Debates of Feb. 16th, 2023

Opposition Motion—Public Health Care Funding and Delivery

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Health and to the Minister of Sport]

Madam Speaker, the member opposite asked a lot of questions, and this has become a really disappointing trend from the Conservatives. It is a lot of slogans and no solutions or proposals for a better system. There are no recommendations, just a lot of slogans with no substance at all.

Canadians know they cannot trust the Conservatives on health care. Their hidden agenda is not hidden at all. There are examples across this country of Conservatives continually privatizing health care and ensuring that private clinics can deliver care to Canadians. That is why our government has had to rescind money. There are actually consequences for Conservative governments that have been doing that, in particular those in New Brunswick and Alberta. Over $100 million has had to be pulled back because of contraventions to the Canada Health Act.

My question to the member is very clear: How can Canadians trust the Conservatives on something so precious and important as health care?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, when we look at things in the House of Commons, the Liberal government has done absolutely nothing after eight years. We have had eight years of increased wait times, eight years of no access to primary care and eight years of refusing to transfer $4.5 billion through the Canada mental health transfer, which the Liberals created themselves. We have had eight years of inaction. We have had eight years of increasing burnout among the people whom I spoke very passionately about. We do not have slogans over here. I do not think I said one slogan in my entire speech.

I think the other very important thing we need to understand is that we need to do something about this. This is a crisis. We need leadership, and on this side of the House, that is what we have. We have leadership. We have ideas.

We do not need to give the government our ideas. We need to oppose the absolute inanity of the ideas it has when it brings them forth and they are not going to serve Canadians. That is our job. I understand that the parliamentary secretary does not like that or does not understand it, but our job over here is to stand up for Canadians and oppose the crazy ideas members on that side of the House have.

[John Brassard, Conservative, Barrie—Innisfil, ON]

Madam Speaker, to hear the member for Cumberland—Colchester is almost like getting a playing lesson from a pro. He is a former medical doctor who is intimately aware of the system. This is as opposed to a playing lesson from a former kayaker.

I sense his frustration. It is a frustration that many Canadians are feeling. We are hearing news today about doctors with foreign credentials. Canadian doctors who are foreign trained are unable to come back into this country to practise. They number in the thousands.

What role can the federal government play in ensuring that doctors with foreign credentials, many of them Canadians, can come back into this country and work with provincial governments to ensure that we build up our capacity in the health care system and have those health care professionals work in Canada?

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, I think it would be inappropriate to give all of our plans away to the government since it clearly has no ideas of its own. I think that would be unfortunate.

What we know very clearly is that there are immigrants who have come to this country, internationally trained medical graduates, who are unable to work in our system. What we need to do is look at the exact skill sets they have. There is a vast need across every health care human resource sector in this country, and we need to understand exactly how to help those folks fit into the system we have.

We know that the training system either does not have the capacity or perhaps, although I am not entirely sure, does not have the desire to train these folks to get to the standard we have, which is very high here in Canada. We also know that Canadians who have trained abroad need to be allowed to come back and show that the skills they have learned in other countries, such as Ireland, are of value to us here in Canada. They would play a fantastic role in our health care system and would be able to provide the care that Canadians so desperately need.

We also need to know very clearly what happens when somebody comes here from another country. We cannot have country X losing a doctor and Canada not gaining a doctor. Not giving a place in this country to somebody the immigration system has brought to Canada as a physician is a travesty and is very hurtful to the immigrants coming here to help us.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The hon. member for Longueuil—Saint-Hubert, for a brief question.

[Denis Trudel, Bloc, Longueuil—Saint-Hubert, QC]

Madam Speaker, this morning's debate is kind of schizophrenic.

Everyone who got up to speak, no matter their political stripe, said there is a problem with Canada's health care system, that it does not make sense, that there are wait lists for surgery and mental health and that seniors are not getting the care they should be getting. Everyone agrees on that. People are practically unanimous in saying something must be done about it.

True to form, the NDP moved a motion that does not belong in the House. We are going to spend a day wasting our breath because the things the NDP wants to talk about today are up to Quebec and the provinces.

