Mr. Speaker, I wish to begin my remarks today by asking why we are suddenly debating health care. Is it because the federal government is doing something about health care? The answer is no. Is it because the federal government has any new policy for health care? No. Is it because the federal government is announcing any new funding for health care? No.
In fact a representative of the government today barely spoke at all on health care. I am appalled. I wish no insult to the parliamentary secretary but the government called this debate on health care and it would have been appropriate for the Minister of Health to come here and begin this debate today.
Instead, all we got was a very brief lecture which seemed to concentrate mainly on the necessity that we all live more healthy lifestyles. This unfortunately is standard practice. This is the second take note debate we have had in the House, a standard practice of the government which, at critical times, wants to change the subject, indulge in rhetoric rather than action and engage once again on a critical matter in careful positioning: watch where all of the various opposition parties stand before taking a communications position itself.
We have seen this before. We saw it even last week. Since I became a member again in May we have had scandal after scandal and so last week suddenly an ethics package appears. It turns out the ethics package has nothing to do with changing any of the practical rules for the ethical standards of the Prime Minister and members of cabinet whatsoever.
We have the same thing with Kyoto. We have the Kyoto accord which is sinking fast. Today it was mired in provincial opposition at the conference in Halifax. We had this developing last week. There was lack of industry consensus and lack of a plan. Suddenly late last week we had a Kyoto package, although the Kyoto package of course provides no key answers to questions on targets or costs.
I would suggest that this particular manner of acting by the government is most dangerous in the area of health care where people are genuinely being affected by it. We have had nine years now of excessive rhetoric from the Liberals on health care and lack of action, which is genuinely contributing to the continual deterioration of our health care system.
Of course this reached a crescendo in the last federal election, and I will speak about this later, when the government attacked provinces that were trying to reform the health care system while offering no alternatives of its own. Much of this situation comes today because of the cutbacks that the government introduced in health.
I remind the House that the former minister of finance loves to take credit for the elimination of an over $40 billion federal deficit. We have never begrudged him that credit but he also must be frank about how he did that. Between 1995 and 1998 tax revenues rose $30 billion. In other words, three-quarters of the deficit was eliminated by taxes. Ten billion dollars was eliminated by a reduction in expenditures in which $6 billion came from a reduction in health care transfers to the provinces.
The record of the government in health care and in federal spending was that it cut in its own back yard on its own administration by 2%. It cut military spending and security by 20% and cut health care by one-third. These ratios are exactly the opposite of what every province did to balance their budgets, although every province ultimately managed to balance their budget.
As a consequence of this, according to data from the Organisation for Economic Co-operation and Development, today we have a health care system that ranks 18th in terms of access to MRIs, 17th in terms of access to CT scanners and 8th in terms of access to radiation machines. In terms of risk of death by breast cancer, for example, Canada ranks sixth among OECD countries. According to the Fraser Institute, across Canada total waiting time is high both historically and internationally compared to 1993. “Compared to 1993, the waiting time in 2001-02 is 77 per cent higher”. Waiting time under this government has increased in all but one of the past eight years. Canadians deserve a much better health care system than that.
When the government came to power it was very common to hear Canadians refer to our health care system as the best health care system in the world. It is extraordinary now how seldom we hear that phrase spoken.
Before I move on to what we think is critical in health care, let me talk once again about the values that should guide us in the health care system. Whatever flaws our health care system has today, it is the only one we have and the only one ordinary Canadians have come to depend on it. In fact we were promised we could depend on it and persuaded to do away with most other alternatives.
Canadians are increasingly worried about the future of the health care system, which is one of the reasons I re-entered politics. Now that my wife Laureen and I have children we have had discussions over the past several years about our future, about planning our future and about planning our children's' future. We have had repeated discussions about some of the challenges we face and health care has come up a lot. My wife and I know we are at the end of what is called the baby boom and that by the time our critical health care needs develop health care will be well into a massive crisis unless something is done about where the system is going.
Where will ordinary Canadians go when we enter this crisis? The government has a monopoly on key health services. My wife and I and many other Canadian families have saved a lot of money for our retirement and other things, but not necessarily for health care. We thought we were paying tens of thousands of dollars a year in taxes toward a long term health care system. For most of us, unlike the Liberal elite in this country, running to the United States to get health care services is not an option simply because those services are expensive. They are expensive not just in absolute terms but expensive because of the policies of this government. With our dollar falling every year, anything purchased in the United States becomes more and more expensive.
What is important? Anyone who thinks about this should be very worried about this in the next 10 or 20 years. Anybody who thinks about this will need to ask some important questions. What is important about the health care system? What is it we are trying to preserve? What is it that we have to let go?
We will hear the Liberals tell us a number of things about the health care system and how important they are, but these often miss the point. They will talk about this as being a Canadian value, a nationalistic thing. They will talk about the public non-profit nature, about equality and about the fact that services are free. Let me address some of those issues because it is important that we have an honest debate.
First, is it really critical for us as individuals seeking health care that this system is Canadian, that somehow it defines the country and our nationalism? We are told this repeatedly by the Liberals and I know it is a popular view, but is it really true? My ancestors engaged in two world wars to fight for the values and freedoms of this country. They fought in those wars without a public health care system. I am not suggesting they did not want one. In fact, having public health care has been one of the benefits of winning those wars, preserving our freedom and moving our society forward. However, we did not fight wars to preserve the health care system. I would suggest that not many Canadians are willing to die for a health care ideology in a health care line-up. They may be willing to die for their country but they are not willing to die for the Liberal definition of the health care system.
When I talk about the health care system as a national value, I will speak specifically about the federal role in health care which has been particularly problematic.
Second, is the important thing about health care that it be public and non-profit? Contrary to a lot of Liberal rhetoric, the fact that our system is public is not what actually makes it terribly unique. For instance, even in the United States a majority of health care is provided publicly, not privately. The most recent figures I have suggest that roughly 69% of our health care is public versus 53% in the United States.
