Grant Hill

[Supply, May 18th, 2000]

Mr. Speaker, I had an opportunity to ask the member from Vancouver what he thought of a private facility in Vancouver. Let me take the opportunity to ask the member from Nova Scotia what he thinks of the Wolfville hospital in Nova Scotia. That hospital was threatened with closure and the Wolfville citizens said, “You are not closing down our hospital”.

Here is what they did. They said they would disregard some of the rules and regulations and charge people for some things such as syringes when they go to emergency. That is against the Canada Health Act according to the rules. That is a user fee. However, the people of Wolfville said their hospital was more important than some rules.

What does the member from Nova Scotia say to the citizens of Wolfville who valued their hospital more than the rules?

[Supply, May 18th, 2000]

Mr. Speaker, the member for Vancouver Quadra lives fairly close to a private clinic called the Cambie Clinic. This clinic is unable to look after individuals from British Columbia. It is illegal for them to enter the door. But this clinic can look after people from the U.S., from Asia, from Alberta, people who come from outside B.C.'s boundaries. However, those who are Workers' Compensation Board patients and those who have become sick through the armed forces or the RCMP have access to that private clinic.

Does this clinic cause any anxiety to the member opposite?

[Supply, May 18th, 2000]

Mr. Speaker, the member for Durham said that some of the provinces that were given money by the federal government kept that money. With his accounting background, he would recognize that the money transferred to the provinces was for three years.

If he were in the province and received $100 million for health care, would he have spent that $100 million in the first week, or would he have spread it out over three years, which is what the provinces are doing?

[Supply, May 18th, 2000]

Mr. Speaker, I thank the hon. member for that sensible question. The issue of brain drain could not be made more clear than to recognize that one-third of the current medical graduates from our 16 medical schools in Canada do not set up practice in Canada. They leave this country and never set up practice. That is a tragedy. We, as taxpayers, have a lot to say in terms of their training.

On the issue of foreign graduates and other individuals, some of them are driving taxis while their medical credentials are left unused. That is another tragedy.

We have a closed shop mentality in our country. We have an idea that the only training that is good is North American training, and that is not accurate. Those individuals should be able to pass an examination. I would open my arms and my heart to their experience, their thoughts, their ideas and their talents. Many of them go to far-flung spots to practise in areas that have difficulty getting practitioners. They will go anywhere to practise their skills.

The sad thing is that governments bought the idea that physicians were driving health care costs and if we restricted the number of physicians we would drive down costs. It would be wrong for me to talk so much about physicians. There is a shortage of nurses now due to the same issue.

It is a very sensible suggestion and I appreciate the hon. member's input.

[Supply, May 18th, 2000]

Mr. Speaker, what a refreshing change to actually have a non-attack. That is a very legitimate question and one which I appreciate.

Since I did tonsillectomies on my own in a public facility, I know that the complication rate is somewhere around 1%. Of 100 tonsillectomies, one of them will bleed and require the trip to the major facility the member talks about.

Would I then do the 100 in the $1,000 or $1,500 a day facility? Not a chance. I would do the 100 in the $150 a day facility and for the complication would go to the big major public facility. Surely the math is not tough to figure out. They are both being covered by public funds. They are not being covered by private funds because a tonsillectomy is an insured service under medicare.

It would be a very legitimate concern if there were 99 coming from the one facility and plugging up the major facility. Surely the 99 that would be done outside the major hospital would open up beds that are not currently opened up.

I thank the hon. member for what I consider to be a constructive, eyeball to eyeball comment. It is refreshing and a treat to get.

[Supply, May 18th, 2000]

Mr. Speaker, in reference to skating, I think he checked me into the boards and it was not very nice at all. I meant that as a joke, it is not true at all.

On the issue of a two tier system, personally I reject two tier medicine. My colleague from Esquimalt—Juan de Fuca who is also a physician has chosen that as his solution. That is a personal solution. That is not the alliance position.

I have already suggested the sort of thing I think would be useful to innovate in health care. We need to have more responsibility for knowing what the costs are and have a reason to husband the resources. Let me take this opportunity to put forward another suggestion.

