Debates of May 11th, 2004

Supply

[Libby Davies, NDP, Vancouver East, BC]

Mr. Speaker, I listened with interest to the member for Quebec who spoke very eloquently about the problems with the funding arrangement, which is, as we well know, at the core of the crisis in the health care system in Canada.

When we look back over the years and we see the retreat of public funding from the federal government in terms of transfers to the provinces, we see where the crisis began. As we all know, the funding level from the federal government, which used to be at 50%, is now at about 16%. We in the NDP have said that we want to see it go back to at least 25%.

If I heard the member correctly, I think she pointed out that, at the current rate, the level of government funding in another 15 years would only be at 17%. That is very disturbing.

As we know, the Prime Minister has made a big deal about how he is going to consult with the provinces. Of course, it coincidentally happens to be on the eve of a federal election. None of us have any idea what this plan of consultation is or what the Liberal plan is for longer term commitments to health care.

I wonder if the member would comment on what she and her party would like to see in terms of a commitment from the government.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, I shall answer the hon. member's question. Nevertheless, I would like to point out that the hon. member for Vancouver Centre spoke about the fact that her government, with the Prime Minister leading the way, was going to draw up a long-term plan.

We would have liked him to put that long-term plan on the table when he was finance minister in 1993, so that we would not be here today discussing percentages. We could be considering other things.

The Prime Minister is well aware of the urgent needs. He does not need a plan to consider all that. He does not need to organize a first ministers conference. What we would like is for the government to give the money to the provinces so that they can get certain operations rolling that are now barely surviving and sometimes nearly non-existent, because the money has not been there.

We could increase the budget by $2 billion right now, so that by 2005 there will be commitments, even before the election. That way, we will not have to wait another year because, during that time, resources will be needed, people will have health problems, and people's lives will be at stake.

Right now, he has a very good idea where the money should go. If money is given to the provinces, and if provincial jurisdiction is respected, it will be clear where the money should go. The provinces are there to judge and the public will judge the provincial premiers on their investments in health.

[Libby Davies, NDP, Vancouver East, BC]

Mr. Speaker, I would like to continue the discussion with my colleague, the member for Quebec. What I hear clearly from the member is that from her perspective and her party's perspective they would like to see the money on the table and the federal government's commitment. It sounds like that is as far as it goes.

However, given the debate we have had here today, particularly the concerns about the increased privatized for profit delivery of health care services, it seems to me, and I think those of us in the NDP, that it is very important that there be some attachment in terms of a commitment to not see an increase in privatized for profit services.

I would be very interested in hearing the Bloc member's perspective in terms of the Canada Health Act and making it clear that it does not support the delivery of privatized for profit services.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Speaker, our party supports having a strong and high quality public health care service in order to meet people's expectations.

Quality service would be possible if the federal government had a plan for financial commitment to the provinces in keeping with their areas of jurisdiction.

The private sector's invasion in health care is not something we want, although, at the moment, the provinces are struggling with funding in the field of health. We might consider the private sector a solution, but a public health care system is desirable, and we want to keep it to meet the expectations of the public as a whole. We want a fair and equitable service.

[The Acting Speaker (Mr. Bélair)]

Before resuming debate, it is my duty, pursuant to Standing Order 38, to inform the House that the question to be raised tonight at the time of adjournment is as follows: the right hon. member for Calgary Centre, Health.

[Jean-Yves Roy, Bloc, Matapédia—Matane, QC]

Mr. Speaker, I am all the more pleased to speak to the motion put forward by the New Democratic Party as I worked in health services in my region for seven years.

If I compare what was happening then with what is happening today, it is quite apparent that, at the time, the health care system in Quebec was changing considerably. We must remember that Quebec did not pass its first health and social services legislation until 1972.

That year, if memory serves, Claude Castonguay was Quebec's minister of health. From 1972 on, health care services evolved constantly, becoming much more open to the public. The Government of Quebec—as was the case with the other provinces—purchased hospitals and began to run them. Previously, religious communities and others had managed them. The Government of Quebec also bought residences for seniors. They too were operated by religious communities for the most part.

