Pauline Picard

[Smoking, February 3rd, 1994]

Part of the plan which the media attribute to the government concerns health and an awareness campaign directed at young people to discourage them from smoking.

My question is for the Minister of Health. Can she tell us what measures she is proposing to the government to make people, especially young people, aware of the danger of smoking?

[Social Security System, February 2nd, 1994]

The policy that the hon. member has just alluded to is outmoded. The fact of the matter, as I mentioned clearly in my speech, is that Quebec and the provinces are facing a different situation. With respect to health care, I stated that health care costs had increased because of the situations I described earlier. The problem right now is that the government is not channelling back to the provinces the funds that are rightfully theirs.

As a result, the provinces cannot balance their health care budgets. Take, for example, Sainte-Croix Hospital in my constituency. It is experiencing an acute crisis because it is underfunded. This facility serves a population of 80,000 and has a shortage of 100 acute care beds. Hospital equipment is outdated and there is shortage of specialists. The situation is growing more critical by the moment and it is always the less fortunate who suffer.

That is what I wished to say to my hon. colleague.

[Social Security System, February 2nd, 1994]

Mr. Speaker, speaking as a woman who is aware of the problems of social development, I welcome this opportunity today to take part in this debate on

social programs. In the riding I have the honour to represent in this House, like all regions in Quebec and Canada, we see daily so many examples of social problems that are unacceptable in a society that ranks among the wealthiest in the world.

The lingering recession in Quebec and Canada has added to the ranks of the unemployed and welfare recipients whose numbers were already unacceptable, considering the standard of wealth in our communities. That the federal system has failed is reflected in Quebec's high unemployment rate, low job rate and unusually high percentage of Canada's poor. According to the latest figures from Statistics Canada, nearly one-third or 31.82 per cent of low income families live in Quebec, although we represent only slightly more than 25 per cent of the population of Canada.

In the course of this debate, the Official Opposition intends to condemn any attempts to cut social programs targeted to the neediest in our society, while the government tolerates unfair taxation, the underground economy, costly and counterproductive government spending, and programs where taxpayers' money is being wasted, as a result of duplication by provincial and federal governments. The government is mistaken if it thinks it can deal with its financial crisis by drastically cutting social programs that are essential to maintaining a minimum of human dignity among the neediest in our society.

I would urge hon. members on both sides of this House to look at the many pockets of poverty that have emerged in their respective ridings during the latest recession, and realize that we must deal with the problem through effective programs instead of cutting into the basic essentials these people need. We believe that cutting social spending is the easy way out, to deal with budget problems caused by previous governments' failure to act. I would ask this government to use a little more imagination and provide some hope for the neediest in this country who are often the victims of government inefficiency.

What must be addressed are the real dangers that threaten the economies of Quebec and Canada and which, especially in the case of Quebec, are holding back economy recovery. We can point the finger at unemployment, the monetary policy, unfair taxation, duplication of services, which is not only costly but also inefficient, lack of expenditure control, and the unbearably high deficit the federal government unloads on Quebec and the provinces. Those are the many evils which put counterproductive pressures on social expenditures, and prove, beyond any doubt, the failure of the Canadian federalist system whose unchanging characteristic is that it cannot be renewed, in spite of the many attempts to do so.

Fifty years after the publication of the first report outlining the premises for our social policy, things have not changed that much. Due to poor management in the past few years, the state of our social security system is giving rise to a growing concern.

For social programs to be better integrated and more faithfully reflect national policy, we need uniform standards regarding efficiency, fairness, consistency and work incentives. These are the characteristics which should still be guiding us today. Unfortunately, such is not the case.

In the last few years, the federal government has in fact cut and altered social programs. Moreover, it has reduced transfer payments to the provinces and Quebec for their social programs. And, as I mentioned earlier in this House, neither Quebec nor the provinces are asking for charity in this respect. All they are doing is demanding what is owed them under a duly signed agreement, let us not forget that.

By raising the standards for unemployment insurance eligibility with Bill C-21, and later on, by imposing new conditions for entitlement with Bill C-113, the federal government gave notice that it had little respect for those who were the hardest hit by the recession.

While doing the less affluent such injustice, at the same time it made Quebec and the provinces bear a heavier portion of income security expenditures. In spite of further tax increases, the federal contribution to provincial governments for health care and social programs has drastically declined, shaking the very foundations of the system.

Between 1978 and 1993, the federal contribution for health care and post-secondary education dropped from 47 per cent to 34 per cent. This means that less money is channelled back to the provinces for established program financing. However, the standards that have to be met in the management of these programs are not being adjusted.

