Keith Martin

[Social Security System, February 2nd, 1994]

Mr. Speaker, it is important for the hon. opposition member to understand that health care services are pulling the wool over the eyes of the Canadian public by instituting a concept called rationing. That means they are telling hospitals how many hips or bypass surgeries they can do. As a result the Canadian public is being deprived of service under the guise of so-called universality. In this current situation people who need essential health care services are not getting them because of the rationing and the withdrawal of services.

We in the Reform Party are trying to say that people who are sick are not obtaining services in a timely fashion. Let us recognize that. Let us do something about that with the amount of funds we have now.

[Social Security System, February 2nd, 1994]

Mr. Speaker, I want to thank the hon. member for his comment.

As the elected members of the provincial legislatures are answerable to the Canadian public it would be political suicide for them to create a health care situation where the people who elected them to office would suffer.

It behoves every elected individual in this country to face the writing on the wall, to realize that we have a situation where health care costs are increasing at four times the rate of economic growth and governments are dealing with deficit spending with less and less money being applied to health care.

We have to face up to this. It is not just dismantling or destroying the Canada Health Act, it is modifying it to make it a better situation. To accept the current situation as it is now is to merely stick one's head in the sand. It is incumbent upon all of us to do something about it in order to preserve essential health care services for all Canadians so that they are not going to suffer, they are going to have their operation and they are not going to die as they do down in the United States due to lack of care.

[Social Security System, February 2nd, 1994]

Mr. Speaker, tonight I am going to speak about a subject that is dear to everyone's heart and in particular to our electorate in this country.

When I was running for office I found, as I am sure many members did, that one of the biggest considerations and concerns of Canadians was what was going to happen to their health care. There were a lot of concerns and a lot of problems and nobody knew which way to go. Canadians are very concerned about what is going to happen to their health care in the future. To that extent I would say that their health care is probably the most valued thing they have in their lives.

The greatest guardians to good health that exists is our personal responsibility for a healthy lifestyle and our national health care system. The first one the government can do absolutely nothing about, but in the latter the government certainly can.

I believe as a physician and a consumer that our system is the best in the world. It is the envy of people outside of our country. We just need to look at the United States to see how they look enviously at our country to emulate for their new health care program.

Canadian citizens receive the best health care free of charge. They are governed by the five basic tenets under the Canada

Health Act. They are: universality of care; comprehensive coverage for all essential services. I under line the word "essential". It is a very important point to remember. It also provides reasonable access by health care providers as well as consumers; portability of benefits from one province to another; and, the administration of health care by a public agency on a non-profit basis.

To give an idea of what we are talking about in terms of figures, in 1990 over $60 billion was spent on health care alone in this country which represents almost 10 per cent of our gross domestic product.

The financing of the system is divided between the federal government and the provinces. The provinces manage the actual day to day affairs and how the money is spent but they have to do it under the Canada Health Act; otherwise the federal government will withhold funding. In other words, the federal government takes their money and uses it as a wedge or a threat to the provinces regarding what they can and cannot do.

Over the last decade some situations have occurred in this country that have greatly jeopardized publicly funded health care which will ultimately lead to the collapse of health care as a publicly funded system. Not only health care but every social program in this country will be jeopardized by the following situation. This has been spoken about quite eloquently by my colleagues in caucus today as well as other members in the House.

The escalating debt over the last 12 to 14 years that we have, which has risen from $125 billion to $500 billion today, is the biggest threat to health care and social programs in this country.

To give an idea of what has occurred, back in 1984 28 cents out of every dollar was spent just to service this debt. Today it is about 33 cents. By the year 2000 at the current rate of spending 40 cents out of every dollar will be used merely to serve the debt. As can be seen we have less and less money to spend on other things such as social programs. This is a system that cannot last.

The other side of the health care situation is that expenditures are escalating dramatically. They are growing at over four times the rate of economic growth. There are a number of reasons for this. Briefly, number one is the ever-increasing aging population which consumes over 70 per cent of the health care dollar. Two, our technologies and intervention and therapeutics are becoming more advanced and more expensive all the time. Three, there are new diseases such as AIDS which are increasing in frequency tragically which also cost a significant amount of money.

