Debates of May 11th, 2004

Supply

[Pierre Pettigrew, Liberal, Minister of Health]

Mr. Speaker, I would like to advise you that I will be splitting my time with my colleague, the Minister of State for Public Health.

I welcome the opportunity that this motion offers to speak to the government's commitment to ensuring the long term sustainability of Canada's public health system.

I want to assure Canadians that this alarmist motion is both misguided and unnecessary as it in no way reflects the government's vision for health and our 10 year plan, which I believe to be consistent with and founded upon Canadian values.

The Government of Canada, like all Canadians it serves, cares a great deal about the fundamental values behind our health care system, namely equality and justice. These values, which are at the heart of our social program most appreciated by Canadians throughout the country, define us and unite us as a people and a nation. They sum up perfectly what it means to be Canadian.

The members of my party reject the idea of having a system whereby jumping the queue—in other words, using one's ability to pay in order to avoid waiting in line—determines one's access to health care or how quickly it is delivered. We expect all our partners to honour to the spirit of the Canada Health Act.

I can assure all Canadians, regardless of where they live or how much money they earn, be they men or women, young or old, that they can have complete faith in their public health care system, which is universal, accessible and single-tiered. The system is there for them and their family if and when they need it because that is the medicare promise.

This national program provides all Canadians with access to medically required health services according to their needs, not their means. Clearly, user fees for insured and medically required services are contrary to the Canada Health Act.

Over and above any debate, this government has a commitment with respect to the health system of our country. The 2004 throne speech and budget have sent a clear message: we plan to bolster the social foundations of Canada, including our universal health care system.

The announcement in the budget of an additional $2 billion on top of the $34.8 billion in new funding over five years announced a year ago in the 2003 agreement, are all proof of our commitment to provide the provinces and territories with lasting, predictable funding that will increase over the long term so that the system may continue to meet the needs of all Canadians.

The federal government's transfer payments in support of social and health programs will be increased by an average of 8% a year for five years. Thanks in large part to these investments, the health system in Canada compares favourably with that of other OECD countries as far as accessibility and health outcomes go.

However, I am certainly not pretending that we have achieved perfection. The health system, like society itself, is not static. It is constantly undergoing change and, indeed, must continually improve to keep pace with Canadians' evolving needs and expectations.

There are all kinds of pressures confronting the system, from the introduction of new diseases that sweep the globe in a matter of days, to our aging population, which puts more demands on the system, and to the impacts of new technologies that offer treatments and therapies unimaginable at the time Canada adopted medicare four decades ago.

Of course, a lot of misinformation and exaggerated anecdotes have led to urban legends about Canada's health system, which motions like the one we are debating today only inflame. But we have to acknowledge some legitimate concerns that arise out of real encounters with the health care system.

For example, we know we need to deal with long waiting lists by addressing mismatches in the demand, supply and distribution of health human resources and service delivery capacity. We also require greater progress in delivering care in the most appropriate setting, whether in a primary care clinic rather than an emergency room, or at home with the right support to recover from surgery.

Given the explosion of health problems related to obesity and unhealthy lifestyles, we clearly need to develop national health promotion and protection strategies to relieve pressure on the health care delivery system. My colleague, the Minister of State for Public Health, will have the opportunity to speak about that contribution of our government. I want to thank her and congratulate her for the excellent job she has been doing on the public health file. Canadians also want greater transparency and accountability to be sure that their tax dollars are put to good use.

Undeniably, these are very real problems that need fixing. That is precisely what we propose to do in partnership with the provinces and territories, health care providers and interested individuals, because Canadians have told us they see their health care system as a collaborative partnership. This is not only what Canadians want and expect; it is what first ministers have agreed to do.

Since the first ministers meeting in September 2000, all governments have been working together, implementing important health reforms to ensure timely access to quality health care services. Despite these improvements, we know more needs to be done. To that end, the Prime Minister will convene a first ministers meeting this summer to discuss the sustainability of the health care system. Our efforts will be aimed at building and strengthening the public health system in Canada. The Prime Minister has promised that first ministers will meet “for as long as it takes...to agree on a long term plan for a health system that is properly funded, clearly sustainable and significantly reformed”.