The Liberals have made their choice. They have decided not to be part of the solution. The provinces and Quebec asked for $6 billion, but the Liberals gave them $1 billion. Now they are merrily flinging numbers around as though they were fixing things.

My Conservative friends have come to the same conclusion, but have they come up with the same answer? They have been pretty quiet about whether they would significantly increase health transfers to fix the country's health care system if ever—

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I had asked that it be a brief question, and the hon. member took more than a minute.

I will give the hon. member for Cumberland—Colchester the opportunity to respond.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Madam Speaker, I think it is very clear that in this country we need a few things. We need great leadership and we need great co-operation.

I believe that in this country, we have the ability to solve this problem. If we all work together with the provinces, with great leadership from the federal government, as we will show on the Conservative side of the House when we take over government, we will be able to solve these problems. We are a co-operative group and will move forward on this issue very clearly.

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, I want to say that I will be sharing my time with my mentor, the member for Rivière-du-Nord.

I think that having a discussion about the role of private health care is a great way to distinguish between certain ideological positions. On the one hand, there are those who think of themselves as social democrats or progressives, even if the latter term is a bit overused. On the other hand, there are people who have more of a neo-liberal vision, inspired by classical liberalism, where positions are often structured around an idyllic vision of the market; it is all about the market. When we talk about the role of private health care, these divisions always come to the fore.

I say this because we, in the Bloc Québécois, tend to define ourselves as progressives, as social democrats, much like NDP members do.

For example, one way to try and define progressives, social democrats, is to look at some of the struggles that have taken place. I am thinking about the fight for better wealth distribution, allowing for equal opportunities, which is more structured by the state. I am thinking about the struggles that women and the labour movement face. I would even say that a progressive is someone who defends secularism. I doubt my NDP colleagues would agree. Indeed, the issue of state neutrality often comes up in discussions about progressivism.

What I am getting at is that Quebec is probably one of the most progressive societies in Canada. Look at the choices that Quebec has made. Child care was put in place in 1997. Canada has just implemented it, more than 20 years later. The same can be said of parental leave and pharmacare. In my opinion, Quebec's government and society is a bit more progressive than Canada. That is Quebec's choice.

I would like to make a distinction. I see what the NDP is trying to do with this motion. The Bloc Québécois will be voting against it, but when we do, members will say that the Bloc Québécois is not progressive and that it is in favour of more privatized health care. However, that is not the case. That explanation is too simplistic.

I do not want to accuse my NDP colleagues of populism. We know what populism means. It often involves using overly simplistic explanations to try to describe complex realities. Health care in Canada is a complex reality. The fact that we are against this motion does not necessarily mean that we are in favour of giving the private sector a bigger place in the health care system. I want to point out that the difference between the NDP's progressiveness and the Bloc Québécois's is that the NDP's progressiveness involves a centralizing, predatory federalism. I want members to remember that. I do not want to use any bad words, but we have to call a spade a spade. It is a federalism that is always trying to infringe on provincial jurisdictions.

When I take a closer look at the NDP motion, what I ultimately see is paternalism, but I will come back to that. Ottawa thinks it knows best. We, the legislators in the House here in Ottawa, are supposed to explain to the provinces how the health care system works and we are the ones who see things clearly. That is basically how the NDP motion reads to me.

This motion is also pretty Ontario-centric, and I will simply point out in passing that it is yet another illustration of the fact that the NDP is rather disconnected from Quebec. Let us move on quickly to the next thing.

What should my colleagues have done if they truly cared about the health care issue? They should have tackled the main problem, which is a structural one.

The problem that we face today is a structural one, where health care is affected by the financial withdrawal of the federal government. Guess what? The fiscal imbalance has provided extensive documentation of this withdrawal. If my NDP colleagues were serious, they would have looked at the issue of fiscal imbalance and at the federal government's withdrawal.