Most Canadians are shocked to learn, particularly with the deterioration in federal funding for health care, that the United States now actually spends more per capita on public health care than we do in Canada. All this spending should point out that while health care is non-profit in most cases in Canada, it is certainly not charity. It is an expensive business.
Do people care about how the health care system is delivered? I would suggest not. They care about whether they are getting treated or not. When we have a public system that increasingly justifies its monopoly through rationing, I must point out that this is having real impacts on ordinary Canadians with diagnoses, treatments and ultimately on mortality itself.
The third point is equality. Equality is an important value in our system and I must say that health care is more equally accessed in Canada than in the United States. That is an important value and one that we should continue to preserve.
However, health care is not equal in this country in any absolute sense of the word. I have already mentioned the fact that some Canadians, including the Liberal elite, can go regularly to the United States whenever the health care system fails them here, but not all Canadians have equal access to health care. Depending on where they live, their province, and whether they are rural or urban, some have superior access, as is the case in any publicly run monopoly. Those who are connected with its running have superior access.
Most important, public health care in Canada has never come close to covering all health services. Most Canadians have supplementary health care coverage. Some pay for it individually and others have it paid by their employers. The House of Commons has one of the best supplementary health care packages in the country. It is simply not available to average Canadian workers. We are fooling people if we think that somehow every Canadian gets equal access under our system.
Is it important that the system be free? First, let me be clear that no reasonable person believes that our health care system is free. We do not generally pay at the point of service, but our health care system is very expensive. It is very expensive and increasingly slow to deliver and hard to access.
The cost of our public health care system in 2001 was about $75 billion. Over $100 billion was spent on combined private and public services. It is not free. It is reflected largely in our tax burden. Our tax burden is too high. It is close to half of the disposable income of the average Canadian. In the U.S. the equivalent tax burden is only about one-third.
All those things may to some degree define our system, but if all of them are not what really matters or what should matter to people in our health care system, then what should matter? I would suggest two things.
First, that we actually get health care, that it be available. That is the single-most important thing and it tells us how ideological this debate has become when we have to remind people that health care be available, especially when we are sick. That means that health care must be patient-centred. It is the health of people that we must be concerned about and not as the Liberal government says, not as many of the invested interests of the health care system say, or so-called health advocacy groups say. It is the health of people that matters, and not the health of the system and those who work in it. That is our primary concern here.
Second, health care needs to be affordable. It is important that we can get it and that we can afford it. I would point out that affordability of health care is almost invariably delivered, whether it is publicly or privately, through insurance. Because of the nature of health care and health care expenditures which are unexpected and often large, it is almost always the case, with the exception perhaps of the extraordinarily rich, that health care must be delivered through an insurance program, whether public or private, and almost everyone requires health care insurance in this combination.
That does distinguish Canada, to some degree, from the United States. We have, as do most advanced industrial countries, a universally available public health insurance system. The United States, notwithstanding its large public expenditures on health care, has no such program. This is a system that this party supports. This is a principle which we will always defend and on which we should build.
However, what is important is that all Canadians get necessary, timely service regardless of financial means, that we do not saddle ordinary people with enormous bills for catastrophic health problems or, on the other extreme, provide them with a system that is so monopolized and rigid that they cannot get health care at all, regardless of these principles. The tax burden of doing this and providing this should crush neither our individual pocketbooks or our economy.
In this regard, what are the key challenges that our health care system faces today? First, what must we do about the availability question? This party has been clear. We must support efforts of the provinces and others to ensure that we have greater choice in health care delivery mechanisms.
Several provinces are involved in pushing for alternative private delivery, even on a profit basis. This is a natural development. In a properly functioning system, profit is the reward that businesses obtain for making substantial, long-term capital investments. One of the problems, given the nature of a government or a non-profit model of anything, particularly as we have seen it in our health care system, is the tendency to under invest in the long term.
This is a serious problem in this system. We have continually, progressively under invested in the development of health care professionals and we have under invested in capital equipment and purchasing, particularly as this system is becoming more capital intensive. That is a key reason why it is deteriorating.
Before the Liberals jump to their normal rhetoric, let me be clear that when the provinces today, which are talking about private delivery, talk about it, they are talking about private delivery options covered through public insurance mechanisms. The federal government, the Liberal Party, has been playing games opposing this, sometimes opposing it strongly, sometimes opposing it not so strongly. It is playing games with the health of Canadians, playing games with the efforts of the provinces and others to ensure that this health care system is properly funded and properly invested in for the long term.
During the last election, for example, this was particularly bad. The government attacked the provinces, especially Alberta, and has since attacked Quebec and has made not so subtle attacks on Ontario for all the same reasons, for trying to broaden private delivery of publicly insured health services. The government has repeated and has a rich record of rhetorical excess when it comes to this area. There is no better example of this approach than what happened in Alberta prior to and during the last federal election.
The Alberta government introduced the health care protection act. This act was introduced in the Alberta Legislature March 2, 2000. I want to make it clear what this act did because we would not know it if we listened to representatives of the government. This act banned the operation of full service, private hospitals. It banned queue jumping for medically necessary services, as well as charges for those services. It set out strict patient protection rules for the sale of enhanced services, services outside the medically necessary definition provided in the Canada Health Act.
The one change in this act by the Government of Alberta was to allow alternative delivery of health services. It provided for surgical facilities, whether public, private or non-profit, to receive public funds to deliver such services to Albertans. It did not change how Albertans received health care. They still require only their provincial health care card. It simply changed the way health care was delivered. I would point out that even the World Health Organizations has stated that the ownership of a health facility should not matter, what does matter is control, sanction and regulation by public bodies.
The Alberta reforms were modest. They allowed for surgical services to be delivered outside the public monopoly system. Yet despite their modesty and the sensibility of the reforms, a mere eight days after the bill was introduced, the federal government cranked up its rhetoric about this development.