What has become abundantly clear to users of the system as well as to those who have studied it and those who work within it is that the sustainability of the health care system is about far more than funding. It is equally about fundamental structural reforms to ensure that Canadians receive the services they need and that these services are delivered in an efficient manner.

What is equally obvious is that reforming the system really comes down to strengthening the relationship with our provincial and territorial partners, because we share responsibility for this critically important social program. Clearly, it was by design that the Prime Minister assigned me to the dual role of serving as Minister of Health and Minister of Intergovernmental Affairs, recognizing that these responsibilities are directly related.

I can assure the House that I am committed to working in partnership with the provinces and territories to restore Canadians' confidence in their health care system and to make the reforms necessary to revitalize the system and place it on a more secure financial footing for the future.

I will work closely with our colleagues in other governments to do just that, ensuring that the principles of the Canada Health Act are upheld so Canadians can have access to a single-payer, publicly administered and publicly delivered health system when they need it. There is every reason to be optimistic that we will succeed.

The Canada Health Act has been and remains for Canadians a symbol of national solidarity and shared values. Its five principles are as relevant today as they were two decades ago when the legislation was unanimously supported by all political parties. I have every confidence that together with our provincial-territorial partners and all members of the House we can strengthen and expand the public health care system, recognizing that it provides our citizens with the best system possible.

I am in no way suggesting we remain with the status quo. Canadians do not want to have better access to a 1960s-era health system. They want to have access to a dynamic system on the leading edge of technology, one that is patient-focussed and quick to integrate new medical technology and the best, and most recent, treatment possibilities. This is what I am seeking to do, in conjunction with the provinces and territories.

I am sure that, with a good plan and the proper resources, the health insurance plan will remain appropriate for all Canadians. Working with our partners, and with all Canadians, we will be able to improve access and put solutions in place that will last for a generation. This is the direction we need to take.

I cannot support this motion by an opposition member, but instead strongly encourage her to work along with this government in continuing to build a health system that reflects our country's reputation as a compassionate and humanitarian society.

[The Deputy Speaker]

Since we are at the early stages of this debate, I want to remind the House that when members choose to split their time, it also means that the time for questions and comments is equally divided. As the minister took only 10 minutes, there are only 5 minutes for questions and comments. If members ask questions that are brief and succinct, more people can participate.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I was extremely surprised by the minister's speech because he left some things out. I would have felt better if the minister had made a clear commitment and agreed to what all the provinces are demanding—which also happens to be a recommendation in the Romanow report—that the federal government provide 25% of health care funding.

Hon. members all know the story. I will not go over it again because there is not a lot of time. Nonetheless, the one thing Canadians and Quebeckers want to know is how the federal government could be so negligent and refuse to fulfil its responsibilities with respect to funding. What is the Minister of Health waiting for to make a firm commitment whereby his government will contribute 25% of the cost of health care, as recommended by the Romanow commission?

[Pierre Pettigrew, Liberal, Papineau—Saint-Denis, QC]

Mr. Speaker, I hope that my colleague from Hochelaga—Maisonneuve will take the opportunity that I expect will be given to him to make his own speech in the House and tell us exactly what the position of his party is, 25% of what? I would like him to be more precise, when he asks us to invest 25%.

What I would like to say is that we, the government, are very much committed to caring for the health care system. These arguments over the numbers, figuring out what share—

[Some hon. members]

Oh, oh.

[Pierre Pettigrew, Liberal, Papineau—Saint-Denis, QC]

The members of the Bloc do not want to hear the answer, because the answer bothers them. The only thing that interests them is money, Ottawa's money, federal money. They are always trying to eliminate responsibility. That is normal, because they belong to a political party that wants, essentially, to completely remove responsibility from the political process. They never seek to govern; they certainly do not want that. They want to stay in opposition.

What I am saying is that while we are governing, we are determined to invest $34.8 billion in health, plus an additional $2 billion, over and above our current investments, over the next five years.