Every patient for every service in Canada should get a bill that shows the date for the service, what the service was and what the cost was and they should have to sign it. They would not pay a nickel for that bill, but they would simply sign it to say that they received it. That would do two things. It would let them know what the procedure cost and it would also prevent extra billing or padded billing by physicians. Some physicians put in bills that are not really appropriate. My colleagues do not like me to say that, but it is accurate and true. This would be a mechanism for bringing some of the responsibility back to the individual patient. There is none today.

My colleague across the way said that I skated around. I hope that is as direct and forceful a way of saying what I believe should be some of the changes.

I am willing to listen to others. Would the Minister of Health say the same thing? I wish he would.

[Supply, May 18th, 2000]

My colleague across the way said to elect Liberals. Maybe that would happen if bill 11 is inappropriate. But do we need an all-seeing omnipotent health minister from Ottawa to come along and say he does not think the motive behind the bill is good? Not in my books we do not.

I do not have forever, but I will talk about a couple of other innovations which I think are worth considering. These are for public consumption, to reject, think about, or not. This is not alliance policy. These are my thoughts on the issue.

What about thinking of a completely different way of delivering the money to individuals in Canada for health care services? What about a medisave account? I would equate this to an insurance policy on a car. We do not insure our cars for oil changes. We insure them for major catastrophes like an awful crash that would break us if it happened. We insure for the repair bills on a major issue.

What if we insured for catastrophic things in Canada? Instead of giving money to the governments to look after everything, what if we gave $100 to each patient in a medisave account? This would be for the regular run of the mill preventive things, regular checkups, a visit to the emergency room for suturing and whatnot. It would be the patient's responsibility. That first $100, which is a very arbitrary figure, would be the patient's responsibility. The person would not spend it if he or she did not need it. The government would allow the person to put those funds into retirement, but the person would be able to keep those funds in a medisave account for the future.

What would that do? That would make people think about what medical procedures cost in this country. Many do not know. Many do not know what an ultrasound for a newborn baby is worth today because they never ever get a bill for it. It is free, paid for by the taxpayer.

That would put a person in a position where, if they had had a cardiogram a year ago and had paid for it out of their medisave account, and they were told during their annual physical they needed a cardiogram again, they might ask whether they really did need it because it would eat up their medisave money. There would be a discussion as to whether or not that would be useful. I believe there is some degree of personal responsibility when it comes to the funding for our health care system.

That was the medisave account idea. It was a very brief overview and I admit not very thorough, but it is an idea.

I have a second idea. The threat of suit in Canada for nurses and doctors is a major cost driver. Somebody who comes into the office with a headache is often given procedures that are not really the best for looking after a headache. They are procedures that are designed to prevent a suit, prevent medical legal action if the individual ends up having more than a simple headache, for example a tumour. The medical legal system in this country is driving costs up. It is becoming more and more like the U.S. in terms of litigation.

In my first speech in the House many years ago I asked the health minister to address the issue of medical jurisprudence. I thought as a lawyer he would grab on to that. Of course, it would mean fewer lawyers, so maybe I understand now.

What principles do I think should guide the federal government on health care? First, I value our public system. I have practised in it and I know that it is a valuable system. But I think we have gone astray when we talk about American style two tier, because on this issue it is literally the wrong debate. Medicare is being used in most countries in the world. It is not being used in the U.S. Taxpayer funded medicare is not there.

When we compare ourselves, let us compare ourselves to similar medicare systems such as those in Europe, Asia or Scandinavia. Countries there have chosen some safety valves in addition to taxpayer funded medicare. Medicare is not falling apart. It is not going down the tubes. Ours would not either if we looked at some of those innovations.

The big principle is that we should remember the patient. Let us put the patient first. Let us stop putting the system first. If we did that in our deliberations here in Ottawa and across Canada, we would be much farther ahead.

The federal government has a role as a paymaster. It is so straightforward that the funding should be predictable. It should be obvious that it is going to medicare and it should be growing with our population growth. Our aging population is another issue. As a paymaster the federal government has a very specific role to play.

The health minister said he would play the role if the provinces played by his rules. I disagree with that. The current approach of threatening the provinces if they do not follow the health minister's rules to bring in health police to enhance the number of people wandering around the country trying to find breaks to the Canada Health Act, deeming private clinics as hospitals, have we ever heard a more legalistic view? Deeming. He is going to deem a private clinic as a hospital.

