Carolyn Bennett

[Health Care System, June 11th, 2002]

Mr. Chairman, maybe it would work for politicians too.

In terms of liability, we have been looking for a new way to do risk management and risk assessment in health care. It would be in much the same way as it is for airline pilots. They do not lose their licence for making a mistake. They lose their licence for failing to report a mistake.

In the learning culture of a real health care system we would want to know about collective mistakes because in this college system we have no place for system wide errors. We have a college of nurses, a college of doctors and a college for all of these things. Quality councils might be able to feed back the learning episode instead of it being a gotcha litigated model and, like so many things, we just want to get the lawyers out.

[Health Care System, June 11th, 2002]

Mr. Chairman, there is no question that the member's earlier comments about stable funding is the most important thing in terms of planning for health care.

The deal the Prime Minister made with the provinces on September 11, 2000, was a commitment to that kind of stable funding with money targeted toward information technology, primary care and those types of things.

Some people feel that infusing money every time the opposition asks for it destabilizes the health care system. Some political scientists and observers feel that planning is more important to health care than just throwing money at it, which was the problem in the eighties. Monique Bégin said that we threw all the extra money at the system in the eighties with no appreciable increase in the quality.

We need to make sure we have a cost effective assessment of the dollars we spend, not a cost containment. The cost containment model ruined the system in the nineties. Province after province and regional health authority after regional health authority were not prepared to make the tough decisions to get rid of the stuff that did not work any more and continued to ask for more money. Instead of moving toward a more cost effective model they just cut.

In deciding where we want the money, I would like more money to go into accountability, transparency and information technology to create a real system. It may be an infusion in terms of what we described. Sharon Sholzberg-Gray and maybe the Fyke commission have said that we might need $6 billion to fund the secretariat or whatever would actually help us design an information technology system for the whole country with the feedback loops around quality and accountability. Just giving money to provinces that goes for strikes and labour disruptions has not been effective up until now.

[Health Care System, June 11th, 2002]

Mr. Chairman, I am particularly interested in the reorganization. I think that from the Fyke commission on down, there is a view that if we actually could get an integrated, coherent system there probably would be a 30% saving in the system. I do not think there is a patient in Canada who has not had to have a test repeated because no one can find the results when the patient shows up for appointments. I believe that if we could make a primary investment in an information technology that would get us a real system, we could begin to think about what else might be necessary.

My primary goal is to develop a real system that is a reorganized, coherent, integrated, accountable and transparent system. I think that in order to get there we will need an infusion of money, particularly around the accountability and information technology framework. We have excellent evidence that user fees do not work. They are like some zombie that keeps coming back like a bad video game. People just continue to want to talk about them. As a physician I found it appalling that time and time again I would have to ask people what they could or could not afford. If I had wanted to talk about money all day I would have been an accountant.

It is extremely important to note the administration fee of trying to collect user fees, but also, user fees, in terms of asking for that extra, private part, are indeed a deterrent to the most vulnerable Canadians, like the fragile diabetic and the pregnant teenager. They are the people who do not seek help because of user fees and they are the people who will cost us buckets of money when they end up in an intensive care unit or the baby ends up in a neonatal intensive care unit.

I do not think there should be more private care in that sort of user fee way, but I do think that there are things in that model of core services, copayments or whatever, for which we have evidence that they do not work any more, that we should not be paying for out of the public purse.

I think that is a conversation to have with citizens: How we can get some of things that are core services now back out again? These are things such as the eighth ultrasound in a pregnancy to find out what the sex of the child is or cholesterol testing every three months because someone is obsessed by it when the person has had three normal cholesterol tests and the evidence shows the cholesterol only needs to be tested every couple of years. There are some things that can come out and if people really want them they can pay for them, but I also think this is a conversation that citizens are perfectly capable of having and we should not be making any of those decisions without them at the table.

[Health Care System, June 11th, 2002]

Mr. Chairman, first I would like to thank the House leaders for agreeing to have this very important debate tonight and the Romanow commission for agreeing to meet with each of our caucuses. I think it is the proper role of members of parliament to be able to report in our homework in terms of what we have been hearing in this ever important policy process.

