Mr. Speaker, I am glad to have the opportunity to speak to the opposition motion by the NDP.
As the minister has said, the government does have grave concerns about public funds going to private for profit facilities. In Canada our health care system is predominantly publicly financed and privately delivered. It is publicly financed in that our universal single payer health care system accounts for about 70% of total health care expenditures in Canada. It is privately delivered in that most health care providers and facilities operate in a private not for profit manner.
The system has always had private components. For example, most of our doctors are private practitioners or entrepreneurs, if you like. Most Canadian hospitals are operated as private non-profit entities.
In addition to the publicly insured physician and hospital services we all receive, provinces and territories also provide public coverage for other health services that remain outside the national health insurance framework for certain groups of the population, such as seniors, children and welfare recipients. These supplementary health benefits include prescription drugs, dental care and vision care. While provinces and territories do provide coverage for some of these additional benefits, for the most part they are privately financed. These health care benefits account for about 30% of Canadians' total health expenditures and are financed privately through supplementary insurance, employer sponsored benefits or directly out of pocket.
As Canadians know and appreciate, the values that underpin our medical care system are synonymous with being Canadian. The fact that people in this country have access to hospital and physician services based on their need and not their financial means is truly a unifying feature of Canadian life. Our publicly financed health system is a social contract between governments and citizens to take care of one another regardless of financial means or economic position.
One has only to talk to Canadians born before medicare and listen to the stories of families who lost their life savings, of individuals who could only have surgery when the community got together and raised funds, or of loved ones who suffered because they could not afford health services, to know how important medicare is to being Canadian. This alone is a strong argument for a one tier, single payer health care system and, more important, for all of us to be working to keep it together.
The real threat to medicare is the increasing involvement of the private sector in the delivery of necessary health care services on a for profit basis. This raises concerns about the integrity of our public system and whether a two tiered system is not far in the future.
This is worrisome, especially since our system is envied by many other countries. Globally, Canada's health system is seen as not only a core social value, but also a program that enhances our competitive position in the world economy.
Let us look at overall health spending. Canada spends about 9.2% of its gross domestic product, the GDP, on health. The United States spends 14% of its GDP on health, and still 43 million Americans do not have health insurance coverage. Another 100 million are under-insured.
How can we spend 9% of the GDP and still cover everyone? The big difference is the cost of administration. The American multi-payer system simply costs more.
Look at payroll costs in Canada and the United States. In the U.S. they are six times higher. Medicare is one of the reasons Canada has the lowest payroll taxes of any country in the G-7. Canada's business leaders recognize that medicare is a key economic asset, not a burden. Our single payer, publicly financed health system makes Canadian businesses more competitive by keeping their costs down.
As John McCallum, chief economist at the Royal Bank of Canada, said recently with regard to health care in Canada “The goals of efficiency and financial egalitarianism go hand in hand”.
While Canada is the country best equipped to deal with the pressures of an aging population and increased health costs, there are still challenges and problems.
The Minister of Health and the Prime Minister have both said and emphasize that the status quo is not on. However, the way to solve these problems is not to replace the status quo with a private, parallel, for profit system. Innovation and change do not necessitate private for profit health care delivery, but sometimes provide an excuse for that very fact. Yet ironically we hear time and time again that the answer is to turn to private for profit systems for health care delivery when in fact from an economic standpoint there is little evidence to support this conclusion.
Numerous studies from countries where there is private for profit health care demonstrate that when compared to publicly provided health care it costs more, provides lower quality and fewer services, reduces equity and accessibility and drives up the cost of public service.
A parallel for profit system would draw the best and brightest doctors and other health providers also from the public system, leaving the rest of us in the public system with diminished services. However, if procedures in the private system get complicated and more elaborate service is required, we know where those cases will be, right back in the public system.
The public system ends up subsidizing the private one by having to provide services that will not turn a profit in the private system. In short, Canadians would be worse off than if the services were delivered publicly. From my perspective Canadians will be better served when changes, innovations and capacity issues are addressed within a publicly financed and publicly provided health care system.
An important decision about changes to medicare should be guided by sound, solid evidence, by governments working together to address Canadians' needs. Instead of privatization we need to be working together to better organize and manage the current public health system.
It is quite clear that the Government of Canada has a long term sustainable plan to modernize, strengthen and preserve public health care in Canada. Canadians expect their governments to work together to ensure the renewal of this most cherished social program. The government stands ready to engage in this most important challenge. It is not beyond us to solve the problems that confront medicare, but we must get on with the job.
The Canada Health Act is flexible enough as it stands now to protect public health care. The Minister of Health has stated that, as we have in the past, we will enforce the Canada Health Act in the future if violations occur. This government will enforce the authority in the Canada Health Act if practices threaten the five principles on which our health care system is based.
