Madam Speaker, I was going to approach the issue of international ranking in the middle of my speech today but just so we do not lose some of the audience, in 1993 Canada was in second place in international ranking. The member was accurate. The National Forum on Health did quote accurate figures.
Since that time we have slipped to fifth place in the world. The U.S. is still at the top. We have been passed by Germany, Switzerland and France. The figures I am quoting are not completely up to date in terms of this day, but we are still dropping in terms of international comparison. For the edification of the member across the way, internationally we are not in second place any more.
As a physician, normally I would approach a debate on health care with a big smile on my face. When I came to parliament it was an opportunity for me to try to express what it is like to be a practising physician in Canada today. I could not express how much enjoyment that would give me. I felt I would be able to bring some common sense to the debate.
I have been really disappointed with the response of the government particularly on health care. I will talk about this in relation to priorities. If I were titling my talk, the title would be “messed up priorities”.
A significant budget was recently handed down. I want to compare what that budget did with grants and contributions in relation to spending on health care. My Liberal colleagues will leave because they do not want to hear this. I can understand their not wanting to listen to it.
I will not start from 1993; I will actually start from 1994 when it is fair to say that my Liberal colleagues had a responsibility for the spending in that year. In 1993 they had just been elected. I will not comment on the previous spending. In 1993 boondoggle prone grants and contributions—when I say grants and contributions, these are programs that can be misused—totalled just under $14 billion. The expenditures for health from that party totalled $7.5 billion. This is CHST cash for health; I am taking out the post-secondary education.
As we went along, the Liberals said there were terrible problems with the deficit, that they had to drop those important expenditures and they dropped them. The CHST component for health plunged from $7.5 billion down to $5.5 billion. That is the CHST cash component for health. What happened to the boondoggle prone grants and contributions component? It dropped a little, from $13.75 billion down to $12.5 billion.
Those were the priorities of the election ready Liberal crew. Boondoggle prone grants and contributions went as low as $12.5 billion. The health portion of the CHST went well down below $6 billion. Is that a messed up priority?
As the last member did, I am going at this from the financial component only. Let us count the tax points and cash. Let us compare 1993 with today. Let us do it per capita. What really matters to the Canadian public is how much money we have per person for transfers.
In 1993-94 before the cuts took place there was $636 per capita on the cash component. In 1999, the last year we have accurate figures for, the cash component was $483 per person in Canada. I will use the tax points in the broad figure. When they started there was a total of $28.991 billion in transfers. It dropped down to as low as $25 billion, and this year it is just again reaching the point.
In the interim, what happened to the per capita expenditures? Almost $30 billion was spent on foolish expenditures, stupid expenditures if I could be so bold as to use a stronger word.
The grants and contributions were mishandled. The audit told us that. In the Prime Minister's riding I call them Shawinigan shenanigans. There was a golf course, which was not a high priority. There were sawmill funds. A special friend of the Prime Minister's stepped up and said “We can get you funds”. He is being investigated because he is an unregistered lobbyist. There were funds for a lit fountain in the Prime Minister's riding, instead of emergency care, organ transplants and compensation for hepatitis C victims. We have RCMP investigations.
What did this budget do? It rewarded the minister of HRDC. It gave her more money. There was no mention of the problem, no retreat, no apology to the Canadian public and no commentary to the ministers of health for the provinces saying “We think grants and contributions are more important than health care”.
What is the role of the finance minister? He is the overseer of the public purse. We trust him to look at the overall expenditures of the government. We trust him to say that health care is a high priority. We trust that, as soon as funds are available, he will put those funds into health.
He sets the broad policy by funds available. What did he do? In the next four years there will be $2.5 billion. What does that mean per capita? It is $83 per capita. If we only consider the health component, it is half of that, or $41.50 per capita for health. That is the figure to which I would like the public to pay attention, the per capita expenditures of the federal government for health.
This is not apples and oranges; this is a specific comparison. If we look at 1993 and we look at 2000, we will not be impressed.
The Prime Minister should lead by example. When he was on this side of the House he said that if there were problems in a department there would be no excuses. There would be no way the minister would get out by blaming somebody else. There would be no cover-ups. The minister would take the responsibility. His responsibility, in my view, would be to remove incompetence from his cabinet.
It is obvious that medicare is under stress. I will go over the three big reasons for that. The debt the country undertook in the last 20 or 30 years is robbing us of a lot of money which we would normally put toward our social programs. Interest payments on the debt amount to $35 billion or $40 billion a year. That debt is a significant reason our health care system is under stress.
Let us look at our debt paydown and compare it to other countries. Australia was in trouble with its debt. It looks like Australia will have its debt paid down in three years. If the U.S. continues on its track, in 11 to 12 years its debt will be paid down. Where are we in our debt repayment program? If we continue like we are going, our debt will be paid down in 150 years. If I delivered babies I would have to be here for six generations to see that take place. That is a significant issue for our health care system.
There are other big problems. We have an aging population. The baby boomers who will be coming through the system will create a big bulge. What we are doing today is not sustainable and the health minister has finally recognized this. He is saying that the status quo is not good enough. That is a tough thing for a health minister to say, because that can raise all kinds of spectres of terrible things happening. The status quo is not good enough.
When I started my practice, organ transplantation was something that was done experimentally. I now see people having such things as hip replacements, extending their useful lives for 15 to 20 years. Those are very expensive things that were never even thought of when I started my practice. MRIs and ultrasounds were experimental. Now, although they are expensive, they are valuable and they do extend people's lives.