It is not surprising then to hear about user fees. By unloading its financial problems onto Quebec and the provinces, the federal government sees, as a result, the principles underlying the Canadian health policy being undermined.

Quebec and the provinces are faced with increased health care costs. This increase in due primarily to the following factors: the aging of the population, new medical technologies that are more costly and a significant increase in spending for pharmaceutical products.

Canadian and Quebec taxpayers give the federal government large amounts of money, some of which is earmarked for health care under the agreement of 1977. The problem is that, for the past 10 years, the federal government has not been giving back to Quebec and the provinces the portion that is rightfully theirs, thereby depriving them of the funds intended for health care. Instead, it transfers its deficit to Quebec and the provinces, all because of the inability of previous governments to control their spending. The federal government must be aware that, by increasing the tax burden for Quebec and the other provinces, it would create a two-tier health system, where the rich will be

able to afford health services while the underprivileged will tend to delay or forgo medical treatment.

We believe in the basic principles of universality, integrality, accessibility, transferability and public management of the health system. What we are criticizing is the fact that these basic principles are being threatened, in every province including Quebec, by the inability of the federal government to honour its commitments.

If you decrease or freeze the federal transfer payments, you jeopardize our health system, which is the one component of our social programs we most rely on. In Quebec, according to the established programs financing legislation, 45 per cent of health cost was to be picked by Ottawa. However, faced with the economic crisis of the early 1980s and the disastrous state of our public finances, the federal government decided to unilaterally opt out, so that by 1992-93 the federal transfer share of health expenditures had dropped by 33 per cent.

This opting out process, often described by the Quebec government as unacceptable, unfair and incoherent, was not followed by a reduction in terms of federal intervention, since Ottawa is maintaining national standards and undertaking parallel programs, hence causing overlap problems. The end results, as I said earlier, are steady pressure for users' fees or other forms of billing, the delisting of some services, a service tax on drugs, drastic cuts in hospital budgets and outrageous waiting lists in many specialties.

Thus, the very foundation of our health insurance plan, that is free, universal and accessible care, is in jeopardy. That brings me back to my starting point: it is always those most in need who are the worst affected.

How can anyone speak about social programs without crying out against a level of poverty so high that 4.2 million people live in poverty in Canada, with Quebec being the main victim? There are 1.2 million children living in poverty and that hard core poverty is the fate of a large majority of single mothers and women raising a family alone. Let us turn now from the current costs of that unusual situation to assess the real issues underlying that crisis and its long-term impact.

Beyond the figures and the statistics, there are real people out there who hurt, who are sick and who go hungry. Those people wish the government would act responsibly, quit squandering money and find lasting remedies. We readily admit that people in government need to travel, but how many families could we get out of the mess for good with what it costs for a single Challenger flight? Every little bit helps.

Many studies demonstrate a clear relation between poverty and bad health. According to a study by Health Quebec on the 25 most common health problems in Quebec, almost all of them were more acute among low income people than among wealthier people. Poor people consume more medicine than rich people and require more health care.

A report made public by Campaign 2000 revealed a 30 per cent increase in the number of children living in poverty in Canada. In addition to being a bigger drain on the health care budget because they get sick more often, these children suffer more often from learning problems and are more prone to becoming school dropouts, twice as often as the children of the wealthy. Finally and most regrettably, they are more likely to become dependent upon social assistance than to participate in development.

In order to better control the global state of health of the population in Quebec and in Canada, and hence to limit health care costs, we must first wage a merciless war against poverty. Therefore, those considerations have to be taken into account in the review of our social programs. Ignoring them would have the effect of worsening the spiraling deficit and the spiraling poverty. We have more than enough of one tragedy already.

The only effective remedy against poverty is the creation of long-term jobs for people who will have first enjoyed adequate benefits. In this context, the direct duplication of similar federal programs and provincial initiatives is an absolute waste of public money and is also, in most cases, counterproductive. Quebec wants an end to this mess in the manpower and job training sector which costs its taxpayers $250 million every year.

In this area, as in many others, the existing rivalry must be replaced by effectiveness and efficiency. Our debt as well as the chilling reality of the unemployment rate and the number of welfare recipients do not allow us to condone waste through sheer stubbornness. Administrative overlapping generates real costs, one of the most important of which is the inability to solve the problem of poverty, especially in Quebec.

Poverty, especially in the case of young people, leads directly to welfare, drug and alcohol consumption, sometimes jail, and even despair and suicide. The fact is that the drop-out rate in schools is alarming. In some districts of the island of Montreal, close to half of the students quit school without any diploma and, as we all know, dropping out of school leads directly to poverty, since the job market massively rejects people without diplomas. According to Statistics Canada, 65 per cent of the new jobs between 1990 and 1993 were filled by university graduates. No speech made by governments on employment makes any sense if it is not supported by an energetic program to change

the objectives and the education system itself. Young Quebecers and Canadians must have access to a very high quality education to be able to take advantage of the need for a highly-skilled manpower.