I would also like to thank my patients, who taught me pretty well all I know about health care and taught me the benefit of what informed patients who are prepared to use the system wisely can actually do to provide input into public policy. I would also like to thank the people of St. Paul's who show up in record numbers at the neighbourhood checkups that we hold and who were at the five town hall meetings that we have had over the past while on palliative care, on health care report cards, with Monique Bégin, with Peter Singer and on health care reform.

There is no question that these people have two overriding themes. One is that they want a strong federal role. They support the five principles of the Canada Health Act, but I think they are very aware that it is only the confidence Canadians have in their health care system that will indeed protect it, that if we erode the quality of care they will begin to demand to pay. We have to protect the quality and they need to know about accountability and transparency.

As we know, there has been a cottage industry of commissions and task forces looking at what we should be doing and there are some very clear consenses. One is the wellness initiatives, which virtually every commission has talked about. There are the ideas of some sort of pharmacare reform or community health groups that would do 24/7 care. There is the idea of the role for information technology and electronic medical records. There is the report card to the public, which again comes back to the competence issue. I would hope the report card would also compare us to international models. If people know that they are doing just as well with their heart attacks here as in California, they will begin to understand what indeed this spectacular health care system really has done.

The key to sustainability has to be prevention. We have to actually decrease the demand side. We have to avoid the Walkertons. We have to avoid the smog in July and August. We all know, from Marc Lalonde on, that poverty, violence and the environment are the most important things in terms of keeping Canadians well. I think most Canadians understand that at 10% of GDP we can have a fantastic health care system and with what we now have as a 70:30 private-public split we can again sustain the system.

We need to have more measurements in quality to provide incentives for good performance. I think we now know that there are two important roles for Canadians in the system. One is as knowledgeable and empowered patients who can drive the quality outcomes, and as well patients need to have the access to information with which they can make quality decisions. Clinical guidelines need to be available for patients so that they know why antibiotics are not appropriate for viral infections or why their ankle will not be x-rayed because it does not meet the criteria.

The most important thing I want to talk about tonight is the role of Canadians as citizens in this ongoing, fluid evolution of our health care system. On May 16 we had a round table at the University of Toronto with Janice Stein, where we brought together the people who know a lot about health care, a lot about governance and a lot about information technology. We were trying to figure out whether information technology, perhaps funded by the federal government, could help drive the reforms we want done.

The paper by Sholom Glouberman and Brenda Zimmerman on complex adaptive systems and the kinds of feedback loops we need was interesting. We in effect described a distributive model of power, where if the incentives are down as close to the ground as they can be, we can eventually have those feedback loops that end up with better quality and better cost effectiveness. What is important in a distributive model is a compelling purpose, a strong belief and an agreed upon process. We must agree upon a process by which the system will continue to renew itself. A few key principles will allow infinite diversity and yet coherence. We can be competing and co-operative at the same time. What we now believe is that a centralized control of an ecosystem is illogical, that equitable membership for members and voluntary co-operation are essential.

I believe it is unreasonable to think that Commissioner Romanow would be able to tell us exactly what our health care system should be, because it is going to continually change. I believe that what Commissioner Romanow should be telling us is to mandate a process by which Canadians will continue to always feel comfortable that their needs are being looked after.

The overall goal of priority setting must be legitimacy and fairness and citizens must be involved at every single step of that priority setting. It should not be a discussion about what should be funded but rather a discussion about how those decisions get made. It is clear that it has been impossible for us to define the term medically necessary, yet I think all of us, even with different values, still agree on how the priority setting should be done.

What is interesting is that in Peter Singer's National Post article entitled “Needed: An honest way to set priorities”, he cites the accountability for reasonableness framework developed by Norman Daniels and James Sabin. It provides guidance on how legitimate and fair priority setting decisions should be made.

First, we must have an inclusive decision where citizens are at the table. Second, that then must be communicated to everyone. Third, there must be grounds for appeal. Fourth, it then must be enforced. I believe that this could happen anywhere, from the very smallest health care organization in terms of a community health centre, to a regional health authority, to a ministry of health deciding on what goes on a formulary, to the highest level of the federal government.

Citizens now know that there needs to be democracy between elections. They need to have a place where their values get imposed at every decision. Ursula Franklin says that good governance is fair, transparent and takes people seriously and that if we do not do it in our small organizations no one can expect us to do it in the big picture.

