Debates of Feb. 10th, 2005

Committees of the House

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Mr. Speaker, I have the honour to present, in both official languages, the sixth report of the Standing Committee on Finance on Bill C-24, an act to amend the Federal-Provincial Fiscal Arrangements Act and to make consequential amendments to other acts (fiscal equalization payments to the provinces and funding to the territories), and agreed on Wednesday, February 9 to report it with amendment.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Mr. Speaker, I have the honour to present, in both official languages, the first report of the Standing Committee on the Status of Women.

The committee is recommending that the federal government increase funding to the women's program in Status of Women Canada by at least 25% for investments in women's groups and equality seeking organizations.

Pursuant to Standing Order 109 the committee has requested a comprehensive government response.

Petitions

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Mr. Speaker, I am very pleased to present two petitions, both pertaining to the matter of fetal alcohol syndrome and the need for alcohol warning labels on all alcohol beverage containers.

The petitioners are very concerned that the government has taken no action over the many years that this issue has been raised and certainly since April 2001 when this Parliament overwhelmingly passed a motion in support of such warning labels.

They will obviously take heart at the developments yesterday in the House but call upon the government to act as quickly as possible to ensure that every alcohol beverage container contains a warning that says drinking alcohol during pregnancy can cause birth defects.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Mr. Speaker, I have the honour to present a petition from many members of my community in regard to the matter of missile defence.

My community is concerned that missile defence is designed to be a step toward weapons and war in space, including nuclear weapons and war.

The petitioners are calling upon Parliament to maintain Canada's multilateral approach to security and reaffirm this country's support for non-proliferation arms control and disarmament; to reject any and all plans for weapons and war in space, including plans for missile defence; and to seek Canada's withdrawal from any discussion of or participation in missile defence and the weaponization of space.

Questions on the Order Paper

[Dominic LeBlanc, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, I would ask that all questions be allowed to stand.

[The Acting Speaker (Hon. Jean Augustine)]

Is that agreed?

[Some hon. members]

Agreed.

Federal-Provincial Fiscal Arrangements Act

[Stephen Owen, Liberal, for the Minister of Finance]

moved that Bill C-39, an act to amend the Federal-Provincial Fiscal Arrangements Act and to enact an act respecting the provision of funding for diagnostic and medical equipment, be read the second time and referred to a committee.

[John McKay, Liberal, Parliamentary Secretary to the Minister of Finance]

Madam Speaker, I am pleased to introduce at second reading an act to amend the Federal-Provincial Fiscal Arrangements Act and to enact an act respecting the provision of funding for diagnostic and medical equipment. It is a very long name, possibly befitting the enormous sums of money involved and the importance of this agreement to all Canadians.

Canadians have told their governments that health care is of primary importance to them. As such, they have asked governments to work together to strengthen the health care system, to improve access to essential services and to reduce the wait times.

Canadians want to ensure the health care system is there for them today and sustainable for future generations. Governments are working to meet those expectations.

In September 2004 all first ministers signed a 10 year plan to strengthen health care. In support of the 10 year plan, the Government of Canada committed to increase its transfer to provinces and territories for health by the sum of $41 billion over 10 years starting in this fiscal year 2004-05. The increased funding of $41 billion will do three important things.

First, it will strengthen the Canada health transfer, the largest federal transfer supporting health care. It will both increase the base level of the transfer and establish an automatic 6% escalator, which is an unprecedented move to ensure predictable and stable growth in the federal transfer support.

Second, it will create a wait times reduction transfer to assist provinces and territories in reducing wait times according to their respective priorities.

Third, the new federal funding will provide an additional $500 million to provinces and territories for diagnostic and medical equipment, helping to improve access to publicly funded diagnostic services. The commitment to provide an additional $41 billion to provinces and territories will help ensure that current and future generations of Canadians have timely access to essential quality health care across the country.

At the September 2004 meeting of first ministers, a broad consensus emerged between governments on a shared agenda renewal of health care in Canada. That agenda focused on ensuring that Canadians have access to the care they need when they need it. As a result, federal, provincial and territorial governments agreed upon an action plan to ensure viable health care for Canadians setting out commitments to improve access and to reduce wait times.

The federal government is committed to doing its part to support the needed renewal and reform of health care. As part of its contribution to an effective working partnership on health care, the federal government brings a commitment to a growing, stable and predictable health care funding so that provinces and territories can plan for the future.

The bill before us today would provide for new federal funding over the next 10 years in support of the agreement signed by the first ministers on health.

To that end, the Government of Canada commits $41 billion in new federal funding over 10 years to meet those goals set out in that 10 year plan. Bill C-39 would implement those funding commitments.

To accelerate and broaden health care renewal and reform, the federal government will take a number of steps to strengthen the Canada health transfer, otherwise known as the CHT. It will invest an additional $3 billion in CHT in 2004-05 and 2005-6 to close the so-called Romanow gap.

A second important initiative is establishing a new, higher base for the Canada health transfer beginning in 2005-06. In that year the new CHT base will be $19 billion.

This commitment fully satisfies and in fact exceeds the recommendations made in the Romanow report on the future of health care in Canada. That new and higher base of $19 billion includes $500 million in targeted funding for home care and catastrophic drug coverage, clear priorities to many Canadians.

This funding for home care and catastrophic drug coverage recognizes and supports the first ministers' commitments to improve access to home and community care services and catastrophic drug coverage. These commitments are important to improving the quality of life of many Canadians and to ensure that no Canadian suffers undue financial hardship in accessing needed drug therapies.