If we accept the facts as I have outlined them today the system that we can see now is living on borrowed time. The dwindling funds and increasing costs are going to crush this system in the future. That is inevitable.

Despite this fact, that the writing is on the wall, the federal government continues to hamstring the provincial governments by preventing their ability to get their health care under control by forcing them to adhere under the tenets of the Canada Health Act and threatening its contribution to financing health care under the health act.

There are a number of things we can do. Not to do this will contribute to the suffering of the Canadian people.

What can we do? We need to modify the Canada Health Act to stop penalizing the provincial governments when they try to get their health care costs under control. We need to strike a committee to define what essential health care services are, which means delisting some services.

I put to you, Mr. Speaker, that those services which the public and professionals decide to delist will not be essential for health. These will not be essential for a good life or for having adequate treatment in hospitals.

We need to set up an accountability system on the part of the consumer. Currently very little value is placed on a system and it is doomed financially unless there is some value placed on this by the consumer. Therefore I would suggest to the provincial governments to entertain the thought of such ideas as modest user fees and deductibles for some groups.

People believe that the Canadian public does not want this but recent statistics show that over 80 per cent of the people in Quebec for example, and some studies were done to show this, would not mind paying a $5 to $10 user fee. The lowest socio-economic groups I would emphasize would be treated regardless. These tenets are still consistent with the ideas of universality of coverage and access.

We also need to concentrate on education of the public in terms of the costs. One of the things we can do is to have statements of account at the time of consumption preferably or during the course of the year.

We need to emphasize health education, especially in the early grade school years. This will pay off dramatically in the future. We need to focus on preventative medicine, on leading a healthy lifestyle with the aspects of drinking excessively, smoking and diets. From a physician's point of view it is amazing and also profoundly tragic the lack of knowledge that some children have when they get into the teenage and adolescent years and we all know the manifestations of that.

Health care professionals must be educated in the cost of technologies and interventions and therapeutic options that they have. I can say again as a physician that we have not done a good enough job on this at all.

I would also suggest that health care professionals be allowed to run private medical services. This would enable some people to get health care services done in a private situation, but all people, whether they are in a public or private situation, would have their health care services done earlier. This would decrease

the amount of pain and suffering in the community, decrease the cost to the economy, decrease insurance costs and so on.

It is in fact a win-win situation. To anyone who would argue that this a two-tier system, I say to them that anybody in this country involved in health care will say that there is a two-tier system in this country right now.

The most important thing that the government needs to do with respect to health care is as I said before get their fiscal house in order. Until we get our spending under control as a nation we simply cannot afford to support social programs in the current state of affairs that we have. To not do that I think would be morally reprehensible and a tragedy for the Canadian people.

The last thing I would like to touch on for a moment is decreasing tobacco taxes. I feel this is an indefensible situation. Every year the cost to the country in terms of smoking is horrendous. It costs billions and billions of dollars. There is a loss of productivity and an increase in health care costs. Over 40,000 people in this country die of smoking related illnesses.

To increase the cost of cigarettes has resulted, as has been proven, in a decrease in consumption especially among the young. Therefore I suggest that instead of decreasing taxes on tobacco that we maintain them; and instead of caving in to the criminals who are engaging in this smuggling activity I would also suggest that we add an export tax to cigarettes going into other countries.

[Pre-Budget Consultations, February 1st, 1994]

Mr. Speaker, our health care system is one of the best things provided by our great country and Canadians attach a great importance to it. Without health, enjoyment of life can be greatly diminished. The protection of our health is dependent upon two major elements: the responsibility that each one of us has to adopt healthy habits, and our national health care program. The government cannot do much about the first element, but it can do something about the second one.

As a physician and a consumer I believe the Canadian system of health care is indeed the best in the world. It is one of which other countries are envious and one in which any Canadian in the country can get the best of medical care free of charge.

At the foundation of the system lies the Canada Health Act which is based on five tenets: universality of care for all Canadians, comprehensive coverage of all essential services, reasonable access by both providers and users, portability of benefits from one province to another, and the administration of health care on a non-profit basis.

The provinces and the federal government both share the management of payments. The care however, and the management of the whole system falls under the provincial jurisdiction. The federal government now provides approximately 25 per cent of the necessary funds so long as the provinces administer their health care plans in accordance with the Canada Health Act.