I say again that if we forget about imperilling the system and instead look at the perils to the patient, we will be better off.

[Supply, May 18th, 2000]

Mr. Speaker, I appreciate the opportunity to speak to health care in broad terms and Alberta's bill 11 in more specific terms.

It is interesting that the NDP has actually called for amendments to the Canada Health Act. It does that with a view to strengthening the Canada Health Act, in its opinion. My idea of going down that road would be to make the Canada Health Act more rigid, and I would not do so. I would like to make the Canada Health Act more innovative and allow some changes.

Let me talk briefly about the Canada Health Act and how it is doing, a subject that is not often addressed in the House. I should like to talk first about portability, one of the big principles of the Canada Health Act. How are we doing with portability?

As far as the people of Quebec are concerned, each Quebec patient who goes to another province has difficulty with services, because the Province of Quebec does not pay full compensation for services provided in the other provinces.

Portability in this instance is being broken every day. The health minister sits here saying that he is the enforcer of the Canada Health Act. My comment is that it is complete nonsense because portability is being broken. He knows it, and he does nothing about portability.

How are we doing with accessibility in the Canada Health Act? It is pretty straightforward. We just have to look at the waiting lines in Canada. They are now being monitored by the government. A year ago it set up a monitoring system to see how we were doing with the waiting lists.

I wait with great interest to see what that monitoring shows. There are monitors that have been doing this for almost 10 years now. I monitored it as a physician in my own practice. When I set up my practice in 1970 and I closed it in 1993 I know my patients were waiting longer for services. On accessibility we are doing very poorly.

Comprehensiveness is another big principle of the Canada Health Act. How are we doing with comprehensiveness? I listened to members opposite say that delisting is going on. That is absolutely true. More and more procedures are being taken off the provincial lists of what is covered and what is not covered by health care. Comprehensiveness is also at risk.

One part of the Canada Health Act is doing wonderfully well, and that is public administration. There is a monopoly in health care in Canada which many of us believe is serving the Canadian public poorly.

Medicare is in stress. This is not unique to Canada, but there are specific things going on in Canada which put our medicare system even more at stress. I have mentioned the waiting lines. I have not mentioned the brain drain of some of our most experienced nurses, lab technicians and physicians who are leaving the country.

One of the big reasons for it is that we are falling behind in technology. A well trained nurse who works in a critical care unit and does not have the most modern facilities says “I am doing a bad job. I learned in school how to do a better job. Just across the line in Boston they have better equipment. I will go there and serve my patients better”. I hear people say that it is only about income. It is not. There is an income difference. There is a tax difference. There is also a technology difference.

I am reminded of a young woman who told me the other day that she was having trouble getting pregnant. She went to her physician in Ottawa who said that at one time there was no problem because there were a couple of world experts in obstetrics in Ottawa. He wanted to send her to them but they had both left. One of them is in Boston and the other is in Florida. He said she would have to wait a little while until we get another world renowned expert in obstetrics for those who are having trouble getting pregnant. That was in Ottawa, and that is taking place in every city in the country.

I mentioned technology. There are ways to measure it. We have dropped from the top three in technology in 1993 in the OECD countries to being number twenty-three. Something happened in 1993. Most people who watch politics will know that there was a new government elected at that point in time.

I will speak specifically to bill 11, what it means and what I think it offers to Canadians. I am not certain that bill 11 is the answer for waiting lists, but the Klein government has plainly said that it wants to try a specific mechanism to reduce the waiting lines in that province. Waiting lines are measurable. It is not that tough. It also said if there were complications in terms of minor procedures that it would allow people to stay overnight in private facilities which exist in Alberta and in every other province.

For those who stand back and say that we should not talk about private for profit facilities, every abortion clinic in the country, every Morgentaler clinic, is a private for profit clinic. I know that my colleagues in other parties recognize this but will not talk about it. They will not talk about the cosmetic surgery clinics that are totally private and are doing things that are outside medicare because they are not covered by the system. They will not talk about private facilities that are doing minor procedures like vasectomies outside hospitals.

Is there some advantage to those facilities? There are some potential problems recognized but there are some advantages. The cost per day to the taxpayers for a major hospital with an emergency, critical care and administration is about $1,500. A private freestanding facility with very little administrative cost, with all the cost being borne by the people who are investors in that clinic, some of whom might well be nurses or lab techs, has relatively low costs which average somewhere around $150 per day in terms of overall cost.