On March 10 the federal government, in the form of the former health minister, did the equivalent of a drive-by shooting by delivering a speech in Calgary. He did this without first talking to the Alberta government and without letting it know he had concerns about the bill or acknowledging what Alberta's health care protection act actually had. What he did is he gave a speech. It was not a private talk. He gave a public speech in which he implicitly suggested without any evidence that the delivery of health care outside of existing public facilities threatened the system.
He made sure that this overblown rhetoric was nationally televised. He gave the media advance notice of this address more than he gave the Alberta government. He hand picked the audience. He ensured it was filled with the fearmongers about the health care system in Alberta, the Alberta Liberal Party and also the union backed friends of medicare. Then he sped away from the drive-by shooting without so much as a phone call to his Alberta counterpart to lay out his case. He even refused to provide a copy of his remarks to the Alberta government for three days.
The rhetorical excess of this speech, the refusal to work with the provinces, the imposition of a centralized view of health care from above has not been an isolated event. I could go through example after example of this with regard to various provinces on various issues over the last three years.
Let me point out that only as recently as this September, at a federal-provincial health minister's meeting, and later when the Alberta government made some additional announcements on new facilities, the present health minister was attacking and raising fears about the development of private health facilities within the public system. The position of the government is clear. Both the current and former health ministers have opposed the idea of allowing private firms to deliver health services even when that delivery means no additional charges to Canadians.
I have spent much of my time talking about alternative service delivery within the single pair system. I do so because this is the direction most provinces are moving in. It is a direction the government opposes. It is a direction that we support.
A government monopoly is not the only way to deliver health care to Canadians. Monopolies in the public sector are just as objectionable as monopolies in the private sector. It should not matter who delivers health care, whether it is private, profit, non for profit or public, as long as Canadians have access to those services through the public insurance system regardless of their financial needs.
We are going to have to become a lot more innovative and flexible in how we deliver health care while holding fast to the principle of universal access regardless of ability to pay.
On the affordability of the current system we have the Senate Kirby committee and we expect to have the Romanow commission soon urging that we spend more money on our health care system. We believe that is necessary. We have allocated, in our own draft budget documents, money for additional health care expenditure. We believe that is important, and I will not get into all the considerations today, provided there are careful considerations and we work with the provinces to ensure that these funds are used efficiently.
The Kirby committee and we expect the Romanow commission will go much farther. They are suggesting not just that we need more money but that we need more taxes as well to pay for health care. Let me make it clear on behalf of every member of this party that this is absolutely unacceptable.
The tax burden in this country is too high. It must fall for this country to be competitive, and for Canadians, whether through private or public facilities, to be able to access health care. The government must adjust its priorities to make health care a higher one.
For example, I just cannot help mentioning the money spent on Groupaction and Groupe Everest and all these friends. Is the sponsorship program as important to this country as spending additional money on health care?
I will say again that this is a government that is out of control in its general spending. In the past three years, under the former minister of finance, the government has raised program spending by over $25 billion. Only a portion of that, contrary to mythology, has gone to health care.
I was just looking at the public accounts report for 2001-02. Last year of the over $7 billion in additional spending, less than $3 billion went to fund additional health care expenditure. The question I need to add here is this. Given the way the federal government does it, are those additional infusions of money really even very effective?
This is the final point to which I want to get. Independent of the difficulties I have with the Liberals and some of their individual decisions in the health area, we have serious reservations of whether this is a party opposite that can ever really deal effectively with the health care problem because of the nature of the party's philosophy, in particular the nature of its attitude toward the federal structure of the country and toward the provinces.
It is significant that once again we are engaged in a grandstanding debate here. Literally the government says “Let's talk about health care” but it has no position whatsoever to deliver. We have had three national studies, two that are now completed and one that is ongoing, yet no meaningful proposals from the government. In fact, after 30-some years of federal intervention in the health care area, there remain no real national standards of what constitutes even core or medical services. Instead what we have and have always had is a constant painting of the provinces, which deliver the system and must improve the system, as somehow the enemy of the health care of Canadians. Of course today what we ultimately have over this period is the federal government using the basic fiscal imbalance that we have in the structure of our federation to score political points against the provinces.
The problem is the Liberal government's philosophy. The Liberals have always wanted to centralize all powers and decision making in Ottawa. In their view, while the provinces may be an administrative necessity in such a large country, they are also a nuisance. In our book, the Liberals have never been real federalists. They are centralists.
For example, we will remember that recently, and in the last federal election, this government attacked those provinces which had undertaken a comprehensive reform of health care, Alberta and Quebec in particular, provinces which were trying to attract private investment to the health system. The Liberals contended that there was nothing fundamentally wrong with Canada's health care system. That is their philosophy.
Following the election, recognizing public concerns about rising health costs and the deterioration of health care, the Liberals established the Romanow commission, which toured the country for two years at a cost of millions of dollars for a study in an area of provincial jurisdiction. Just weeks before submitting his report, what is Mr. Romanow telling us? He is telling us that there is no problem with the health system, except perhaps for some lack of funding and confidence.
Our party, the Canadian Alliance, must tell the truth to Canadians and Quebeckers. Our health care system is experiencing serious long-term problems. We can inject more money into it. We advocate this, but money alone will not solve the problem. The federal government must recognize that the health care system is first and foremost a provincial responsibility, that it was the provinces that established the system, that run it, and that, in the end, must solve the problems that are plaguing it. It is the Liberal government, it is the Liberals, who messed things up all along, who never kept their promises for funding, who reduced health care funding to balance the budget. They are the ones who are preventing innovation and blaming the provinces for their own failures.
We saw it again recently, when the former Minister of Finance, he who made drastic cuts to provincial transfers, attacked the Action Démocratique du Québec simply because it was suggesting new policies.
