Jean Crowder

[Federal-Provincial Fiscal Arrangements Act, February 18th, 2005]

Madam Speaker, I am so pleased to get up and respond to that question. Let us talk about the fact that federal transfers to health care were continuously being reduced, crushing provincial governments with a debt load that was unbelievable.

If we want to talk about where the responsibility for those kinds of things lie, let us talk about where it really belongs. It started with Conservatives and then ended up with Liberals.

What we want to talk about is the fact that slashing and cutting does not ensure we have a health care system that remains on a stable footing.

[Federal-Provincial Fiscal Arrangements Act, February 18th, 2005]

Madam Speaker, in question period, the minister's response was that perhaps I needed to turn up my hearing aid. I guess my response to that would have been, for what? To hear more empty promises around credit card medicine?”

However, on credit card medicine, again the Canadian Health Coalition's analysis around the first ministers health care agreement, and of course Bill C-39 is a result of it, was a D grade for stemming the tide of privatization, as well. Again quoting from the analysis, which is very appropriate. It states:

The First Ministers’ Health Care Agreement is silent on the question of for-profit delivery of healthservices. Indeed, the very day the agreement was signed the bold headline in the National Post read:“Privatized Care Keeps Expanding”.

The proliferation of investor-owned private, for-profit clinics and facilities acts like a viral infection inthe body of Canada’s public health care system. The for-profit health care virus cannot exist withoutfeeding off and damaging public bodies. Canada’s largest and richest provinces are laying thefoundations for a private parallel for-profit regime. This trend threatens the integrity and the viabilityof the public health care system. This is happening without any public discussion by First Ministers.Indeed, it is a plan whose objectives no politician dare utter in public.

It goes on to say:

The corporate virus infection in Canada’s health care delivery system may have been driven underground. However, it remains a serious threat as it can spread through stealth, deception, and lack of accountability.

I interject here to underline “lack of accountability”.

It goes on to say:

It flourishes in the dark but runs from the light of public scrutiny. You don’t stopthe spread of a life threatening virus by not talking about it. Instead, you first isolate and then treatand eradicate the virus light of public scrutiny. You don’t stop the spread of a life threatening virus by not talking about it. Instead, you first isolate and then treat and eradicate the virus. The proliferation of initiatives to privatize health care delivery undermines the letter (objectives) andthe spirit (purpose) of the Canada Health Act. It represents a significant threat to the publicly fundedhealth care system, in particular including the requirements that universal access to publicly fundedhealth care be provided on uniform terms and conditions to all insured persons.

I am quoting from Dr. Arnold Relman's testimony at the Kirby Senate committee. He states:

The facts are that no one has ever shown, in fair, accurate comparisons, that for-profit makes for greater efficiency or better quality, and certainly have never shown that it serves the public interest any better. Never.

Why do so many First Ministers and their officials show no interest in the facts, or the values uponwhich Medicare is built? The noticeable exceptions are Premier Calvert of Saskatchewan andManitoba Premier Doer, who both explicitly referred to not-for profit delivery of care. If Canadiansare gullible and listen to the true believers in the miraculous powers of the market to solvehealth care problems, we will pay dearly for the mistake.

That is a very clear indictment of the kind of creeping privatization happening in our health care system. Accountability measures need to be open and transparent so Canadians can see where their health care dollars are spent.

[Federal-Provincial Fiscal Arrangements Act, February 18th, 2005]

Madam Speaker, I rise in support of Bill C-39. The NDP has already indicated its support; however, I am compelled to speak about the fact that there is a lack of accountability in the bill.

In order for Canadians to have continued confidence in our health care system, they need to know how and where their money is being spent and what the results are. This is not a lone voice in the wilderness that is calling for accountability. It is supported by any number of sources. I will quote from a number of different documents.

The first is the “Health Care Renewal in Canada: Accelerating Change” document put out by the Health Council of Canada. The council is quite unequivocal in its statements around the need for accountability. It starts out by talking about the fact that governments are making significant investments in health care and how Canadians will know whether the money is being spent on health care renewal. The council goes on to talk about the fact that money is important. I will quote directly from the document:

Inform Canadians as to whether the increased investments in health care are supporting the change governments have agreed to implement--

The council stated:

We believe the public has a right to know how the money has been spent across the country.

