Bill Blaikie

[Supply, May 11th, 2004]

Mr. Speaker, I have debated the member before and he is always very careful with his words. He talked about clinics. He did not say private clinics, for profit clinics, or non-profit clinics. All of a sudden he is trying to misrepresent the NDP position.

I said that we do not want for profit clinics. What happened in Manitoba was that a for profit clinic was turned into a non-profit clinic and brought under the public health care system. That is what I said was done in Manitoba. That is the sort of thing that we would like to see done right across the country.

That is our position. The member does not have to like it or agree with it. It is clearly quite different than the federal Minister of Health who stood up and talked about for profit private delivery of services in clinics or otherwise that he did not seem to feel was a problem.

The next day of course he said that he did not want to encourage that sort of thing, or he did not want to promote it. These were afterthoughts after the alarm bells went off that showed that the Liberals were actually sort of neutral when it comes to providing our public health care services by for profit private delivery.

[Supply, May 11th, 2004]

Mr. Speaker, obviously the solution to the clinics that now exist is twofold at least. One solution is to create a publicly funded health care system where there is no demand for such clinics, particularly those clinics that enable people to pay for diagnostic services by themselves and then queue jump because they got their diagnosis and people who are waiting for the public system do not.

There were private clinics in Manitoba. I can think of one in particular. The Manitoba NDP government did not want to have this private for profit clinic in Manitoba, so it negotiated with that clinic and brought it into the public sector. This is certainly one of the things that was done by the Manitoba NDP government. It has been a huge success as far as I know.

There are different ways to do this. The member wants to force us into some kind of radical unacceptable position, that somehow if the NDP government was elected, all these places would be shut down tomorrow. We want to initiate a process by which, by a certain time, there would not be these kind of private for profit clinics. If that means changing the Canada Health Act, then that is exactly what we would do.

In terms of the so-called second tier that exists by virtue of the fact that some Canadians can go to the United States, we can never change the fact that some Canadians may choose to go to the United States for health care. What we can do is reduce the number of Canadians who feel that they have to go to the United States in order to access particular services. We can do that by properly funding the publicly funded health care system.

I am glad to see that the Conservatives are now saying this kind of thing. However, it is getting awfully close to the election. I can remember when the hon. member's colleagues often rose in the House and talked about the fact that there needed to be cuts in federal transfer payments to the health care system. The record will show this.

The member makes a point that, yes, we will always have this other tier called the United States, for people who either have the money or who can get the money together. We should create a publicly funded health care system in this country where no one feels that they have to do that.

With respect to adequate funding, I have already said that we accept the recommendations of the Romanow commission.

[Supply, May 11th, 2004]

If I intended to split my time, Mr. Speaker, I would have indicated that to you at the beginning of my speech. However, I thank you for your concern.

The leader of the official opposition is reported to have said that he does not really care who delivers health care. Whether it is public or private, it is not a big deal for him. I commend the leader of the official opposition for at least being honest about his position. If he had said otherwise, I would not have believed him. I know where he is really at. I did not just walk into this chamber yesterday. Anybody who has listened, particularly to former Alliance members over the years, really knows where the Conservatives also are on this, and is not surprised by that position. I commend him for at least being straight up about his indifference. I would say he probably has a preference in some cases for private delivery, but at least he is willing to say that it does not make any difference to him.

Whereas the Liberals are being quite disingenuous and dishonest with the public about their true feelings on private for profit health care. Either they are indifferent or in their heart of hearts they think this is part of what they mean when they talk about the need for innovation or part of what they mean when they talk about the accord they want to reach with the health ministers on new federal money, plus innovation and reform in the health care system.

When I asked the Minister of Health the other day in the House if he saw a place for a privately owned chain of MRI clinics in the Liberal vision of health care in this country, he would not answer the question.

If we were going to have an honest debate about health care, then instead of answering a question I did not ask or repeating the mantra about the Canada Health Act, which is what he did, would it not be useful for Canadians to know before the election what the Liberal position on this is? We know what the Conservative position is. We know what the NDP position is. Why can we not know what the Liberal position is? Why can we not even know what their preference is? Liberals might say that this is what they prefer and then go into negotiations with the provinces, but they will not even go there. We hope they might go there today and shed a little light on their position.

While I am talking about user fees, extra billing and the origins of the Canada Health Act, I was very distressed to see that the National Post , in its editorial about the Canada Health Act, actually had the nerve to recommend user fees in an article by Nadeem Esmail, senior health policy analyst at the Fraser Institute. I suppose it does not take much nerve at the Fraser Institute to come up with a recommendation like that. If the Fraser Institute has its way, I cannot believe we will have another debate about user fees. I thought that debate had been put to rest 20 years ago.