Mr. Dumont's ideas are somewhat different from ours. However, his ideas must be discussed by Quebeckers in the debate that is taking place in their province. It is not up to a leadership candidate for the federal Liberal party to decide, a candidate who, more importantly, is the one who created these problems.
A number of provinces are currently trying to cope with the problem by attracting more private investment into publically insured services. The federal government must support this initiative. Ever-growing waiting lists are unacceptable. Regardless of who is providing the health care services, what matters is that Canadians and Quebeckers have access to these services, regardless of their ability to pay.
The hon. member for Yellowhead, our health care critic, and others will speak at greater length today about some of our concerns in the health care area, our reaction to some of the proposals that are on the table and where we think the country should go.
I just want to end here by summarizing what I have talked about today. What I have tried to outline is the contrast between how the Canadian Alliance approaches the health care system and how the Liberals have approached it. First and foremost, just as a general phenomenon, the Liberals engage repeatedly in grandiose rhetoric aimed at generating headlines or diverting headlines from other subjects, headlines that hide the deeper reality that they have done nothing to address the health concerns of ordinary Canadians. This contrasts with our approach in addressing health care in a way that deals with the health concerns of average Canadians, the kind of average Canadians who fund and support the Canadian Alliance.
Second, when it comes to availability, the Liberals have and continue to oppose alternative service delivery for health care by making grandiose claims that this will somehow destroy the public medicare system. This contrasts with our support for provinces that are wishing to find alternative methods of delivering health care, to shorten waiting lists, to improve service and to reduce costs, while ensuring that Canadians have access to insurance services using only their provincial health care card.
Finally, when it comes to affordability, the Liberals engage repeatedly in grandiose rhetoric about the dollars they have spent or the dollars they will spend on health care. Of course the reality is that what they really want is new taxes to deal with health care because they simply cannot control their spending in any area whatsoever.
The reality of course is that after all this spending the Liberals do across the board, health care spending at the federal level is still actually below what it was when the government took office. Instead what we have is the Liberals pursuing this in a way that hampers efforts at reform in a key area of provincial jurisdiction. This contrasts with our approach of accepting the diverse nature of the country and accepting the positive leadership that the provinces have provided historically and are trying to provide now ensuring that Canadians have strong accessible health care services provided in a timely manner.
This party wants to work cooperatively with the provinces in this manner. There is no more important concern that ordinary Canadians have than receiving health care in a timely and accessible way. That is what we will continue to do. We will continue to challenge the government to stop this shameful charade of raising health care, attacking the provinces and, as it has done today, providing no solutions whatsoever.
Mr. Speaker, it goes without saying that I will use my 20 minutes, and more if the House gives its consent. This take note debate initiated by the government is an important event, because there is no greater priority than health care and its availability.
I would like to mention a number of historical facts to help clarify the situation in which we find ourselves. In 1984, the Liberal government was about to lose power. This was a washed up government, overtaken by events, plagued by patronage and bad budget decisions. The result was that Canada found itself faced with an anticipated budget deficit of several millions of dollars.
What is often overlooked is the fact that, during the last year of its mandate, the Liberal government—under then Minister of Health Monique Bégin—introduced a bill which became a very important piece of legislation, namely the Canada Health Act.
Of course, this bill could not have been introduced if the federal government had stayed within the strict confines of the respective jurisdictions of the two levels of government. We all know that the federal government cannot get directly involved in the delivery of health services, except in the case of aboriginals, penitentiaries, epidemics, quarantines, drug certification and its logical corollary, drug licensing.
In 1984, the federal government, on the advice of the Privy Council, which is often said to be Canada's largest department of political science given the scope of its resources, used its spending power has an excuse to introduce a national health act. This sparked a more or less general outcry.
Even in Ontario, doctors went on strike for days because they feared that, under this national health legislation, they might be restricted in their ability to organize their work.
The Canada Health Act established a number of guiding principles to direct the way the provincial governments would organize the health system. This is why the majority, if not all of them, were opposed to the legislation. In this House, however, in 1984, all parties supported the Canada Health Act, including the opposition—Brian Mulroney had just come into power. I do not, of course, include the NDP here, as we are all aware that its approach has always been centralist. In short, all opposition parties, including the one now in government, were in favour of the National Health Act.
To recap briefly, this act encompassed five principles. There was to be public administration. There was to be comprehensiveness, in other words the provincial or territorial health insurance plan had a duty to cover all insurable health services. There was to be a specific minimum of coverage, or comprehensiveness. Then, of course, there was universality, which continues to be discussed to this day. There was the principle of portability, which implied that we were part of a common market as far as health was concerned. By virtue of his mobility, a person in Alberta, Saskatchewan or Quebec was supposed to have the same coverage. This, of course, was the principle of accessibility.
At that time, with the debates in the House of Commons, there was confirmation and reaffirmation of the commitment made in 1957 and again in 1961, when the federal government passed the legislation on health insurance and on hospital insurance.
It is important to recall that at that time the federal government made a commitment to be a partner and pay 50% of health care costs. That is the irony of the situation in which we now find ourselves.
There have been a number of commissions of inquiry by the federal government, by the Senate, the other House; there have been several studies, such as the report of the Romanow commission that is expected at the end of November. We have been asked to reflect on how the health care system should be reorganized. I do not mean to suggest that this should not be done, and I will come back to this later before my time runs out, but we are sidestepping the most fundamental fact.
That fact is that the government with the most resources, the federal government, the government which made promises in the past to cover 50% of health care costs, has completely, or almost completely, backed out of this promise. In what can only be described as a betrayal, it has broken its past promises and it has gotten away with it.
When the debate took place in 1983-84, the federal government was a significant partner in health care funding. Today, the situation is so troubling that all of the premiers, from Bernard Lord—I do not mean to bring up bad memories for the Tories—in New Brunswick, to the New Democrats in Saskatchewan, including the government of British Columbia, and the sovereignist Government of Quebec, have formed a coalition. They have mounted a campaign, with ads running on television almost every day, to remind people of the extent to which the federal government has backed out of its commitments.