It will report about this in its annual reports, but it is very clear to the council that there is a fundamental issue attached to the question of money, how it is being spent, what the results are, and what is being achieved.

The next document is quite an interesting one. It is called, “Principles for Governance, Management, Accountability and Shared Responsibility” and was put out by the Canadian Health Care Association and the CCAF. Their opening statement is actually a quote from an address by the Prime Minister at the first ministers meeting on September 13, 2004:

When it comes to health reform, Canadians expect real and meaningful accountability. They deserve to know what they should expect--and what they are getting.

The document lays out some key principles around what we expect out of accountability.

As the minister pointed out earlier today, we are spending significant amounts of money in health care over the next 10 years. Surely Canadians deserve to know how that money is being spent.

One of the things the CCAF and CHA outline is that health system partners need to demonstrate commitment to public transparency and accountability. They do this by explaining to and involving the public in what they plan to do, how well the system is performing, and the implications of both. Surely these are the elements of good practice in any kind of respect. They then go on to outline areas of responsibility. Under public accountability and involvement, the CHA and CCAF outline a principle which states:

Health system partners need to demonstrate commitment to public transparency and accountability. They do this by explaining to, and involving the public in, what they plan to do, how well the system is performing, and the implications of both.

Again, this is a fundamental principle on how Canadians need to have access to how Canadian tax dollars are being spent.

They go on to talk about how these things might be reported. Again, these are principles. These are non-profit bodies that are talking about principles in terms of accountability and transparency. They talk about reporting principles and standards being key to the integrity and utility of reported information and a prerequisite for fair comparison and benchmarking. They state:

Principles and standards may be issued as a pronouncement by the requiring party, or developed cooperatively. Regardless of how they are developed, these reporting principles and standards should be commonly understood and consistently applied.

To me that means there is an agreement on what we should be reporting, and it should be clearly understood by all parties, including the Canadian public.

On the first ministers health care agreement the Canadian Health Coalition actually issued a report card in September 2004. Under the accountability and reporting aspect of the report card the government was given a D . The coalition said that the agreement is based more on trust and an assumption that the public will hold governments to account. We are talking assumptions here.

Since the weak accountability facilitates privatization by stealth, Canadians will have to be diligent to ensure real accountability. Medicare is still on life support, not from lack of money, but because of weak controls on where and how the money will be spent.

The Canadian Health Coalition is talking about the fact that what we really need to do is follow the money. The CHC did a detailed analysis on the 10 year plan to strengthen health care. I will quote from the document on accountability and reporting to Canadians. I talked about the fact that the agreement is based on trust. The document states:

It is no coincidence that the governments with the most resistance to meaningful accountability (Alberta, Quebec and B.C.) are the ones determined to transfer the delivery of insured health services over to commercial, for-profit health care corporations. Proponents of private, for-profit health services do not want public funds accounted for or traced but this is what true accountability requires. Canadians don't realize that current accountability requirements in federal legislation are being ignored by the federal government. Under the Canada Health Act, the Minister of Health has a statutory duty to monitor, report and enforce compliance with the five criteria of the Act. The Minister's annual report to Parliament on the Canada Health Act consistently fails to identify, report and stop privatization initiatives underway in several provinces. This poses a serious threat to the integrity and viability of Medicare.

The CHC goes on to state:

We expect the Canadian Institute for Health Information and the Health Council of Canada to include in their data collection and analysis a breakdown, by mode of delivery of health care services specifically, for-profit and not-for-profit. A full public accounting would expose unfavourable comparisons between private for-profit and public not-for-profit....Citizens need an accountability mechanism which is independent and in the public domain. The Health Council of Canada could grow into that role with public pressure and direction. The first task for the Health Council must include tracking every single dollar of public funds in health care in order to monitor how much is going to investor-owned private for-profit health care, home care, and long-term care and the health outcomes and financial performance achieved. Canadians must also insist that the federal Minister of Health correct the deficiencies in monitoring, reporting and enforcing the Canada Health Act.