Over the last decade we have seen the emergence of a mounting fiscal crisis. If unchecked it will ultimately lead to the collapse of publicly funded health care in Canada.

The largest crisis which many of my colleagues have mentioned today is the mounting debt and deficit. In this country federally we have gone from $125 billion in 1980 to over $500 billion this year.

The amount of revenues that are required to service this obscene debt load has increased. Roughly in 1984 we were paying about 28 cents out of every dollar for interest payments. Now it is running around 33 cents. If our spending goes on as it is going on at current levels, in the year 2000, 40 cents out of every dollar will be used merely to service this debt. This means we have less and less money to spend on social programs such as health care.

Another interesting fact that people may not be aware of is that the amount of money the federal government spends as a percentage of total program spending has actually declined since 1970 from 10.9 per cent to 7.6 per cent. This means that the federal government itself is spending less and less money on health care regardless of anything else.

I am not taking into consideration the provincial fiscal crisis which is also going to impinge on the ability of governments to fund health care.

At the same time that the governments have been reducing their spending on health care, there is the other side of this equation. That is that the costs of medical care in this country are escalating dramatically. In fact they are going up over four times the rate of economic growth. This situation will only worsen in the future. There are many reasons for this such as an ever increasing aging population that consumes over 70 per cent of the health care dollar; technologies of intervention and equipment which are getting more and more expensive all the time; and new diseases such as AIDS which are very expensive to treat are raising their ugly heads. For all of these reasons and many more it is clear that health care in Canada is living not just on borrowed time but on borrowed money.

The health care crisis is a result again of dwindling funds and escalating costs. The problem is clear. The federal government continues to hamstring the provinces and is preventing them from getting their health care under control by using its fiscal contribution to the provinces as a wedge that will prevent them from enabling us to continue with publicly funded health care.

This as one can see is an unsustainable system. We must do something about it because it will ultimately contribute to the demise of health care in this country and to the suffering of Canadians. Is this a lost cause? No, it is not. There are a number of things we can do.

We must freeze federal spending for health care at 1993 levels. We need to modify the Canada Health Act to stop penalizing the provinces when they try to get their health care under control.

This suggestion is in a provincial jurisdiction but I am saying it for the record so that we can address it. We need to strike a committee to define what essential health care services are that will be covered across the country from coast to coast and we should delist other ones. Delisting services would be those services that would not be considered essential health care for Canadians.

We can make consumers more accountable. The current system encourages waste and will lead to unnecessary cost. Some suggestions have been bantered around and it is up to the provinces to decide on modest user fees and the use of deductibles. Remember, if we can save publicly funded medical care in this country, no one will go without essential health care services.

As a physician, one of the reasons I got into this was to preserve the system that we have in Canada. We do not want to get into a system like we see in the United States which I personally think is reprehensible.

We also need to inform the public of the cost of medical services. Perhaps we can do this with a statement of accounts at the time of consumption or perhaps annually or bi-annually. We also need to put a greater emphasis on health care education, particularly at the early grade school years. This will pay off in spades later on. I can guarantee that.

We also need to address health care professionals and we must educate them more, myself included, as to the cost of technologies and intervention. By and large we have not done a good enough job of that.

I would also allow the provinces to enable health care professionals to run privately funded services. This would serve two purposes. It would decrease the horrible waiting lists that we now have and ultimately it would be a win-win situation for all people those who would go private and those who would go public. People under that circumstance would get their health care services a lot quicker than before which would mean less pain and suffering. People would go back to work sooner and it would be far more beneficial for the economy, not to mention the insurance companies whose premiums would go down.

The current hodge-podge two-tiered system of rationing that we have is the last futile attempt to correct a system that is broken and will soon sink under its myopic tenets and fiscal mismanagement.

The second topic I would like to speak about briefly in view of the Auditor General's report is how we administer foreign aid. We can look at the CIDA disaster in conjunction with this.

Some fundamental changes have been considered and I would like to suggest a few of them today.

First, no government to government aid as much of this money lands in the Swiss bank accounts of despotic third world rulers. As a result of that the heads of many of these states are some of the richest people in the world.

Second, dispense aid directly to projects on the ground administered by foreign aid workers in conjunction with local peoples.

Third, focus on helping people to help themselves.

