Mr. Speaker, I appreciate the opportunity today to speak to this issue. I think it is fitting that on the last day of the session of this parliament we spend our time talking about the number one issue on the minds of Canadians across the country.
It is clear that what we are discussing today is a subject of vital importance to Canadians.
The state of our health system is of major concern to our fellow Canadians. It is obvious, and we must be frank during this debate, that we are faced with some major challenges.
We can discuss the long waiting lists, the over-crowded emergency rooms, the shortages of physicians and nurses.
In these circumstances concrete action is required from all governments working together.
In responding to the motion put before the House by the Canadian Alliance Party today, let me make three points. The first is that in the efforts we make to solve the problems facing Canadian health care, we must stick to the principles that are spelled out in the Canada Health Act. Simply stated, a single tier, publicly financed, universal system of health care provided for by the Canada Health Act is the best possible approach to providing health coverage for our population.
Let me explain why I say that. The member for Fraser Valley described the Canada Health Act as an old act, as though somehow in the 16 years since it was adopted by the House the statement of the principles contained in that statute has become outmoded, outdated or must be reframed.
I suggest that the evidence, our experience as Canadians and the experience elsewhere in other countries shows that those five principles in the Canada Health Act are as relevant and as valuable today as they ever were. Those principles are as important and as relevant to health care in Canada today as they were when they were formulated by the Liberal government in 1984.
Why do I say that? I say that for two reasons: First, they spell out the foundation of a system of universal health coverage that is socially fair; and second, they provide for a way of making services available to a population that is economically efficient. I will deal with each of those in turn.
As to social fairness, we all know that Canadians cherish our public system of health care. Why? It is because to them it is about more than just doctors and hospitals; it is about values, about being Canadian and about the way we want to live our lives.
It is about the promise we have made to one another as Canadians that we will look after each other in times of need regardless of wealth or privilege. Access to needed services will not depend on the state of one's bank account, but will be determined by the state of one's health.
That is what the Canada Health Act is all about. It reflects something that lies very close to the heart of this nation's sense of self. For that reason, because of the social fairness of public medicare in Canada, the principles of the Canada Health Act are as important today as ever they were, and it is important that we defend them.
The second reason is economic efficiency. We do not talk about this often enough. Public medicare in Canada allows us to provide health coverage for the population in a way that is less expensive than approaches taken in other nations. Let us look at the comparative situation between Canada and our closest neighbour, the United States. We are so much alike in so many ways, but there are important distinctions that demonstrate the economic value of Canadian medicare.
At the moment, as the member for Red Deer observed this morning, Canadian medicare costs just over 9% of our gross domestic product. For that we insure 100% of our population for medically necessary services. In the United States, health costs are 14.2% of the gross domestic product. Notwithstanding that much higher level of spending, coverage is provided for only part of the population. Today there are 43 million Americans who have no health coverage. There are 100 million Americans who are underinsured and who worry that one day they may have to choose between their health and their homes.
Why is it that we can provide health insurance for everyone for 9% of our gross domestic product and the Americans spend 14.2% and leave so many tens of millions uninsured? It is because the single payer publicly financed universal coverage provided for in the principles of the Canada Health Act is economically efficient. The overhead in the American system is a huge source of cost with so many people providing coverage with private insurers. I will give an example.
Last year a professor from the United States was in Toronto at a conference on this very subject. He described a hospital in Boston which had about the same number of beds as a Toronto hospital. In the Boston hospital there were 317 people in the billings and collection department. In the Toronto hospital there were 16 people in the billings and collection department. That is a vivid illustration of the difference between us.
A few weeks ago I was in Grand Falls, New Brunswick. During my stay in that beautiful community I met a man who had come across the Saint John River from Maine, which is immediately adjacent and just a few moments away from Grand Falls. This American, a resident of Maine, had recently had open heart surgery. He told me that the cost of that surgery was $400,000. This man was among the lucky ones. He had some private health insurance that paid 80% of the cost, but simple arithmetic makes it clear that this man from Maine was obligated to fork out $80,000 of his own money to pay for that open heart surgery. That is a vivid illustration of what happens when private for profit interests take over the organization and delivery of needed medical care.
Surely the case is made to the satisfaction of the party opposite that our first goal must be to hang on to those principles, to preserve this public system of which we should be so proud. In Canada, unique in all the world, we have found a way to provide health coverage to our population that is socially fair, that reflects our values and speaks of the way we treat each other as citizens. At the same time it makes economic sense.
In the course of my work in the Prime Minister's government, I have occasion to travel to other countries or to receive here in Canada health ministers from abroad. In the course of those meetings the subject has often arisen whether Canada should import some of the features of foreign health systems and particularly, as the alliance members would contend, the private for profit element to, as some of them say, take the pressure off our public system.
I can tell the House that without exception, every such foreign minister to whom I have spoken has urged me not to follow that course. They have urged me to hang on to our present public system and to do what we must to fix it, but not to go down the road of the private parallel health system. Why is that? They usually give me the same reasons speaking from the experience in their own countries.
They say that if we open the private parallel system of care, then we will lose doctors, nurses and other health workers to the private system. The problems we have now with providing medical care professionals in the health care services will become even worse. It is often the best and the brightest who leave the system to practise privately.
They emphasized that the private parallel service will focus on the simple repetitive procedures where profit is greatest. And as soon as there is a problem, we know where that case will go. A complication will be sent right back into the public system and the public will end up subsidizing the private for profit sector.