What we need is a system. We have had a fantastic health care insurance plan. We now need a system. That means governance, and I believe that citizens have to be at the table in every decision. We can no longer have joint management boards where providers and bureaucrats sit behind closed doors and the bureaucrats save money if something comes off the list and the providers get to charge more if it is off the list. The citizens must be at that table. Citizens must be at the federal-provincial negotiating table. As Judith Maxwell said in this week's Canadian Medical Association Journal :

Citizens, as the owners and funders, also have something to offer to the construction of our health care edifice. What they offer is their core values about how the system should be financed, about what rules should determine who has access, and about the way the patient interacts with the system.

That gives us Peter Singer's legitimacy and fairness and Trudeau's social justice.

It is imperative that we look back to the social union framework agreement, where we and the provinces have already agreed that we would “ensure access for all Canadians, wherever they live or move in Canada, to essential social programs and services of reasonably comparable quality”. We have to be measuring that quality and we have to be doing what principle 3 in this social union framework states, which is that we would be informing Canadians in public accountability and transparency. Whether that has to be companion to the Canada Health Act or whether we just sit back and enforce what was agreed to in the social union framework agreement is left to be seen. The principle states that we must be ensuring “effective mechanisms for Canadians to participate in developing social priorities and reviewing outcomes”.

I am particularly intrigued with the model that Carolyn Tuohy and Colleen Flood presented to the Kirby report, which is concentric circles with the things that would be public in the centre, things with co-payments in the middle area and then the things that would be privately funded in the outer area. I believe that citizens should form a semi-permeable membrane by which things come in and out of there all the time based on the education by experts and by the information sharing and value systems that they would afford.

I believe we should not be making any decisions without citizens joining hands in terms of that educative function. I think if we look at that we can move it into all levels. I am particularly interested that citizens at those tables must have a responsibility for connecting back to their communities using strong associational networks.

The confidence that Canadians have in the system is the only thing we can count on in terms of protecting our system. Other countries like Australia and England have now mandated the importance of citizen engagement at all levels in decision making.

It is imperative that if we think of a national body that could look at pan-Canadian standards, could review the CIHI, could look at a national formulary, and could perhaps involve the citizens' council for health quality, we could start to look at the federal government as a provider, the fifth biggest provider, of the health care in this country, for aboriginals, soldiers, veterans and in corrections, and bring the federal government to the table in its joint project with all of the provinces on the delivery of health care.

We then need to share the best practices. We need to do the performance pool and reward the great things that are happening across the country. Then, I think, we can look forward to the system. Canadians are the solution to this system. They no longer want to be seated out of the project. I know they want to help us make it work and I know that they will be forever involved in this incredibly important--

[Research and Development, May 27th, 2002]

Mr. Speaker, it was over 15 years ago that our Canadian hero, Rick Hansen, embarked on his record setting Man in Motion World Tour, raising awareness and $24 million for spinal cord injury. Since then he has raised $137 million.

Could the Minister of Industry tell us what the Government of Canada has done to help Rick Hansen in this important endeavour?

[Hepatitis Awareness Month, May 27th, 2002]

Mr. Speaker, I am pleased to inform the House that May has been declared Hepatitis Awareness Month by the Canadian Liver Foundation.

Hepatitis is the most prevalent liver disease in this country. It affects over a half million Canadian men, women and children. Hepatitis C, which spread by contact with contaminated blood, is expected to reach epidemic proportions in Canada increasing the number of liver related deaths by 126% and the demand for donor organs by 61% by the year 2008.

Hepatitis A and B are the only forms of liver disease that are preventable by vaccine, yet thousands of people still contract these diseases each year because they do not understand their risks or how to protect themselves.

The Canadian Liver Foundation was the first organization in the world committed to reducing the incidence and the impact of hepatitis and other forms of liver disease.

For those living with hepatitis, the foundation's 30 volunteer chapters across the country are a valuable source of information and support. I ask the House to join me today in honouring the Canadian Liver Foundation and its volunteers during Hepatitis Awareness Month.

[Canadian Charter of Rights and Freedoms, April 17th, 2002]

Mr. Speaker, today marks a very significant anniversary. Twenty years ago the Canadian Charter of Rights and Freedoms, a piece of paper that enshrined our fundamental rights as Canadians, became a reality but not many Canadians realize the battle women and men of our nation had to fight in order to ensure equality for all.