Also of note, the health reform transfer created as part of the 2003 accord is now being rolled into the CHT effective 2005-06 and beyond. This consolidation of federal support for health reflects the continuing commitment to enhanced transparency and accountability and to support reforms established in the 2003 accord, including primary care, home care and catastrophic drug coverage.

To ensure predictable and sustainable growth in health care funding through the CHT, the government has committed to legislate an automatic escalator. An automatic escalator of 6% will be applied to the new health care transfer base of $19 billion effective in the fiscal year 2006-07.

This rate of growth is higher than the projected rate of nominal GDP growth, the rate of growth of the Canadian economy and, therefore, growth in total federal revenues over the periods 2006-07 to 2013-14. This rate of growth is fully consistent with the recommendations of the Romanow report. In other words, the federal government has agreed to increase the funding to CHT faster than the economy will grow and faster than we anticipate that federal revenues will be realized.

Foremost in the 10 year plan is the need to make timely access to quality care a reality for Canadians. The government remains committed to the dual objectives of better management of wait times and measurable reduction of wait times where they are longer than medically acceptable. All jurisdictions have taken concrete steps to address wait times, particularly in such priority areas as cancer, cardiac care and diagnostic imaging. The bill provides for an investment of the Government of Canada of $5.5 billion over 10 years in wait times reduction transfer.

Funding of $4.25 billion will be provided through a third party trust and accounted for by the Government of Canada in 2004-05. The government recognizes that not all provinces and territories are at the same stage in implementing their wait time reduction strategies. Provinces and territories will now have the flexibility to draw down funding according to their respective jurisdictional priorities to meet their wait time reduction commitments.

This funding will primarily be used for priorities identified by each jurisdiction. These priorities include: clearing backlogs, training and hiring more health care professionals, building capacity for regional centres of excellence, and expanding appropriate ambulatory and community care programs and tools to manage wait times.

Beginning in the fiscal year 2009-10, $250 million will be provided through an annual transfer to provinces and territories in support of health human resources and tools to manage wait times.

The government will also provide to provinces and territories a further $500 million for medical equipment in 2004-05. Building on previous investments in diagnostic and medical equipment under the 2000 and 2003 health accords, this funding will assist provinces and territories in improving access to publicly funded diagnostic services by providing funding for new equipment and the related specialized staff training that is required to operate this new equipment.

The $500 million more than fulfills the government's commitment that additional revenues from the goods and services tax as a result of the spike in gasoline taxes would be redirected toward further investments in medical equipment on a one time basis.

As a result of these commitments, total federal cash transfers in support of health are scheduled to rise to $30.5 billion in the years 2013-14 from $16.3 billion in 2004-05. The bulk of this new funding is being provided through the Canada health transfer, which will grow by 6% annually from its new base of $19 billion in 2005-06 to nearly $30.3 billion in the year 2014. This represents a significant and continuing federal investment in the Canadian health care system.

In addition, all funding will be distributed to provinces and territories on an equal per capita basis in order to ensure equal support for all Canadians regardless of their place of residence.

The new federal support of $41 billion for 10 years builds on previous federal investments in provincial and territorial health care achieved under the 2000 agreement on health and the 2003 first ministers accord on health renewal.

In September 2000 first ministers agreed to an action plan for health care renewal. In support of the first ministers agreement for health, the federal government invested an additional $23.4 billion through the Canada health and social transfer to accelerate and broaden health renewal and reform.

Drawing on the 2000 framework supporting reform and renewal, in February 2003 the first ministers accord on health care renewal set out a plan for reforms to improve access to quality health care for Canadians. Building on the significant investments in 2000, the federal government provided $36.8 billion in support of the initiatives outlined in the 2003 accord.

In addition to increased federal financial support, the first ministers also agreed in the 2003 accord that the sustained renewal of Canada's health care system required structural change. That is why they agreed to restructure the Canada health and social transfer into two separate transfers: the Canada health transfer and the Canada social transfer.

The Canada health transfer was designed to provide growing and predictable support for health. It also improves the transparency and accountability of the Government of Canada's support for health. And through the new CST, provinces and territories have continued flexibility to allocate federal funding for post-secondary education, social assistance and social services, including child care programs, according to their respective priorities.

In addition, these transfers meet the recommendation in the Romanow report for the creation of a dedicated cash transfer for health.

These measures contained in the 2000 and 2003 accords provide a predictable, sustainable and growing long term funding and planning framework for transfers to the provinces and territories in support of health care.

The new funding of $41 billion in the 10 year plan builds on the significant federal investments in health care in the 2000 and 2003 accords. This new funding confirms the government's commitment to making major reinvestments in health a clear priority for Canadians.

Improving our health care system is not just about money. It is about results. All orders of government remain committed to an action plan that achieves results. As such, first ministers recognize that making health care sustainable and able to adapt to the ever-changing needs of Canadians will take time, sustained commitment and adequate resources.

Under the 10 year plan, the governments agreed to report to their residents on health system performance, including the elements outlined in the communiqué of September 16, 2004. In fulfillment of its commitment to Canadians, recognizing that it has authorized significant new expenditures of Canadian taxpayers' money, Bill C-39 includes a provision for parliamentary review of progress in implementing the 10 year plan.

As the hon. members know, at the first ministers meeting this past October, the Government of Canada announced fundamental changes to Canada's equalization program and territorial financing formula. These changes will bring stability, predictability and growth to the overall level of funding for these programs.

Bill C-24, currently before Parliament and just reintroduced into Parliament from the finance committee as of this morning, sets out a new $33 billion framework for equalization and territorial formula financing. When combined with the $41 billion health accord, these investments will total a cumulative increase of $74 billion in new money transferred from the federal government to the provinces and territories over the next 10 years. This illustrates the government's commitment to ensuring that all provinces and all territories can offer the best possible services to their citizens.