Here is an example. In the 1990s, in 1996-97, the federal government made ongoing cuts of $2.5 billion to provincial transfers. Lucien Bouchard was premier of Quebec at the time. He had to deal with these cuts, which completely destabilized Quebec's health care system. His critics were quick to paint him as a neo-liberal politician because he made cuts to health care. However, at the same time that he was creating a $5 child care system and implementing a family policy, he was being strangled by the federal government and forced to cut health care services to the public. That is the kind of predatory federalism that I was talking about earlier.

I am coming back to the fiscal imbalance because I would simply like to provide the definition that really speaks to me. It is the one that was included in the Séguin report. It states that the provinces' spending structure is such that expenditures grow faster than the economy, while those of the federal government grow at roughly the same pace. Furthermore, when it wants to adjust its spending, the federal government can just unilaterally cut transfers to the provinces, without any political fallout.

“Without any political fallout” worked for Paul Martin in the 1990s. He balanced his budget on the backs of the provinces. Who paid the political price? It was the various premiers and health ministers in Quebec, who were held responsible for the shortfall in the health care system because Ottawa choked the resources.

The NDP's response to something like the fiscal imbalance is to say that funding for the provinces should come with conditions. To me, that is quintessential predatory federalism. I did not make up that term. It came from a health minister from Quebec who was a Liberal and had absolutely nothing to do with sovereignists and separatists.

The fiscal imbalance has been documented in a fairly impartial manner. I am thinking in particular of the Conference Board of Canada, which has shown in many studies that if nothing is done by 2030-31, the provinces will collapse under the weight of deficits, while the federal government will be swimming in surpluses. The Parliamentary Budget Officer has also demonstrated this many times.

When I look at the NDP motion, I see direct interference in provincial jurisdictions. Health is not the purview of the House of Commons.

Naturally, in Quebec and other provinces, governments may take approaches that are controversial, but that is democracy. If people are not satisfied with the actions of their legislatures, they can run for a seat there. If health care is the real concern of my NDP colleagues, they can stand for election in Quebec, Ontario, Saskatchewan or Manitoba and tackle the health care system. That certainly does not fall to the House of Commons.

I want to conclude by highlighting the predatory federalism we can see in the NDP proposals. Imposing national standards on long-term care facilities is interference. Hiring health care workers is interference. Investing in mental health and preventing the use of private health care, which is the basis of their motion, is again interference.

To add insult to injury, if the New Democrats had done their homework, and I am sure my colleague from Rivière-du-Nord will elaborate on this, they would have looked at the Chaoulli decision and realized that if they want to go against the provinces in the delivery of health care, they have two options.

One option is to use the notwithstanding clause that they condemned last week in the debate on one of our opposition motions.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Madam Speaker, I agree on the progressive policies in Quebec. I have said many times in the House that I benefited from the very first $5-a-day child care when I lived in Quebec in 1998, but I also want to point to when I had my second child in Quebec in 2003. At that point in time, C. difficile was in the hospitals. I did not get a meal delivered to my room because there was not enough staff. I needed to rely on my spouse to ensure I was fed during the two days I was in the hospital.

When we look at the long-term care outcomes and the deaths through COVID in Quebec, these are the realities about which we are talking. This is about a lack of staff, a lack of funding to have adequate staff, and reliance on the free market is no way to fix these problems.

Does the Bloc agree that we need to have an all-hands-on-deck fight to ensure we have the human resources in the health care system across our country?

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, I understand the difficulties my colleague has experienced in the health care system, but the major issue is one of funding and imbalance.

To fix that, the government should have listened to the provinces when they asked for an additional $28 billion to increase health transfers from 22% to 35%. That is what needed to be done, and the NDP still has an opportunity to do it. The budget will contain measures that the government proposes for health care, and the NDP just has to oppose them. We can re-establish a balance of power and force this government to invest in health care to meet the provinces' expectations, to meet the expectations of patients who are on waiting lists, and to meet the expectations of nurses, who are at the end of their rope. The NDP can still make a difference. They just need to grow a backbone and stand up to the Liberal government.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the Leader of the Government in the House of Commons]

Madam Speaker, the Bloc seems to be of the impression, and I really disagree with this, that the only role the federal government plays is to provide provinces money, nothing more, to be that ATM machine. It is like having a system in Canada where data and information is irrelevant to health care, data such as having a three-month waiting list for a hip replacement in one province and a 14-month waiting list in another.

