Mr. Speaker, I am rising to speak on Motion No. 91 concerning federal funding support for abortion services on demand. I want to address the role of the federal government vis-à-vis the Canada Health Act with respect to determining insured health services.
As one of our greatest national projects, Canada's health care system is a defining element of Canadian society. Medicare has contributed to a quality of life that is recognized to be one of the best in the world. It also gives us a comparative advantage in the global marketplace.
I am happy to say, as I usually do, that the riding of Windsor-St. Clair and my community of Windsor had a great deal to do with that, starting with early insurance plans like Windsor medical and with the great vision of the Right Hon. Paul Martin, Sr.
The health care system represents the best of the Canadian spirit, reminding us of the good that we can achieve together. Medicare was introduced and developed by a succession of Liberal governments, providing a tangible example of the commitment of the Liberals to compassionate public policy.
The Liberal Party and the government remain firmly committed to the five fundamental principles of medicare as set out in the Canada Health Act: public administration, comprehensiveness, universality, portability, accessibility.
The one principle which I particularly want to focus on is comprehensiveness. At its most basic, comprehensiveness requires that provincial health care insurance plans cover all medically necessary services performed by doctors or in hospitals. The term medical necessity is a key concept. It is an integral part of the understanding and operation of the act. The term medically necessary is used in the Canada Health Act in conjunction with other conditions to assure Canadians that once a decision has been made that a service is medically necessary, then access becomes universal and on uniform terms and conditions.
In my view this debate is not just about abortion. This motion has much broader consequences than that. It is about which government is going to decide that any medical procedures are necessary. It is about whether our aging parents will have access to oxygen when their respiratory systems fail. It is about whether children and adults with disabilities will get the specialized support they need. It is about whether our constituents will have universal access to any medically necessary procedure.
Since the beginning of federal support for health care in 1957 through the hospital insurance and diagnostic services act, decisions regarding what is medically necessary have been left to the provinces to determine. This is consistent with the provisions of the Constitution. It makes sense because after all the provinces manage the health care system. The government does not do that and the man or the woman on the street does not do that.
The provinces work with the appropriate medical experts. They are delivering the service, they are closer to the patients. This means that decisions regarding medically necessary insured health services are up to the provinces and their medical associations or those whom they consult to decide.
I might add that there is a remarkable degree of congruence and consistency among all provinces and territories on this front. On the matter of health insurance coverage for services all provinces and territories, particularly for abortion services, have regarded them as medically necessary services and insure them on this basis. I emphasize that there is almost no service that is not medically necessary in some cases. These determinations have been made based on the context of the service being provided.
The government firmly believes that it is not for Ottawa to say that this procedure or that procedure must be covered. This responsibility is better left to the provinces and physicians who deliver services on a daily basis and who are aware of the circumstances under which they are delivered.
This approach stands in sharp contrast to what is happening in the United States where insurance companies are telling more and more physicians what they will cover, what they can or cannot do for their patients and even how to do it.
The Canada Health Act permits the determination of medical necessity at the point of delivery of the service. This approach is superior to developing a list of insured health services. Lists are simplistic and rigid. They result in some services being insured and others not being insured in all circumstances. They also invite a steady move to privatization especially if more and more services
are covered by private insurance because the government is out of them because it is not on the list.
Determining medical necessity at point of service is one of the greatest strengths of the Canada Health Act. This approach allows circumstances to vary from service to service. It is an approach that recognizes the medical condition of the patient. It is an approach that ensures Canadians receive services on the basis of need, not on the basis of ability to pay.
Since the beginning of medicare, medically necessary services have been made available without point of service charges. I cannot deny that fiscal realities have forced us to make some tough decisions regarding our health care system. There is still room to make our health care system more efficient.
Putting our universal and comprehensive health care system in place took commitment. Facing the challenges and finding solutions to problems which arose over the years took commitment. That commitment is still here today. It is a commitment that Canadians want and one that this government takes seriously.
We will ensure that Canadians continue to receive medically necessary services on the basis of need and not on the basis of their ability to pay. Access to services is based solely on the medical needs of the patient. Medical necessity, not how much money one has, should dictate access to medical services. Canadians expect that they will have medically necessary services available without point of service charges.
The federal government has an important role to play in ensuring that Canadians receive the care they need. What we can and will continue to do is to interpret the Canada Health Act as requiring coverage of all medically necessary services.
Our national health insurance system is close to the hearts of Canadians. It is something too precious to tamper with on a piecemeal basis. This is why the federal government cannot support this private member's motion. Supporting this motion could jeopardize the principles of the Canada Health Act. It could jeopardize the constitutional authority of the federal government and the provincial governments. More important, it could jeopardize the health of Canadians.