In summary, Canadians have told their governments, year after year, to work together to ensure that our health system will be there for them and their children. Governments have responded.

On September 16, 2004, all the first ministers signed the 10 year plan to strengthen health care. As stated in the Speech from the Throne of October 5, 2004, “the Plan sets out a clear commitment, shared by all provinces and territories to achieve tangible results--results for patients”.

The 10 year plan provides $41 billion in new federal funding in support of these commitments. This is new funding that goes directly to provinces and territories in support of health care services that Canadians need.

The funding strengthens core support for health care and the principles of the Canada Health Act through increases to the Canada health transfer. It helps provinces and territories reduce wait times through the targeted wait times reduction transfer, and it provides additional funding for diagnostic and medical equipment.

The federal government has confirmed its commitment to health care reform and renewal through the tabling of this legislation to implement the funding commitments of the 10 year plan and provide growing and predictable transfer support for provinces and territories.

The $41 billion in increased federal investment represents the firm commitment of the Government of Canada toward ensuring the sustainability of the health care system and that all Canadians have access to essential health services when they need them.

Hon. members can no doubt appreciate the importance of passing the bill in a timely fashion so that provinces and territories can have access to the 2004-05 funding and begin to plan for future programs. I therefore urge all hon. members to support the speedy passage of the bill.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Madam Speaker, the hon. member talked about results and equal access regardless of the place of residence. I would like to point out that results and the past performance of individuals or governments can be a measure of what one can expect in the future. As we all know, the Liberal record on health care is terrible. The Liberals are the ones who cut the $25 billion from the health care system in the first place and caused this health care crisis that we now have to deal with.

The member has said that everyone will have equal access regardless of their place of residence and that the moneys will be accounted for. I wonder, then, if the member can explain why the health care system for our first nations throughout Canada has been compared to those of third world nations. Why is it that the federal government has no measure of accountability on how the moneys are spent on first nations? And this is not just someone from a political party making this suggestion; it is the Health Council of Canada.

It is really disturbing that the federal government, which provides health care benefits for almost a million people, which makes it about number five as far as health care providers in Canada are concerned, has shown consistently that it is unable to provide health care for those people. Therefore, why should anyone believe that the government has any credibility on this file?

Thus, my question to the member is about equal access. We know that equal access does not exist. Regarding place of residence, I am sure that the people of our first nations would say that their health care is not adequate. As far as accountability goes, where is all the money going to these places? How can the member make these assertions when he knows very well that the Liberals are the ones who are not accountable? We just have to look at the Prime Minister's testimony today to find out where Liberal moneys are going. I wonder if the member could respond to this.

[John McKay, Liberal, Scarborough—Guildwood, ON]

First of all, Madam Speaker, I would like to point out to the hon. member that this bill is entirely with respect to federal transfers to provinces and territories and therefore has nothing to do with the federal government's additional responsibilities for first nations. In that respect, at one level, his question is irrelevant.

At another level, he asks about the issue of accountability. The issue of accountability is accomplished here. It is accomplished here in the House of Commons, it is accomplished here at the health committee, on which I know the hon. member sits, and it is accomplished by the Auditor General's review of the performance of the federal government in a whole variety of areas, which includes fiduciary responsibility for people of first nations.

There is an accountability mechanism, but as I say, the larger part of his question really has nothing to do with the bill before us today.

[Guy Côté, Bloc, Portneuf, QC]

Madam Speaker, during his speech, the hon. member for Scarborough—Guildwood talked a lot about the significant amounts to be paid to the provinces under this health agreement and the bill. He also talked at length about the broad consensus among the provinces regarding the implementation of this legislation and the accountability process.

I should point out that, in September, the participants at the meeting that led to the introduction of this bill recognized the notion of asymmetrical federalism, more specifically in the health sector where specific agreements can be reached with various provinces. Indeed, Quebec did sign a specific agreement.

I wonder if the hon. member for Scarborough—Guildwood could elaborate somewhat on how this bill will apply to Quebec? To what extent does it recognize Quebec's specific situation in the context of an agreement on asymmetrical federalism?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, as the hon. member knows, there were a series of communiqués, and I believe there were three agreements in total, entered into by the provincial premiers. All of the subnational governments entered into these agreements as part of the overall health care plan in September 2004.

Included in those communiqués was one entitled “Asymmetrical Federalism”. That communiqué, along with the other communiqués, is actually referenced in the bill before us. Therefore it is incorporated by reference. It fully respects the jurisdictional sensibilities of all the subnational governments.

[Rob Merrifield, Conservative, Yellowhead, AB]

Madam Speaker, I listened to the hon. member's speech. He talked about the $41 billion over the next 10 years that is going from the federal government to the provinces.

Last June we had an election. In that election the Liberals ran on health care as the number one item on their agenda. As an election promise, the number of dollars they said they would put toward health care was only half of what the government came up with in September. Actually, the numbers that came forward in the 10 year health accord were much closer to the numbers the Conservative Party had laid before the people of Canada, in genuine honesty, as far as what we should be doing with regard to health care over the upcoming period of time.

How did the Liberals miss their numbers so badly going into an election? Was it lack of foresight, lack of understanding, or a lack of vision when the government came up with the deal that it struck with the provinces last fall?

[John McKay, Liberal, Scarborough—Guildwood, ON]

Madam Speaker, my recollection of the various platforms is that the government had numbers that were fully costed and which reflected viability within the growth of the federal government's revenues within the growth of the economy as such. All governments regardless of their political stripe are necessarily constrained by the growth or indeed the absence of growth of government.

