Libby Davies

[Housing, October 2nd, 2002]

Mr. Speaker, what is a throne speech worth? Will the promises for housing actually translate into real and affordable housing units for the two million Canadians who need them?

Do the recycled promises to address deepening poverty actually put food on the tables for five million Canadians who have suffered under 10 years of Liberal commitment that was worthless?

I ask these questions because that is what the 200 people camped out in the tents around the empty Woodwards building in Vancouver are asking. That is what the 125 homeless people asked as they were evicted from a homeless depot in Toronto. It is cold comfort for them to hear another throne speech.

Political promises that purport to help the poor while the record shows the opposite is true is the worst form of political exploitation.

Today New Democrats call on the Prime Minister to honour his commitments. He should begin by acknowledging the damage that his government has done to the most vulnerable people in our society.

[Petitions, June 10th, 2002]

Mr. Speaker, I am pleased to rise in the House to present a petition consisting of about 90 pages that calls on the government to enact a proper national housing strategy. These petitioners also support what is called the 1% solution for housing. This would ensure that there are adequate resources dedicated to the provision of affordable housing for every Canadian.

I would like to particularly thank Daniel Dufresne from Calgary who spent many hours collecting many of these petitions. They signify the great weight and importance that Canadians attach to ensuring that affordable housing is available to everyone in the country.

[Poverty, June 10th, 2002]

Mr. Speaker, we have heard the same mantra before. If these figures are correct, why is it that child poverty has doubled in this country since the resolution was passed by the House in 1989? Why has food bank usage gone up so much?

The same report from the food bank association specifically exposes government policies like EI cuts that have driven families into poverty.

I ask again, where is the evidence that the government's actions have reduced poverty rather than increased it?

[Poverty, June 10th, 2002]

Mr. Speaker, I know the Prime Minister has been busy these days fighting off mutinies and scandals, but it is about time he paid attention to issues of daily survival not of himself but of Canadians facing poverty.

Today the Canadian Association of Food Banks released a scathing report showing that twice as many people need food banks today compared to in 1989. How does the Prime Minister reconcile his support for ending world hunger at the Rome summit while here at home three million Canadians are victims of his government's legislated poverty?

[Canadian Transportation Agency, June 10th, 2002]

Mr. Speaker, first, I would like to congratulate the member for Lévis-et-Chutes-de-la-Chaudière. This is a very important motion and what the member has outlined in speaking to his motion is exactly the same problem I face in my riding in east Vancouver.

To go back into the historical record, the previous member of parliament to my predecessor, Margaret Mitchell, who was elected in 1979 and whom I am sure some members remember as being a very outstanding member of parliament, took up this issue way back in 1979 and into the 1980s in terms of constituents in east Vancouver who were severely impacted by the incredible noise from rail yards along the waterfront on the port of Vancouver lands.

The issue the member has raised is something that has been ignored for a very long time. As the member of parliament since 1997 in east Vancouver, I have written countless letters to the Minister of Transport, to the Canadian transportation authority and I have sent copies to the committee. I have raised this issue again and again to try to get some relief for residents who cannot sleep at 1 a.m., 2 a.m. or 3 a.m. as a result of the switching yards and train shunting in east Vancouver.

After hearing the member from the Canadian Alliance, this is not an issue where somehow we are against rail transportation. I would agree that rail transportation is a very exceptional mode of transportation, particularly in an age where we have to be very concerned about emissions into the environment. The people in east Vancouver who have historically lived next door to an industrial port and have had trains going by their houses for decades, do not deny the right and the opportunity for those rail operations to be operated in a way that is efficient, businesslike and so forth. However the reality is that for rail yards, which are adjacent to residential neighbourhoods, there have to be particular precautions put into place to ensure that the daily and nightly lives of local residents do not become completely disrupted. That is why I support this motion.

In my riding people like Shane Simpson, Barbara Fousek and Jim Campbell have spent thousands of hours dealing, in this case, with the CPR trying to get it to understand and be sensitive to resident concerns about noise. I will quote from one of the many e-mails that I have received from Mr. Campbell, a local resident. He said:

Shunting 100+ car lengths at a slow speed means residents endure 10-20 minutes of screeching, grinding and then diesels howling to move the sheer weight of the load.