We created what are called the social service centres, today consolidated into the local community service centres. These started up in Montreal as a kind of pilot project and now are all over Quebec, replacing the former health units.

If we compare the present situation with how it was then, or even before that, we can see that making the public health system accessible to the population has contributed significantly to improving people's quality of life all over Quebec, not just in the major centres but in the regions as well. Many additions have been made over the years to the health system.

Why is the health system across Canada, including that in Quebec, being challenged today? There must be a reason for this. Costs are constantly increasing, of course, as is pressure on the system because of our ageing populations. As the number of seniors increases, there is more and more pressure on services providing accommodation for the elderly.

We have to realize that, in light of the provincial governments' inability to invest sufficient funds, the private sector is becoming more and more active within the health care system.

I have one good example to offer hon. members. In the early 1970s, there was no such thing as a private old people's home. If there was anything for this age group, it was either a rooming house or a residence that offered no support services and no health services. People in such places were totally on their own.

Today, this is no longer the case. This kind of home for the aged provides more and more health services, because the public sector does not have the funds, or does not have enough funds, to build new residences, or to expand existing ones for seniors who are facing greater difficulties. Sometimes tragedies occur. Most of these facilities provide excellent care, but we have seen recent examples of others where this was not the case.

Our population is aging and there are more and more seniors who can no longer live independently. Such people have no place to go. They do not have access to accommodation in the public system. In some types of facilities, we can see that services are deteriorating because the funds are not available to provide all the services this type of client requires.

In a region like mine we have small health institutions because we do not have the necessary catchment population. I am thinking about the Matapédia valley, Sainte-Anne-des-Monts and other places. As a result, people have to travel great distances to get health and social services. If we look at the big picture, we see that the system will be under ever greater pressure given the aging population and the improvement of equipment.

This is something very important that is very rarely talked about with respect to the cost of the health care system. Institutions are increasingly acquiring new systems. New treatment methods are discovered through research.

Accordingly, we have ever better equipment available to us. Unfortunately, such equipment is ever more expensive. With new treatment methods more services available, we artificially increase the life expectancy of the population. This creates a great deal of pressure and increases the cost of the health care system.

The real reason the private sector has a greater presence in the health care system is because public funding is inadequate.

Costs will increase significantly over the next 10 to 15 years. In 2002-03, the cost was some $72.5 billion. In 2019-20, the cost of the health care system will be nearly $100 billion. Here we have the real question.

Do we truly want to invest in a health system and do we truly want to develop it as a public system that is accessible to everyone? I believe we do.

Indeed, people my age and a little younger will recall what it was like to live without a public health care system. Hon. members have to remember that, like me, most people my age were born at home. There was no giving birth at the hospital. This was your experience, Mr. Speaker, because you are about my age. We can agree on “about”.

Why did women give birth at home at the time? There was no access to the health care system. A nurse or a midwife was available. However, people did not have the means to go to a hospital to have a child, because it cost quite a bit to go there for treatment.

These were private institutions. Even if they did belong to religious communities, people still had to pay, because the government did not contribute to the system, for a stay in the health care system.

There were a lot of tragedies because the system was not public. Many women died giving birth at home because they did not have access to a doctor or a nurse. This is the sort of tragedy we faced in our time.

When the health care system came in, of course the life expectancy of the population just exploded. Yes, but why? Because the people were getting proper services. In Quebec and all the other provinces, they had access to excellent services. The people had an opportunity to increase their life expectancy, and to fight the diseases that once had been untreatable.

That is why, when we look at what has happened since 1990 or so, we see that the federal government has been withdrawing its financing from the health care system. As has been recently stated, the federal government claims that it contributes 40% to the health care system. But let us see what that includes.

It includes direct federal expenses, including such things as health care for the first nations. There is also everything related to veterans. There are compassionate benefits. There is health protection and disease prevention, as well as research and health-related information technology.

Moreover, this year, $500 million is being invested in a health agency. The 40% includes that same $500 million. But these are not direct services provided to the public. When we talk about health services, we mean direct services to the public. When the figures say it is 16%, we are talking about direct services to the population, and that is what we need to talk about in order to have a real picture of the health care system and its funding.