It is clear that there is a reluctance by the government to report on the dollars that are being spent, because it is en masse for profit delivery that is creeping throughout Canada.

One of the things that is fundamental in the Canada Health Act and one of the program criterion is public administration. It is a fundamental criterion for receiving funds under the Canada Health Act. The act itself states:

In order to satisfy the criterion respecting public administration,

(a) the health care insurance plan of a province must be administered and operated on a non-profit basis by a public authority appointed or designated by the government of the province--

In the prebudget consultation to the report on the Standing Committee on Finance, which is talking about health care and how money is spent, I quote:

Several witnesses spoke about specific aspects of the Canada Health Act. While witnesses generally support the principles contained in the Act, there was concern that some of the principles are not being respected and that information provided to Parliament is not accurately indicating the degree to which privatization initiatives are underway in several provinces. In particular, it was recommended that the ministers of Finance, and Health fully enforce the accountability mechanisms in the Canada Health Act and that provinces/territories be required to provide information on the mode of delivery of health care services, in particular for-profit and investor owned versus public and not-for-profit.

This is from the prebudget consultation which was clearly calling for more accountability. Yet when we look at Bill C-39, any mechanisms for accountability are absent from that bill. It is very cold comfort to hear that there will be a review done in 2008. That is like slamming the barn door shut after the horse has escaped.

We are talking about some of the pillars around public administration and the issue that we are not able to look at the impact health care dollars are having and where they are being spent. In my own province we have a current P3 under way and the government cannot tell me that this is a for profit situation.

We have an organization called Access Health Abbotsford, which is a consortium that includes the Dutch bank ABN AMRO, U.S. health giant Johnson & Johnson and Sodexho, a French cleaning and food services company, that will be responsible for the design, construction, financing and maintenance of the hospital that is being built in Abbotsford. Surely that is a for profit organization, which seems to be very dismissive of one of the key pillars of the Canada Health Act.

How will Bill C-39 protect Canadian taxpayers from that kind of creeping privatization. There are certainly any number of questions about the quality of for profit health care. Again, independent studies have been conducted and established on these kinds of private health care delivery.

Canadians deserve to know how the money invested in health care is being spent. Canadians are very passionate about their health care system, and they want to continue to see a publicly funded and publicly delivered health care system.

We are asking the Minister of Health and the Prime Minister to honour their commitments. In the minister's own words, he stated after being sworn in:

I can tell you that what we need to do is stem the tide of privatization in Canada and expand public delivery of health care so we have a stronger health-care system for all Canadians.

Those are very strong words. It would be shameful if the government did not live up to its commitment around that.

I will go on and repeat the Prime Minister's words because they bear repeating. He made a commitment around real and meaningful accountability. He said was:

When it comes to health reform, Canadians expect real and meaningful accountability. They deserve to know what they should expect--and what they are getting.

Surely stating that Canadians deserve to know what they should expect and what they get talks about accountability. It should be one of the fundamental principles in the bill. It is glaringly absent.

I would urge that we quickly put in mechanisms to deal with the accountability, so Canadians have some confidence in where their health dollars are being spent, and that we can proudly stand up and talk about the fact that we have a publicly funded and publicly delivered health care system.

[Health, February 18th, 2005]

That is another non-answer, Mr. Speaker.

When he was a New Democrat, he could make up his mind about privatization. Now he has caught the dithers. I asked a very simple question and want a simple answer.

For two elections the Liberals have pretended to oppose credit card medicine. We have credit card medicine all over the place. Will the minister either finally admit that the Liberals will do nothing to stop credit card medicine or announce what action they will take in Montreal to protect patients' pocketbooks?

[Health, February 18th, 2005]

Mr. Speaker, my question is for the Minister of Health.

As he will know, his predecessor encouraged experiments with credit card medicine, such as Ralph Klein's credit card hospitals in Alberta and now the $2,000-a-knee operation in Montreal. During the election, the Prime Minister asked people to vote Liberal to stop credit card medicine.