What Canadians and Quebeckers want to know is that our government is determined to invest additional money when we sit down at the next meeting of first ministers, where we will sit down with representatives of the provinces and determine the best way to make these investments so as to ensure the long term viability of our health care system. We shall try to do so without bickering over numbers.

[Bev Desjarlais, NDP, Churchill, MB]

Mr. Speaker, in response to the minister's comments that he cannot support the motion, I have to wonder what part he cannot support after his flip-flop at the health committee a few weeks back.

He indicated that he supported Romanow's position that public delivery was the best way to provide health care services to Canadians. There are numerous reports that have proven it is more cost effective, so one has to wonder why we would not be looking toward public delivery. I think the key factor in this is not for profit delivery. That is the key factor: that it is not for profit. If we have private and not for profit delivery, there will not be an objection. We have the Victorian Order of Nurses, which is a not for profit organization.

I wonder whether the minister has done another flip-flop on his position that he supports Romanow's comment and also on the fact that the government has allowed this to grow since 1993. All we have to do is look at the figures. It has grown immensely since 1993, so what part does he not support?

[Pierre Pettigrew, Liberal, Papineau—Saint-Denis, QC]

Mr. Speaker, I find it quite interesting to hear the policies of the NDP evolving this very morning. Now its members are telling us that they support private delivery in the health care system. That is quite interesting.

I will say one thing. This government is absolutely committed to every one of the five principles of the Canada Health Act. We are determined to work with the provinces to continue to build on it. We have looked at the Romanow report, which came to the same conclusions as the Kirby report, the Mazankowski report and the Clair report done in the province of Quebec. We believe that the road to reform involves investments in home care and our interest in pharmacare, and we have begun to do work on catastrophic drug care. These things are new elements.

The NDP loves to live in the 1970s. The NDP thinks the 1970s were so much nicer. Those members want to turn back the clock. Canadians do not want access to the public health system of the 1960s or 1970s. They want to make sure that our health care system integrates the best technologies available and integrates what exists now with the new way of delivering services on the health front with home care and with primary care that can be done differently.

The system has evolved. It is not only hospitals and doctors. It has other elements. That is what the government is trying to integrate and give Canadians: the best possible public health care system in Canada.

[Carolyn Bennett, Liberal, Minister of State (Public Health)]

Mr. Speaker, as my colleague the Minister of Health has clearly articulated, we are committed to the values that make the Canadian health care system one of the best in the world. In his speech the Minister of Health spoke about a comprehensive and collaborative system. I want to expand on this idea by speaking to the House about the balance of upstream and downstream in health.

Just as we are committed to a publicly funded and administered health care system, the government also believes that we must be proactive about the health of Canadians today and in the future. That is why we approach health from a holistic perspective. We understand that poverty, violence, the environment, shelter, education, equity are all about trying to keep as many Canadians healthy for as long as possible. This is absolutely pivotal in our vision for a long term sustainable system.

Shortly after I was appointed the Minister of State for Public Health, I was asked if public health was the opposite of private health. I have to admit I was little surprised at the question. Today I want to state publicly that absolutely a strong public health system for Canadians stands in stark contrast to the for profit health care that waits for people to get sick and then lets the market determine their costs and their access, leaving countless people out. This is indeed about the public good. It is about Canadian values. It is about those public health goals of health protection, prevention and promotion.

Canadians should be proud of the health care system they have created, a system founded on accessibility, universality and quality. Some have described it unfortunately as a sickness system that has too much focused on the repair shop or the tyranny of the acute.

Our recent experiences with SARS, West Nile and the avian flu have exposed areas of our system that need to be improved. Developing trends such as obesity and inactivity and health disparities tell us that more can be done and more should be done.

The clear consensus of the Naylor and Kirby committees last year, as well as that of other public health experts, is that the Government of Canada must act to demonstrate leadership in this field. We are acting.