[The Acting Speaker (Mr. Bélair)]

The hon. deputy government whip on a point of order.

Business of the House

[Diane St-Jacques, Liberal, Shefford, QC]

Mr. Speaker, following consultation with the parties, you will find unanimous consent for the following motion:

That the Government Order for consideration of Bill S-17 be discharged and that the said bill be ordered for consideration at second reading and placed at the end of the order of precedence for consideration of private members' business in the name of the member for West Vancouver—Sunshine Coast.

[The Acting Speaker (Mr. Bélair)]

Is there unanimous consent of the House to move this motion?

[Some hon. members]

Agreed.

[The Acting Speaker (Mr. Bélair)]

The House has heard the terms of the motion. Is it the pleasure of the House to adopt the motion?

[Some hon. members]

Agreed.

(Motion agreed to)

The House resumed consideration of the motion.

Supply

[Jeannot Castonguay, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, I have listened attentively to my colleague's presentation. I myself worked in the health field for several years and I have seen how things have changed over time.

I clearly recall how, at the very beginning of the program, physician and hospital services were covered on a 50-50 cost sharing basis. Over the years, the practice of medicine has evolved. WIth the advent of new technologies, there have been additions made to the programs by various provinces, and as a result there are now disparities. Some provinces have added services, while others have not. An imbalance has resulted, one thrown in our faces constantly together with the accusation that there is an unbelievable disproportion in funding.

I was personally very pleased to hear the Prime Minister say that what was needed was to sit down with the provincial premiers and health ministers in order to ensure, in light of all that has gone on in recent years, that there is a system in place to meet the needs of Canadians for the next ten years at least. That pleased me a great deal. It is all very well to point fingers of blame, but that does not solve the problem.

I would like to hear my colleague's comments in connection with the proposed meeting this summer. Does he agree with such an approach to stabilizing our health system?

[Jean-Yves Roy, Bloc, Matapédia—Matane, QC]

Mr. Speaker, I do not agree. There have been dozens of such meetings over the years. Meetings between the Prime Minister and the premiers or the health ministers—there have been so many of them.

We must realize that the health care system is underfunded. We must realize that we must invest in the health care system. On the other hand, it is not up to the federal government to decide how the provinces will manage their health systems.

I understand that there may be disparities. That is fine; I have no problem with the fact that there are differences or disparities. The goal is to offer adequate health services and basic health services to everyone, so that every individual gets the care he or she needs.

So there may be a difference between the delivery of services in New Brunswick and in Quebec, or Quebec may do things differently from Ontario, I do not have a problem with that. The reality is that there may be different ways of doing things. But as long as the services are being provided, I absolutely agree.

But why does this need to be wall-to-wall coverage? Is it possible for there to be differences, for those differences to be accepted and more investment made in the health system? Governments have this mania. Every time they do not want to make an investment, they decide to change the system. They change the structure rather than making investments. That is the problem. A structure can evolve gradually but not in a flash. Instead of trying to change the structure, this time, why not let the system evolve?

I have worked in politics for seven years, and during those seven years the system has changed constantly. I agree with that. A static system is not a good system,. The system must evolve and continue to change. To achieve this, we must accept that there are differences. What is important is to finance the system in response to the needs of the public and in keeping with our abilities, of course.

At present, the federal government has the ability to do this. In Quebec, the federal government collects 62% of our taxes and only returns 16% for health. Thus, there is a problem.

[Jeannot Castonguay, Liberal, Madawaska—Restigouche, NB]

Mr. Speaker, in light of my colleague's answer, it is obvious that his vision is not a pan-Canadian one. On this side of the House, our vision is a pan-Canadian vision, where the health care system is fair to all Canadians, regardless of the province where they live.

This is why I believe a time comes when it is important to get together to work out certain disagreements. Clearly, we will never be able to meet if the vision, on one side of the House, is limited exclusively to Quebec while, on this side of the House, our vision includes all of Canada.