Point number one is that the hon. member will note that the escalator in the agreement is 6%. Six per cent is way beyond the number for either nominal GDP or indeed real GDP going forward. We have not had a 6% year in I do not know how long; I would be speculating to name the year.

The second point has to do with the fact that this is an agreement. An agreement among governments would certainly supersede any election platform, whether it is the hon. member's platform or whether it is ours.

This was a negotiated agreement among the first ministers. This bill reflects that particular agreement.

I think that in some large measure the hon. member's question is irrelevant.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Madam Speaker, when the Prime Minister cut $25 billion from the health care system in 1995, he gouged it for at least a generation. Essentially the bill only replaces some of the funding the government took from the health care system in the first place. The government should stop its self-congratulations and reflect on the harm it has caused all those who need care.

The Conservative Party supported the 2004 health care deal in part because any deal is better than no deal. The people on the front lines, the patients and the health care professionals need help and they need it now. The return of the stolen money deserves no accolades; rather it demands a watchful eye to prevent the same crime from happening again.

Restored funding is a welcome development, if a decade too late. However, money alone will not solve the problems with which the Liberals have burdened our health care system. It is not enough to throw money at a system and say, “Heal thyself”. Leadership is needed, leadership that is accountable to Parliament and to Canadians. Leadership means having the courage to commit to the necessary change and to see it through. Leadership means focusing on a goal until it is realized. Leadership means keeping those with a stake in the system in all cases, in this case Canadians, informed and aware of the progress made.

More money will not ensure accountability. Dollars invested must be accounted for, but unfortunately, measuring how money is spent and the value of that investment is difficult due to the dearth of reliable information provided by the government.

In the next 10 years $41 billion will be transferred to the provinces. That is a lot of money, but I ask, how will Canadians know how that money is being spent? How will Canadians judge if it is being used effectively and for its intended purposes? The Liberal government's past handling of the public purse instills little confidence that it will manage the transfer of such a large amount of money and important funds in an honest and effective manner.

The bill makes mention of a parliamentary review in three years and one more three years later. There will be two reviews in the span of a decade. Giving the Liberals three years to manage our money without any accountability is like hiring the Hamburglar for a late night shift at McDonald's; Big Macs will inevitably go missing. Virtually no accountability mechanisms will be put in place. It makes me wonder how we will know that Canadians are getting a bang for their buck.

If the government were truly serious about reforming health care, it would not have walked away from the table in 2004 without agreeing to accountability measures. It would have included something in the bill that did not need to be reinvented. In fact, a mechanism for accountability already existed with the previous accord of 2003. Why does the bill not provide a mechanism that allows Parliament to review the progress and expenditures on a yearly basis?

Although accountability provisions are very weak, we will hold the federal and provincial governments accountable for meeting the commitments that they made in the 10 year plan.

In its annual report to Parliament the government consistently fails to report on a variety of important issues. These were recently highlighted in reports last fall. One of these deals with privatization.

A wait time reduction transfer will also be created to provide funding to help provinces reduce wait times according to their respective priorities. Unfortunately, the bill will give the finance minister the right to determine how much money is given and when, therefore opening the door for yet more Liberal funny accounting.

We are seeing that today. The Prime Minister is in front of a judge trying to explain why the Liberals were able to funnel money to their friends. It is the first time in 130 years a prime minister has found himself in this situation. It is very disturbing that we are setting up a playing field for such activity to occur again.

The value of this transfer and when it would take place should be predetermined and not be subject to the whims of a minister looking to fiddle with the books. Nary a whisper has been heard from the government in its yearly reports on privatization within the health care system. Private for profit services have proliferated, yet these reports make no mention whatsoever of this reality.

Governments at both levels are obviously not following the reporting protocol demanded in law by the CHA. The provinces fail to provide the information they are supposed to, and the federal government is not enforcing the law it is required to uphold.

Again we saw this with the Health Council of Canada in its report last fall and in the testimony of Michael Decter. The federal government is not leading the way in accountability to Canadians. In fact it is the anchor of non-progress on transparency and accountability.

Canadians deserve to know the details about the private clinics across the country. They deserve to know how new public-private partnerships initiated in several cities are progressing. What is the extent of this change? How much does it cost? What are the effects on the health care system?

Soon after his appointment the minister said that it was his priority to stem the tide of privatization. The lines of accountability are non-existent. He can continue to ignore his promise to Canadians. Privatization in health care, the supposed scourge of the Liberals which the Liberals vowed to defend Canadians from, is now a day to day reality in Canada.

In the last decade increasing medical use of MRIs, patient concerns and the business needs of for profit medical enterprises have fuelled an explosion in demand for high tech non-invasive diagnostic imaging. Private MRI clinics have sprung up across Canada in the past decade.

Canada's first for profit MRI clinic opened in Calgary in 1993. It was followed quickly by another in Vancouver. Today there are for profit MRI and CT machines in four provinces: three MRIs and one CT in B.C.; five MRI clinics, three with CT scanners in Alberta; ten MRIs and six to eight CTs in Quebec; and one MRI in Nova Scotia. At least one public hospital, St. Paul's in Vancouver, offers CT scans to patients for pay.

The health minister has indicated his intention is to penalize B.C. for allowing private clinics to charge fees for medically necessary treatment. Yet he fails to acknowledge that some provinces take liberties with the Canada Health Act. In fact Quebec is a province that is home to half of the country's 34 private MRI clinics.