The Speech from the Throne clearly articulated our commitment to public health and the federal budget has given us the means to move forward. We have committed in the budget over $665 million targeted at issues like the first ever national immunization strategy, building surveillance capacity through the Canada Health Infoway and supporting front line provincial and territorial capacity.

The immunization strategy is a perfect example of our commitment to proactive and preventive public health and investing in the system. It is also a splendid example of real federal-provincial cooperation.

In the 2004 federal budget the Government of Canada has committed to providing the provinces and territories with $400 million over the next three years to enhance their immunization programs and help relieve the stresses on local public health systems. Three hundred million dollars will be earmarked to support the national immunization strategy. It will support the introduction of new and recommended childhood and adolescent virus vaccines such that no longer will family physicians have to recommend a vaccine and then ask if the family can pay for it.

In the 2003 federal budget $45 million over five years was allocated to pursue this national immunization strategy. With these investments we have begun strengthening key federal infrastructure programs for addressing immunization issues such as vaccine safety, surveillance of vaccine preventable diseases and immunization coverage, procurement processes and professional and public education.

The strategy will result in an enhanced national collaboration on immunization issues; improved monitoring and control of vaccine preventable diseases; better vaccine safety monitoring and response to safety concerns; more affordable vaccines; improved security of the vaccine supply; increased public and professional confidence in vaccines and immunization programs; and better information on which to base policy decisions related to immunization.

Additionally the funds will support a forum for discussion and exchange of information on immunization with provincial and territorial jurisdictions and other stakeholders in order to improve the safety, effectiveness and efficiency of immunization programs in Canada.

The national immunization strategy will address a number of challenges currently being faced by all jurisdictions. It will allow federal, provincial and territorial governments to work in partnership to improve effectiveness and efficiency and toward equitable access to immunization programs in Canada. It is a proactive investment in the future and wellness of our children.

We are confident that this and our other investments will strengthen public health care capacity across Canada, ultimately contributing to a stronger and more responsive public health system for the future.

In addition to this, we are following through on our announcement in the Speech from the Throne to create a public health agency of Canada. Using Health Canada's population and public health branch as a foundation, the agency will be a focal point for federal efforts in the areas of public health emergencies, chronic and infectious disease prevention and control, and will also promote population health and wellness.

The agency will be key in building on the existing relationships with our counterparts in the provinces and territories as we work toward the ultimate goal of making Canadians among the world's healthiest people. It will also be key in representing Canada and working with international health organizations, such as the World Health Organization and the Centers for Disease Control in the United States.

We are also moving forward with the appointment of the chief public health officer of Canada. The chief public health officer will manage and lead the agency, providing clear federal leadership on public health. He or she will be the national spokesperson in public health emergencies. He or she will be seen as the country's doctor, someone whom Canadians can count on for accurate and timely public health information.

Finally, we are developing a pan-Canadian public health network that will ensure coherence and collaboration across all jurisdictions and structures, a truly integrated public health system for Canada. We are in the process of establishing an action plan for this network. We are confident that it will lead to a more robust public health partnership.

The network will be founded initially in five centres of collaboration, one in each region of the country. Each centre will be a champion for a component of public health and will build on the already existing expertise in each particular area. These centres will be national resources for the benefit of all Canadians. We are confident the network will strengthen federal, provincial and territorial collaboration and increase public health capacity in all jurisdictions.

I should mention that we recognize the role of our partners in this integrated public health strategy. The public health system must be built on a strong common purpose and respect the local wisdom and local knowledge to get the job done.

Provinces, territories, local authorities, various other stakeholders and the citizens themselves are the real experts on the challenges and opportunities in their own communities. They have a key role to play in relation to emergency response, disease control and prevention, and health promotion. It is absolutely essential that all stakeholders and citizens have a chance to contribute to the development of our public health strategies.

Over the last few months I have met with numerous public health stakeholders across the country on a broad range of public health issues. Their input has been invaluable to our vision on a way forward for public health in this country. I have also met internationally with the World Health Organization, the U.S. Centers for Disease Control and public health experts from the United Kingdom and the European Union.

As we talk about the health care system in Canada, we remain committed to continuing to foster this interaction.