Imagine that taking place every night. Imagine coming home from work after a long day and going to bed. All people want is to go to sleep but they awake every hour or so, perhaps several times a night or a week. When that happens people end up suffering from sleep deprivation. It begins to affect not only the health of individual families but also of the whole community.

In the case of east Vancouver there have been several local committees such as the Wall Street and Burrard View Residents' Association, for example, that have banned together to take up this issue. They have put forward numerous submissions to the Canadian transportation authority only to find that the CTA now claims it has no responsibility in this area, and I find that very shocking.

We followed very closely the situation in Oakville. I even spoke to the government member of parliament for that area. I was very interested to see that the residents of Oakville, which is a very affluent community, had hired some pretty hot shot lawyers to take on the CN company in that case. They won and then, as we know, the appeal was thrown out.

It was interesting to hear the parliamentary secretary speak behalf of the government today and leave the impression that everything is A-OK, that there are joint initiatives and a dispute settlement mechanism and that mediation services have been offered. If that is the case I can tell the House that they are not working, because obviously there are communities across this country that are still suffering very badly as a result of excessive noise from diesel engines, from shunting and switching and from engines being turned on and off and so on.

If the parliamentary secretary is correct that the minister is prepared to come forward with some amendments to the Canadian Transportation Agency and that there may be some legislation, this is something that is long, long overdue, because the current processes in terms of dispute resolution simply are not working. In my opinion, when there is a flurry of complaints the rail companies, in our case the CPR, may respond to them and may provide some temporary relief, but the fact is that over the long term the situation does not change.

I would also like to address the fact that the parliamentary secretary has kind of sloughed this off and has said that it really is a local problem. I am sure he knows that where these rail tracks and the switching and shunting that is taking place are in a port area or in an area of federal jurisdiction, it is very difficult for the municipality to apply the noise bylaw. We have gone this route in Vancouver. The residents went before Vancouver city council to try to get the noise bylaw enforced. The parliamentary secretary says this is a local problem and that is where complaints should be taken, but I can tell him that the residents have received no relief there.

I want to reiterate my support for the motion. I actually went out on the train tracks with local residents, with the CPR, and we actually drove in a car along the tracks to look at the situation firsthand. I was really quite disturbed by the lack of any sort of process or any sort of facilitation that would resolve the problems these residents are facing.

I too wish that the motion were votable. It would have been a very good motion to have as a votable motion. Based on what we have heard today in the debate and based on the experience across the country, I implore the government to listen seriously to these complaints and to understand that the lives of local residents and communities are being severely disrupted.

We are not talking about a low level background noise like a freeway. We are talking about, in the case of east Vancouver, noise levels that are up to 100 decibels. It seems to me that this is completely unacceptable in an urban environment. We have regulations about airports. No one would expect people to live right next to a runway and hear the decibel levels of airplanes, but when it comes to a rail line or a shunting yard where this kind of activity, which is as noisy, is taking place, somehow all of a sudden there is an absence of any federal regulations that can deal with it.

In regard to the responsibility of the CTA, it is a glaring omission to somehow slough this off. Again I want to implore the government and the minister to take their responsibilities seriously and ensure that amendments are brought forward if the motion is not voted on today. We want these amendments brought forward as quickly as possible so that the CTA will have authority to unequivocally deal with these rail companies. Maybe these companies are busy doing other things and do not think the complaints of local residents are important, but I want to say this: They have a responsibility to act in a neighbourly way. They have a responsibility to act in a way that is sensitive to the needs of local communities, just as local communities are very sensitive to the fact that they have business to do. This can be a win-win situation if only the Liberal government would bring in these amendments and make it clear that the CTA must act on these complaints and must take responsibility and provide relief to the people of east Vancouver and other affected communities.

[Public Safety Act, 2002, May 30th, 2002]

Madam Speaker, I understand that we are now debating the main motion. I listened with great interest to our colleague who was just recently elected to the House of Commons, the member for Bonavista—Trinity—Conception, and actually could not believe my ears in terms of what he was prepared to do to give his government so much licence with the bill. I listened to him today and heard him say that we have to place confidence in our government, we have to give the government the room to make decisions. He talked about World War II and used that as an example.