This is not an academic discussion. This is not a financial discussion. This is really and truly a discussion about individuals. I wish we could stop talking about the system and start thinking about the patient. If we could do that I think we would have a much better chance of fixing the system.
The future of medicare, frankly, is in doubt. There are long waits, inferior technology, anxiety and brain drain. Some of our finest nurses have left the country. They were turned away from secure jobs because the funding was not there.
I hesitate to go into the finances of this problem because it sounds like that is where my interests lie. That is not where my interests lie. However, I hear comments from the health minister which are inaccurate and I want to raise them. He says that we spend $60 billion in Canada on the public component of health care. What he omits to say is that our total expenditure on health care is touching on $90 billion.
I share the concerns of my NDP colleagues who fear privatization, who fear the U.S. style of health care. That is not the way to go. However, they should recognize and accept that 30% of our health care dollars in Canada today are private. There are many things which are not covered by medicare, such as plastic surgery, cosmetic changes and, in some provinces, sex changes. There are new technologies, such as new prostate therapies, which are not covered. Some of them should not be covered and maybe some of them should be, but 30% today is private.
When my colleagues raise the spectre of two tier American style health care I ask them only to do one thing: look at the balance of the world, look at Europe, look at Scandinavia, look at all of the other industrialized countries and find a country other than the U.S. to compare us with. Compare us in terms of private versus public expenditures on health and compare us with Europe. There is no other industrialized country in the world that has given the public purse the monopoly on health care.
I will return to the comparison of international expenditures. To be accurate, this is 1997. It is not today. The latest figures are not available to us.
Let us compare Canada in terms of its public spending, taxpayer funded spending, on health care. We are 10th in the world and falling. My colleagues ignore that completely. Other countries are spending more for public health care than Canada.
Let us take France as an example. France is in third place, spending 7.1% of its GDP on the public component.
Where is Canada in private expenditures? We are in seventh place, at 2.8%. Fifth place overall, 9.2%; tenth place in public, 6.4%; seventh place in private.
Like my colleagues in the NDP who fear the U.S. style of two tier health care, I do not like it, but let us look at the innovative changes that have been taking place in Europe. Look at those and ask if there is something we can learn in those jurisdictions, because I think we can.
What has been the response of the provinces to this budget in relation to health? There has been a pretty vigorous denunciation.
Personality conflicts and politics aside, what do the Liberal provincial governments in Canada have to say about this budget? I can sum it up. I will sum it up by giving it a thumbs down.
Is it all just about a political battle? I do not think so. I think that it really and truly is because the provinces are faced with dealing with an aging population. They are faced with dealing with a population that is rising in numbers. They are faced with dealing with this new technology.
What has been the federal health minister's response? He says that money is not the only thing; it is one component, but we need physically to go at this with new proposals. Now there is a point on which we can agree: new proposals.
What are his proposals? He says that we need to have national pharmacare and that we need to have national home care. His promise is that, if the provinces will come along, he will fund 50%.
Is that not eerily familiar to a promise that was made back in the 1960s? I remember it well. The federal government said it would fund 50% of medicare. The provinces said “That is a pretty good deal. We will buy into that”. Then the funds started drying up.
Why would the provinces enter into any program with a federal government which pulled the plug on funding soon thereafter? They are not stupid. They can remember. I am not surprised that the provincial response has been one of great hesitation.
I am going to talk for a moment about a subject which we might say is not exactly covered here. I am going to talk about hepatitis C. As the previous health critic for our party, I fought vigorously for hepatitis C compensation for all victims of tainted blood. I do not get a chance to speak of this daily, as I did for a long time, but I want to bring it up today.
There has not been one penny in compensation from the promise made by the government to hepatitis C victims. Not one penny has gone to them. It has been two years. Who is happy? The lawyers are happy. The lawyers who have been involved in this process are real happy because their funds are going up. The victims' funds have not been disbursed.
The government chose the wrong mechanism. It chose a legal argument, rather than saying that if the regulators had failed it had a responsibility and would transfer funds to those poor souls who were injured. It chose a legalistic mechanism. That legalistic mechanism was wrong.
I will never forget Joey Haché, a young man who came to the House. He stood here and said “I am going to be the Prime Minister's conscience”. He continues to be the Prime Minister's conscience. He rode across the country on a bicycle to raise awareness for hepatitis C.
I cannot help but think, in the order of priorities, what do the grants and contributions in the billions of dollars to get elected have to do with Joey Haché and the victims of hepatitis C? They have nothing to do with Joey Haché. I am profoundly disappointed that the victims have not been taken care of.
The debate on health care is here whether we like it or not. There are people who will tell us not to look at anything related to private insurance and not to look at anything related to the comparison of the most efficient use of resources. I simply say that today in Canada we do not have a one tier system. Our system is at least three tiered. We have a tier for the average Joe, we have a tier for the athletes and the politicians and we have a tier for those who are plugged into the system.
There are people who can leave and quickly get services outside this country. That tier is one which I want to capture and keep here in Canada. I want those individuals to feel that they have the highest quality of care here in Canada, if the wait is too long here in Canada.
The debate on medicare can turn into a slanging match. I think it is fair to say that there is a fear in Canada of the U.S. style of medicare. That is a fear which I share.
Let us look at Europe and let us get a Canadian made solution to make this program sustainable. If we do not, we are going to be criticized forever.