[Jean-Yves Roy, Bloc, Matapédia—Matane, QC]

I shall be brief, Mr. Speaker. I think that my colleague misunderstood. Given his medical background, I suspect he understood perfectly well, but his question was intended to get at me.

I have no problem with all the provincial health ministers getting together to harmonize the system and get in tune. I do, however, have a problem with the federal government imposing its views and saying that provinces will receive funding only if they agree with its proposals.

That does not allow differences. Yet, this is important when dealing with health care delivery, in certain regions in particular. It is normal for services to vary from region to region, because the situation in regions like mine is not the same as in downtown Toronto, for example.

There have to be differences, inevitably, and we must accept them, but the federal government does not.

[Jim Karygiannis, Liberal, Parliamentary Secretary to the Minister of Transport]

Mr. Speaker, I am happy to speak in the House today on health care because it is an issue that is important to so many Canadians.

I have a great respect for our health care system and I am amazed at the commitment that our health care providers have shown, especially during such events as the SARS outbreak that affected our country, particularly the riding of Scarborough—Agincourt which was the epicentre.

Health care is the number one priority of the government, as it is for Canadians at large. We welcome any constructive debate on this issue. While I am glad that the NDP has given the House the opportunity to debate health care, I am disappointed to see that the NDP has once again resorted to scare tactics. This week that party's theory will have health care becoming privatized. With our government in charge, nothing could be farther from the truth.

The government is absolutely committed to public health care and intends to maintain the public health care system. We on this side of the House support the work of the Romanow commission and the recommendations of that report.

The Liberal government has committed new money to health care and the Prime Minister has made it perfectly clear that he intends to negotiate new agreements with the provinces in order to reform health care in Canada. We plan to move forward with the recommendations of the Romanow report to ensure a stable and viable health care system.

While I am more than happy to be given the opportunity to state our strong support for the public health care system, I really cannot help but wonder what the NDP has to complain about. Then again, the NDP has always been a tax and spend party, except that now, under Jack Layton, it is a spend and spend party.

The NDP, under Jack Layton, will never be happy with any amount of government funding announced in any policy area, let alone health care. That is one of the reasons why today former NDP members, such as Chris Axworthy from Saskatchewan and Ujjal Dosanjh from British Columbia who were in Ottawa today, have left the NDP and joined the ranks of the Liberal Party.

Spending on health care, like spending on other social programs, must be one of sustainable spending. Sustainability can only be assured through economic stability. Our government, for the past seven years, has put forward balanced budgets and tax cuts, which is giving us the ability to spend money on social programs.

However, we do not spend money we do not have. While I welcome the opportunity to debate the government's unwavering commitment to our public health care system, today's motion is nothing more than political grandstanding. It is not an honest reflection of the government's clear commitment to Canada's cherished public health care system.

The Conservative-Reform-Alliance Party across the way scares me when it talks about its vision for the future of health care in Canada. I truly believe the hon. Leader of the Opposition when he says that if the Conservatives were to take power, Canada would be a nation we would not even recognize. It would be a Canada where people would have to take their credit cards with them to see their doctors. The health care system under a Conservative-Reform-Alliance government would only widen the divide between the have and have nots.

Realizing how out of step it is with the Canadian people and health care, the Canadian Reform-Alliance-Conservative Party has begun spouting off about supporting public health care. Witness the Conservative-Alliance leader's speech yesterday in Toronto where he was showcasing his Mike Harris government retread candidates. He spoke about health care and tried to soften his party's approach. I do not blame him for wanting to try to change or at least hide the health care policy. Somehow I doubt his sincerity.

How can the Conservatives have campaigned for 10 years for two tier health care and user fees when they have talked about public health care for the last 10 days? How can they expect anyone to believe that they are now the defenders of the public health care system?

Members across the way would implement a system where in a matter of a year we would see the public health care system fall by the wayside. It would be a system where those who could afford to opt out would opt out. It would be a system where they would receive prompt and efficient service while the public health care system would deteriorate. It would be a system where those who opt out would demand that their tax dollars go toward something more relevant. Perhaps this is what the Conservative-reform-alliance party has in mind. It would be the only way the Conservatives could pay for tax cuts, which is clearly that party's top priority.