I have to say for those of us in the federal NDP that we are actually appalled at the scope and the dangers that are inherent in the bill. From the very first day that it was introduced, formerly as Bill C-42, now as Bill C-55, we have spoken out against the principle and the substance of the bill. How much room does the member want the government to have? It would have so much power under the bill. The power that would be conferred upon the minister and the cabinet is so enormous, and I think many members of opposition parties and organizations that are monitoring the bill have pointed out that many of our civil liberties would be at risk.

I would really beg to differ from the comments that the hon. member made. This is not about having trust and confidence in our government. This is about having an intelligent debate, looking at a very significant piece of legislation and determining the proper balance that is required to provide security but not infringe upon the democratic and civil rights of all Canadians.

I do not know whether the member has fully studied the bill, has followed the debate prior to getting here or has read some of the commentary and the analysis, but I can only say that having read the analysis and looked at the bill, one cannot come to any conclusion but to state that the bill is fundamentally wrong. To somehow equate the situation to what took place during World War II and the emergency measures and powers that required is a false premise. In fact, other members of the House have talked about the emergency War Measures Act that was enacted 30 years ago. I guess one of the really scary things is that even in that time, when the emergency War Measures Act was brought forward by the Right Hon. Mr. Trudeau, prime minister at the time, it was very controversial, but even that was a time limited thing. It was something that was not enshrined in legislation forever in a permanent way.

I was a young person attending university at the time the War Measures Act was brought in and I felt appalled that our Canadian government would go to that length and basically violate the civil liberties of people in Quebec under the guise that these full powers had to be put forward. However, I have to say that in looking at Bill C-55 we are now facing a much more serious situation in terms of the impact of this legislation and what it will do.

I wanted to begin by responding to the comments made by the new member for Bonavista—Trinity—Conception. I certainly welcome him to the House. However, the idea of giving the government carte blanche, of just sort of turning over all and every power to a minister or a cabinet under the name of security is something that I find very offensive and deeply disturbing. I, as one member of parliament, and all of us in the federal NDP caucus will do and say everything we can to make sure that the bill does not go through.

We are now back to debating the main motion and reviewing the provisions of the bill before us. I do not think that Canadians really have an idea of the far ranging scope of the bill and how many other pieces of legislation it impacts on. For example, the bill before us would amend the biological and toxin weapons convention. It would amend the Aeronautics Act. It would amend the Canadian Air Transport Security Authority Act. It would amend: the Canadian Environmental Protection Act; the criminal code; the Department of Health Act; the Organization of American States inter-American convention against the illicit manufacturing of and trafficking in firearms, ammunition, explosives and other related materials; the Export and Import Permits Act; the Food and Drugs Act; the Hazardous Products Act; the Marine Transportation Security Act; the National Defence Act; the National Energy Board Act; the Navigable Waters Protection Act; the Office of the Superintendent of Financial Institutions Act; the Pest Control Products Act; the Proceeds of Crime (Money Laundering) and Terrorist Financing Act; the Quarantine Act; the Radiation Emitting Devices Act; the Canada Shipping Act and the Canada Shipping Act, 2001; and it would enact the biological and toxin weapons convention implementation act.

That is an incredible scope. I think we can begin to see just how far-reaching the impact of Bill C-55, if it were enacted, would be on all kinds of other pieces of legislation that have been debated in this House. We in the federal NDP feel very concerned about the fact that the federal government is now trying to rush through this legislation. The first piece of legislation that came forward, Bill C-42, drew enormous public opposition from individuals, organizations and the media. Clearly the government had to respond to that opposition and withdraw the bill. It has now come back to the House with Bill C-55.

Although there are some changes in the bill, upon examining it the reality is that the fundamental premise of the bill, the conferring of enormous power to a minister and a cabinet away from parliament and away from public oversight, is still contained in this new version. For that reason we in the NDP continue to oppose the bill.

My colleague from Dartmouth, in speaking to the amendment, mentioned her concerns regarding what would happen at the upcoming G-8 summit in Kananaskis. She spoke about her concerns regarding what would happen to young people, seniors and members of the labour movement who are planning to gather to voice their legitimate right to dissent around what is going to take place at the G-8 summit. I certainly concur with her concerns. One has to question the bill and be suspicious as to whether or not the government's intent is to use its provisions to shut down legitimate protest and shut down the voice of dissent.