We have the Canada Health Act, which is there to ensure there is a national health care system that provides basic fundamentals in health care, the expectations that Canadians have. Some provinces might be more progressive than other provinces, but would he not agree we should be able to look at the different provinces and see those basic fundamentals that are prescribed in the Canada Health Act?

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, I would like my colleague to tell me how he can magically find solutions, here in the House, to wait times in the health care system. How can he magically do that when his government cannot even deliver passports on time, deal with irregular border crossers who do not have work permits, and help people who spend weeks waiting for their EI payments?

The Liberals should take care of the things they are responsible for and let the provinces manage health care. For the provinces to manage health care, they need the necessary resources, and the federal government is the one that has the fiscal capacity to do that. The government is shirking its responsibilities. It is as simple as that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Madam Speaker, I say this with the greatest of respect, but there is a profound error in my colleague's comment, when he asserts over and over again that health care is a provincial responsibility in jurisdiction only. That is just incorrect. The Supreme Court of Canada said, “'Health' is not a matter which is subject to specific constitutional assignment but instead is an amorphous topic which can be addressed by valid federal or provincial legislation...”.

We know there are conditions attached because the Canada Health Act establishes them. When Quebec or any other province gets money, they agree to take that money on the basis of respecting five conditions of the Canada Health Act.

Is the Bloc Québécois in favour of two-tier private access to care? He says he is going to vote against our motion. Does that mean the Bloc Québécois is in favour of two-tier private care in our country, because that is what this motion is about today?

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, that trap was easy to see coming. I said earlier in my speech that that was what the NDP would say. It is easy. Populism involves using overly simplistic explanations to describe complex realities. They are saying that if we do not vote in favour of the NDP motion, it is because we are in favour of giving the private sector a bigger place in the health care system.

We will not be voting in favour of the motion and we do not support it because it directly infringes on areas of provincial jurisdiction. That sets a precedent, and we maintain—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Liberal, Alexandra Mendes]

We have to resume debate.

The hon. member for Rivière-du-Nord.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, I want to begin by saying that I agree with my colleague from Jonquière. He is very reasonable.

I would add to the list of the problems with this government the fact that it has been unable to issue paycheques properly for years. I have been a member of the House since 2015, and we have been hearing about the Phoenix pay system all this time. I was a lawyer before I became an MP, and I had business clients. If they had not been able to give their employees paycheques, they would have gone bankrupt and been taken to court. I will move on to other topics, but let us just say that this government has not proven it has the competence to manage the affairs of the provinces.

I would say that there are two big problems with this NDP motion. First, it does not respect the division of powers set out in the Constitution Act, 1867. We know that health is not a federal but a provincial jurisdiction. The federal government's role, with all due respect to my colleague opposite, is to transfer money to the provinces so they can manage their health care systems. As was mentioned, the federal government has no competence in many areas, certainly including health care. The federal government does not manage any hospitals, clinics or anything else to do with health care. It is dreaming if it thinks it can impose its vision on the provinces.

Second, there is the issue of the Canadian Charter of Rights and Freedoms. The Supreme Court ruled that, under the charter, the federal government cannot restrict access to private health care in the provinces. I will talk about that in more detail later.

When I look at this constitutional problem, I realize that the NDP does not seem to understand that the feds have nothing to do with health. I was thinking about it this morning and thought it felt like a legend. The NDP dreams of a totalitarian federal government that controls everything and of a country where the federal government is all-powerful, like a supreme authority. That is the federal legend and the NDP's dream.

[Mario Simard, Bloc, Jonquière, QC]

Is it the myth?

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, the myth, the legend, that is what we are talking about today. Beyond the legend, there is a constitutional problem, because health is not a federal responsibility, but rather a provincial one. There is also a problem in relation to the Charter of Rights and Freedoms, which protects a certain number of rights. It protects privacy in section 7, among other things.