I am personally committed to ensuring that citizens and stakeholders will be embedded into the very DNA of this new agency. They will play a role in all future public health strategies.

Together with my colleague the Minister of Health, I have provided tangible examples of the government's commitment and vision for a comprehensive strategy on health in this country, one that values the preventive, proactive and educational pieces as much as it values a responsive health care system that will be there when Canadians need it.

Building on the voice of Canadians, we are confident that we are taking the right steps to ensure that citizens get the public health care they deserve and more important, that as many Canadians stay healthy for as long as possible.

[Jay Hill, Canadian Alliance, Prince George—Peace River, BC]

Mr. Speaker, I appreciated the comments of the junior minister for public health.

I note that in her speech she remarked about the Canada public health agency and the chief public health officer for Canada, which were key recommendations contained in the Naylor report.

I should point out to the viewing public who might be watching the proceedings that the Naylor report to which the hon. minister referred was tabled last October. The commitment to go through a process to appoint a chief public health officer for our country was contained in the budget in March, a couple of months ago. To our knowledge there is not even an application form out there yet.

The minister made the statement that the government is following through on its commitment or its promises in this regard. Especially in light of the fact that SARS has reared its ugly head again and is only a plane trip away, and that the West Nile virus will certainly be flaring up again this summer, I think it is incumbent on the government to further enlighten us about where it is in bringing about the actual existence of this agency and the appointment of the chief public health officer for Canada.

What is the government waiting for, would be the question, and will these steps actually be taken before an election is called?

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, in my view, from the tabling of the Naylor report, to what was in the Speech from the Throne, to the dollars we actually got in the budget so that a chief public health officer could actually do his or her job, to what I have seen in my 32 consultations around the country, we are trying to make sure that in the job description for the chief public officer for Canada we have reflected the voice, relevance and responsiveness of what the people of Canada have said that they would expect of that person.

I am pleased to tell the member that we now have the job description and it includes a very significant piece of citizen engagement. We will be able to announce the committee within a few days to commence that really important search for Canada's doctor.

[Wendy Lill, NDP, Dartmouth, NS]

Mr. Speaker, I thank the member for her comments and commitment to public health which I believe is very real.

I am trying to understand as I listen to the thousands of comments that are now flying around about health care. All Canadians have the same concerns. They have concerns about the lack of diagnostic services, about waiting lists, about the lack of cancer treatment, about the fact that we have a sicker population, about the fact that we have an unequal level of services across the country.

All of those problems are deeply embedded in our very troubled health care system which has been underfunded for many, many years. I do not believe that money is the only thing that is required at this point in time but it clearly is one of the things that is needed to bolster our system.

In light of the huge structural problems that now exist, how is it that the government can actually stand up and say that it is going to do this and this without putting forward a significant dollar figure? That figure at this point is way above what is going to be available from what I am hearing from the member.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Mr. Speaker, I share the member's concern. Really this is about confidence. Canadians need to know that over the next generation the health care system they cherish so much will be there for them when they need it.

As much as money is an issue, I think the member will recognize that a lot of the concern has been about our not having a real system. It has been a patchwork quilt of non-systems, with perhaps not as much emphasis on quality, appropriateness of care and a real integration of the way the system works.

I was pleased on my trip to and from Whitehorse this weekend to have read the book by Michael M. Rachlis, Prescription for Excellence . He makes a very good case that there may well be some need for additional funds but really we have to work hard on sharing best practices across the country and looking at results, the areas that are really getting good results.

Therefore I say to the member, I am thrilled that since the Romanow report we have been able to establish the Health Council of Canada. Michael Decter and his colleagues at the council have been able to tackle the really important issue around wait times.

As we look to the first ministers meeting with the Prime Minister, what they call that long, boring technical meeting, we will look at important things like the confidence around getting diagnostics and treatment and outcomes. We can share across the country where it is working better, where areas have certain needs and how we can get the best value for the money that we are spending.