The federal and provincial governments cannot afford to waste time and energy in futile bickering over who has jurisdiction, at the expense of a coherent and structured financing for post-secondary education.

We believe it is more urgent than ever that a House committee look into government spending in order to eliminate waste and duplication, and to reduce operating expenditures. This would enable us to allocate the budgets necessary to maintain social programs.

We also believe it would be more appropriate to cut military spending rather than reduce the budget for health care. We also propose a courageous tax reform to eliminate tax evasion, unfairness, as well as tax shelters such as family trusts, which only benefit the wealthy. This type of reform, and not a charge led against the poor through cuts to social programs, would get our support.

Those are useful solutions to help solve the budget crisis which we are concerned about. However, we will strongly oppose any violation of the commitment made by this government during the election campaign not to dismantle social and health programs.

In conclusion, there is no doubt whatsoever that the health of Quebecers and Canadians is closely related to poverty.

This House and the government have the moral obligation to put in place the necessary mechanisms to provide for the urgent needs of more than four million people, mostly women and children, for whom poverty has replaced hope.

[Health, February 1st, 1994]

Mr. Speaker, my supplementary question is this: Is the minister aware that 9 million taxpayers will have to pay this tax, which could cost each family up to $700 a year?

[Health, February 1st, 1994]

My question is for the Minister of Health.

The newspaper La Presse reported this morning that the Minister of Finance said that dental and health insurance premiums could be taxed for the first time in order to reduce the number of tax loopholes and to generate additional funds.

My question is as follows: In this International Year of the Family, does the minister agree with this proposal to tax dental and health insurance plans?

[Social Programs, January 31st, 1994]

Mr. Speaker, the government is intensifying its consultation efforts on manpower training, education and health. Does it mean that, as far as health care is concerned, the government is using this forum to centralize services and encroach on areas of provincial jurisdiction?

[Social Programs, January 31st, 1994]

Mr. Speaker, my question is for the Minister of Health. The government is currently engaging in a vast consultation exercise. Your colleague, the Minister of Human Resources Development, is holding consultations to restructure social programs. On the other hand, the Prime Minister gave you a mandate to hold a national forum on health to identify priorities in this area.

Does the Minister not think that is a lot of consultation? How is she going to harmonize her own reform program with that undertaken by the Minister of Human Resources Development?

[Speech From The Throne, January 27th, 1994]

Mr. Speaker, I want to tell the hon. member that he did not understand me at all when I referred to the return trip taken by taxpayers' money. As you know, health care is paid for by taxpayers, by the provinces, including Quebec. Taxpayers send money to pay the federal government for health care. The federal government administers and manages; the department of health administers and provides health care to pay for medicare. But the federal government does not do a favour to taxpayers. Taxpayers pay their share. What I am saying is that when the money which comes from the provinces, from the taxpayers, goes to the provinces who then send on here the taxes paid by people for these services, it costs a lot of money to administer. The federal government takes its share, it takes its money, and then gives some back to the provinces so that they can administer their health programs.

And it is this administration by the federal government which costs a lot of money. If each province was in charge, and if taxpayers gave their money to the province, which would manage its own health care program, it would be cheaper and hospitals would not have a deficit such as is the case right now. That is what I wanted to say.

[Speech From The Throne, January 27th, 1994]

Mr. Speaker, I would like to thank my hon. colleague on the other side for his remarks. What the Bloc Quebecois is calling for is the removal or elimination of federal taxes on cigarettes. The black market is thriving and this is the only way to curb the illegal activities now taking place.

[Speech From The Throne, January 27th, 1994]

Mr. Speaker, I would like to take this opportunity to acknowledge and thank the people from the riding of Drummond for their confidence in me; I will try to discharge my mandate to the best of my knowledge and with total dedication.

What I heard last Tuesday in the Senate does not reflect in any way the strong program that Quebecers and Canadians had a right to expect to regain a feeling of hope and confidence in the future. That is why I want to convey to this House and to the government my concerns and those of my colleagues concerning the throne speech, and the health care system in particular.

