Madam Speaker, I rise today to speak in favour of Bill C-39, but with some reservation.
We are pleased that after 10 years of cuts to the provinces for social spending, the Liberal government finally realizes that tax dollars should be spent on more than artificial debt targets and that Canadians want a balanced approach to financial management in Canada, an approach that protects and enhances the social safety net that helps define us as Canadian.
This funding formula will close the gap in funding identified in the Romanow report on health care. We welcome the end of reduced federal funding for health care and support the move to funding 25% of health care spending by government. It is about time. We cheer the Liberals' realization that costs increase over time and that base funding must increase, or in real dollars the amount of money available goes down.
The addition of an escalator clause in this agreement is very welcome; however, this agreement is missing an important element. Our system of governance in Canada is based on a series of checks and balances, but this legislation provides no check on how health care funding dollars are spent. Again and again, Canadians are telling us that they want to know where their tax dollars are paying for public health care and where those dollars are increasing the profits of private health care corporations.
Immediately after being sworn into office, the federal health minister said:
--what we need to do is stem the tide of privatization in Canada and expand public delivery of health care so we have a stronger health care system for all Canadians.
Since this agreement was signed in September 2004, health care advocates have been asking the health minister to affirm that the enabling legislation, when it comes forward, would include provisions to protect publicly funded and publicly delivered health care in Canada. There is nothing in this legislation to protect small communities and Canadians from for profit health care.
Since the actual agreement was made, I have been reading an analysis on the 10 year health plan. Again and again, I read how Canadians want governments to be accountable for the health dollars spent by Canadians, but they rarely get that accountability. This accountability discussion has been an ongoing issue. In 2000 the first ministers made a commitment to regular reporting and they indicated that it would be a process that allowed for third party verification, yet there are huge gaps in the data.
The last annual report from the Minister of Health could not indicate where money was being spent on the for profit delivery system, and in the report from September 2002, the Auditor General indicated that Health Canada is unable to tell Parliament the extent to which health care delivery in each province and territory complies with the criteria and conditions of the Canada Health Act. This is a serious shortcoming in this current piece of legislation before the House.
I want to quote from a paper written by Cindy Wiggins, a senior researcher from the Canadian Labour Congress. It is important that this is read into the record because this is how working Canadians see this agreement. It states:
The unified front maintained by the provinces during federal-provincial/territorial negotiations also has a significant downside for national social programs. Democratic deficits and provincial-territorial unity come at a cost. Dissent is muffled. Issues on which there is no consensus simply do not make it to the federal-provincial/territorial negotiating table, regardless whether such an issue is a key priority of the public.
We know provinces and territories have different opinions on the issue of for-profit care. Some provinces are ideologically committed to creating a role for the commercial health care sector. Some already have pursued this path. Others believe that a tier of commercial health care situated within the public system will do irreparable harm to the public, non-profit system and produce poor health care outcomes.
She goes on to say:
This issue has been at the centre of public debate around health care. Canadians are clearly opposed to for-profit health care and view it as a threat to Medicare. This issue was central to the conclusions of the Romanow Commission report. Because of the lack of consensus among the premiers, commercial health care and the threat it poses to Medicare was nowhere on the agenda of the September First Ministers' meeting. We can assume that this will be the same for other national issues, such as child care
As an example of the drive to use public dollars for private delivery, this morning CBC Radio was saying that provinces, especially Alberta, are already saying no to any child care program that directs money to not for profit centres, even though research has proven they provide better care than for profit centres. This is just an example of the public dollars going into for profit delivery.
Ms. Wiggins' paper continues:
The federal government played a role in the silence on commercial health care. For several years now, it has refused to enforce the Canada Health Act with respect to for-profit initiatives which violate the Act. As a result, Medicare has been left without a guardian and remains at grave risk.
I want to emphasize again that we welcome the closing of the Romanow gap, but throwing money at a problem and then refusing to be accountable for how that money is spent is absolutely wrong. While first ministers claim that this funding formula will put the health care system back on sustainable footing, the fact is there is no protection from for profit care and no accountability for how funds are being spent.
Again, from the Canadian Labour Congress paper:
The accountability measures in the agreement do not address this important sustainability issue. Accountability is in the form of reports on progress in areas covered by the agreement, such as wait times and home care.
Those are important initiatives.
Provincial jurisdictions supposedly must meet these reporting requirements as a condition for receipt of federal funds attached to the agreement. Report cards do not solve problems: they identify them. Provinces and territories are only responsible for reporting to citizens in their own jurisdictions - a provincialization of accountability for a national social program. Should provincial jurisdictions fail to meet the reporting requirements in the agreement, there are no consequences for such failure, making true accountability an illusion at best.
Canadians truly want to know where their health care dollars are being spent. Another area that the federal government needs to be accountable to Canadians for is protecting our public health care system from trade regulations. Canadians do not see our health care system purely as a business transaction, however.
Canadians see health care as an essential part of our identity, but when given the chance, the government did not negotiate an exemption for our public health insurance system. It did not exempt health care from World Trade Organization agreements.
Now, because it also refused to enforce accountability and to stem privatization in health care, the government leaves the door open to our health care system being decimated by multinational corporations moving in to provide for profit health care. This is just another example of big box credit card medicine and it is not a route that Canadians want us to go.
One area not mentioned when the Liberals talk about health and human resources is the leeching away of good talent to the private sector. Every private MRI that opens increases wait lists because it must take qualified people away from the public sector. There are simply not enough health care workers out there to staff a public system and a private one, and certainly not health care professionals. We need a pan-Canadian health and human resources strategy that truly identifies the serious shortages that are coming up in the health care professions and we need to act on that now.
Furthermore, the government is moving far too slowly on a pharmacare plan. The cost of drugs is now second only to hospital costs and slightly higher than the amounts we pay to doctors.
Last night in the House we had the first hour of debate on private member's Bill C-274 presented by my colleague, the member for Windsor West. It has a real plan to ease some of the spending crunches that provinces are currently facing with drug costs by reforming the system of patents and allowing generic drugs to enter the marketplace sooner. This is a critical issue as well. The Liberals could have made these changes already, but they have introduced regulations that maintain the status quo and will not help Canadian families access cheaper drugs to keep themselves healthy.
In closing, in view of the lack of accountability from this particular bill and the creeping privatization, we need to have an open and public debate to shine the light on the decisions that were made behind closed doors at the first ministers meeting in September. It is absolutely critical that we have a full review at the committee level on the issue of accountability.