Mr. Speaker, I only have 10 minutes to speak to the motion of my caucus, the Canadian Alliance, which states:
That this House recognize that the health care system in Canada is in crisis, the status quo is not an option, and the system that we have today is not sustainable; and, accordingly, that this House call upon the government to develop a plan to modernize the Canadian health care system, and to work with the provinces to encourage positive co-operative relations.
I cannot cover the scope of the problem at this time, but I can briefly say that we must first understand that medicare is the constitutional responsibility of the provinces. The federal government, through the Canada Health Act, controls a declining portion of the funding in exchange for the famous five principles.
As predicted at the start of medicare, the principles have been abandoned by all governments, yet the hollow phrases are fought over for the political advantage of posturing before the public about what party or government is more caring, wiser, and therefore should be trusted and supported by the voters.
The principles are: accessibility, portability, universality, comprehensiveness, and public administration. However, we must look at the five principles of the Canada Health Act and question if they are working.
Concerning accessibility, in the nineties there was an increase in people waiting for care. In 1993 the average wait was 9.3 weeks, but in 1998 the average wait was 13.3 weeks, an increase of 43%. Patients wait months to see a specialist. There is a huge shortage of technology that is available in other countries but is spread thinly in Canada. People are dying because they cannot get timely access, or they suffer needlessly.
What about portability? This supposedly means that every Canadian has the right to be treated anywhere in Canada. However, Quebec patients outside Quebec are required to pay upfront because the Quebec government did not sign the portability agreement and cannot be counted on to pay up.
I am told the reverse is even worse, about a person from B.C. who gets sick in Quebec and about how that person is seemingly discriminated against in the Quebec system. In other words, the interprovincial payment system is full of problems.
Next we have so-called universality. There are great shortages of services in outlying areas of Canada, far beyond the expected concentration of special services in regional centres. Where one lives, how and where one acquired the medical need and one's personal legal status all undermine universality because these affect what one gets from the system.
What about comprehensiveness? That has never been followed from the beginning. Each province has a different list of things that are covered and those that are not. As the pressure has mounted, provinces have been forced to delist services. In other words, there is no operational, national working agreement of core services. Consequently, Canada does not have comprehensiveness.
Finally, what about public administration? Most of it is public, in theory, except that there is a lot of contracting out that goes on for efficiencies such as computer services and financial support, and the labyrinth of personal cash payments for services mixed with tax dollars. As well, about 80% of total public spending for health care is consumed by labour costs for doctors, nurses and administrators.
Public administration of the complexities of medicare should be held accountable for cost and efficiency, but since there is no real competition how do we know what is happening?
The main point of a recent national study was the huge list of things that the system really did not know, could not account for or measure. In other words, medicare is administratively in the dark.
Dr. Heidi Oetter outlined the situation eloquently when she said in the Vancouver Sun :
This is the year I turn 40. It is a reflective year, a time to take stock of the past and ponder the future. When I was 20, I chose to stay in British Columbia and finish my education at the University of British Columbia's faculty of medicine. When I was 30, I chose to stay in Canada, unlike many of my classmates.
Since then, I've participated in more committees than I care to count, provincially and federally, to try and make Medicare work. Sadly, as my fourth decade comes to a close, I have to publicly say Medicare is decaying rapidly, and if we don't act now, its future is bleak...
Each new discovery, medication, diagnostic machine or operating device is expensive. For example, the additional equipment to do laparoscopic gallbladder removals—the cameras, TVs and laparoscopes—typically costs $100,000. The new neurosurgical equipment that will use computers to assist in brain surgery will cost upwards of $1 million. A magnetic resonance imaging machine (MRI) costs $1 million. B.C. has nine MRIs and should have 18...
In reality, it is difficult to fund research and new technologies when the Medicare system cannot even keep up with today's demands. Already we have medications and new technologies that Medicare simply cannot afford. Three times last year I referred patients to the United States, not to avoid the long Canadian waits, but to obtain a service that just was not available here. There now is better technology with improved outcomes for the public, but it's so expensive that Medicare cannot provide it.
I doubt my parents' generation will accept anything less than the best for the management of their heart disease, diabetes, cancers and chronic illnesses. Yet, my boomer generation, by sheer numbers alone, will challenge the sustainability of Medicare, as we age into our costliest health consuming years...
So, what do I want for my birthday? I would like to see further serious public debate on the issues as we have some serious decisions to make. We have to ask: “How much will we spend on Medicare? How will we fund new medicines and technologies? How do we decide what is necessary? What will our spending priorities be?...Our reality is that Medicare is decaying and is at risk of imploding. So, let's talk sustainability”.
Dr. Heidi Oetter is a practising family physician in Coquitlam and chair of the British Columbia Medical Association General Assembly.
What can we do, especially for those who really care about health care rather than health politics? We can be very watchful of the motives and the understanding of those who rant and derisively point the finger, saying “Someone wants two tier, American-style health care”. All agree that Canadians want great health care that is provided fairly and without catastrophic personal cost.
The constitution of Canada gives the provinces jurisdiction over social services, including health, education and training, and social assistance. We need to respect our constitution and refrain from intruding into the provinces' jurisdiction, including the formulation of social policy. Is Quebec listening?
The public sector now spends about $60 billion on health. A cheque the size the premiers want would boost that sum by a little more than 5%. Their report says that at a minimum “health spending could increase by close to 5% per year during each of the next 27 years”. The premiers estimate that by 2026-27 health expenditures will be 247% higher than today. That prospect is not sustainable.
We believe all Canadians should have access to quality health care regardless of their financial situation. We need to provide greater freedom of choice because it raises standards. The needs of patients must come first in the delivery of health care services, before restrictive union contracts and administrative empire building. We must work co-operatively with the provinces so that they have the resources and the flexibility to find effective approaches to the financing and management of health care.
We should not be afraid to allow the greatest freedom possible to Canadians in their choice of natural health products. We need to introduce restrictions only on those products that the government can clearly and scientifically demonstrate to be harmful. With the right incentives we can learn to manage for health rather than for sickness.
We can fix the national economy for real growth through tax reduction and spending reallocation so that we nationally can create the wealth to pay for the medicare economic challenge and create a reliable long term funding base.
The provinces are calling for $4.2 billion, and we need to grow it, rather than borrow it from the next generation. We can bring standards and independent auditing for greater transparency in the delivery of health care. We can initiate relations with the provinces to support and co-operate, not punish. We can examine and challenge the traditional roles of administration to get better efficiency and productivity. We can become more patient focused with the timely use of comparative measures. We must give evaluative tools to patients so they can make the local system more accountable and responsive to them.
The Canadian Alliance believes that families should get the best health care when they need it, regardless of their ability to pay.
Our plan to address the issues will only work if Canadians accept the need to innovate and change through co-operation rather than coercion, local adaptability rather than condemnation of others.
We can change the present dismal picture and place ourselves in the top one-third of OECD countries for health care, with no waiting lists, services that are not in jeopardy of being delisted, reversing the brain drain and ending the shortage of health care providers through wise incentives rather than defensive, punitive rules and barriers.
Who we are as Canadians and our standard of living will depend largely on the quality of our health care system. Instead of resisting change, we need to embrace it to solve the challenge of medicare in our time.