I cannot resist explaining to the House that after seeing a National Post headline criticizing the Canadian system, I want everybody to look at the Fraser Institute survey and look seriously at why it would leave out the United States when it is trying to slam us. It is purely partisan and poor methodology. We cannot tolerate that kind of bad examination of our really fabulous health care system.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

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.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Speaker, the motion is very important but I note the reference to delivery of health care, which, in itself, is not defined, although I think there was an intent to define it.

The member, who just gave his speech, spoke substantively to the issues of pharmacare and drugs, which is not covered by the Canada Health Act or in terms of federal responsibility. The fact is that we have had this speech which includes or suggests somehow that the whole debate should be inclusive of all the things that we can imagine are in health care, as someone said, for example, dental care, vision care and mental health care, none of which is paid for under the public health system.

We define health care holistically and we are using that in this discussion. I am pretty sure, based on the member's identification of priorities, that he would be opposed to the motion simply because health care, as he defines it, is not as it is intended by the mover of the motion. This may be part of the problem of what we are trying to address here.

What does the Canada Health Act cover and what is the federal responsibility? More specifically, how do we define medically necessary? I think Canadians have quite a different view as to what constitutes medically necessary. That is a very important element. Maybe the member would like to comment on the element of medically necessary.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I think that the intent of the motion before us today is to say that, when hospital insurance was introduced in the mid-1950s, we had a service delivery model which was essentially based on in-hospital care. I recognize that many services are no longer provided in a hospital setting.

The NDP motion is intended to recall that the federal government has acted unilaterally, without consulting the provinces, and in a cavalier manner, and transfers have been reduced from $18.7 billion to $12.5 billion. Accordingly the waiting lists for medically insured services, provided in a hospital setting, have grown longer and longer. Some services have become less accessible because the provinces were financially strangled, and the federal government did nothing about it. In certain provinces, this has created room for the private sector where none was planned.

It is hard not to correlate the federal government's irresponsible attitude with the appeal of private health care. I was in agreement with the minister when he said that no one should be able to jump to the front of the line because they have money. But at the same time, for this to be true, the federal government must take its responsibilities. What we are calling for is 25% in cash transfers of the cost of operating the health care system.

That is very clear. That is what the Romanow report says. I am sure that my hon. colleague from Joliette will have a question for me.

[The Deputy Speaker]

I can understand that a number of members may want to ask questions, but it is always up to the Chair to make this difficult choice. I will give the floor to the hon. member for Trois-Rivières.

[Yves Rocheleau, Bloc, Trois-Rivières, QC]

Mr. Speaker, I will begin by congratulating my colleague for Hochelaga—Maisonneuve for again demonstrating his expert knowledge of this matter.

I would, however, like to ask him whether perhaps there are not two ways of looking at things. My colleague for Hochelaga—Maisonneuve is right to criticize the federal government for its attitude over the years and its cavalier, authoritarian and irresponsible attitude. As hon. members are aware, there have been attempts ever since 1867 to gain more and more control, particularly over health, which is such a crucial aspect of our collective lives.

Are there not, however, grounds for seeing the situation as even more threatening? The federal government can be faulted for its cavalier and disdainful attitude, except when it has a post-referendum game plan to ensure that things will be done here in Ottawa, where all national standards and objectives will be determined for the provinces to adhere to or be penalized. This can be seen from a negative angle, as my colleague has done, but it can also be seen from a positive angle, which is even more dangerous.

I would like to have my colleague's impressions on this. Where are we headed, Quebec in particular? It is no doubt a good thing for Canada that all decisions are made here, once and for all. But what happens to the Quebec difference then? What happens to the Quebec genius in health, as in other sectors, when the huge federal steamroller comes along? What is happening in health is also happening in education, culture, and with the municipalities. Where will it end? What would become of Quebec if it were to remain within Canada?

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Far be it from me, Mr. Speaker, to deny you prerogatives. You do the deciding when you are in chair. There is no doubt about that.

I think that the Minister of Health and member for Papineau—Saint-Denis will recognize that health will be to his government what the Rowell-Sirois report was to the last century, in the sense that it will provide an opportunity, the framework for nation building. The federal government will use the Romanow report in its effort to define health policies.