I, along with my colleagues in the federal NDP and activists from across the country, participated in the demonstrations and the protest that took place in Quebec City last April on the free trade agreement of the Americas. We saw the kind of police brutality and violence that took place in responding to legitimate demonstrations. I find it very scary that this legislation will legitimize and increase the powers of law enforcement agencies as well as government to stifle protests and to stifle dissent.

I am sure there are members of the Liberal backbench who privately share many of our concerns but are being whipped into place to get this legislation through the House. I sure wish some of those members would speak out, not only within their own caucus but publicly as well, because what we are about to do today is something that will set into motion a piece of legislation that will be here for the long term, for the foreseeable future.

I am proud to rise in the House to speak against this legislation and to encourage other members to do so as well. This is a bad piece of legislation. It goes too far. It tramples on the civil rights of Canadians and should not be supported.

[Housing Bill of Rights, May 28th, 2002]

Mr. Speaker, I would like to thank the members who participated in the debate and for the time they took to read this important bill and give their perspective.

I acknowledge that the province of Quebec has been leading the way in social housing. I came from a province that was leading the way in social housing but since the change of government there we have been going in the other direction and losing a lot of ground.

I appreciate some of the comments from the parliamentary secretary. I would agree that housing is not a unilateral solution. The bill advocates the need for federal, provincial, territorial, and aboriginal people to work together.

The parliamentary secretary said that the federal government recognized the need for housing. That is somewhat true but it has to be qualified by pointing out that it was only after an incredible amount of pressure by groups like the Federation of Canadian Municipalities, the Canadian Housing and Renewal Association or the Toronto Disaster Relief Committee, or even a guy that I came across called Daniel Dufresne who on his own went out and collected almost 1,500 signatures on a petition to put forward the need for housing. There has been a groundswell from the community who have pressed the government since it bailed out in 1993.

I was curious to hear the parliamentary secretary say that the government supports co-ops. I am glad to hear that the need for an independent agency may finally come to fruition because the Co-operative Housing Federation of Canada has worked for that for a long time.

In some ways it is such a sad irony because co-ops are a real Canadian success story. They were started in Canada. They are the living example of how to produce affordable, mixed housing where families can live in safety and security, and where a real sense of community can be developed. However there have been no new co-ops developed since 1993 when the federal government opted out of social housing and co-op funding. To me that is a real tragedy.

Even with this new agreement the province of Quebec will still continue to develop co-ops. That is great, but nowhere else is that likely to happen because unfortunately this framework does not have the teeth or the guts to bring to fruition some of these important points that have been made by various members in the House today. To me that is the real tragedy of what is going on here.

We have enormous capability and resources in this country to produce not for profit social housing, or co-op housing, yet we seem to let it go to waste because we have not had the financial program to put it together.

This debate has been important. I hope we are a little further ahead in recognizing the importance of people's individual human rights, to have basic shelter and adequate, safe and secure housing. I encourage the government to go beyond its framework agreement and to look at a real national housing strategy that gets us closer to the goal of providing 30,000 units a year, to build safe and healthy communities with the municipalities, provinces, territories, aboriginal communities and with local organizations that are now ready to develop that housing.

[Housing Bill of Rights, May 28th, 2002]

moved that Bill C-416, an act to provide for adequate, accessible and affordable housing for Canadians, be read the second time and referred to a committee.

Mr. Speaker, I am pleased to rise in the House today to speak to Bill C-416, the housing bill of rights. This is an important debate. I will begin by outlining the purpose and intent of my bill.

The housing bill of rights addresses the need to create a national affordable housing strategy. It may be surprising to Canadians that this is something we do not have in Canada. We are the only industrialized country in the world that does not have a national housing strategy.

However the bill would do more than that. It would entrench in law the right to affordable housing for all people. As a signatory to the 1976 United Nations international covenant on economic, social and cultural rights, Canada already recognizes and protects the fundamental human right to adequate housing. Under Bill C-416 the right would be formalized and enshrined in Canadian law and not merely in international covenants to which Canada is a signatory.

I will talk about the scope of Bill C-416 and what it would do. It outlines that individuals would have the right to secure, adequate, accessible and affordable housing without discrimination. These rights would extend to security of tenure as well as protection against arbitrary eviction, forced relocation or any other form of harassment. The right to housing would include housing appropriate to individual or family specific needs.