Fourth, concentrate on small projects that incorporate and are sensitive to local customs and practices. Expensive mega projects are usually expensive mega failures.

Fifth, focus on projects that involve family planning and birth control. Perhaps the greatest threat to the welfare of all peoples on this planet is the population explosion. We are rapidly outstripping our ability to provide for ourselves and are straining our resources to their maximum and laying waste to the environment.

I would not encourage foreign aid as a lever in developing nations as it only affects those most in need.

Make no mistake that what happens in other parts of the world will one day land on our doorstep one way or another. That is inevitable.

[Auditor General's Report, February 1st, 1994]

Mr. Speaker, there is widespread agreement in Canada and in this caucus that the primary way in which governments can reduce their deficits is through reducing expenditures.

To this end there is one potent tool that I do not think the government is using wisely and that is the Auditor General's report. This report outlines numerous areas where the government can spend public money more wisely and in fact points out areas of gross fiscal mismanagement.

Therefore I suggest that instead of allowing the Auditor General to report only once a year, let us allow these reports to come out several times a year in a timely fashion, so that remedial efforts can be put into effect as soon as possible to correct the problem. This would significantly help getting our fiscal house in order. The facts are there. Let us use them.

[Foreign Affairs, January 25th, 1994]

Mr. Speaker, I think it would tell the rest of the world that our involvement in these conflicts, to some extent, would not be as much as we could have done.

As I said before, if we remove ourselves from this conflict then the other member states that are engaging in the UN protective forces UNPROFOR are also going to move away from it and leave the people tragically to their own devices.

The important point I would like to make, as I said before, is that the people we are talking to tend to be the leaders of the fighting groups and they do not necessarily represent the people on the ground. That is a very important point to remember. The people who are paying the price are the people on the ground, the innocent civilians. We are not talking to them. We are talking to the wrong people, in a sense.

Although the Canadian people and our armed forces have done an admirable job, and nobody can criticize them for the work that they did, even if they do pull out for whatever reason, I think it will be a personal tragedy. The other nation states that do follow us in this endeavour will also tragically pull out too.

[Foreign Affairs, January 25th, 1994]

I understand, Mr. Speaker. I thank the member for a very intelligent question. It is a very far-reaching one.

The world, in my estimation, is breaking up into tinier and tinier nation-states. Areas within countries are now defining themselves within the context of a certain ethnic group. That is tragic because they are not practising big T tolerance. That is what is occurring in the world today. We see it in many areas. We see it in Afghanistan, Cambodia. We see it in Bosnia and in fact in South Africa. It is going to happen time and time again.

One of the lessons we have to learn through this is that we are going to be faced with these situations in the future time and time again as areas in countries start breaking down to the smallest sub-groups. We had better have a plan to deal with them.

As I brought up in my speech, we have to get into these situations early and prophylactically. The United Nations did a very good job in Macedonia and has done a very good job in preventing the war from escalating there.

I hope we can collectively address the particular issue that the member mentioned because we are going to have to make a plan. We are going to be faced with it more and more in the future.

[Foreign Affairs, January 25th, 1994]

Mr. Speaker, if we are going to make conditions upon our humanitarian aid efforts then we had better be ready to back them up with some action.

As I said before in my speech, my personal feeling on the matter is that if the stick we are going to use is the withdrawal of our humanitarian aid efforts, I disagree with that. We are obligated to continue with humanitarian aid efforts and not to do that would only involve an ever expanding war in the area with the loss of hundreds of thousands of lives. I do not think we should use that suggestion as a stick. Rather we should use what leverage we have gained over the years to convince the other

countries involved in this endeavour to side with us in strengthening the sanctions.

For those countries that are not involved in the endeavour, we have trade and other agreements with them that we can use as a stick to make them do what we say in terms of stopping illegal export of arms, fuel and weapons to the warring side. There are alternatives that we need to use but I do not think we should use it as a stick in the UN.

[Foreign Affairs, January 25th, 1994]

Mr. Speaker, I would like to thank you for the opportunity to speak today and to congratulate you on your ascension to the position of Deputy Speaker. I look forward to working with you. I also thank members of the government who have given all of us the opportunity to address this very important issue.