What does the health minister intend to do to stop credit card medicine in Montreal?

[Quarantine Act, February 10th, 2005]

Mr. Speaker, as was previously pointed out, the NDP does support the bill but we do have some concerns.

I previously mentioned the importance of protecting workers like our customs officers and our health care workers, and ensuring that they have the resources they require to do their jobs.

In the submission to the standing committee, the Canadian Medical Association pointed out that during the SARS outbreak of 2003, physicians and other health care providers were not only partners in containing infection, but many became ill or died as well, and since health care workers expose themselves to infection as they respond to health emergencies, protocol should ensure that care and attention is paid to their safety through measures such as ensuring ready availability of proper masks.

The CMA went on to say that the act or regulations should address precautions required to protect quarantine officers and other health care workers from transmission of disease or the effects of becoming ill. For example, it should address compensation for quarantine officers who lose work because they become infected in the course of their study. It is absolutely essential that we ensure those kinds of protections are available for frontline workers and that they get the resources they need to do their jobs.

We also need to have one clear health authority and urge that the enabling legislation for the Public Health Agency be expedited. This has been pointed out by a number of organizations, including the Canadian Nurses Association and the Canadian Medical Association. They were not included in this legislation because the expediting legislation for them has not been brought forward.

The Canadian Medical Association also talked about the importance of supporting the need to enact this legislation for the Public Health Agency, and pointed out the need for a comprehensive Canadian emergency response strategy so that when we are faced with things like the SARS crisis, we have a coordinated response.

It is our hope that we never need this bill and that we will never have to use it, but if we do, it does give sweeping powers to the minister to detain people, to use privately owned facilities and to force people to accept medical assessment or treatment. Not enough assurances are in the legislation that the minister will act in a reasonable manner, that people's privacy rights will be respected or that workers affected by the quarantine will actually be protected.

Some of these areas of concern are going to be dealt with by regulations, and we have already indicated how important it is that the government act quickly on this, but other areas will not and we need to know that the government will soon bring forward legislation, especially for workers, that provides a quick response during a health emergency to such issues as employment insurance claims, medical leave and health and safety standards for frontline workers. We are asking our frontline workers to put their lives on the line in a crisis and they deserve every protection that the government can afford them.

Another omission that was identified during the committee stage was how the bill covers travellers and materials travelling in and out of Canada but has absolutely no provisions for interprovincial travel. Considering that it takes longer to fly from Vancouver to Halifax than it does to fly from Europe to Halifax, the chances of a communicable disease being transmitted from one end of the country to the other are great.

I would urge the House to consider the various concerns that members have raised around some of these issues and that we look forward to passing the bill quickly.

[Federal-Provincial Fiscal Arrangements Act, February 10th, 2005]

Madam Speaker, leaving the trade issues aside, Bill C-39 in part certainly is moving in the right direction in terms of reaffirming our commitment to a public health care system in Canada. If we could build in the accountability measures and the publicly delivered not for profit measures, I think many of us would feel far more comfortable.

We have not seen the kinds of initiatives that we would like to see from the government in terms of protecting our public health care system. We have certainly seen creeping privatization, with private MRI clinics and a number of other issues coming up on which the government is not actually acting. It can take any number of years for measures to be brought forward under the Canada Health Act. They just do not get dealt with in a timely fashion.

We would encourage the government to actually enforce the regulations that are currently available and to look at tightening up that loophole.

[Federal-Provincial Fiscal Arrangements Act, February 10th, 2005]

Madam Speaker, before I get to the member's final comment, I want to address the facts about what we need in a health care system. I agree that we have an aging population and we will have some serious problems if we do not deal with it, so I would encourage the government to actually develop a strategy that includes the social determinants of health and looks at health care in a much broader way than is currently done in looking primarily at acute care and primary care. We really need to encourage the system to be innovative and creative and to look at prevention. What we really want to do is stop people from getting into the health care system. When we look at things like the social determinants of health, that goes a long way toward that strategy.