We have had study after study. We have the Romanow Commission. We even have studies that do not necessarily agree with everything that the NDP says. None of them have advocated a return to user fees. Unless we have significant enough user fees, the cost of administering them cancels what we gain from the user fees. If we have significant enough user fees, then we begin to punish people who do not have the money straight up to go to the doctor or whatever the case may be, and we begin to penalize people. This has been proven over and over again.

Every once in a while we might get an intelligent notion from the Fraser Institute or from the National Post about these kinds of issues, but to suggest that somehow a return to user fees is the answer is really retrograde and harmful to what could be a useful debate about the future of health care.

While I have not had a chance to check, at the end of the debate on the Canada Health Act 20 years ago, on various occasions during that era I had occasion to say that no amount of principles enshrined in the Canada Health Act and enforced by the federal government would save medicare if it were progressively underfunded to the point where the system became untenable and people therefore felt they needed some kind of alternative to the publicly funded health care system.

We have not exactly reached that point yet, but there is no question that over the last 20 years successive federal governments have unilaterally changed the terms of reference by which medicare was created in the first place. The original deal that brought provinces into medicare, the fiscal midwifery that brought provinces into medicare, was the fact that for every 50¢ provinces spent on health care, they would receive 50¢ from the federal government. What is that 50¢ down to now? The most popular and accepted percentage that I have heard is 16% of spending on health care. Clearly, we have a case of governments progressively, in an unprogressive spirit, reducing the role of the federal government in health care.

This goes all the way back to a Liberal finance minister under Allan McEachern. Under the Mulroney Tories in 1984, the first budget had unilateral cuts in federal spending on health care. This occurred in budget after budget. The mother of all cuts was in the budget of 1995, when the Prime Minister was the then minister of finance. All those other nicks and cuts were bad, but they paled in significance to the cuts that came under this current Prime Minister. Billions of dollars were taken out of the federal transfer to provinces for health care.

It is that cut, the deepest cut of all, that created the circumstances in which we now have this debate. There would not be any need, perceived, real or otherwise, for MRI clinics and for other private for profit delivery of health care services if the public system was adequately funded. If we are to save medicare, the public system does have to be adequately funded or Canadians will rightfully want an option to a system in which they have no trust.

I think at this point Canadians still have trust in their health care system, although they know that it is not perfect. They know that with respect to certain kinds of services, diagnostic tests and others, there are unacceptably long waiting lists, et cetera, but they do not think it is beyond repair, and it is not, if we can gather the political will across this country to create a federal government that is willing to contribute its fair share.

What are we talking about here? Romanow was only talking about 25%. A minute ago, I was talking about 50%. That was the original deal. For the longest time, the NDP and others who were concerned about medicare advocated a return to fifty-fifty cost sharing. We still do in our heart of hearts, in our dream world. However, for now, we would be happy with a Liberal government that is willing to spend 25%, half of the original contribution by the federal government to medicare. That is not what we have over there.

It is clear to us that we need to have a much more honest debate about health care. The Minister of Health has come into the House. I hope he is not here to tell us that he stands by the Canada Health Act over and over again. As I said before, and I will say it for the benefit of the Minister of Health, that is not enough. The Canada Health Act was not designed to deal with that which now threatens the health care system; and that is, the proliferation of private for profit delivery of even insured services. However, we have the private for profit delivery of diagnostic services, which people are able to pay for and then they jump the queue.

Since 1993, there has been a complete lack of will on the part of the Liberals to deal with this. Why have they been unwilling to deal with it? They do not exactly have the moral high ground with the provinces. On the one hand they are drastically reducing their contribution to health care and on the other hand they are laying down the law to the provinces. The provinces are rightly irritated that the Liberals are reneging on the fiscal side, but they want to get tough on the regulatory side, and they have a case with regard to this. Some provinces have tried to deal with it differently than others.

We think it is time for the Liberals to fess up to where they are really at on private for profit delivery of health care. They should share our concern. Even if the for profit sector in our health care system is providing insured services now, at some point a second tier will be created. A private health care system would be created that initially would deliver insured services, but five or ten years from now say that it could make a lot more money if it were not under medicare. It could break free of medicare and create a second private tier all by itself. That is the danger.

Our system has always been an ideological hybrid, but public delivery and non-profit delivery of health care has been the dominant mode. If this Liberal government allows the private for profit delivery of health care to become the dominant mode, to expand even more so than it already has in their last 10 years of government, medicare will suffer a defeat on its watch, despite the fact that the Prime Minister's father had something to do with it in the 1950s.

[Supply, May 11th, 2004]

Mr. Speaker, the NDP is pleased today to provide the House with an opportunity to debate a motion having to do with the delivery of health care in the country. We think it is particularly appropriate given the confusion that seems to abound on the government side with respect to the Liberal position.

We hope that during the course of the debate today, assuming that Liberals wish to speak to the motion, that we might get some clarity with respect to the Liberal position, particularly when it comes to private for profit delivery of health care.