It would be nice if the government could come clean on this subject. It should at least be transparent and admit the reality. We do have private health care in Canada, yet the government pretends it does not exist.

If public moneys are being used to provide services to Canadians at for profit clinics, should there not be some acknowledgment of this fact? Should Canadians not know how much of their $41 billion is being spent on private medicine?

Aside from the one time contribution in 2005-06, no money is offered for pharmacare. This is despite the fact that many Canadians, especially in Atlantic Canada, have no catastrophic drug coverage.

There was also passing mention to affordable drugs. There is nothing new in this deal on health that will lessen the burden of prescription medications for Canadians. The government agreed to set up a committee to study the issue and report back. More committees will not help Canadians. In fact, the committee will not report until many years in the future. Contrast that with the Conservatives, who promised a catastrophic drug program. By now, if we had a Conservative government, no doubt it would already by underway.

However, Conservatives feel that individuals and families should not be financially ruined by exorbitant drug bills. Nor should they be unable to get the drugs they need because they do not have the money. The Liberals simply failed to address this question.

Canadians are now realizing that the Liberal government's solutions on health care will not provide relief to an already burdened medicare system. More money is not the key to reforming the system and providing a truly universal health care system in Canada. We need to look at other issues as well, for example, healthy living initiatives. Health care is more than just hospitals and clinics, MRIs and pharmaceuticals. Health care is about healthy living.

The government approach to health care is in many ways in the wrong direction. Rather than devoting billions of dollars only to treating those already sick or injured, why not focus as well on preventing Canadians from becoming sick or injured in the first place? Provincial governments across Canada are taking steps to encourage and educate their populations about the benefits of healthy living. It can relieve a great deal of burden on our health care system so our doctors and nurses can focus their efforts on those who are truly in need of medical attention.

Reducing smoking, encouraging healthier diets, more frequent exercise and cleaning the environment will all improve the general health of Canadians. Government's role in these efforts is not to force Canadians to change, but to educate them about the benefits of a healthier lifestyle and cleaner environment, and provide them the incentives to change.

Patient safety needs require attention. Studies have shown that preventable or adverse events may cause 10,000 to 20,000 deaths per year. Over a million hospital days are devoted to treating injury and sickness caused by adverse events. Imagine the time and money that could be saved if these were reduced. This again highlights the Liberals' backward approach to health care reform. Rather than simply having a health care system that people deserve, they are trying to deal with chronic care at the end.

A national mental health strategy would also have benefits. Mental health is like the estranged cousin of the health care system. Canada is the only country in the G-7 that does not have an articulated strategy for dealing with mental health. It is time the government addressed this issue and plays a leadership role in helping Canadians with mental illness. In conjunction with the leadership of the provincial governments across Canada, the federal government will play an important role in devoting resources and research to the treatment of mental illness.

Then we have the personnel shortages about which we hear so much. Responding to public concern, the government would establish a waiting time reduction transfer. The reason for this is obvious. Waiting times for certain services in certain places have become dangerously long. However, waiting times are only part of the problem. No matter the funding level, without enough health care workers in the system, the system will not function properly.

Canada's health care system faces looming personnel shortages. The number of doctors, nurses, technicians and other practitioners is increasingly inadequate to meet the demands of an aging population. Supply simply cannot keep up with the demand.

According to a Decima poll, more than 4 million Canadians cannot find a family doctor. Without a strong front line health care system, people cannot adequately access health care and deal with the health care issues from which these people suffer.

Front line physicians as a group are getting older, accepting fewer patients, working fewer hours and providing fewer services. The Ontario College of Physicians reports that since 2000 the average age of a practising physician in Ontario has increased from 49 to 51 years of age. In the past four years the number of family doctors accepting new patients has declined from 39% to 16.5%. Compared to their older peers, younger physicians are devoting less time to direct patient care. Doctors across the country are reducing the services they provide. Traditionally, half of all physicians were family doctors. Today less than 30% of medical students opt for family practice as a career and increasingly prefer less stressful, more lucrative careers is specialization.

Nurses too are aging as a profession. When baby boomers start retiring in droves, there simply will not be enough nurses to staff an already overburdened workforce.

The bottom line is that more funding alone will not solve the growing personnel shortage. The government lacks a comprehensive strategy to recruit and train tomorrow's health care workers.

Foreign credentials need to be recognized so more qualified foreign trained physicians can practise in Canada. The government must pressure federal health organizations to end protectionism and controls that make it so difficult for foreign health professionals to get their credentials accepted. The government should also free up and provide resources so residency spots can be provided to allow these professionals to get the necessary training or qualifications they need to practise in Canada.

This is not a health issue, but needs cooperation on other files such as immigration, labour in cooperation with the provinces that are responsible for education.

Disparities in health care, access and the quality of service are rampant. It is no secret that despite the Liberal assurances that health care is provided universally to all Canadians, many receive less than adequate care, and it does depend, unfortunately, on where one lives.

Disparities and access to services and quality of services received is divided in regional and socio-economic groups. Atlantic and northern Canada tend to have poorer service than central Canada. Rural areas generally have poorer health care than do urban areas. Aboriginals and others with lower income certainly have poorer health care services.

Increased funding will not narrow the widening disparities in health care services provided to different Canadians. The government bill provides no assurances that this embarrassing situation will be addressed adequately. It is the same old theme, talking about the problem, throwing money at it and expecting everything to be all right. Then we have another health care summit to divvy up more money to solve the same problems. People are getting sick and tired of these health care summits. They want action.

We have a report that shows that 24,000 deaths per year may be caused by adverse events. Health Canada officials agreed yesterday before the health committee that this estimate is probably too conservative, as in all likelihood many more adverse events go unreported.