With regard to Tommy Douglas, a number of years have gone by since Tommy Douglas and the party of the time took great strides in making sure that Canada had a national health care system. As they were making a transition from no medicare into something that was difficult for many people to get their heads around, he was making statements in the context of that day and age. I think that if we go out to the public in this day and age, we will hear the public clearly saying that it wants publicly delivered and publicly funded health care. Some 40-odd years later, that is what I think Canadians want.

I would encourage the Minister of Health to include in the Canada Health Act something to actually prevent for profit delivery. It currently does not.

[Federal-Provincial Fiscal Arrangements Act, February 10th, 2005]

Madam Speaker, I agree with the human resource strategy. It is absolutely essential and I suggest that we need to go further than is indicated. I met with the College of Family Physicians this morning. It clearly indicated that unless we deal with it expeditiously in a coordinated fashion, we are going to be in real trouble with human resources over the coming years.

On aboriginal health, I have one of the largest first nations communities in British Columbia in my riding. Aboriginal people welcome being included in any solutions that are dealing with aboriginal health. It is absolutely essential that aboriginal voices are at the table when we are developing strategies to deal with aboriginal health. They must be at the table in a meaningful way, not just for consultation but able to give meaningful input.

When it comes to a mix of private and for profit, I would argue that as we are providing funds into for profit health care we are actually pulling money out of the public system. As soon as we introduce an element of profit I would wonder why we could not be spending that for profit money in the direct delivery of publicly funded and publicly delivered health care. Canadians have been very clear that they want a publicly funded and publicly delivered health care system that remains accountable.

[Federal-Provincial Fiscal Arrangements Act, February 10th, 2005]

Madam Speaker, I rise today to speak in favour of Bill C-39, but with some reservation.

We are pleased that after 10 years of cuts to the provinces for social spending, the Liberal government finally realizes that tax dollars should be spent on more than artificial debt targets and that Canadians want a balanced approach to financial management in Canada, an approach that protects and enhances the social safety net that helps define us as Canadian.

This funding formula will close the gap in funding identified in the Romanow report on health care. We welcome the end of reduced federal funding for health care and support the move to funding 25% of health care spending by government. It is about time. We cheer the Liberals' realization that costs increase over time and that base funding must increase, or in real dollars the amount of money available goes down.

The addition of an escalator clause in this agreement is very welcome; however, this agreement is missing an important element. Our system of governance in Canada is based on a series of checks and balances, but this legislation provides no check on how health care funding dollars are spent. Again and again, Canadians are telling us that they want to know where their tax dollars are paying for public health care and where those dollars are increasing the profits of private health care corporations.

Immediately after being sworn into office, the federal health minister said:

--what we need to do is stem the tide of privatization in Canada and expand public delivery of health care so we have a stronger health care system for all Canadians.

Since this agreement was signed in September 2004, health care advocates have been asking the health minister to affirm that the enabling legislation, when it comes forward, would include provisions to protect publicly funded and publicly delivered health care in Canada. There is nothing in this legislation to protect small communities and Canadians from for profit health care.

Since the actual agreement was made, I have been reading an analysis on the 10 year health plan. Again and again, I read how Canadians want governments to be accountable for the health dollars spent by Canadians, but they rarely get that accountability. This accountability discussion has been an ongoing issue. In 2000 the first ministers made a commitment to regular reporting and they indicated that it would be a process that allowed for third party verification, yet there are huge gaps in the data.

The last annual report from the Minister of Health could not indicate where money was being spent on the for profit delivery system, and in the report from September 2002, the Auditor General indicated that Health Canada is unable to tell Parliament the extent to which health care delivery in each province and territory complies with the criteria and conditions of the Canada Health Act. This is a serious shortcoming in this current piece of legislation before the House.

I want to quote from a paper written by Cindy Wiggins, a senior researcher from the Canadian Labour Congress. It is important that this is read into the record because this is how working Canadians see this agreement. It states:

The unified front maintained by the provinces during federal-provincial/territorial negotiations also has a significant downside for national social programs. Democratic deficits and provincial-territorial unity come at a cost. Dissent is muffled. Issues on which there is no consensus simply do not make it to the federal-provincial/territorial negotiating table, regardless whether such an issue is a key priority of the public.