This is not the first time a situation of this kind has been brought before the courts. My colleague from Jonquière talked briefly about the Supreme Court of Canada's Chaoulli decision from 2005. The chief justice, Justice McLachlin, supported by Justices Major and Bastarache, agreed with the findings of Justice Deschamps. I quote:

[T]he prohibition on private health insurance violates s. 1 of the Quebec Charter and is not justifiable under s. 9.1...The prohibition also violates s. 7 of the Canadian Charter and is not justifiable under s. 1...While the decision about the type of health care system Quebec should adopt falls to the legislature of that province, the resulting legislation, like all laws, must comply with the Canadian Charter.

Again, it states that “the type of health care system Quebec should adopt falls to the legislature of that province”.

The Supreme Court wrote that over 15 years ago, but the NDP members did not read the Supreme Court decisions, and that is okay. I know they have other things to do, like dreaming up this legend of a totalitarian Canadian government and trying to promote it. That cannot be easy, and I would not want to be in their shoes. I understand why they might be busy.

However, it is still important to read the Constitution and the charter at least once, to know what we are talking about and to avoid such huge traps. The New Democrats set this trap for themselves by proposing, on the one hand, that the federal government meddle in provincial and Quebec jurisdictions and, on the other hand, that the federal government completely violate the provisions of the charter.

That said, is it a fatal error? Yes, interfering in provincial jurisdictions is a fatal error.

I do not think that the federal government has any business meddling in areas under provincial jurisdiction. It can try, but it will end up in court. After a few years, the Supreme Court will say, as it already has, that this cannot be done. The federal government can try if it wants. We shall see.

Is the charter question fatal? No, it is not. I must concur.

We could contravene the provisions of the charter and say, “Too bad for section 7, we are still going ahead with a measure that would prohibit nurses from accessing private health care.” Even if it violates the charter, it could be done. How would we go about it? It is easy. The charter contains just such a provision. It is section 33, which reads as follows:

Parliament or the legislature of a province may expressly declare in an Act of Parliament or of the legislature, as the case may be, that the Act or a provision thereof shall operate notwithstanding a provision included in section 2 or sections 7 to 15 of this Charter.

The Chaoulli decision dealt with section 7. When I read the charter, I see that it can be overridden. Yes, what the NDP is proposing violates the provisions of the Canadian Charter of Rights and Freedoms. That is a major sacrilege, clearly, but section 33 allows for the charter to be overridden.

The only problem is that just this week, mere hours ago, the NDP was getting all worked up and crying foul because Quebec had the nerve to use this notwithstanding clause to protect French and secularism in Quebec. Scandalized, our Canadian federal Prime Minister said that he would go to the Supreme Court and ask it to declare that the provinces cannot use the notwithstanding clause that his father gave them many years ago when he had this legislation passed. He said that they should have to go through the courts first and so on.

We argued that this did not make much sense since section 33 states, “Parliament or the legislature of a province may expressly declare in an Act of Parliament or of the legislature”. That is what Quebec did, that is what the federal government detests and that is what the NDP finds so outrageous and astounding. However, that is what the NDP will have to do if they want to follow their motion to its logical conclusion.

Are they going to follow their motion to its logical conclusion? Perhaps. If they do, we will bring back our motion, which they defeated this week. After all, a person cannot enjoy ice cream one day, be allergic to it the next, and then enjoy it again the day after. It either works or it does not.

If they want it to work, I am willing to consider it. There will still be the jurisdictional issue, which remains unresolved, but we could at least resolve the charter aspect. If they want to continue down that path, with that reasoning, we will follow their lead and allow them to apply for a charter exemption. We know that they are entirely within their rights.

However, if they persist in saying that we are not allowed to do it, it is hard for me to see how they can logically say to us that they want to contravene the charter and violate the division of powers.