As this is my maiden speech I would certainly like to take the opportunity to thank the people of Esquimalt-Juan de Fuca, my riding, for giving me their confidence on October 25. I commit to them that I will again do my very best to represent them here in Ottawa. This subject is of great importance to the people of my riding because of its long history in defence and peacekeeping with Canadian Forces Base Esquimalt being there and the Princess Patricia Rifles.

I would however like to say that because of the seriousness and gravity of the situation we are speaking about today, I will keep my introduction to the most beautiful riding in Canada to a minimum and rather invite everybody to come there to see it for themselves.

The issue at hand today is Bosnia, a very serious one, and what should be Canada's role in this bloody civil war. I will preface what I am about to say by mentioning that there are no white knights and no black knights in this situation. Rather there are many gray zones. Atrocities have been committed by all sides. However certainly there has been a preponderance on the side of Serbian aggression.

It is important to note that the people of the former Yugoslavia did in fact live together quite nicely up until the beginning of this century. After World War I and with the collapse of the Ottoman and Hapsburg empires the Serbians, Croats and Muslims were fused together to form what we have come to know as Yugoslavia. There was little rancour beforehand. However ethnic tensions mounted because one group, the Serbians, were given preferential treatment to the expense of the other ethnic groups there. I hope this subject I have just mentioned is not lost on the Her Majesty's Loyal Opposition.

This culminated in World War II as ethnic tensions mounted with the slaughter of over two million Croats and Serbians at each other's hands, a number I might add that far exceeds the number of people who were killed at the hands of the Nazis. This deepened the hatred between the two groups, widened the rift between them, and set the stage for the carnage we see today in all its horror via CNN. As time goes on and the atrocities pile up on both sides, the rift between the peoples widens and the misunderstanding and hatred deepen. That is a profound tragedy.

Now that I have presented my preface what will our role be in this conflict? Since there is no peace in existence today, as has been said before, there is no peace to keep in the seething caldron of racial hatred. Is there peace to make? I think so but it will only come through diplomatic channels and not with force. To commit our troops with force today would in my estimation banish them to be just another fourth force in this encounter.

Along this line of questioning are air strikes. Should we or should we not employ them? If we use air strikes the impartiality of the peacekeepers would be forever forsaken. This would set us up for two things. First, it would set us up for full-scale reprisals by all sides that would produce a large loss of life both among the United Nations troops and therefore among our own.

It is interesting to note in these conflicts-and I speak from some personal experience-that one group can go ahead and kill its own people to make it look like another group is doing the killing. It is the easiest way to go against the group that is disliked intensely and against which the other is fighting.

Second, what would happen if we engaged in this conflict-and this is very important to understand-is that it would completely neutralized the humanitarian role the United Nations has engaged in so far. While this role has been imperfect it has indeed saved the lives of hundreds of thousands of people from death, rape and torture. Thus I do not think that air strikes are an option.

Now we are left with the last option, the humanitarian effort for which we have been given a mandate under the United Nations. At this time I would publicly like to state that it is a role our Canadian men and women have been doing admirably. Often overworked, underarmed and outgunned they have carried out their UN humanitarian role with profound bravery. I would like to extend to them publicly my heartfelt thanks and admiration.

Should we engage in this endeavour? If we pull out it can be fairly certain that other member states will pull out too. Therefore no humanitarian aid effort would go through in this conflict whatsoever. It would set the stage for mass genocide. Hundreds of thousands of people would be killed and there would be an escalating conflict.

It is very important to understand that this whole area is a tinderbox. The escalating conflict would involve other countries such as Russia, Bulgaria, Turkey, Albania, Italy and Germany. I do not think Canadian people would tolerate it.

At this time I would like to hearken back to the holocaust memorials we see every year and our response to them. As we view the horrible footage of Nazi atrocities the world commits naively to say never again. Tragically we may say this and believe it but clearly our heads are stuck in the sand for we have allowed the situation to continue in other countries over the years such as Cambodia, Iraq, Burundi, Sudan and Ethiopia, to name just a few. Bosnia represents an opportunity to say never again and to do something about it.

The soldiers are fighting these dirty little civil wars, but the greatest penalty to pay are the penalties that are paid by the civilians. I can say from personal experience that the penalties are paid by the children, the infirm and the aged. Those are the people who are subjected to the brunt of it.