Bill C-416 would guarantee the right to privacy and a safe and healthy environment free from the threat of violence. It would ensure housing was affordable. It would provide for protection from rent increases, property tax increases or other costs that were sudden or excessive and had the effect of diminishing housing as a basic human right. That is the general thrust of the bill.

It is important to enshrine these rights because many people take for granted that everyone in Canada is well housed and that we are a wealthy country. The reality is that growing numbers of people in Canada do not have adequate, safe and affordable housing. This is in part because we have not recognized housing as a legitimate right in Canadian society.

I have brought the bill forward because for a number of years we have seen a growing crisis in Canada. Four years ago the Federation of Canadian Municipalities declared homelessness a national housing disaster. Municipalities across the country passed resolutions urging the federal government to develop a national housing strategy to respond to the growing crisis. The Toronto Dominion Bank, the Toronto Board of Trade and many other organizations have recognized that we have a housing crisis in Canada. As I have mentioned, we are the only western developed nation without a national housing strategy.

I will speak briefly about the crisis before us. It may surprise some people to learn that about 250,000 Canadians will be forced to sleep in emergency shelters this year. Almost one in five rental households, or about 800,000 Canadians, pay more than 50% of their income on rent. Between 1991 and 1996 housing need as defined by CMHC, not by me or anyone else but by the government's own housing agency, skyrocketed upward. Some 1.7 million Canadian households are now defined as being in core need. That means people who pay more than 30% of their income on rent.

I find it quite shocking that the number has increased by 40% over a five year period. Half the tenant population in Canada can afford to spend only $580 per month on rent. Yet what we have seen, particularly in our urban communities, is the lowest vacancy rate in history since statistics were adopted by CMHC.

We are facing a crunch not only for people at the bottom of the economic ladder who are destitute on the streets. We are a facing a crunch for tenants who work, students, seniors, and families who find they are paying more and more of their often meagre monthly incomes for shelter costs which are becoming exorbitant. These are some of the things that contribute to the housing crisis

I am sure when some members of the House, particularly from the government side, get up to speak they will say there was a problem but the federal government fixed it by signing a housing agreement in Quebec City last November with the provinces and territories. I was there when the agreement was signed. I have worked with many of the organizations that have monitored it. While the agreement is an important step it has in no way created a financial or policy foundation from which to develop a truly national housing strategy.

In the six months since the deal was signed only one of the provinces, the province of Quebec, has lived up to the commitment it made in terms of the money it has put in. Five of the 10 provinces have gone the other way and cut money for housing.

This information has been monitored by the National Housing and Homelessness Network. The network put out a report card a week ago which clearly demonstrates that the agreement has been a dismal failure. First, it does not provide for an adequate number of units. Second, only one province has made a real commitment to put money into developing affordable housing.

As the National Housing and Homelessness Network has pointed out, the agreement is flawed. It offers no guarantee that affordable housing will be produced. It allows the provinces to replace provincial money with federal money. This is happening in my own province of British Columbia. Some provinces are sidling around the agreement and doing a bit of a shuffle game. They are robbing Peter to pay Paul. There are serious flaws with the agreement the government signed with the provinces and territories last November.

The agreement outlines that over a five year period $680 million should be committed at the federal end to housing. Maybe that will produce 5,000 units per year, and that is a qualified maybe. We have documentation from CMHC and other organizations that says the need in various communities across the country is about 30,000 units annually.

This should give members an idea of how far short the agreement is from what we need to do to develop a national housing strategy. Even the government's own task force, the Prime Minister's caucus task force on urban issues which was not an all party task force, called for a national strategy. I will quote from its report. It recommend that the Government of Canada:

Establish A National Affordable Housing Program that could include:

--Strengthening the mandate of Canada Mortgage and Housing Corporationto develop A National Affordable Housing Program in collaboration with allorders of government, and housing providers--

It made the recommendation after the agreement was signed last November, so clearly even the Liberal task force is aware of the grievous shortcomings of the agreement signed last year.

I am one of the people in the House who continually raises housing issues. I found it ironic that the Deputy Prime Minister who is the minister responsible for CMHC and housing responded to a question of mine last week by saying no one noticed he had responsibility for CMHC. It was alarming that the minister responsible for housing would joke about the fact that no one knew he was the minister of housing because of all his other duties.