The real Conservative-reform-alliance health care policy was also very evident in the most recent leadership race where two tier Tony Clement said, “co-payments or user fees for non-emergency health care is the sort of thing that needs to be looked at if the health care system is going to match an increase in demand thanks to an aging population”. He was the minister of health under Michael Harris who devastated the Ontario health care system.

During the last election the then leader of the Alliance Party was quoted in the Red Deer Advocate as saying “An increasingly large percentage of the population are asking for some kind of health care user fee”.

What has changed? Absolutely nothing has changed.

The party across the way is so desperate to get some sort of electorate credibility that it is hiding its true intentions and trying to trick the electorate into voting for it. I do not believe the people of Canada are so naive that they will be fooled by those wolves in sheep's clothing.

The Liberal government has done everything possible to ensure that the current publicly administered health care system meets the standards of Canadians from coast to coast to coast. This includes the extra $2 billion in funding that the provinces recently received and the new Canadian public health agency that was announced in the budget of 2004. We are committed to doing even more.

The Conservatives, clearly, are trying to hide their true intentions for our health care system from Canadians, but it will not work. Canadians already know what the Conservatives stand for. They stand for a system where it is not one's medical needs that matter but how fast it will be approved on a credit card.

All members on this side of the House agree with me in stating that we will fight for the right of all Canadians to have the best public health care system possible. Liberals will defend against the ideals of the right and private health care; the ideals that would lead to not only two tiers for health care but as many as possible, if the Leader of the Opposition has his way.

[Jim Karygiannis, Liberal, Scarborough—Agincourt, ON]

We all remember what the Leader of the Opposition said in 1997:

--what we should be doing is not figuring out how we can have the most equal system but having the best system. The best system means having a system where you have as many tiers as possible and you bring as many health care dollars into this country as possible.

Having as many tiers as possible is not our view. Canadians cherish our single tier, universally accessible system. After all that, the reform-alliance-Conservative Party said it supports chequebook medicine. I can assure members that it will be a long time before Canadians ever trust that party with Canada's proud health care legacy.

In the next weeks and months ahead we must restore Canadians' confidence in the future of their health care system in order to ensure its sustainability. Of course, the key to success in this national initiative will be forging a successful partnership with the provinces and territories.

Recent initiatives, like the Canadian Patient Safety Institute, Canada Health Infoway Inc., the Canadian Institute for Health Information and the Health Council of Canada, point to the ability of governments to work well together when they choose to. More to the point, each of these intergovernmental bodies will have a role to play in any national effort to improve access and quality.

The fact that the Prime Minister has agreed to meet and consult regularly with the premiers to establish a mutually agreeable agenda bodes well for the future.

In his Toronto speech, the Prime Minister also noted that any health care reform plan must include measures to support the evolution of home and community care services and the development of a national pharmaceutical strategy. These are the new frontiers of the health care system and pharmaceuticals is the fastest growing area of provincial health spending.

The Government of Canada is already supporting efforts in these and other areas but we are prepared to engage in a discussion with the provinces on how we can do more.

The next step in creating a productive and successful partnership in health is to make accountability the centrepiece of any renewal effort. We will not restore confidence in the system unless we give Canadians broader and better access to the facts.

Canadians no longer accept being told things will be better. They want to see proof that they are. Canadians need this information, not to make governments accountable to each other but so that all governments and all providers are held accountable to citizens.

The Government of Canada will continue to work with provinces and territories, stakeholders and the Canadian public to ensure that we have a health care system that provides timely access to quality care. The Prime Minister has committed to continue discussions to ensure that the health care system will be sustainable for generations to come.

The upcoming election will focus on leadership and governance. It is my belief that Canadians will look at the issues, and especially the issue of health care, and determine that voting Liberal will ensure the long term sustainability of our public health care system and provide the necessary honest leadership that Canadians deserve.