After one long week of negotiations with provincial leaders, women's organizations and Canadians, section 28 guaranteeing that rights and freedoms apply equally to male and female persons was included in the charter in 1982. It took three years, thousands of petitions from Canadian women and a group of female politicians who crossed party lines to ensure these rights were guaranteed to all Canadians regardless of their race, national or ethnic origin, colour, religion, age, mental or physical disability, or sex.

It is because of this battle that the Government of Canada remains committed to the principles stated in the charter relating to equality for women. Canadians should celebrate not only the inclusion of this section in the charter but also the power of all Canadians to make an impact on their nation in a very positive way.

[Hadassah-WIZO Organization of Canada, April 15th, 2002]

Mr. Speaker, I rise today to invite the House to recognize the 85 years of great work and achievement of the Hadassah-WIZO Organization of Canada. Hadassah-WIZO was founded in 1917 as a non-political women's volunteer organization dedicated to the support of education, health care and social welfare programs for women and children in Israel. In Canada Hadassah-WIZO works closely with other organizations in the promotion of Canadian ideals of democracy and equality for all members of society.

Last night I had the distinct pleasure of attending the Hadassah-WIZO's 85th anniversary official launch celebrating 85 years of vision and achievement here on Parliament Hill. As part of the celebration the hon. Sheila Finestone and the hon. Wilbert Joseph Keon were presented with lifetime achievement awards.

I thank them very much and, especially at this time, I say shalom.

[The Middle East, April 9th, 2002]

Mr. Speaker, tonight's debate is about the Middle East. For many of the people in my riding, this is not a debate about Canadian foreign policy; this is about family. Like the member for Mount Royal, many of the citizens of St. Paul's every day watch the news, listen for a phone call with the thoughts of their family members who live there, study there, work there.

As a little girl growing up in Toronto, I knew only one Hebrew word, shalom. It means peace. We sang about peace in the song Shalom Haverim . We knew it was about peace and about friends hopefully coming back. I do not think that at any time we could have even remotely contemplated what the absence of peace could feel like, what the worry about friends that might not come home would mean.

When I first started knocking on the doors of St. Paul's in 1997 I remember being surprised at how often I was asked if I had ever been to Israel. I did not really understand why that would be so important to so many. I do know now. It is about the families, their histories and today, on Holocaust remembrance day, it is about making sure that the atrocities chronicled in Yad Vashem must never happen again.

I believe it is about eliminating hatred and moving from the tolerance that we usually enjoy here in Canada to try to reach real respect and dignity worldwide.

As September 11 taught us so clearly, this is a very small planet and the costs of hatred and its byproduct terrorism are intolerable.

As Thomas Friedman quoted in his March 10 article in the New York Times , the Middle East analyst Stephen Cohen said:

The question is whether Palestinian extremists will do what bin Laden could not: civilizational war. If you are willing to give up your own life and that of thousands of your own people, the overwhelming of America and Israel does not deter you any more. We are now on the cusp of the extremists' realizing this destructive power, before the majority is mobilized for an alternative. That's why this Israeli-Palestinian war is not just a local ethnic conflict that we can ignore. It resonates with too many millions of people, connected by too many TV's, with too many dangerous weapons.

As the member for St. Paul's, I have travelled to Israel and the Palestinian territories three times; in 1999 with my eldest son, Jack; in 2000 with the Prime Minister and my friend and brilliant colleague, the member for Mount Royal and with many other parliamentarians with strong relationships to the Middle East; and last year I went with my youngest son, Ben.

It was indeed travelling with my sons that was the most poignant. As I looked at the soldiers, some younger than my own boys, I could only think what their mothers must feel and how they must hope and want to work toward peace.

As we sat in the town hall in Metullah last year I felt an insecurity that was palpable, that as the clock showed 8 p.m. the counsellors kept glancing at their watches. It was at that time that they had come to expect the Katushka rockets over the border from Lebanon. As we sat in a cafe in Ben Yehuda, everyone of us was aware of the previous bombings there. Would tonight be safe? We were no longer able to take our Canadian homeland security for granted.

We went to meet with Saeb Ereket in Jericho by bulletproof van. We heard his personal narrative. With his Ph.D. in peace and conflict studies he was worried for his son, worried that his father's preoccupation with the peace process would make his son a target, worried that his son might decide to act out by going and throwing stones and getting into harm's way.