Therefore it is no coincidence that our motion reads:

That this House condemn the private for-profit delivery of health care that this government has allowed to grow since 1993.

In effect, what the motion addresses is the Liberal record, as much as any abstract or ideological debate about the merits of for profit delivery versus non-profit public delivery, although we stand firmly on the side of non-profit and-or public delivery of health care, as did Roy Romanow in his conclusions vis-à-vis the royal commission that was conducted by Mr. Romanow on health care.

However our concern today is what has happened under the Liberals over the last 10 years. Privatization of our health care has increased markedly in that last 10 years,as a result of changes that the Liberals made to the Canada Health Act, as a result of cuts that were made by the Liberals, particularly under the current Prime Minister when he was the minister of finance, and also just the way in which the Liberals have sort of turned a blind eye to the creeping privatization of our health care system. We see that blind eye continuing to operate in the kinds of things that have been said recently by the Minister of Health.

At the same time as he acknowledged that there was room for the private delivery of insured services within the Canada Health Act, he did not express any concern about the tendency of that sector within our health care system to grow. We would have liked to have heard him say that the government was concerned about the growth of that kind of privatization and was determined to do something about it.

Instead, it was obvious that this was regarded as a neutral fact about the current health care system by the Minister of Health. It was only after alarm bells rang that the minister felt obliged to stand and say that the government was not encouraging the private delivery of publicly insured services. However it would have been much more authentic and convincing if this had been said right off the bat, which it was not.

It is also important that we get some clarity on this matter of health care because we are facing an election. In the election it is obvious that the Liberals want to create what we think is a false distinction between themselves and the official opposition when it comes to health care. It is no secret that part of the Liberal strategy is to demonize the official opposition when, in our view, there is very little daylight between the position of the Liberal government and the official opposition when it comes to health care, particularly when it comes to the role of private for profit delivery of health care in the country.

If the House will permit me a little bit of historical reflection, I think I am one of the few members of Parliament left in the Chamber who was here when the Canada Health Act was brought into being in the spring of 1984, 20 years ago. In fact, I was the NDP health critic at that time and sat on the Standing Committee on Health and Welfare that considered the Canada Health Act, amended it and heard the witnesses. Certainly it was one of my formative political experiences to be part of that process by which the Canada Health Act came into being. Therefore I know a little bit about it.

I find it curious that the Minister of Health, instead of answering the questions we ask him in the House of Commons, all he says is that the Liberal government will stand by the Canada Health Act, as if this tells us what we want to know. It is not enough to say that the government will stand by the Canada Health Act because the act, frankly, was not designed to deal with the problems that our health care system has today.

The Canada Health Act, which was the successor to the Medical Care Act which brought medicare into being in the first place, came as a result of advocating that the then Liberal government, under Pierre Trudeau and health minister Monique Bégin, do something about the proliferation of extra billing by physicians and user fees in the health care system.That is what the Canada Health Act, to the extent that it was different than the legislation that proceeded it, was designed to do.

The principles that are embedded in the Canada Health Act were also in the previous legislation. What is substantially new about the Canada Health Act is that it has given the federal government the ability to withhold from provinces, which allow the extra billing and user fees for medically necessary services, the equivalent amounts, so there would be no incentive, in fact there would be a punishment for allowing extra billing and user fees. This is what the Canada Health Act was about.

The Canada Health Act was not designed to punish, discourage or deal with the whole question of privatization. It is quite disingenuous, not to say intellectually dishonest, for the Minister of Health and the ministers of health before him, to get up, whenever they are asked a question about oranges, say privatization, and say that they are all for apples. As I said before, that is not what the Canada Health Act was designed to deal with.

It was very interesting that at that time, in 1983-84, after the second Hall commission report and the recommendations by Justice Emmett Hall, the government would do something like the Canada Health Act. The Conservatives of the day were led by Brian Mulroney after his entry into the House in August 1983 in a byelection in Central Nova. I remember going down to Central Nova to challenge him to a debate on health care, which, incidentally, he did not take up.

In any event, the Conservatives at that time moved to the left to adopt the emerging Liberal position. It was not easy to get the Liberals to move on and create the Canada Health Act. It took three or four years of persistent questioning in the House and agitation by the Canadian Health Coalition, the Canadian Nurses Association and all kinds of people who were concerned about what extra billing and user fees were doing at that time.

The principles are the same with respect to extra billing, user fees and privatization. What unites those issues is the concern that Canadians have to pay out of their own pockets, whether it is in the form of extra billing, user fees or privately run clinics, particularly those who are now making available diagnostic services so that people can actually pay for those services, and then even more unacceptable, jump the queue because they have their diagnosis before someone else who has to wait in the public system.