We have issues around prescription error. Online prescribing can help deal with this needless loss of life. It is not enough for the Liberals to say that funding has been provided and progress has been made. While they dither, people die. Aside from the cost in lives, researchers estimate that more than a million days in hospital could be attributed to adverse events.

The Liberals continue to show that they are unable to deal with health care in Canada. They caused the problem. They have a shameful record when it comes to tracking aboriginal health.

Is it not ironic that the government talks about accountability when it is not accountable itself? We have the ad scam, we have the cancelling of the helicopters, we have the HRDC boondoggle and the gun registry.The list goes on and on.

Conservative promises were made, and only the Conservative Party has the credibility.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Madam Speaker, I appreciate my hon. colleague's speech today and the concerns that he has raised. I know he has real heart to see the health care system improved in the country.

On the issue of accountability, he mentioned statistics about adverse events. Just yesterday we had the Canadian Patient Safety Institute at committee. There have been a tremendous number of deaths and casualties from medical treatment. That is just in the hospitals.

Is the member aware of an issue that came up recently with regard to C. difficile in Montreal area hospitals and across the nation. About 600 deaths were reported from this bacteria, a hospital based infection. Related to that was handwashing, overcrowding and use of antibiotics. However, there was another issue and that was the use of a commonly prescribed class of medications that people were on when they entered the hospital. That is gastric acid inhibitors that people take for heartburn and to reduce gastric acidity. There is a 250% increase in risk for people on these medications.

However, no one wanted to address the accountability in the system even though the CMA Journal had raised the issue in July. By October, they were reporting 600 deaths and no public warning and no warning to doctors that if a patient was on this class of medication, they should not go near a hospital with C. difficile. It surprised me that Canadian public health officials did not see that as a public health issue. They saw that as a practice guideline issue.

Along with his concerns, would he care to continue his remarks? I know he had remarks on his concerns about safety. Would he care to comment on that one.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Madam Speaker, this is obviously a very important issue. People are dying as the member has stated.

Given the short period of time to answer the question, I will just say this. The Liberal government has caused a crisis in the health care system. This crisis permeates the entire system. This is just another example of not having the adequate number of health care professionals to deal with the increased number of patients. It is poor planning, a lack of funding and accountability.

It shows that the Liberals have caused a very difficult situation. We need to work hard. It will take a long time to deal with the damage that the Liberal government has caused to the health care system. I hope that when the Liberals go to bed at night, they think about all the people who have died needlessly due to their policies.

[Guy Côté, Bloc, Portneuf, QC]

Madam Speaker, unfortunately, the Bloc Québécois cannot support this bill in its present form.

Earlier, I asked the hon. member for Scarborough—Guildwood how, in the bill, Quebec's specificity, or Quebec's specific agreement, negotiated in September 2004 at the first ministers' conference, was recognized. The hon. member said that all the communiqués were incorporated into the bill and, consequently, that asymmetrical federalism and the agreement reached with Quebec were recognized de facto in the legislation.

Unfortunately, I must correct the hon. member opposite. While there is a brief mention of all the communiqués, the reference is found in a very specific part of the bill dealing with the parliamentary review. What is a parliamentary review? Once the various measures included in this bill are implemented, how will they be monitored? How will the accountability process relating to the implementation of these various measures be conducted? Indeed, the relevant clause provides that, for greater certainty and for the purposes of this section, the 2004 10-year plan to strengthen health care includes the communiqués released in respect of the first ministers' meeting on the future of health care that was held from September 13 to 15, 2004.

This is unfortunate, for it shows just how sensitive this government is to Quebec. For so important an accord, an accord on asymmetrical federalism which even the government recognized as historic, when the time comes to implement it, this government forgets the most important thing, recognizing the distinctiveness of Quebec in implementing the accord.

How is it recognized? I remind you that, in the wake of this 2004 conference, the government acknowledged that asymmetrical federalism allows for any province to have specific agreements and arrangements. The first ministers also agreed to a separate communiqué to report on the arrangements made between the Government of Canada and the Government of Quebec with regard—and this is very important—to the interpretation and implementation of this communiqué. The funding made available by the federal government will be used by the Government of Quebec to implement its own plan for ensuring timely access to quality health care and reducing wait times.

We are not talking about parliamentary review or accountability in this agreement. We are talking about the interpretation and implementation of the agreement and the possibility for Quebec to have its own plan. Unfortunately, we do not find this in the bill.

Thanks to the vigilance of the Bloc Québécois, I know that discussions have been held, and are still being held, to ensure that these provisions, namely recognition of this communiqué which recognizes asymmetrical federalism and the specificity of Quebec, are included in the bill.

Let us be quite clear. If this fact is recognized only in the sections referring to parliamentary review, we cannot support this bill. That would be a shame, for we are of course talking about substantial funding for the health of our fellow citizens. Also, this is an agreement which was subsequently acknowledged as an established fact. I refer more specifically, for example, to the conference of health ministers held in Vancouver last October. The news release was very clear. A series of measures was listed relating to this agreement—measures concerning, for instance, reduction of wait times, improved access, the national pharmaceuticals strategy, and general and specific public health goals. The news release recognized the specificity of Quebec by mentioning, for example, that Quebec's contribution to these initiatives would correspond to the provisions of the document entitled “Asymmetrical Federalism that Respects Quebec's Jurisdiction”, which accompanies the 10-year plan to strengthen health care.