Do members know how much the federal government is investing? For each dollar spent on health care, the federal government's contribution amounts to 14¢. For every dollar spent, the federal government's contribution is only 14¢. It is incredible. The federal government has a surplus of $6, $8, $12, $15, or $18 billion, yet it is unable to honour commitments it made in the mid 1980s.
I do not mind commissions of inquiry, to reflect on the issue of health care and how to solve the problems and how to reorganize it, but I think we must remember the following three facts.
First, as we speak, seven of the ten provinces have already set up commissions of their own; they have done a diagnosis of their environment and are well aware of the main challenges facing them in coming years.
In the years since 1996, Nova Scotia, Prince Edward Island, New Brunswick, Ontario, Saskatchewan, Alberta and Quebec have conducted their own commissions of inquiry. They have themselves done a diagnosis of their environment and are fully aware of what major changes lie ahead in health.
Before discussing the substance, let us look briefly at these major changes affecting health. Regardless of who is in power in the various provinces, some things are certain. For one, people grow old; our population is aging and people are living longer. Today, we are no longer talking about the old, but the very old.
In our ridings, it is not unusual to meet people who are 80, 85 or 90 years old and who are in relatively good health. But this puts considerable pressure on the health care system.
My friend, the hon. Parliamentary Secretary to the Minister of Health, is himself an internist, if I am not mistaken. This brings me to what the main pressures on the health care system are. People are living longer and want to stay in the community as long as possible.
This is the whole challenge of primary care, natural caregivers and home care. So much so that, at present, with the great pressures put on the health care system, it is matter of figuring out how to reorganize care to allow people who, again, are living to be not only old but very old, to remain in their natural communities. The information required to manage these situations is available.
We will recall that, in its 1998 budget, the federal government established three funds, one of which was for the acquisition of new medical technologies and another for monitoring the evolution of the health care system. It is within this fund that, on the basis of the expertise they had and the work of the task forces they had set up, most of the provinces identified the major changes that lie ahead. Home support is a very important issue.
The second—and not the least—challenge we face is the advancement of medical technology. Equipment and facilities are evolving so quickly that there is a new generation of equipment every three years on the average. Of course, these are what help provide care and extend life expectancy, so that a number of sicknesses that were fatal fifty years ago have been conquered and are now chronic conditions instead. Medical technology has, therefore, a major role to play.
The acquisition of new medical technology has, however, meant that now forecast investments are not in the thousands or millions, but billions. Where cardiovascular disease alone is concerned, we have the possibility of prolonging people's life expectancy, but often at a cost of $800,000 to $1 million per person. That is what we have to deal with. We are confronted with the cost of medical acts that have to be performed by specialists.
After the challenges of extended life expectancy and medical technology, we have a third challenge: a whole new generation of drugs. There is no longer any question of reopening the debate on generic versus the patented drugs.
Let us not forget that, last year, the House passed a bill that was the result of the ratification of a treaty. Since Canada is a member of the Council for TRIP, or Trade-Related Aspects of Intellectual Property Rights, this means that some things are now illegal. Canada would be in violation of the treaty if it did not provide a 20 year protection for all patents. This is true for patents that relate to copyrights and to the pharmaceutical industry. So, this is now a moot point. Canada cannot amend its legislation.
I was a member of the Standing Committee on Health when it reviewed the Patent Act, in 1997. I was also there when the legislation was reviewed in 2000. We can no longer think that Canada can reduce its protection for patents. Three factors must be considered, namely the increased life expectancy of people, the new medical technologies and the new drugs.
For example, let us look at hospital budgets. When I meet with hospital administrators, the first thing they mention is that the issue of drugs impacts on the pressure that contributes to the operating deficits of hospitals.
The debate that will have to take place in the House will have to deal with pharmaceutical companies that do research. Of course, I am not denying that it is a major investment. I am convinced that the Secretary of State for Amateur Sport is aware of that, because he runs and he is in good health. In fact, I would like to challenge him. I would be pleased to go for a run with him whenever it suits him. Mr. Speaker, I run half an hour every day and I am in relatively good shape. But let us not forget that some our fellow citizens need drugs.
An hon. member: Let us go for a walk on the Hill.
Mr. Réal Ménard: Let us go for a walk on the Hill. I am taking the Secretary of State up on his offer and I also invite all members of Parliament to practice some sport, because exercise is important. It oxygenates our system and it improves blood circulation, not to mention of course that it also helps eliminate some of the fatty tissues that, all too often, is present on the abdomens of some hon. members.
Back to the heart of the matter, the real issue that needs to be looked at. New drugs are very costly when they hit the market, and it is no simple matter. The Patented Medicine Prices Review Board, whose report I read every year, lists new drugs that have been registered and that are available. It is really quite easy for pharmaceutical companies, through their advertising people, to promote these drugs, yet there are very few new drugs with new therapeutic value. That is where we have a problem, as a society. Consumers want these new expensive drugs, but their therapeutic value is in reality far below that of drugs that already exist.
The debate should not be over how long patents should last. There must be a mechanism that gives us some guarantees, as parliamentarians, that when drugs are registered, they have new therapeutic value. This is how to put pressure to bear to obtain new drugs. Drugs, as a budget item in the hospital operating budgets, make up an extremely large share of expenses.
We know what to expect when it comes to health care systems. The Romanow commission will not contain anything new on the subject. This is not to say that we should not give some thought, as a society, as to how to reorganize the health care system. Of course, we should.
I recently had the pleasure of meeting with the minister of health, Mr. Legault. The Parti Quebecois really does provide excellent government for Quebeckers. The government has concerns, which need to be given some thought. For example, in a society like Quebec, there are 5,000 general practitioners, but only 1,000 of them work in emergency rooms.