Unfortunately, the meagre content of the throne speech in this respect creates more fears than hopes. Our fellow citizens are expecting solutions to the problems associated with our deteriorating health care system, such as bed closures, crowded emergency wards, higher drug prices, and so on. Let us take for example the acute crisis prevailing in Sainte-Croix Hospital of Drummondville in my riding. Inadequate funding and severe budget cutbacks have led to obsolete equipment, a lack of specialists, frequent service cuts, split shifts and patient transfers. All this makes life harder for staff and patients alike. What hope does the throne speech give us that these unacceptable situations will be resolved? Very little, I'm afraid, Mr. Speaker.

Let us talk about federal transfer payments and established programs financing. We must first recognize that the finance minister's commitment to improve equalization payments every five years is certainly reassuring for all provinces.

But we must not confuse equalization payments with transfer payments. In 1986, the previous government, criticized on many occasions by the current Prime Minister, started to reduce federal transfers for established programs financing. In 1987, the Tories announced that Canadian provinces and Quebec would receive $270 million less for health care and post-secondary education.

Worse still, they announced in February 1991 that per capita transfer payments for established programs financing would be frozen until 1994-95. All these measures were applied unilaterally, without the consent of Quebec and the other provinces, despite the formal agreement reached by the parties in 1977. So, between 1978 and 1993, the federal government's contribution

to health care and post-secondary education programs in Quebec fell from 47 to 34 per cent.

As we all know, whenever transfer payments are reduced, it is the poorest provinces that suffer the most. What we are talking about is fairness for the provinces and Quebec. A freeze in federal transfers for established program financing is in itself a serious threat to the principles set forth in the Canada Health Act.

Therefore the Official Opposition intends to promote a review of the transfer payment procedures, in a way that will respect the financial capacity of Quebec, the provinces and Canada.

We must also stress that as the federal government got out of funding this program, the provinces and Quebec faced increased costs for health care. This growth is due to several factors, like the aging population, the appearance of costly advanced medical technology and higher drug prices.

The taxpayers of Quebec and Canada entrust the federal government with large sums of money, part of which has always been intended for health care under the 1977 agreement. The problem is that for 10 years, the federal government has not given the portion due back to the provinces and Quebec and thus diverts funds meant for health care. Instead, what it transfers to Quebec and the provinces is its deficit, a consequence of the previous government's inability to control its spending. We are talking about a reduction of nearly a third in transfer payments here. This has had major consequences on the financial health of Quebec and the provinces. If the present Liberal government just froze transfer payments, it would mean a cut equal to the increase in the cost of living.

The federal government would be making the choices which Quebec and the provinces have to make more difficult as they try to cover their shortfall and reduce their tax burden. Since greater efficiency is unlikely in the short term, Quebec and the provinces would be faced with two equally unpleasant options: reducing the quantity or quality of services or going further into debt. In either case, we are not telling anyone anything new when we say that it is still the poorest people who will suffer the most.

Let me point out to this House that neither Quebec nor the provinces are asking for charity here. They are only demanding the money which is their due under an official agreement, remember.

Furthermore, we question the federal government's right and justification in requiring the provinces to maintain certain health insurance procedures, after the Conservative government in its nine years in power systematically went back on its financial commitments with respect to transfer payments.

As a result, the provinces and Quebec have been forced, in spite of themselves, to propose various so-called palliative measures in recent years, such as user fees, service charges, deductibles and so on. All these alternatives have one thing in common: they make health care and services less accessible.

The federal government must be sensitive and above all aware that by increasing the financial burden of Quebec and the provinces, a two-tier system will be created: on one hand, those who can afford access to health care and services, and on the other, those who for financial reasons will delay treatment or even do without necessary care.

We believe in the great principles of universality, comprehensiveness, accessibility, portability and public administration. What we oppose is that these great principles are seriously threatened in all provinces and Quebec by the federal government's very inability to meet its commitments.

As my hon. colleagues realize as well as I do, in Quebec like elsewhere, it is always the same people who have to foot the bill. In terms of transfer payments, the federal government takes money out of the pockets of the taxpayers and transfers it to the provincial government. Basically, the taxpayers' money is taking a round trip to Ottawa.

But this trip has a price. In Ottawa, the bureaucracy takes its cut. Consequently, some of the taxpayers' money does not come back. That part is kept here to satisfy the appetite of the federal administration.

Just last week, the Minister of Finance warned us not to expect any gifts when transfer payment agreements expiring next year are renegotiated.

Would it not make more economic sense and make the taxpayers feel safer if they were to pay directly to their provincial government the money they owe for health care, thereby eliminating the federal intermediary, the additional costs and, more importantly, the risk that the federal government will grab this money to reduce its deficit?

In view of the fact that the federal government did not manage to make good its promises in the past, we are convinced that the people of Canada would be better served in terms of health care if each of the provinces and Quebec took things in hand and looked after implementing the Canada Health Act themselves.