The health ministers and the first ministers agreed. Now the time has come to introduce the bill implementing these elements. Through a lack of sensitivity, no doubt—thank heavens that we are here in the House to remind them—they forget to include these elements so that they have the importance that they deserve.

It is the same in regard to human resources in the health sector. Quebec has a specific agreement. In the same news release from the health ministers, it said: “Quebec, having its own process, will collaborate on this initiative by supporting ongoing exchange of information”. One way it will do this is through its own health commissioner.

What has been negotiated by the first ministers and what has been presented by this government as a historic agreement must be referred to in the bill and not just in connection with the parliamentary review.

What did this joint Quebec—Canada communiqué say, more specifically? It stated that ,in regard to the application of the clause in question, this specific agreement did not deal solely with the parliamentary review, but was much broader. It said, and I quote:

—resting on asymetrical federalism, that is, flexible federalism that notably allows for the existence of specific agreements and arrangements adapted to Quebec's specificity—

Quebec will apply its own wait time reduction plan, in accordance with the objectives, standards and criteria established by the relevant Quebec authorities—

There is nothing here about federal interference; it is all about Quebec's powers. It also says, and I quote:

The Government of Quebec will report to Quebeckers—

This joint communiqué goes much further. Indeed, it says the following in the last paragraph:

Nothing in this communiqué shall be construed as derogating from Quebec's jurisdiction. This communiqué shall be interpreted as fully respecting its jurisdiction.

In short, this means that health is Quebec's jurisdiction, period. This is a fact that is not mentioned anywhere in the bill, which talks solely about parliamentary review, and that is too bad.

As soon as we read this bill, we started negotiating with the government to ensure that this reference would be included, ideally in the introduction. It would really be too bad if we could not support this bill because of a lack of clarity on the way the measures to provide the Government of Quebec with considerable financial amounts will be implemented—amounts that will enable it to accomplish its missions, in the health field.

The federal government made us laugh when it said this was an historic agreement and that finally two federalist governments had managed to agree. However, this sense of harmony was short lived because of the conference on equalization that was held in the weeks that followed.

Following a number of criticisms by other provinces and various hon. members regarding the acceptance of this asymmetrical federalism, the government had no choice but to strengthen its resolve on equalization and impose an agreement on the provinces, especially Quebec. It is too bad.

If, in the context of equalization, we had managed to reach a more flexible agreement that was more generous toward Quebec, similar to the recent agreement reached with Newfoundland, for example, then the federal government may not have needed to present a bill that also gives effect to its interference in the area of health, by allocating specific funds to specific areas. It is unfortunate because this is not under the federal government's jurisdiction.

Once again, the government claims to know it all and know best how to manage every issue, especially those under Quebec and provincial jurisdictions. When it comes to managing federal jurisdictions, this government—and the previous government—has a disastrous record.

I could give you many examples, such as agriculture, the Canadian Forces, the softwood lumber crisis, and the mad cow crisis. These are all matters under federal jurisdiction in which the government has almost totally failed.

At the same time, this government is saying it has money it does not know what to do with and that it will show us how to manage a slew of situations that come under provincial responsibility, such as health. Thankfully the agreement confirms the specificity of Quebec and its jurisdiction over health. This must be recognized clearly, precisely and without ambiguity at the beginning of the bill so that the reference applies to all the measures in the bill and not just the parliamentary review and accountability.

This situation is surprising, to say the least, since one would have thought that the members of Parliament from Quebec who sit on the government side would have sounded the alarm. It seems to me that as soon as they read this bill, someone in the government party ought to have noticed that an essential element was missing. Just by chance, once again, something was forgotten, demonstrating, I repeat, the lack of sensitivity to the needs and specificity of Quebeckers.

Consequently, without a guarantee, without amendment to this bill, it will be impossible for us to support it. We will keep on fighting. We will ensure that this bill is amended to correspond with the agreement made by all the first ministers, in order to correct this unforgiveable oversight.

I hope that we will get the government's cooperation on this subject so essential to the health of our fellow citizens. I fervently hope that in committee the members of the government party will quickly remedy this situation. Because, as the hon. member for Scarborough—Guildwood mentioned, this bill must be implemented as soon as possible, so that all citizens of Canada and Quebec can benefit from the money provided under this agreement and this bill.

Why are this agreement and this money so important? We must not forget that in recent years the federal government has radically slashed transfer payments, thereby making it necessary to raise its funding one notch higher, bringing it to nearly 25%. Thank God this will permit the Government of Quebec, in particular, to provide some services which, at the moment, are very difficult to provide, since naturally it must fund other sectors. I am thinking, for example, of education. In this field, again due to the government's draconian cuts, federal funding is now around 12%. As a result, the provinces are called upon to make an extra effort, Quebec especially. In fact, Quebec has to ensure that the services it must provide to its citizens are adequately financed.

This agreement will ease the situation somewhat. Still, in order for this agreement to be effective—I repeat: without this condition we will not be able to support this bill—it is essential that the joint communiqué recognizing asymmetrical federalism, the situation specific to Quebec and Quebec's full jurisdiction over health be acknowledged.

In conclusion, I call upon the government MPs to assure us as promptly as possible of their absolute and total cooperation in getting these amendments into the bill, as otherwise we will not be able to support it.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Madam Speaker, my colleague from the Bloc Québécois is correct. The federal government has made substantial cuts to health care over a period of time, which has caused great problems among the provinces. In my province of Ontario I think something like 14¢ on the $1 was cut in the funding, which is a long way from where it was originally, which was 50¢ on the $1.

This funding was agreed to by all the provinces, which is why I was interested in the comments by the member for the Bloc when he said that what was agreed to was not in the bill. I have not heard Mr. Charest grumbling about this or raising issues in the media or anywhere else with respect to the fact that the federal government did not honour its commitment.