Obviously, it is up to the government to ensure that emergency rooms are open 24 hours a day. That is the role of the government. However, if the Government of Quebec is to be able to carry out its responsibilities, the federal government will have to come up with some cash.
Let us be clear. All premiers are demanding—there is no ideological split here, and no partisanship—that transfer payments be restored to their 1993-94 levels. For health, this would mean at least $5 billion more.
With respect to the accumulated deficit, in Quebec alone, the cuts made by this government in health in 1993-94 have deprived the various health and finance ministers in the Quebec government of at least $3 billion. This is for health alone, to say nothing of income security or education. For health alone, there is a $3 billion shortfall when the provinces and the Quebec government have to plan the services they will be providing to the public.
What do we know? The finance ministers gave a mandate to a task force, whose report was released two years ago. If it wanted to provide citizens with exactly the same services in 2003 as in 2002, the Government of Quebec would have to increase its health budget by 5%. This trend will continue beyond 2003. It will continue in 2004, 2005, 2006. You can imagine the challenge it will pose for the provinces.
I cannot have only one minute left; I have not said half of what I wanted to say. I am confident I will have consent to continue.
Five percent, that is where the pressure comes from and by how much the budget will have to be increased. Quebec is investing $17 billion in health.
If this take note debate we are having today is to be meaningful, it would seem to me that it should result in a consensus to urge the federal government to agree with the analysis of all premiers, who are putting ads in newspapers and on television asking for the purse strings to be loosened. We do not need a new tax. There are constant surpluses.
Is there unanimous consent to allow me to continue for 10 minutes? Could you please check, Mr. Speaker?
Mr. Speaker, I want to say how pleased I am to have the opportunity to speak today on this take note debate on health care, although I think the traditional manner in which we express the resolution supporting a take note debate is rather feeble and is inadequate to the challenge that is before us. I just briefly remind all members that the resolution coming from the Minister of Health reads:
|| That this House take note of the ongoing public discussion of the future of the Canadian health care system.
Feeble and inadequate, to say the least, and I would be a lot happier if we were here today debating a resolution which very clearly expressed the urgency of every member of the House and every party represented in this House to nurse back to a state of health our health care system, the health care system that is the promise and the true benefits of a public, not for profit, comprehensive, universal health care system that Canadians need.
The member for Acadie—Bathurst will be sharing my time and I am very happy to do that. I listened to the question the member for Acadie—Bathurst put to the Bloc member who just spoke. I found it absolutely astounding, and I have to say deeply distressing, that the response of this Bloc member whom I generally admire for his progressiveness was to say to the member for Acadie—Bathurst to mind his own business, not to criticize what the Péquiste government in Quebec is doing on health care, and to only put the challenges to the federal Liberal government.
I have two responses to that. One is that it is precisely a question that is pointing out the weaknesses and inadequacies of what the federal Liberal government is doing on health care, because it is not taking seriously its responsibilities to enforce the standards of the Canada Health Act as it relates to privatization. Second, and I guess the reason I found that response so astounding from the Bloc member, was that in his retort to the member for Acadie—Bathurst he revealed how similar the view of his party is to that of the Canadian Alliance, by basically saying that what happens to health care for people all over this country is not the shared concern and responsibility of every member of the House.
I could not believe my ears when I heard the leader of the Alliance Party, the official opposition, stand up and say basically that people do not care where their health care comes from, they do not care how it is funded, they only care that an individual Canadian, when he or she is sick, is going to get the health care, period, which again shows that it completely lacks an understanding. Yes, individual Canadians, when they are sick, need and deserve health care and of course they are very upset when they are not getting it, but there is a fundamental Canadian value, one that was rejected by the Bloc member in his question, one absolutely rejected by the Canadian Alliance leader in the House today, which is that Canadians care about health care for themselves, but they also care deeply about Canadian health care for their neighbour.
That gets to the real question about the crisis that our medicare system is in. It is not an exaggeration to say that medicare in the country today is at a crossroads. We have a fundamental decision to make about the kind of health care system that we want in the 21st century.
I think that all Canadians are very concerned about the report that is to come from the Romanow commission, not from the backrooms or the inside of the Liberal Party or from a Liberal Senator but from a royal commission that has been given the mandate to go out across this country and invite Canadians' input. I think that Canadians are very concerned about ensuring that this report is given the weight and the careful attention that it desperately needs. Canadians deserve to make this decision about the future of our health care, both on the basis of shared values, which the opposition leader has rejected, and on the basis of solid information.
We have seen too many scare tactics and this has had the effect of stampeding Canadians toward extreme solutions and solutions that have no place in this debate, as we heard this morning.
It is remodelling, not demolition, that should be our watchword. The evidence is clear and convincing. Canadians strongly believe in the fundamental tenets of medicare. A single payer, public not for profit health care system does not solve all the problems because we decide to create that. However it does create the conditions, the possibility, the potential for Canadians to receive the health care they need when they need it, regardless of wealth or privilege and regardless of where they happen to live.
Health care in recent years has fallen short of the goal for far too many Canadians. Starved through cutbacks, Canadian health care has been ill-equipped to grapple with the challenges of increased costs, partially as a result of excessive drug patent protection, but also as a result of medical and technological advances. The result is an intolerable and growing burden, both on patients and on those who care for them.
I could not believe what I heard from the Canadian Alliance member when he said that the health of the system was not a problem and that we were not talking about the health of those who provide the care. Those are critical elements of a universal not for profit system. What does the leader of the official opposition think the health care system is other than those who work in it to prevent ill health and to provide treatment when people are sick and to bring them back to a state of health? Something has to change.
The interim report of the Romanow commission outlined four possible paths for medicare. Let me reiterate that the New Democratic Party of Canada believes that the first two of those paths would lead backward, not forward. They would lead back toward the very for profit health care system that made medicare so necessary in the first place.