I want to get back to the politics of this. In 1983-84 Brian Mulroney decided that he would not stick to the usual historical Conservative position on health care, which was to be critical of medicare or at least not defend it. In fact, in all those years leading up to the Canada Health Act I do not think there was a single question asked in the House of Commons by the Conservative opposition at the time with respect to extra billing and user fees, just as, 20 years later, there has not been a single question asked by the Alliance and now Conservative Party in the House leading up to this current debate on health care with respect to privatization, with the exception of the official opposition raising the question of health now as a way of trying to get around the Liberals' strategy.

The difference now is that I think there was for a while, until Mulroney changed it, a genuine difference between the Liberals and the Conservatives at that time. I am not so sure that the Liberal government is anywhere near as progressive when it comes to health care as Monique Bégin and Pierre Trudeau were in the early 1980s and which culminated in the Canada Health Act.

Instead of the Conservative position moving over to adopt the Liberal position, we have a kind of meeting of the minds, and I use that word loosely, meeting somewhere in the middle of the aisle, with there being very little distinction between the Liberals and the Conservatives, when it comes to private delivery of health care.

The leader of the official opposition said--

[Health, May 7th, 2004]

Mr. Speaker, that was a totally deceptive and elusive, if not dishonest, answer. I did not say that the Prime Minister paid for an MRI. I did not even raise it.

I asked the minister whether there was a place in the Liberal vision of the future of health care in this country for a private MRI clinic, for private for profit delivery of insured services.

Is there or is there not a place for that in your vision of health care? Answer the bloody question.

[Health, May 7th, 2004]

Mr. Speaker, my question is for the Minister of Health.

The Minister of Health says that the Liberal policy on health care is no secret. That is certainly the case now but it was not always so when the Liberals were trying to keep their real policy on health care from Canadians. The Minister of Health revealed some of it a few weeks ago, and now we see more of the connection between Liberals and private delivery of medicare.

The question is not about the Prime Minister. The question is about private for profit MRI clinics. Do these kinds of clinics have a place in the future of health care envisioned by the Liberal Party?

[Statistics Canada, May 7th, 2004]

Mr. Speaker, for months the NDP has been objecting to the fact that Statistics Canada contracted out the next census to Lockheed Martin.

Questions in the House resulted in the usual non-answers, but I am pleased to say that as a result of our pursuit of this issue and as a result of the pressure exerted by all those Canadians who contacted Statistics Canada, we learned earlier this week that Lockheed Martin will no longer be doing the next census.

As a result of further pressure later in the week, the remaining role of Lockheed Martin in the mini-census was also identified and then dealt with, that is, eliminated.

I say hats off to the Vive le Canada website and to all those who persuaded Statistics Canada that the integrity of the census was at stake. It is one thing to buy software from a company. It is another thing to have it do what Canadians want done in-house by their own Statistics Canada.

The NDP is pleased to have played a role in changing this policy by working with its extra-parliamentary friends on this issue. Unfortunately, as usual the Liberals never got it and did nothing to help.

[Gasoline Prices, May 6th, 2004]

Mr. Speaker, the Prime Minister acts like he has never been on a committee before and does not know anything about the dynamics of how majorities work. Perhaps he has forgotten.

I want to turn to another issue and that is the issue of gas prices in this country. The NDP has put forward the idea of a fair prices review commission for gas. The government has rejected that.

I have another question for the Prime Minister on another matter having to do with fuel. Why is he backing away on his promise to give a share of the gas tax to cities which they could then use for building public and mass transit in this country so that people would not have to pay high prices for gas?

[Standing Committee on Public Accounts, May 6th, 2004]

Mr. Speaker, I do not know if there is such a thing as a parliamentary tranquilizer but perhaps some could be administered to those members. My question is for the right hon. Prime Minister.

The Prime Minister likes to talk about stark differences and yet the starkest difference in Canadian politics these days is between what the Liberals say and what they do. One law for the Liberals and one law for the rest of us.

The Prime Minister said he thinks it is urgent that the Liberal majority on the public accounts committee report, before the election presumably. He is not concerned that an independent inquiry will not report until over a year after the expected election.

Why does the Prime Minister think that Canadians should go to the polls with only the Liberal view instead of the independent view?

[VIA Rail, May 5th, 2004]

Mr. Speaker, I did include in my question an inquiry as to whether the Prime Minister had conveyed his concerns to President Bush prior to this morning. Perhaps the Prime Minister would like to respond to that.

Further to other questions that we have raised in the House this week about the inclination of the Liberals toward privatizing things, we notice that the Minister of Transport recently made a speech in which he talked about the commercialization of passenger rail in this country.

I want to ask the Minister of Transport, will he tell the House whether the government has any plans to privatize VIA Rail, or will he do the right thing and get up and say that the government has no intention of privatizing VIA Rail?