Could we take a minor procedure like a tonsillectomy from a major hospital costing $1,500 a day and do it in a facility costing $150 a day? Could we free up some spaces in that $1,500 a day facility for the bigger procedures that are required to happen there, the major surgery, the major problems? There is some advantage to moving such procedures out of the big facility and into a smaller one.

Bill 11, according to the health minister's own words, does not tread on the Canada Health Act. However he says that it might. Here we are talking about motivation. He said that there was a threat of selling uninsured services while offering insured services. He said to me today that was not done in any other facility or province. I want to say that is categorically and demonstrably false.

I hope the minister will listen to this example. In every emergency department in the country that provides insured services an individual with a broken arm can obtain a cast. The cast is covered by health care. However, if the individual wants to upgrade the cast to a fibreglass one he or she will pay. It is the individual's decision. It is a little lighter. It is waterproof. It allows significant mobility in some cases.

That upgraded service, that enhanced service that is not covered by medicare, is being provided in a facility which provides insured services. The minister says that it is not the same. I beg to differ. Is it not for profit? Out of the pocket comes the $10 for the fibreglass cast. That is an uninsured service being provided by an insured facility. The minister can say anything he wants. It is just flat out provided.

Let me go to bill 11. I have a copy of it. I believe in going to the source. As I said, this is Alberta's mechanism to try to reduce waiting lines for surgery. Will it be successful? I am not sure but I am willing to give them a chance to prove that it will be.

On the issue of enhanced services bill 11 says that enhanced medical goods and services are upgrades that are not medically necessary, like foldable lenses for cataract surgery. A person might choose those upgrades. A sensible patient could say that a foldable lens has some advantages. It is not covered under medicare, so he or she will have to pay for it. The information must be explained to the person in writing. It cannot be nudge, nudge, wink, wink, we cannot provide the lens wanted but only the enhanced lens. The information must be provided in writing with an outline of the costs and advantages. Patients then have an opportunity to review it and change their minds as long as they have not received the service.

There is are big fines of $10,000 for the offence of not providing the information and $20,000 for every offence thereafter. This is legalistic stuff. I think the health minister would like it. It is important to note that if the upgraded product or service is all that is available, in other words if the foldable lens is all that is available, it cannot be charged outside medicare.

This gets away from the legitimate concern that the facility might say that it has no lenses other than foldable lenses. If foldable lenses are all that is available, it cannot charge for them. Those are responses to legitimate concerns. I admit the concerns are legitimate because it would break the principles of the public health care system if those services were offered in an inappropriate way.

I strayed from my NDP colleagues and the health minister on bill 11. Will it work? This is Alberta's opportunity to prove whether or not it will work. Would I hire more health police to look after it? There are health police in Alberta. There are patients in every hospital in Alberta in waiting lines. They will decide whether to step out of a waiting line and go to an overnight facility to receive services. If it were my mom, I might take her in my car and try to get her out of the waiting line.

Should we let Albertans decide this? If it does not work, what will happen? Bye-bye bill 11, maybe bye-bye Klein. I think Albertans will turf Klein out if it is an inappropriate bill. We do not need health police.

[Supply, May 18th, 2000]

Mr. Speaker, I will try the same question that I asked of the NDP.

In B.C. contracting out for private facilities is being attempted to reduce the waiting lines on some minor surgery and cataract surgery. Does this minister have a problem with the NDP government in B.C. doing that, yes or no?

[Supply, May 18th, 2000]

Mr. Speaker, my colleague asked a question of the leader of the NDP a few moments ago. He tried to do it twice and did not get an answer, so I would like to try again.

The NDP government in B.C. wants to protect medicare, as I believe every individual in the House wants to do. It has recently experimented with private practice procedures relating to cataract surgery and minor surgical procedures. They have reduced the waiting lines for those two procedures in a relatively short time. This is an innovation and it involves doing exactly what bill 11 attempts to do, reduce waiting lines in Alberta. The NDP government is making innovations in exactly the same way.

Would the member comment about B.C.'s attempt to reduce waiting lines by doing exactly what bill 11 is trying to do?