Again, this legend exists only in the minds of my esteemed colleagues in the New Democratic Party or, should I say, the New Liberal-Democratic Party. I am not sure what to call it anymore.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Madam Speaker, I want to start with the fact that, yes, it is New Democrats' dream to one day see a universally administered, universally accessible health care system in this country. If that is our dream, we are the Bloc Québécois's nightmare because this piece of legislation, this work and the funding models that need to be put in place are the kinds of things Canadians expect from coast to coast to coast.

The reality is that we are living in a confederacy; our country was founded on the principle of confederacy, and that model came from indigenous nations. If the Bloc members would look at a history book, they would realize that those indigenous nations actually bound together in their confederacies to work with one another and to help one another, rather than block the health care that people in my province, people in Saskatchewan and the good people of Manitoba would otherwise benefit from.

I do appreciate this member's speech, but it does not go far enough to protect Canadians from coast to coast to coast. Can the member explain what his plan is to ensure that other Canadians have the opportunities that Quebec may have?

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, what I can tell my colleague is that we dream similar dreams but have different ideas about how to achieve those dreams.

He dreams of a great nation from coast to coast to coast with rules that apply from coast to coast to coast to everyone who lives from coast to coast to coast. We dream of our own country, of Quebec. We know that we have one way of doing things. It is not better, but it is different from how things are done elsewhere in Canada. We dream of the alliance my colleague talked about. I have nothing against the Canadian Confederation. On the day that Quebec becomes a country, we are not going to build a fence around Quebec and tell others they must stay out and we will stay in. We want an alliance and trade relations. We want a lot of things. We are going to get along with our neighbours.

However, this marriage has a problem, because we do not see things the same way. We want to make our rules, and we want Canada to make its rules. Then we will see what we can agree on. I will always be happy to shake hands with my colleague and work with him to make life better for everyone in the great and beautiful country of Canada and in Quebec.

[Élisabeth Brière, Liberal, Parliamentary Secretary to the Minister of Mental Health and Addictions and Associate Minister of Health]

Madam Speaker, I thank my hon. colleague for his speech, which reflects his legal background.

Surely my colleague would agree that more and more Canadians, especially young people, are suffering from mental health issues. That is why it is important to invest in mental health and in integrated services for youth. By negotiating their bilateral agreements, the provinces will have the flexibility to decide to invest more money in mental health. Is that not a good thing?

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, I thank my colleague for her question. I know this member as a great parliamentarian and a very competent legal expert.

That said, obviously we are not against mental health care. I have never met anyone in Quebec who was against apple pie. Everyone likes it. People with mental health issues need to be taken care of. I hope the rest of Canada has the same concerns. In fact, I have no doubt that they feel the same way. The issue is not whether we want to take care of people with mental health issues. The issue is who is going to take care of them. Pursuant to the Constitution Act, 1867, could each province not have its own provisions to address its own specific concerns, which differ from one province to the next? After all, that is a fact of life.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Madam Speaker, we are learning about Veterans Affairs' mental health rehabilitation services treatments being outsourced to a company owned by Loblaws.

My good colleague from North Island—Powell River has been calling on the government to deliver that through Canada's health care system, not privatize it. Meanwhile veterans, people who have put their lives on the line, are not getting the services and treatment they need and deserve.

Does the member think that this privatization of veterans' services should be included in the health care system for Canada and Quebeckers rather than outsourced, where profits are actually flowing to investors while veterans wait for services? It is absolutely absurd. It is unconscionable that the government is doing this.

[Rhéal Fortin, Bloc, Rivière-du-Nord, QC]

Madam Speaker, I thank my colleague for his question. I have a great deal of respect for him as well. I know that there are many health care issues in British Columbia. My heart goes out to the people in that province.

That said, I agree with the premise of the motion, which is to prohibit private health care and try to improve public health care. Yesterday, Quebec introduced Bill 10, a bill to restrict the use of staffing agencies and self-employed workers in the health and social services sector. Last spring, in April 2022, it adopted a plan to implement necessary changes in health care. We are concerned about this issue, and we are working on it. I am convinced the same thing is happening in British Columbia, Ontario and elsewhere in Canada. We just have to do things our way, and the federal government must stop interfering in the provinces' management of health care—