Behind the friendly rhetoric of private sector choice lies the simple reality that for profit health care offers less care at a higher cost than public health care. Public sector health care dollars should go to health care, not to marketing campaigns, not to investor relations, not to mergers and acquisitions of health corporations and not to profit. Real world experience backs that up.
In Alberta waiting lists and costs for cataract surgery are greatest wherever private clinics dominate. In the United States for profit dialysis centres, patient death rates are 20% higher than in not for profit centres. U.S. health administration costs are more than double those in Canada. The failure of for profit health care is echoed in efforts to shift costs onto patients and their families. We believe that those efforts are blatantly unfair. They amount to regressive taxation and they hit hardest at those who can least afford them.
Evidence has shown that as well as being unfair these initiatives just do not work. Singapore's experience with medical savings accounts has been a disaster. User fees are no more successful in controlling costs. They discourage lower income patients from seeking the treatment they need for a minor ailment until it becomes a major expensive one.
It is critically important that we not give up the dream for universal, comprehensive, not for profit health care, a system of public health care that calls up among all members the requirement for courage, leadership and vision. It is important that we get on with ensuring that we have a comprehensive system that not only deals with people's illnesses, but also deals with the kind of preventive measures that can only be assured if we recognize the fact that it is the responsibility of government to create a system of health care that will address the need for prevention as well as for treatment for people when they need it, wherever they happen to live, whether they live in a province that is mean-spirited and tight-fisted or a province that understands that priority should be given to health care. We need national standards that will ensure that each Canadian gets the health care they need regardless of where they live. It is everybody's business to be concerned about that issue.
Mr. Speaker, it gives me great pleasure today to speak on the issue of Canada's health care system, to have the chance to say a few words on the subject.
First, I was somewhat disappointed, earlier, when the member for Hochelaga—Maisonneuve told me to mind my own business. As a Canadian, I think this is my business; as a citizen, this is my business. No one in this House will silence me when it comes to this, as long as I am alive.
Last week I asked a question that I felt was important. Whether it is Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan or Alberta, when a government violates the Health Act, be it British Columbia or Prince Edward Island, I will not shy from asking a question of one of its partners, the federal government.
It is unfortunate when one of my colleagues tells me to mind my own business. It is a unfortunate that a colleague would stoop so low.
I would like to repeat the question that I asked last week here in the House, and I quote:
|| Mr. Speaker, it was reported on the news, on Radio-Canada, that some private medical clinics in Quebec are renting out operating rooms to health professionals to perform surgeries. A total of 11,000 surgeries have been performed in violation of the Canada Health Act. The Quebec health minister says “If there are no complaints, I am not taking action”. They do not care about the act.
Am I doing something wrong by standing in the House today to say that we have a partnership between the federal government and the provinces, not centralization, but a partnership where both pay? Does the hon. member think I am here to commend the Liberal government for paying its share? No way. It is impossible to have adequate health care for Canadians with a mere 14% contribution. The government needs to pay up its share to the provinces, which is 50%.
I certainly will not argue with you that the federal government is contributing its share. It is not. However, when I hear that it makes no difference if a province violates the act, and that it will wait for a complaint before taking action, I do not think that is right. Nor do I think it is right when a member of this House defends that position.
Last week, when I asked a question in this House, the member for Rivière-des Mille-Îles shouted “Get out of Hull”. I am renting an apartment in Hull. I am living in Hull. As I say “My home is in New Brunswick, my work is in Ontario and my bed is in Quebec”. I am proud of that.
Besides, I am just as entitled as anyone else to speak of what is going on in Quebec. I have a daughter who has been living in Quebec for years. I have a grandson living there. I love my grandson and I would like him to have a good health care system. It does not matter where he lives in Canada.
I find it shameful for someone to rise in this House this morning to tell me to mind my own business. This is my business and I am minding my business. I have a sister-in-law in Lévis who has a brain tumour. She has not had her hair washed in three weeks. It is my business to discuss in this House the ill health of the Canadian health care system.
It is my business if back home, in our rural regions, we are not getting the services we need because the federal government is not putting money where it should, that is into the health care system.
The Canadian Alliance is prepared to put a private system in place; in Alberta, the Progressive Conservatives are also headed down the private health care road. In the U.S., we know what their experience was; a private system is very expensive. There are large companies making their money on the backs of patients. I think we should be able to have a public system that can be monitored. We should organize it so that we have a public system that is even less expensive. Instead, there is talk of handing it over to private insurance companies.
As for the experience with private insurance companies, we need only look at car insurance. Today, an automobile owner in New Brunswick can go to his or her insurance agent and be told, “You are costing us too much and we no longer want to give you coverage”. That is what the private system is telling us now, “You are costing us too much”.
Sick children, sick families, people who are often hospitalized because of poor nutrition, will all hear from the private insurers, “You are costing us too much, and we no longer want to give you coverage”.
That is where we are headed. That is what a two-tiered system is all about: one system for the rich and one for the poor. The poor stay at home and do not get treatment. This is where we are headed. Our system is sick.
If the government does not assume its responsibilities and if it does not give money to the provinces as it should, there will be no going back. The insurance companies will have bought off the politicians as they have in the United States. Actually, The U.S. wants to get out of the situation it is in. The ordinary people no longer want a private health system.
How can any member of this House stand up and say that this would be a good system, that a two-tiered system would be a good system. It is shameful to say such a thing and to hear the reaction from our colleagues here, when a province is affected, that the federal government should mind its own business. This is bad manners in the extreme. Frankly, when I heard that from the member, I was upset, because this was a member I held in great esteem. Yet that is what he just said.
In a democratic country or province, we ought to have the ability to express ourselves. When the only thing a person can say is “mind your own business”, it is because he or she lacks any supporting arguments.
Frankly, it upsets me—which is why I am repeating myself—to be told “go back where you came from”. That is not what I expected from Quebec, and I did not think I would ever hear that from colleagues here in the House. There was mutual respect here, I thought.