I have published an article in Le Devoir , which I hope the hon. member for Papineau—Saint-Denis has read. The four conditions for the partnership he proposed would be the way to nation building in the area of health, and that is something we cannot accept.

[The Deputy Speaker]

I give the floor to the hon. member for Joliette, because he is always very patient.

[Pierre Paquette, Bloc, Joliette, QC]

Mr. Speaker, one should never hesitate to be patient and I am pleased to see that you agree and have given me the floor.

I, too, would like to congratulate the hon. member for Hochelaga—Maisonneuve, who has given a brilliant demonstration of the problems in the health systems in the provinces and Quebec, and the relationship between these problems and the federal government's withdrawal from funding.

I would like to return to the question the Minister of Health asked during his speech. We know that there has been a withdrawal, and everyone agrees on that, including the finance ministers and premiers of the provinces. The Romanow report also made reference to it and all parties in the National Assembly are agreed. At present, the federal government's share of transfers to the provinces for health care costs stands at 14 or 15%.

We have found one other measurement that I think the hon. members would be interested in. In a report prepared by the former president of the Quebec treasury board, Mr. Léonard, it can be seen that in 1994-95 for every dollar the federal government collected in revenue, in all kinds of taxes, it invested 4.5¢ in the CHST. If we look at the breakdown in the CHST, 60% for health and 40% for other social programs, it means 2.8¢ for each dollar in revenue the federal government collected. That was at the time the Liberals took power, with the current Prime Minister as Minister of Finance.

In 2002-03, the federal government's share in health and social programs was only 2.7¢, or 1.7¢ on health for every dollar of revenue. And they want to make us believe there has been no federal withdrawal.

Once again, for the benefit of the our audience, I would like the hon. member for Hochelaga—Maisonneuve to explain the Liberal government's mathematical sleight of hand.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I thank the hon. member for Joliette who, as you know, is my former professor of economics—a most fascinating course.

Basically, when the Liberal government came to power under Prime Minister Jean Chrétien, the Canada Health and Social Transfer was $18.7 billion. It has dropped as low as $12.5 billion. Today, as we know, the federal government's contribution is not even 16% for health spending.

This is utterly unacceptable, and I am counting on the Minister of Health to correct this situation.

[Pierre Pettigrew, Liberal, Minister of Health]

Mr. Speaker, I would like some clarification from the member for Hochelaga—Maisonneuve, who says that we should take Mr. Romanow's 25% funding model. Mr. Romanow was very specific, however. He said that the Canadian government should invest some 25% of funding in health, but that money alone would not be enough.

The supplementary sums of money to be invested in the health care system must allow us to make some changes that would ensure the long-term sustainability of our health care system.

I would like the hon. member to explain just how far he is going with Mr. Romanow. Did he just happen to focus on the 25% but not think it necessary or important to look at the recommendations in the Romanow report, which states that this money must be invested, in a sense, to ensure the long term sustainability of our health care system?

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Speaker, I thank the minister for his question. I follow the Romanow report right from its beginnings until it hands on the torch to the Clair report.

The latter identified the reforms clearly. First of all, the Minister of Health must be aware that seven out of ten provinces held commissions to reform their system from the inside, and they have carried out that reform. The Romanow report says reforms must be carried out. This is true. The provinces need to have the torch passed on to them so that they may accomplish this.

The difference between the minister and us is that he suggests our fellow citizens need to be accountable to the federal government, whose share of funding is less than 16% but who would like to become the guardian of the health care system.

This is where we deviate from the Romanow report and the minister's position. We say that it is not true that the government, which makes a contribution of under 16%, will become the guarantor, the definer, the guardian of the system. There must, however, be reporting mechanisms, and the National Assembly will provide them.

[Bev Desjarlais, NDP, Churchill, MB]

Mr. Speaker, I want to acknowledge your indication to try to correct a technicality in our presentation of the motion. As a result of it, I need to seek the unanimous consent of the House to proceed with my speech.