hon. member for Matapédia—Matane, who will speak in the second 10 minutes.

What the federal government wants, of course, is to deny that it has been withdrawing since 1990. The process has accelerated since 1993 with respect to health. The numbers speak for themselves. At present, the government members appear to be satisfied with the sum of $2 billion. They will not stop pointing it out to us, reminding us of it, oral question period after oral question period, whenever a question is raised by a member of the opposition, including the Bloc Quebecois. I would like to remind the House that this $2 billion is the same amount promised in 2003-04 in a budget under the former Prime Minister, Mr. Jean Chrétien. This is an old story, and an old hobby horse. It is like highway 175 in the Saguenay. They announced once again that they would be providing some money and giving the go-ahead to the highway 175 project. We have heard it all before.

One could say that, this afternoon, the health care system is not a goal of the federal Liberal government, and that will continue. For example, it would be a good idea to tell us when we are going to receive much more money. At the moment, the percentage has been raised but it is below the expectations of the provincial premiers. The Romanow report said that the investment should be 25%. And what percentage have we reached? We are barely at 15.3%. We have been below 11%. Thus, we have only corrected the federal withdrawal that has been occurring year after year since 1993.

They are telling us that in 15 years we will get to only 17% as the federal contribution to health care. Thus, we are very far from the needs and expectations of the provinces. If there had been a wish to satisfy the provinces, the opposite would have been done. A realistic plan would have been drawn up to meet the provinces' expectations. The debate on for-profit private health services would perhaps be different from today's debate in this House.

The federal government's withdrawal from health care funding has had a huge impact. There is uncertainty in the provinces with respect to a real health strategy to respond to the needs of the public. We know that these needs are growing. The population is aging. I think that my riding of Québec is the one with the largest concentration of seniors in Canada.

it is urgent to give this some thought. With an election drawing near, we have this new Prime Minister who, when he was finance minister, completely abandoned his responsibility to fund the provinces through the CHST, by putting in place programs that invade jurisdictions. I will tell hon. members later how the federal government has been invading provincial jurisdictions since 1990, and even 1919.

This is a huge challenge. There are new technologies that we are unable to address. The population is aging. The demand on available resources is increasing.

With its $2 billion, the federal government is doing poorly in terms of expenditures. Between 2019 and 2020, these will be approximately $170 million, as compared to $72.5 billion in 2002-03. As we can see, there is a huge difference. When we say that expenditures have increased and all we get is $2 billion, it does not go a long way.

In 2004-05, the governments will invest 38% of their total budgets in health care. At present, the provinces are allocating 38% of their budgets not to responding to the various needs, but just to keeping their heads above water.

Furthermore, the Conference Board of Canada told us in February 2004 that the era of federal government surpluses was not over. This proves that there is a problem, or a fiscal imbalance. The federal surpluses are not about to end; they are predicted to reach some $10 billion in 2004-05 and even higher in 2020 when they will be somewhere around $80 billion.

Instead of apologizing and admitting that there is fiscal imbalance, the provincial governments should be able to squeeze out more taxes, money that should be transferred to them so that they can at least pay for services. Health is a provincial responsibility, not a federal responsibility. Since 1919, year after year they have been trying to undermine it. Let me explain how. The most blatant encroachment is done through the Canada Health Act, which imposes conditions and criteria on health services.

First they implemented a National Health Council, the creation of which did not receive unanimous support. Alberta refused to participate. Quebec followed suit, not only because it already has its own monitoring agency, but because this council is an obvious intrusion in Quebec jurisdiction. Quebec indicated that it would cooperate with the federal agency but in the meantime, this agency will cost money.

Another example of encroachment in provincial jurisdiction is the Canadian public health agency. Again, even though he has not committed any increase in health spending, Paul Martin continues to impose his priorities, namely by creating this new agency—

SupplyGovernment Orders

4:10 p.m.

The Acting Speaker (Mr. Bélair)

Order, please. You have just used the name of the Prime Minister, which is not allowed. You have one minute left, by the way.

SupplyGovernment Orders

4:10 p.m.

Bloc

Christiane Gagnon Bloc Québec, QC

The Prime Minister of Canada, then.

Once again, creation of the Canadian public health agency is another incursion into areas of provincial jurisdiction. Then there are the health research institutes, another example of this interference in areas of provincial jurisdiction.

The sovereignists and separatists are not alone in saying this in Quebec. Philippe Couillard, the new Liberal health minister has said he will not take part in the work of the national health council. Jean Charest says the council is not necessary. Paul Martin keeps on trying to impose it on us.

SupplyGovernment Orders

4:10 p.m.

The Acting Speaker (Mr. Bélair)

Order, please. I have just warned you not to use the Prime Minister's name. Your time is up at any rate.

The hon. member for Vancouver East.