[Dick Harris, Canadian Alliance, Prince George—Bulkley Valley, BC]

Mr. Speaker, the member's words and statements are not only unbelievable but, in many cases, appear to be downright deceitful.

He talks about the proud legacy of health care under the Liberal government. Does he call the over $20 billion that the Liberals ripped out of the health care system and the waiting lists for critical operations that are in the tens of thousands at the present time a proud legacy?

The Liberals have created, enhanced and encouraged a two tier health system in this country. They have forced it on Canadians who cannot afford to pay to get to the front of the line, like the Prime Minister did a couple of weeks ago.

I find it absolutely astounding that the member would stand up and, in all honesty, as he believes, as misguided as it is, try to defend the health care system and criticize the Conservative Party of Canada. We are the ones who would bring in an affordable, sustainable, quality public health care system where Canadians could go to a clinic or to a hospital anywhere in the country and get the kind of health care they need when they need it and at a price they could afford.

The member talked about our leader bringing out, and I think the term he used was the retreaded Mike Harris candidates, to run for the Conservative Party of Canada. Those candidates ran for nomination and they were nominated. How does the member explain his Prime Minister, his leader, appointing candidates out in B.C.?

Speaking of retreads, how about Mr. Ujjal Dosanjh, the former premier of the province of British Columbia who led the failed provincial NDP, being appointed by the leader of his party? Talk about a hypocritical situation.

[The Acting Speaker (Mr. Bélair)]

Easy on the word hypocritical .

[Jim Karygiannis, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, I want to read for the member across the way a statement made by his leader in 1997. Maybe he will pay a little bit more attention this time around. If he wants some Q-tips I am sure we can find some.

The statement reads:

--what we should be doing is not figuring out how we can have the most equal system but having the best system.

So far that is not a problem but this is where the kicker comes:

The best system means having a system where you have as many tiers as possible...

Does that mean one, two, three, four, maybe ten? We do not know. All we have to do is show our health card and we will move to the front of the line. This is what that party wants to do. All of a sudden those members see an election coming and they decide to change their platform.

The members of that party are wolves in sheep's clothing who want to fool the Canadian public. The Canadian public will have absolutely nothing to do with them.

[Libby Davies, NDP, Vancouver East, BC]

Mr. Speaker, I wish the member would keep going. He was just about to launch right into it. It is very entertaining. If he wants to talk about a wolf in sheep's clothing, my goodness, all we just have to do is look at the other side.

Was that not the most non-partisan speech that we have ever heard in the House from that member? It was just a delight to hear it.

What I found very interesting is that not once did the member actually say where the Liberal Party stands on health care. Why? It is because we have been hearing all day dozens and dozens of different positions.

Maybe the member should ask their newly minted member from Esquimalt—Juan de Fuca. If members will remember, he was a leadership contender for the Alliance Party. He was Mr. Privatization. Maybe he should ask that new member--

[The Acting Speaker (Mr. Bélair)]

Order, please. Let us try to be a bit more relevant.

[Jim Karygiannis, Liberal, Scarborough—Agincourt, ON]

Mr. Speaker, it is refreshing to hear from the NDP members. I need to remind them that their leader lived in co-op housing for a number of years.

If they want me to keep going, let me just tell the House what the Leader of the Opposition said on health care. He said:

What we clearly need is experimentation--with market reforms and private delivery options within the public system. And it is only logical, in a federal state where the provinces operate the public health care systems and regulate private services, that experimentation should occur at the provincial level.

He made that speech in Charlottetown June 27, 2001.

Later, he continued:

Monopolies in the public sector are just as objectionable as monopolies in the private sector. It should not matter who delivers health care, whether it is private, for profit, not for profit or public institutions, as long as Canadians have access to it regardless of their financial means.

That was in the address in reply to the Speech from the Throne, October 1, 2002. I can give the members more. The Leader of the Opposition also believes that:

--our health care will continue to deteriorate unless Ottawa overhauls the Canada Health Act to allow the provinces to experiment with market reforms and provide health care delivery options. He is prepared to take tough positions including experimenting with private delivery in the public system.

These statements can be found at www.harperforleader.com, from February 2002.