We know provinces and territories have different opinions on the issue of for-profit care. Some provinces are ideologically committed to creating a role for the commercial health care sector. Some already have pursued this path. Others believe that a tier of commercial health care situated within the public system will do irreparable harm to the public, non-profit system and produce poor health care outcomes.

She goes on to say:

This issue has been at the centre of public debate around health care. Canadians are clearly opposed to for-profit health care and view it as a threat to Medicare. This issue was central to the conclusions of the Romanow Commission report. Because of the lack of consensus among the premiers, commercial health care and the threat it poses to Medicare was nowhere on the agenda of the September First Ministers' meeting. We can assume that this will be the same for other national issues, such as child care

As an example of the drive to use public dollars for private delivery, this morning CBC Radio was saying that provinces, especially Alberta, are already saying no to any child care program that directs money to not for profit centres, even though research has proven they provide better care than for profit centres. This is just an example of the public dollars going into for profit delivery.

Ms. Wiggins' paper continues:

The federal government played a role in the silence on commercial health care. For several years now, it has refused to enforce the Canada Health Act with respect to for-profit initiatives which violate the Act. As a result, Medicare has been left without a guardian and remains at grave risk.

I want to emphasize again that we welcome the closing of the Romanow gap, but throwing money at a problem and then refusing to be accountable for how that money is spent is absolutely wrong. While first ministers claim that this funding formula will put the health care system back on sustainable footing, the fact is there is no protection from for profit care and no accountability for how funds are being spent.

Again, from the Canadian Labour Congress paper:

The accountability measures in the agreement do not address this important sustainability issue. Accountability is in the form of reports on progress in areas covered by the agreement, such as wait times and home care.

Those are important initiatives.

Provincial jurisdictions supposedly must meet these reporting requirements as a condition for receipt of federal funds attached to the agreement. Report cards do not solve problems: they identify them. Provinces and territories are only responsible for reporting to citizens in their own jurisdictions - a provincialization of accountability for a national social program. Should provincial jurisdictions fail to meet the reporting requirements in the agreement, there are no consequences for such failure, making true accountability an illusion at best.

Canadians truly want to know where their health care dollars are being spent. Another area that the federal government needs to be accountable to Canadians for is protecting our public health care system from trade regulations. Canadians do not see our health care system purely as a business transaction, however.

Canadians see health care as an essential part of our identity, but when given the chance, the government did not negotiate an exemption for our public health insurance system. It did not exempt health care from World Trade Organization agreements.

Now, because it also refused to enforce accountability and to stem privatization in health care, the government leaves the door open to our health care system being decimated by multinational corporations moving in to provide for profit health care. This is just another example of big box credit card medicine and it is not a route that Canadians want us to go.

One area not mentioned when the Liberals talk about health and human resources is the leeching away of good talent to the private sector. Every private MRI that opens increases wait lists because it must take qualified people away from the public sector. There are simply not enough health care workers out there to staff a public system and a private one, and certainly not health care professionals. We need a pan-Canadian health and human resources strategy that truly identifies the serious shortages that are coming up in the health care professions and we need to act on that now.

Furthermore, the government is moving far too slowly on a pharmacare plan. The cost of drugs is now second only to hospital costs and slightly higher than the amounts we pay to doctors.

Last night in the House we had the first hour of debate on private member's Bill C-274 presented by my colleague, the member for Windsor West. It has a real plan to ease some of the spending crunches that provinces are currently facing with drug costs by reforming the system of patents and allowing generic drugs to enter the marketplace sooner. This is a critical issue as well. The Liberals could have made these changes already, but they have introduced regulations that maintain the status quo and will not help Canadian families access cheaper drugs to keep themselves healthy.

In closing, in view of the lack of accountability from this particular bill and the creeping privatization, we need to have an open and public debate to shine the light on the decisions that were made behind closed doors at the first ministers meeting in September. It is absolutely critical that we have a full review at the committee level on the issue of accountability.