This way, the bureaucratic load would be significantly reduced and management would be exercised much closer to home and be much easier to adapt to the specific requirements of the situation, as it would be more responsive and effective in the short term. It would also take away the sword that hangs over the heads of Quebec and the other provinces with every new federal budget!

Health also calls for prevention. As we all know, an ounce of prevention is better than a pound of cure, however good the care system is. This is to say that in terms of prevention, any budget cut that is not immediately compensated by an equivalent increase in the efficiency of the programs affected would translate into a cost increase higher than the expected savings.

The best prevention with regard to health is to enhance the socio-economic condition of the people of Quebec and Canada. A large segment of the population could be negatively affected by the precarious state of the economy in Quebec and everywhere in Canada.

From Saint John's to Victoria, women and men, young and old, live in socio-economic conditions that do not allow them to develop their full potential. We all have in our ridings families living under the poverty line and barely surviving.

Pregnant women are not eating appropriately, preventing the foetus from developing normally. Several newborns are underweight and require prolonged hospital care. Others are born with diseases due to deficiencies in their mothers' diet and require treatment during several years. The prenatal nutrition programs announced in the throne speech will have to provide a real solution to this important problem.

School children are even reported to be starving because the fridge is almost empty at the end of the month. These children often do badly in school and drop out before getting a diploma. We must do something for these children.

People who cannot find decent housing are even worse off. As it was pointed out in the health and welfare policy issued in 1992 by the Quebec government, living in a run-down apartment with poor heat and poor ventilation is particularly harmful to the health of young children and seniors.

Therefore, the social housing problem is extremely serious in every province, including Quebec. This situation cannot go on forever.

One of the best ways to reduce health costs is to enable everybody to live in adequate and decent conditions. And it is by providing decent jobs that we will be able to improve the situation.

Also, even though we agree with the efforts of the Department of Health to reduce tobacco consumption, we deeply regret the program implemented by the previous government to increase taxes on tobacco. This program, which is a disaster, has generated four major adverse effects.

First, the creation of a contraband network and a black market which have generated uncontrollable and unnecessary illegal and criminal activities. Second, tobacco sales have dropped everywhere, resulting in a sharp drop in profits for businesses. Consequently, tax revenues have also been reduced drastically. Finally, and this is both unfortunate and ironic, the emergence of this black market has not only prevented the expected reduction in tobacco consumption, but has in fact provoked an increase in consumption among young people, if only because of the appeal of cigarettes as a contraband product.

It is a real shame that this House is responsible for having provoked such a serious and unnecessary crisis when there are so many real problems to tackle. Therefore, we ask the new government to reduce drastically taxes on tobacco products.

The throne speech states in less than two lines that a Centre for Excellence for women's health will be established to ensure that women's health issues will receive the attention they deserve. This project is certainly commendable, but will it be a true program for support, research and action for women's health or will it be merely a documentation centre as the Liberal government program seemed to suggest?

What funds will be targeted to research on women's health? There are deficiencies in the research on breast cancer, gynaecology and obstetrics, chronic and degenerative diseases, mental health, violence and occupational illnesses. If it is the socio-economic situation of women which determines their health needs, what concrete measures are needed to eliminate these unfortunate conditions? It is urgent to act and to go to the roots of the problem. Women are poor and that is the reason for a lot of their health problems.

Everybody has a brother, a sister, or a friend struggling with a drug or alcohol addiction. We urge the government to give special support to organizations which work for the detoxication and rehabilitation of those who are affected by such problems.

The throne speech mentions a national forum on health to foster a dialogue on the renewal of Canada's health system. We can only praise the government for this initiative but, at the same time, we are concerned that this type of exercise might take too long to get under way, might cost too much and might end with a report which will be shelved. The Bloc Quebecois will strongly criticize any attitude which would lead such an initiative to flop.

The Bloc will also ensure that the government does not use this forum to justify unilateral changes in transfer payments which would be to the detriment of Quebec's and the other provinces' interests. Indeed, the Bloc Quebecois' mandate is to

ensure that the poor will not have to suffer from changes made for fiscal consolidation purposes.

This is why, as some of my colleagues have pointed out, we are adamant that the government must set up a House committee whose mandate will be to review each budget item in order to eliminate unnecessary and frivolous expenses.

In conclusion, Mr. Speaker, in order to protect the health of Quebecers and Canadians, the government must guarantee to all the provinces that they will get their fair share of the money paid by taxpayers to this end, as well as the all services which Quebecers and Canadians desperately need.

The Official Opposition intends to intervene in a useful way and, if necessary, as energetically as required, to ensure that each citizen of Quebec and Canada has access to the health care and services which they need.