The Bloc of course is saying that the government has not. Either the Bloc is right or Mr. Charest is not doing what he is supposed to be doing. However that is another story as far as I am concerned. In fact, many of the provinces thought Quebec got a better deal than the other provinces. However the deal was made and all parties agreed.

My question for a comment from the member, which he may or may not have an opinion on, is something entirely different. It has to do with the section in the bill that deals with funding for diagnostic equipment and medical equipment.

It is all very fine and good for a government to say that it will give funding for that type of equipment. In my riding of Dufferin—Caledon there is a hospital centre called the Headwaters Health Care Centre. Several years ago some private citizens wanted to donate an MRI to the centre but were told they needed to go to the Province of Ontario and get permission for people to operate this equipment. The province said that it did not have the funding for that and consequently we never received the MRI. That can be directly attributed to the lack of funding by the federal government and that problem has not been addressed in the bill.

[Guy Côté, Bloc, Portneuf, QC]

Madam Speaker, as my colleague has pointed out clearly, the underfunding in recent years has created very great needs in the provinces and in Quebec. Some sectors, such as imaging, may have been neglected by the provinces because they are so hugely expensive. That is one of the direct consequences of the federal government's insufficient funding to the provinces.

This specific agreement, found only in the context of the parliamentary review is unfortunate. One might think at first glance that it refers to all communiqués which it does, but only in connection with a very specific section: parliamentary review, and not implementation of the entire bill.

It is very important that it be for the entire application of the bill. The joint Canada-Quebec communiqué referred to three or four very specific situations, which I will address rapidly. Among other things, reference was made to the following:

The Government of Quebec will report to Quebecers on progress in achieving its objectives, and will use comparable indicators, mutually agreed to with other governments. In this respect, Quebec will continue to work with other governments to develop new comparable indicators.

Quebec’s Health Commissioner is resposible for reporting to the Govenrnment of Quebec on Quebec’s health system. He will cooperate with the Canadian Institutefor Health Information.

Yet the responsibility lies with the Government of Quebec, through its Health Commissioner.

Continuing the quote:

Funding made available by the Government of Canada will be used by the Government of Quebec to implement its own plan for renewing Quebec’s health system.

This is not a reference to accountability, but to implementation. It is not in the bill at the present time.

Naturally, since there is much talk about accountability and reviews, the communiqué is quite explicit. It states, and I quote:

The Government of Quebec will continue to report to Quebecers on the use of all health funding.

The member is quite correct. There are serious problems in a number of health care sectors. This bill corrects them to some extent, but we must not forget that they are the result of poor management, cuts to transfer payments and the underfunding of health by this government.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Natural Resources]

Madam Speaker, I would like to comment on the remarks made by the official opposition. I have no comments for the Bloc member.

I want to set the record straight on the amount of health care funding. It has been suggested that the level has dropped from around 50% to 14%, which is not true. I beg the member to go back to his researchers and check it out more carefully. The percentage now is over 30% and it is higher than it was before program review.

I have no problem with the concept of asymmetrical deals. Provinces and territories came into Confederation with different deals. That is one of the great flexible things that makes our Confederation work and makes us modern and successful.

I would like to compliment the member of the loyal opposition for making the point that all the provinces and the territories and the federal government signed on to this huge deal that will provide massive funds for health care. This is an amazing concept when we have such distinct views across the country. However I would like to remind people that this is the second major deal in this decade that the provinces have signed onto. This is an important issue to Canadians and we are making good progress on it.

[Guy Côté, Bloc, Portneuf, QC]

Madam Speaker, to be honest, at this time, I do not have the exact figures, in terms of percentage, on the government's current contribution.

However, we must not forget that if there was a funding increase, it followed many years of cuts and reductions. I am convinced that this increase in no way compensates for the cuts over the past several years. I am convinced of this even without having the exact figures on hand.

We have suffered the consequences of these cuts in Quebec, and in all the other provinces. This government, in order to pay down its debt, sometimes endangered the health of people in Quebec and Canada, by making drastic cuts. It was high time this government increased its contribution so that the provinces and Quebec can provide decent health care, among other things.

[Keith Martin, Liberal, Parliamentary Secretary to the Minister of National Defence]

Madam Speaker, I cannot believe what the member from Quebec is saying about the federal government. No other province in this country has been given more flexibility to maintain and manage its health care system under the laws of our land than Quebec.

The member across should be embarrassed and should apologize to the government considering what this government has negotiated with Premier Charest in the province of Quebec. We have given extraordinary flexibility and large amounts of money to ensure that the people of Quebec can get timely access to health care that is of high quality.

Instead of criticizing the government, the member should be working with us and thanking us for helping the people of Quebec to ensure that the best we can do is to make sure that anybody in the province of Quebec, and indeed in every part of this country, gets access to health care when they need it.

This is a big challenge. We all have problems with this because our aging demographics and more expensive technologies are making it extremely difficult to ensure Canadians have access to timely health care.

We want to continue to work with the provinces, who are the managers of health care, to ensure all Canadians have this. It is a big challenge and we know it will be very tough to do but we have made an amazing contribution with the $41 billion and we will continue to work hard to do better.

[Guy Côté, Bloc, Portneuf, QC]

Madam Speaker, the member opposite is the one who should be embarrassed at presenting this money as a gift from the federal government. If one thing is clear in the Constitution, which was forced on us, it is that health care is a responsibility of the provinces and Quebec. This is not a gift, it is money that is owed Quebeckers.