Alex Shepherd

[Supply, June 15th, 2000]

Mr. Speaker, it is a pleasure for me to engage in the debate today on health care.

I had the privilege of hosting a health care forum in my riding only a few weeks ago, so I am very familiar with some of these issues. In attendance were the former Ontario deputy minister of health, some of the leaders of our hospitals, some primary care workers and some home care workers.

We are now having the debate in the House. Members have talked about money. They seem to think that the simple solution is just to put more money into health care and suddenly all the problems will go away.

Members will be interested to know that the health care workers themselves, while they of course would like more money, made the statement that it was not about money. Indeed, Canada is the fourth highest spender on health care in the world. We spend 9.6% of our GDP on health care, $86 billion a year. I have heard members of the Alliance, surprisingly enough, who are so cost conscious, say that maybe it should be 12%. I was quite incensed by that.

One of the conclusions of the health care forum that I put on was that we could not continue to put money in the top of this thing because it was not coming out the bottom and it was not being delivered to the patients.

Do we have a problem in health care? Yes, we do. We have a problem getting the newest technology. If we look at the waiting lists, we see that they are getting longer and, at the same time, we are paying more money for the system. There is definitely something wrong with the system.

We also see that our health care costs have been rising at the rate of about 5% a year and are scheduled, because of our demographics and our aging population, to continue to rise. People say it will rise as high as 6%.

Mr. Speaker, I do not have to tell you, as I know you have studied the economy quite a bit, but our economy is only expanding at the rate of 3% a year. In other words, health care costs are actually rising twice as fast as the economy is growing. Obviously, we cannot continue that because instead of talking about tax cuts, we would be talking about tax increases to maintain a system like that.

There is no question that we need some changes in the health care system but what changes are needed? Maybe some doctors are listening to this today and I do not want to offend them, but one of the comments I heard was that a normal doctor-patient ration is about 2,000 patients to 1 doctor. There are differences depending upon specialization and so forth, but as a general comment, as a quick working tool, based on the province of Ontario's population base, we should have about 5,000 doctors. In fact there are 9,000 doctors in the province of Ontario and I am told Ontario is screaming for more doctors.

What is the problem when we look at that quantitative analysis? One of the other members actually mentioned some of the structural problems. It would appear that many doctors are not engaged in the practice of medicine or, seemingly, not on a full time basis. In fact, it is thought that almost 40% of their time is taken up with administrative duties, such as filling in forms, pushing papers and so forth because of structural problems. By the way, these are structural problems that provinces have put in place.

I dare say that the whole question of malpractice also creeps into this, the question of how to protect oneself in public liability cases. This has created a big paper burden as well for the medical profession. The reality it that these structural problems have basically created a health care system which, quite frankly, is broken and is not working.

By the way, I will be splitting my time with another member.

We can agree on a number of things. First, I do not think we have full agreement about money. I hear politicians of all stripes saying “Another $4 billion on the table will solve all of our problems”. That is not so. If it were $4 billion this year, it would be another $4 billion year after year after year. It will never go away and the system will not get any better because we will not have changed the structural problems with health care.

What are some of the problems in health care as I perceive them? Some of them are that we do not have an integrated health care system. In many of the regions we do not integrate the health care system itself. In other words, when somebody gets sick at home and has to go to the hospital, a bunch of health care providers are involved in that: ambulance drivers, paramedics and so forth. In fact, by the time the person actually ends up in the hospital almost 40% of the costs have got nothing to do with health care workers.

How do we integrate those services to ensure a proper delivery of the system? What occurred to me is that in many parts of this country we do not have a fully integrated health care system. We are not using some of our best technology. We know that we are in a technological revolution but if we go to some of our hospitals, although we do see doctors working on computers rather than working on patients, we also see a lot of people pushing paper around. We also find that we cannot track patients. In other words, we do not have the simple technology of a health card with a computer chip on it that gives information on our health record when we travel from one place to another in this country. We have the technology to do that but we are not spending the money on the technology to make it more efficient. In that sense, we are not using the new technology available.

Because we have so much inefficiency within the health care system, we have also made choices on how we spend the money. We have spent money in areas where it is not very efficient and we have neglected to spend money on those things that are important, like investing in new technologies. I am not just talking about information systems, but also the newest equipment that we need to keep our people healthy.

There is no question that people are healthier today than they were 15 years ago. We would rather be sick today than 15 years ago. All the talk in the House about the health care system being a terrible system has been a little bit overexaggerated.

What are people looking for? They understand that the system is not up to speed. They also recognize that the Canadian population is an aging population and that this problem is just going to continue to get worse. The reality is that they do not really care.

When I had my health care forum, I was amazed that people did not care whether it was the federal or provincial government that was presenting the health care forum. All they wanted was somebody to take some leadership on this file, solve these problems and stop all the finger-pointing back and forth between governments about who is responsible for what. It is not about private health care as opposed to public health care. It is about how we can make the existing system work better.

There are some ways we can make the system work better. We must have an accountability framework to find out what people are concerned about in this country. People are concerned about getting 24 hour primary care. They are concerned about the long waiting lists that they are suffering in getting to see a specialist, in getting specific knee transplant operations, or whatever the case may be. We can define the targets.

What do we have to do as a government? Unfortunately, or some may say, fortunately, we do not administer the health care system. We are simply the givers of money. People are fed up with that kind of attitude. It is not about giving money. The federal government must re-impose a vision of health care in this country. That vision must be from sea to sea to sea and it must be based on basic standards that people find acceptable.

When we put the money on the table we are going to say that we are putting it on the table but under certain conditions. The conditions will be that these objectives may not be met today, but that over a period of time we must see progress in creating a better health care system or there will be no more money.