As a physician and surgeon I worked in Africa and treated people who had suffered under a bloody civil war. I can say I have seen the effects of gunshot wounds, people who were chopped up with machetes, victims of torture and gang rape, children and teenagers with their arms and legs blown off, and the death, social destruction and dislocation that tear apart the very fabric of a country often forever. Once we have seen it we are compelled to do something about it. We cannot turn our backs on it.

What I have heard is that our soldiers feel the same way. It was perhaps best put most eloquently by a commander of our United Nations forces who said that there was a tremendous feeling of satisfaction when a young man or young woman came home and was able to say: "I helped keep this peace. I helped save lives. I helped people in distress. I helped people who are much worse off than I am". It raises the morale of individuals and collectively contributes to the well being of Canadian forces at large.

Apart from the purely altruistic reasons of continuing these humanitarian efforts there are some very concrete reasons why we should get involved in this venture. By having a leadership role in these multinational peacekeeping efforts, Canada raises its profile, strengthens its positions and gives us leverage across a broad range of diplomatic endeavours.

My philosophy is that we should get involved in these efforts earlier. In that way we can often obviate these situations, not always but sometimes. Bosnia is a case in point. The writing was on the wall in 1987.

I would summarize by suggesting the following. First, we should continue to provide humanitarian aid and not pull out of this endeavour. Remember we are there for the innocent civilians and not the combatants. This is another important point to remember. Many of the fighters and their leaders would like us to be out of this conflict so they can continue to increase the pace of the battle, increase the brutality and the killings. If we ask the civilians whether they want us there, they will tell us yes they do because we are often the difference between life and death for them.

Second, do not use air strikes unless we need to protect our own troops.

Third, we need to strengthen the sanctions against the Federal Republic of Yugoslavia, including the freezing of state assets and additional trade restrictions. I would go so far as to say complete isolation of the republic, but I would also engage in trade embargoes and sanctions against any other state that refuses to enter into these peace talks in a legitimate and determined fashion. Bring them to the table.

Fourth, penalize countries which break the embargo that exists with economic and financial penalties. They are being broken now. I suggest we get on them collectively and do something about it.

Fifth, continue with diplomatic efforts and let us play diplomatic hardball with these people with the aforementioned sanctions. I would go so far as threatening them with freezing their assets long after this resolution comes about, if they do not come to the table now.

Sixth, I would demand immediate guarantees for the safe movement of humanitarian aid by UN forces throughout Bosnia.

Seventh, create more safe zones where appropriate.

Eighth, continue with the war crimes tribunal under UN auspices which would hold accountable those individuals responsible for the atrocities that we have seen. I feel that the credibility of international humanitarian law demands a successful conclusion to this endeavour, for if we do not do it the failure of this process will exist. If we do continue, it will act as a deterrent in the future.

Finally, I would strongly suggest to the government and in fact plead with it to continue our humanitarian involvement under the UN auspices for the reasons that I have mentioned before. In fact I can probably summarize by saying if you do not do it now, you pay me now or you pay me later. That is what is going to happen.

I would like to make a personal plea for two brief things in which I think Canada should take a leadership role. First, Canada should act in a leadership role in banning the manufacture and distribution of anti-personnel devices. These devices from Hades have but one function and that is to maim and not kill civilians. We have seen them used with horrific results in Cambodia and other countries. Even when these conflicts are resolved the country is hamstrung. The people cannot move anywhere. They cannot move any goods and services because of these anti-personnel devices. They are truly horrific.

My second point ties into what I said before. We need to look in the future for potential conflicts. One I would bring to the attention of everyone is the Republic of South Africa. It is a tinder box and going into its elections in April is a very sensitive time. I would suggest that the United Nations consider bringing in an interim observation force to ensure that the elections go ahead in a fair and unbiased fashion. If these elections are perceived as being unfair and rigged, then it could lead to a bloody civil war.

I believe my time is up and I thank you for you attention, Mr. Speaker.

[Registered Retirement Savings Plan, January 19th, 1994]

Mr. Speaker, a supplementary for the Minister of Finance.

Will he guarantee or at least allay the fears of the Canadian people that he is going to continue the RRSP and that it is not going to be a tax concession to be reduced but rather a personal retirement safety net that is to be encouraged for these people in the future?