These ministers also pointed out that the private for profit element, the private parallel approach, has not resolved problems in public medicare. England is an example where the waiting lists are worse than ever. In England a person can go for the private for profit parallel services, yet its waiting lists are worse than ever.
The members ought not to think that the simple answer to the problems that confront medicare is to establish the private for profit parallel system. It does not work.
There is one other point that those from other countries urge upon me in arguing that we should keep our public system of medicare in Canada. They point out that if we allow the most influential and wealthiest in our society to purchase access to services, if we allow those with money and influence who help to shape public opinion to purchase access to private services in health care, then to that extent we will reduce the pressure on governments across the country to fix the problems in medicare. It will slip down the public agenda and the problems will not be resolved. That is a very important consideration.
The first of the three points I wish to make this morning in speaking to the member's resolution is that we should do what it takes to hang on to our system of public medicare. It is socially fair and economically efficient and it reflects the best that this country has to offer.
My second point is that the public system of medicare must be financed properly. It must have the money it needs to provide the services that Canadians must have. That includes the obligation of the Government of Canada to do its part in financing public medicare.
In 1993 when this government was elected, the total value of transfers to the provinces was about $28 billion per year. This year the total value of transfers to the provinces will be over $30 billion. We have not only restored the transfers, but we have increased them in the time that this government has been in office.
Every year in Canada the federal government contributes one-third to all public health spending. In the last two years we have increased by 25% the cash transfer to provinces, including $2.5 billion just three months ago.
I am not suggesting that we do enough. Indeed, I am an advocate for increased federal funding for health care and for increasing transfers to the provinces for health. The Prime Minister himself has said that the Government of Canada is prepared to increase transfers to provinces for health when we reach common ground with the provinces on a common vision for the future of medicare and an approach to the problems it faces.
The argument in favour of additional funding from the Government of Canada is clear. In parts of the system more money is needed. If Ottawa is to play its role, if it is to have the moral authority to protect the principles of the Canada Health Act across the country, it must have a credible voice at the table. This government will ensure that the Government of Canada is at the table to play its part in protecting public medicare in this country.
That leads me to the third point I wish to make this morning and it is simply this. It is not just money alone that is going to succeed in solving the problems we confront in medicare. Our goal must not be simply to make health care more expensive in Canada. Our goal must be, by supporting provincial innovation, to make access to quality health care available across this country.
We must work with our provincial partners toward developing a common vision and common approaches to the resolution of these issues. We must speak with our provincial partners about establishing these objectives, finding some way to measure the performance of the health care system, and reporting to Canadians whether we are making progress toward those objectives.
Do not misunderstand. I am not suggesting for a moment that provincial governments are accountable to the Government of Canada, but that governments of both orders are accountable to the public of Canada. We must use common indicators to measure the performance of the system and report to Canadians so that we can work toward restoring public confidence in medicare by proving and by establishing that we are making progress toward our shared goals.
We must also identify areas of innovation. The hon. member for Fraser Valley asked for innovative ideas. He wanted to know what would work and what we could do that would help change the system.
I suggest that we know that, from the national forum which the Prime Minister chaired, to the excellent work the provinces have done, including last week when they tabled their cost driver report, to the innovations that the Government of Canada funded through the health transition fund.
In 1997 we set aside $150 million in the health transition fund. We have funded over 400 pilot projects across the country, demonstrating the value of new approaches in home and community care, in primary health care reform and in integrating health services. We have learned from those pilot projects.
We have watched as provinces themselves have innovated. Now is the time for the Government of Canada to get behind those provincial efforts, to broaden and to accelerate the innovations in which they have engaged in order to make real progress in improving access to quality care.
I believe we know the broad directions we must take. It is now up to governments to work together to ensure that we pursue them.
Primary health care reform and broadening the availability of home and community care, those are the changes that will take the pressure off our emergency rooms by making services accessible. Dealing with shortfalls in medical equipment, investing in health information technology to integrate our health care system and sharing information among providers about patients, dealing with the issues of the right number of doctors, nurses and specialists to care for Canadians, these are the issues we must pursue in common. We have begun.
Let me also mention wellness because there is an important federal role in that regard, not just to think about treating those who are sick but to think about encouraging all to remain well.
Cardiovascular disease continues to be the number one killer in the country. There are four risk factors, three of which are within our control: diet, exercise and smoking. That is why we will continue our aggressive efforts against the tobacco industry to encourage Canadians to understand the tactics of big tobacco, to encourage young people not to begin and to protect children from the tactics of big tobacco.
I stress that we must work with our provincial partners to achieve these goals.
We have already begun. Six months ago, I wrote to my provincial and territorial counterparts, inviting them to the negotiating table, inviting them to work with me to identify priorities and to develop an action plan to address these problems.
This afternoon, I shall be holding a conference call with them. I trust that, in coming weeks, we will be face to face around the negotiating table.
I want to ensure that we put before the first ministers when they meet in September something upon which we can agree as common ground and a common vision for the future.
In conclusion, I do not support the motion before the House. I am as concerned as the next person about the issues in medicare. We are confronting them with our provincial partners. I disagree that the health system is in crisis. I believe we have grave issues to deal with, but let me quote from the provincial report last Friday wherein the provinces said:
Canada's publicly funded health care system is not in crisis. Canadians continue to be well served by their health care system but it is under serious challenges due to rising demand and cost strictures.
I entirely agree with the provinces. Let us work together to make sure that we preserve our greatest social asset, our public medicare system.
