Mr. Speaker, I am grateful for the opportunity today to talk about medicare and the Canada Health Act. I want to explain how and why the government supports medicare and why we on this side of the House will continue to support it.
The federal budget tabled in February was one of the most widely supported budgets in the history of Canada. Some people, in particular the Reform Party, say the budget raises questions about our commitment to health. They ask whether we will continue to have the capacity to maintain a national system and they ask whether we will uphold the principles of the Canada Health Act.
There are no grounds for dire predictions that the federal government will not be able to uphold the Canada Health Act or that Canada's health care system will disintegrate as a result of the budget. Take the new Canada social and health transfer. It will not diminish, weaken or erode the strength of our health system.
On many occasions the Prime Minister and the Minister of Health have been quite clear on the matter. Let me remind the House how clear the budget speech was on this matter. The Minister of Finance said no change will be made to the Canada Health Act.
The Minister of Health was equally clear when she spoke to the Canadian Hospital Association last March: "There is no change in the government's commitment or in my own commitment, to uphold and enforce the principles of the Canada Health Act". As the Prime Minister said in Saskatoon, for Canadians these principles are non-negotiable.
The word health was added to the title of the new transfer when the enabling budget legislation was introduced to the House. This was no accident. It confirms the government's intention to remain active in enforcing the principles of the Canada Health Act.
The new transfer agreement will be in a block funding arrangement. That move may worry some members but let us not forget block funding for health care and post-secondary education is now 18 years old. The established programs financing funding mechanism put in place in 1977 is a block funding arrangement. There is no requirement in it for provinces to spend money on health. However, what is there and what was nailed down in 1984 when the Liberal government passed the Canada Health Act is the requirement that provinces deliver health care services in compliance with the five conditions of the act or face a deduction from money transferred to them.
Some worry that under the current thinking about the Canada social and health transfer no clear dollar amount will be denoted as a health portion. Again it is worthy of emphasis that under the EPF funding there was no longer a relationship between what was called the health portion and the actual provincial expenditures. It was merely a historical artefact based on the national averages of some 20 years ago.
Nothing in the budget will change the government's technical ability to enforce the Canada Health Act's principles. The enforcement mechanism remains the same. The deductions from transfer payments are necessary; they will be made. Canadians can rest assured the Canadian social and health transfer will not reduce the federal ability to enforce these principles. We will enforce them because the principles of universality, accessibility, comprehensiveness, portability and public administration are ultimately rooted in our common values; Canadian values such as equity, fairness, compassion and respect for the fundamental dignity of all. We will also enforce the principles of the Canada Health Act because we support an economically efficient health care system.
It is worth reminding opposition members that the principles of the Canada Health Act are not just words. They have meaning. I want to touch briefly on each of the principles.
The first principle of universality is that all residents in a province must be insured by the provincial health plan if it is to receive federal support. This means we must all have access to services. People cannot be deinsured because they might be too costly for the system to cover. We cannot be turned away from a hospital door because we have not paid our annual tax bill or some provincial premium. If we need health care we will be treated in the same manner as everyone else.
Accessibility on uniform terms and conditions is the second principle. It means we should not face any financial barriers in receiving health care or extra billing, user charges, facility fees or up front cash payments. If the service is medically necessary we will get it at a time defined by medical considerations, not by the size of our wallet.
The next is comprehensiveness. This principle recognizes Canadians have a range of health care needs and that those needs should be met. If we scratch the surface a little more we will see that comprehensiveness again means the practice of fairness. It would not be fair to ensure only some medically necessary services and not others. I do not believe we should choose at the federal level which services are medically necessary. In my view we should continue to interpret the Canada Health Act as requiring coverage of all medically necessary services.
The government will continue to take a position that if a province insures any part of the cost of a service it is an indication it believes it to be medically necessary and all of the costs should be covered.
Justice Emmet Hall in his original royal commission on medicare recommended a very comprehensive package. Liberal governments in the 1960s, 1970s and 1980s accepted the concept of comprehensiveness, although not quite as broad a concept as Justice Hall's. Liberal governments in the 1990s will not turn their backs on these principles.
The fourth principle is portability. It means Canadians maintain their health care package when they travel or move. The portability principle is rooted in one fundamental element; underpinning our federation, it recognizes our mobility. Canadians are free to work and travel anywhere in the country without fear of losing their health care insurance coverage. Portability is what makes our national health insurance system truly national. Each separate health insurance plan may be provincial in origin but it is recognized nationally in every province.
The fifth principle is public administration.
Our health insurance plans must be operated by provincial governments on a non-profit basis. In my view these principles never seem to get the same attention as others. But they should. It is the core of our ability to contain costs in the system and thus to deliver quality care at an affordable price. One would think that of all five principles our Reform friends across the way would certainly be able to relate to this one.
Public administration is a means by which to ensure the principles. Health care insurance is operated and funded through governments. We can guarantee that our health care is universal, accessible, comprehensive, portable, and that we have direct control over it. It is through public administration that we demonstrate our collective responsibility to the health care of Canadians.
I look forward to further comments this afternoon.