We see the Prime Minister shuffling his cabinet. I sure as heck wish he would shuffle in a real housing minister. We would then have someone on the government side who was clearly responsible for this most basic human right and need in Canadian society. The Minister of Labour is the co-ordinator of homelessness. However we have not yet seen a minister truly responsible for taking on this important question.

I find it quite ironic that parliament has not had a debate on housing policy since I came here in 1997. It is a demonstration of how the Liberals have not been committed to a proper affordable housing program.

When I started working on the bill and putting out information I wrote to organizations and individuals across the country. I received some wonderful mail. I will quote a few people who wrote to me. I got a letter from a fellow in Kelowna, B.C. who cannot afford housing. He said:

I agree we need more affordable housing. I am 44 years old and have had to leave the workforce at 33 due to health problems. I would be writing to you by computer but I do not have one. I am on a disability pension, but now there is nothing out there to rent for $325 a month.

I also have a letter from the National Union of Public and General Employees, often referred to as the national union. In a letter to the finance minister in support of my bill the union pointed out:

While your government sits on the largest budgetary surplus among the OECD countries we have a growing housing crisis in this country.

This is a shocking fact. We do not have a housing crisis because we lack the financial capability to deal with it. We have a housing crisis because we have lacked the political will and leadership to make it a priority and make sure it is adequately contained in the budget.

I have a letter from the Carnegie Community Centre Association in my riding of East Vancouver. It says:

Given the Carnegie Centre's situation in the centre of one of Canada's poorest neighbourhoods, the crisis of homelessness is particularly critical for us as we have constant and immediate contact with the extreme suffering it causes.

I want to underscore this. It is not some sort of academic or hypothetical situation. A week or so ago a video was released in Toronto that showed the conditions in an emergency shelter. It showed people sleeping on mats on the floor inches away from each other in violation of even the United Nations' policies for refugee camps. We are talking about Canada, not refugee camps.

I have visited shelters in Toronto. I was appalled to see people sleeping on the floor on mats with only one washroom for the men and one for the women. I am talking about extreme suffering. I am talking about people freezing to death and people who have TB because they are out in the cold and living in unhealthy conditions. This speaks clearly to the suffering caused not by individual failure but by the failure of the government to do anything about it in terms of public policy.

Bill C-416 is a good bill. It is well written. Many people have commented on that. I want to acknowledge some of the groups that contributed and helped produce the bill, particularly Dr. David Hulchanski, a professor at the University of Toronto. Dr. Hulchanski is one of Canada's foremost housing experts. He has helped monitor Canada's progress in meeting its housing commitments under the social and economic covenant.

The National Housing and Homelessness Network has done a tremendous amount of work to keep the pressure on the federal government and bring the issue forward. I also acknowledge the Toronto Disaster Relief Committee and the Tenants Rights Action Coalition.

I have received about 2,000 petitions in support of Bill C-416. I hope the bill will bring about a real commitment from all members of the House to recognize housing as a human right, act on it and make it a reality for Canadians.

[Social Programs, May 28th, 2002]

Mr. Speaker, on May 25 my colleague from Burnaby--Douglas and I joined 40,000 British Columbians who marched through downtown Vancouver to voice our dissent and opposition to the massive cuts perpetrated by Gordon Campbell's cruel agenda.

Seniors, single moms, students, the disabled, aboriginal people, workers, kids and families were all united in speaking out against the devastating cuts to our health care, environment, education, welfare, legal aid, employment standards and schools. Even today we hear that tuition at SFU will go up a whopping 30% and yet again poor people are being hit, this time a $75 a month cut on welfare.

Where are the B.C. federal Liberals? Why are they not sticking up for people's basic rights and services? Is our federal government now so gutless that it would allow this B.C. premier to destroy fundamental Canadian values of universal health care and a decent quality of life without fear and punishment for being poor.

We say that B.C. federal Liberals must do their job and support the people of B.C. in stopping Gordon Campbell and these awful cuts.

[Health, May 27th, 2002]

Mr. Speaker, this past Saturday 40,000 British Columbians spoke out against Gordon Campbell's horrifying vision of B.C. It is a vision where one cannot afford to get sick or attend school and where even the basic right to assistance is being destroyed.

Why is the Minister of Health not supporting the people of B.C. to stop the destruction of our public heath care system. Is the government now so gutless that it will not even defend its own vision and mandate for health care as set out under the Canada Health Act? Why will she not defend our public health care system?