Maybe some of the provinces will not buy into this accountability network. We must also get the provinces working together. The provinces must have their own permanent registry system so that they can determine best practices between provinces. One of the other members talked about the inter-transfers between provinces not working well. The sharing of best practices between provinces does not exist. The sharing of medical records does not seem to exist. We have to do these fundamental things in order to have a better health care system.

I believe that is what the Canadian people want. They want to stop this silly debate that we are having in the House and in the media about money, money, money. This is not just about money. It is a much more difficult problem to solve. We have it within our power to solve it. That is the vision that this government has going forward.

[Petitions, June 14th, 2000]

Mr. Speaker, it is my pleasure to present a petition on behalf of 122 of my constituents. They note that on July 22, 1997 the CRTC ruled against the licensing of four religious broadcasters, including one Roman Catholic and three multi-denominational broadcasters, while at the same time approving, in their definition, the pornographic program Playboy .

As a consequence, the petitioners request that parliament review the mandate of the CRTC and direct the CRTC to administer a new policy which will encourage the licensing of single faith religious broadcasters, including EWTN and TVN.

[Nuclear Energy, June 8th, 2000]

Mr. Speaker, my question is for the Minister of Natural Resources.

Ontario Power Generation is currently negotiating the sale of Canada's largest nuclear reactor to a foreign owned corporation. Given Canada's dependence on energy, is it appropriate to have our nuclear industry owned and controlled from outside our borders and is public safety being sacrificed on the altar of profit maximization?

[Budget Implementation Act, 2000, June 6th, 2000]

Mr. Speaker, I did not vote on the previous motion and I wish to vote in favour and vote with the government on this one.

[Budget Implementation Act, 2000, June 5th, 2000]

Madam Speaker, I listened intently to the member for Saanich—Gulf Islands. Once again the Canadian Alliance Party is back on its kick of a flat tax. Everyone in the Canadian Alliance dream world believes that everyone will get a tax break: from the poorest to the richest everyone will benefit from a flat tax. Most of us know this is not possible. I do not think we can fool the Canadian people.

When we start looking at the concept of a flat tax, the reality is that any of the so-called people who support that philosophy must find other ways of reducing revenue to make it work. Most of us would understand that if we are collecting x numbers of dollars in revenue and personal income taxes today, in order to impose a flat tax there has to be a shift between taxpayers from poor people to the wealthy. In other words, wealthier people would be paying significantly less tax and poor people would be paying more. That is the way it has to happen. There is no other way for it to be effective.

Canadian Alliance members would have us not understand that they would also gut a lot of other programs. We heard the member allude to private health care, the CBC and other things they would simply gut. That is how it works. They would gut government programs that people are now receiving. Undoubtedly some the people in the low tax range who would benefit in his wonderful dream world are the people who would miss the services.

Why do members of the Canadian Alliance not just come clean with people and tell the truth? A flat tax will be a shift in taxes away from the wealthy to the middle income earners. The only way to give everyone a tax break in a magical world is to gut government programs. Why does the member not just admit that?

[Supply, May 18th, 2000]

Mr. Speaker, I listened very intently to the member's speech. He mentioned a lot of things that have merit. While he described some of the chronic problems of the health care system, he has taken all the examples, turned them around and shifted them solely on to the shoulders of the federal government.

I criticized some of my other colleagues who want to get this done on the basis of money because I do not think it is about money, but the hon. member seems to think that the sole purpose of the federal government is to dole out money. I should like to have the member's opinion.

In approximately 20 minutes some of his colleagues in the front row will jump up to cross-examine the government. They will say taxes have to be reduced, that expenses have to be cut and so forth. Yet the member says that we should be spending significantly more money on health care. I think some more funding is in the cards.

Having said that and looking at the reality in terms of spending on health care, 10% of our gross domestic product is spent on health care. In all seriousness, if they criticize the federal government for not spending enough money, what is the percentage of our gross domestic product that Canada should spend on health care? We are already one of the highest spenders in the world. I want the member to be honest and tell me if the issue is about spending or the administration of the spending.

[Supply, May 18th, 2000]

Mr. Speaker, by all means, no I would not. But I would not be like the province of Ontario which is saying that it does not have any money when in fact it has $300 million sitting in an account. It turned around and took $160 million out and did not spend it on health care. It spent it on tax cuts. That is not my idea of leadership on the health care file.

[Supply, May 18th, 2000]

Mr. Speaker, I talk to our health care workers, people such as nurses who actually work in the system. They have told me that more money is not the answer. If we pump more money into the system, it is going to be just as inefficient as it is today.

The only way the federal government can show leadership on this file is to say that these are the ways the health care system should change across the country from sea to sea to sea. Yes, we will put some more money on the table, but we want to see commitment from the provinces that they are going to spend it on improving health care for people.

[Supply, May 18th, 2000]

Mr. Speaker, the issue of a collapsing health care system occurred while there was that $25 billion. By the way, the statistics are quite clear. With the transfer payments we have restored all the money that we were funding in health care back in 1993-94. Does the member want to ignore reality and forget about tax points?

That is just not reality. The money is back in the system today. My province has something like $300 million from the federal government in one time start up funding that was not even spent on health care. So do not tell me that the provinces know how to spend money on health care. The fact is that health care across the country is in collapse and the provinces are responsible.

[Supply, May 18th, 2000]

Mr. Speaker, that is very simple. The people of Canada are not asking for more money. It is the members of New Democratic Party because they cannot think themselves beyond dollars and cents.

The people in my riding are asking us for better quality health care. That is the issue, better quality health care, not more money. Let us talk about money.

I heard these comments today, that now we have $14 billion more in surplus. But we forget about the $890 billion in debt that the country still has and the $44 billion we spend every year in servicing that debt. The members over there would walk away from it; to heck with money, money is not important.