This is no way to live. Too many have lost their lives.

Out of these darkest times we must look forward to a way out. I believe that the way out is a way that we already have through an agreement. The political process must resume as a matter of extreme emergency. We must look forward to the commitments that have been made to the longstanding Canadian policy in the Middle East, Israel and Palestine living side by side within secure and recognized borders.

We must work to implement the Tenet security work plan as a first step toward the implementation of the Mitchell committee recommendations with the aim of resuming negotiations on this political settlement.

Last Sunday night in St. Paul's I met with some of my constituents who are very concerned. I think at some level they are feeling abandoned by their Canadian government. We talked and it was a very constructive conversation. They feel that as Canadians we should not be taking a them and us, teeter-totter path. They feel that we should continue to make decisions based on our Canadian values.

Professor Dewitt of York University thought we must begin with an absolute campaign against incitement, that we must find ways to audit it and that we must act to eliminate it. We must continue to earn the gavel that the UN working group gave us on Palestinian refugees. It is extraordinarily important that Canada keep that gavel and keep the moral authority to be able to be fair in the region. It is extraordinarily important that we continue to build democracy and that we use all the skills of public servants and all people we could mobilize to help in the region.

On the incitement file I have to say following my trips to the Middle East I feel there is a disparity between what we witnessed in Israel and what we saw in the fantastic museum demonstration which showed the effects of hatred in Northern Ireland and in Bosnia. They brought school groups to see the quotations of peacemakers and peacebuilders from around the world.

I am concerned that we do not have evidence of that happening on the Palestinian side. I am concerned that there are still maps without Israel, that hatred is being portrayed against Israelis. The kinds of pamphlets that were turned in by our Canadian delegates from the Durban conference would bear that out.

I do not believe that suicide bombers just happen. They are created and encouraged. As Thomas Friedman said in his April 7 article, a normal state cannot be built on the backs of suicide bombers. We as Canadians should insist that everyone must declare the right of both states to exist.

We must take our audit and gather evidence of incitement. We must work hard in our truly Canadian tradition based on Lester Pearson and George Ignatieff to strengthen the rule of law that can only happen in an institution such as the United Nations. It is not perfect. We have a responsibility to make it even better.

We must support the efforts of people such as Arnold Noyak who are working in Jordan and in the Palestinian territories with Jewish doctors, showing that they can actually work on the ground.

This is a difficult time for Canadians. We have many friends affected by this horrible situation in the Middle East. We understand it is not clear. This weekend we had the Jews for Peace vigil, the Israel solidarity rally and many e-mails saying that we should stop pandering to the Jews.

It is imperative as parliamentarians that we stay the course in sticking to our Canadian values and make our decisions in that way. On a personal note, the Minister of Foreign Affairs has done an admirable job in keeping that fine line and the corrections that are necessary to keep this complex situation on the rails to peace. We must work toward the peace process. We must make sure there is a political solution that will end terrorism.

It is extraordinarily important as we move forward that we look back at one of the most brilliant people we have known, Albert Einstein, as a constituent from the Ontario Cancer Institute reminded me, who said that peace could not be achieved through violence, that it could only be attained through understanding.

[2002 Winter Paralympic Games, March 11th, 2002]

Mr. Speaker, I wish to pay tribute today to the members of Canada's paralympic team which presently is in Salt Lake City participating in the 2002 Winter Paralympic Games from March 7 to 16.

The games opened on March 7 with Mr. Mark Ludbrook as Canada's flag bearer. Mr. Ludbrook, who is participating in his fifth paralympics, led a proud Canadian team consisting of 29 athletes and 30 coaches and staff. Over the weekend the accomplishments were stellar. The team brought home four medals and nine top eight finishes.

In nordic skiing Shauna Maria Whyte placed fourth in the women's 7.5 km biathlon on March 8 and placed fifth in women's cross country short distance on March 10. Brian McKeever, with guide Robin McKeever, placed sixth in the men's biathlon on March 8 and also won Canada's first gold medal in men's cross country short distance on March 10. Colette Bourgonje placed fourth in women's cross country short distance on March 10. Karolina Wisniewska brought home the bronze medal in women's downhill.