Coming back to health, it is a disgrace that we should be moving toward a system where specialists may choose to practice in the private sector, where they perform operations, and not in the public sector. This is where our specialists have gone. They are making money on the backs of patients, people who are sick, people with cancer. These specialists would rather be making loads of money in the private sector. That is not what I want for my province, New Brunswick.
I want people, veterans for example, to be welcomed in our hospitals, I want them to have access to services by the public sector, not the private sector. It is not right for private companies, insurance companies, having made money with people, to start getting rid of those with whom they are not making any, as is happening in car insurance. We are not cars. We are people.
If there is one thing in life that is important, it is good health. This is true whether you live in Quebec, New Brunswick, Ontario, or anywhere in the country or the world. The single most important thing is health, and we must be able to look after our people.
I have often said that dogs and cats are better treated at the veterinarian than people are in hospitals. This is a disgrace. If animals were treated in veterinary hospitals the way human beings are in hospitals, veterinarians would probably be thrown in jail.
But such treatment is tolerated in the case of human beings. We put up with the fact that some children cannot be admitted to a hospital; we put up with the fact that the federal government is not doing its fair share in health to help the provinces. I am convinced that our public sector can manage our health system. We must give it the tools and the money necessary to do so. We can work together to build a good health system.
Whether one is poor or rich, one should be able to get admitted to hospital and enjoy the same services as others. We should not, as suggested by the Canadian Alliance a few weeks ago, be able to go to a private clinic in Quebec and simply pay to get an MRI because we can afford to do it, when a person who is poor does not have that option. This is the type of health system that we do not want.
We want a health system under which everyone would be treated on an equal footing and under which money would not make any difference at an individual level. Globally, the whole community must get together and say “We will not tolerate that a young person has to stay at home and cannot have access to health services. We will not tolerate a system in which the poor are shoved aside while the rich can pay for luxury services”.
No, this is not the country that I want. This is not the type of province in which I want to live. I want to live in a country that has a good health system and in which our children can be treated, whether they are rich or poor.
Mr. Speaker, there is no question that we need change in our health care system. It was interesting to listen to some of the members this morning. There is some commonality in our approach and differences as well, but there is one thing we agree on. We do not want to go to an American system of health care.
The leader of the Canadian Alliance talked a little bit about the American system this morning. I want to point out a couple of things. In comparison to the American system, our system is working pretty good. We do know there are problems with it. I am experiencing some in my home town in terms of doctor and nursing shortages, people who cannot get doctors and doctors retiring.
There is a headline story today in the Ottawa Citizen about the doctor retirement problem in Ontario. It is a big problem. One of the doctors pointed out how we got into this mess in Ontario in terms of doctor retirement. Twenty-five years ago Ontario decided it had too many doctors and launched action to stem the flow of doctors into the system. We are all victims of mistakes that were made many years ago. We have these changing demographics in Canada that makes it even more urgent that we address the problem soon.
In the American system 14.5% of GDP goes to health care. The Americans usually say it is 40% of people, but clearly well over 40% of people are completely left out of the American system with no health care. In Canada, where everyone is in the publicly funded system, it is costing us 9% of GDP, so we are getting a deal. However there are some problems that have been examined very carefully by Mr. Kirby.
I do not want to get into debate back and forth with members from various parties, but the member did mention something just a moment ago. I want to talk about that as well, because the Canadian Alliance leader is a trained economist, which I am not, and I do not know whether or not that gives him an advantage over me.
In the American system the tax brackets or the level of taxation in their society compared to ours, whether it is for corporations or individuals does not say it all. We know full well that in the American system one of the huge costs for American businesses is health care because they are required to pay that. It is just like a tax.
I want to use the specific case of a young family I spoke to in the United States a couple of weeks ago. This is typical, not an unusual case at all. It gives the example of how much it costs companies or corporations, either private or public, in the United States to do business and provide their workers with health care. The young couple in their mid-thirties have two children. He is working for a company where his health insurance premium for the year was $15,000. We might call that the Cadillac system because there is a zero deductible. In other words if he went to the hospital the first dollar would be paid by his insurance plan. The premium was $15,000 a year. His company paid $10,000 of that.
That is an expense that most companies in this country do not have. A lot of companies could not afford it, as is the case in the United States. In addition to that, the young man and his wife had to pay $5,000, but that was for Cadillac coverage in that system. The young man lost his job and now he is working for a smaller company that cannot afford that kind of coverage so it is up to him and his wife to provide coverage for their family. That coverage is costing him $600 a month. In my province that is the monthly rent or the mortgage payment for a lot of people or at least a car payment.
Mr. Loyola Hearn: Or the income for seniors.
Mr. Greg Thompson: The member for St. John's West just said the income for seniors when we look at some of the restricted incomes that our seniors are on.
However, under the new plan, which is not a Cadillac plan, there is a $5,000 deductible. In other words, the only time the insurance company will pay anything is when it is over $5,000. It is a huge expense for them. I do not think we want to go there. We understand that the American system has big problems. I do not think we want to consider going into that system.
As one of the member's mentioned this morning, there is no question that the American health care system is driven by two groups of people, lawyers and insurance companies. I might mention actuaries as well who determine the rates of these individuals whether they are young people or older people. In fact some people cannot get any coverage at all. It is just like car insurance, if people are poor drivers it is really tough to get insurance. Some companies simply will not insure them no matter how much money they want to pay.
The interesting thing about the Kirby report is that it hit some of this head on and is pretty daring in some of the things that it proposed. One of the things that he suggested was that any new money, and he was talking about $5 billion a year going into the system, must buy change. He stated that throwing money into the system would not do the trick. It would not produce the kind of results that we want to see.
One of the reasons that would lead to that conclusion from those of us who watch the Auditor General's reports with a great deal of interest is the simple fact that under our system today, the system where we are transferring money to the provinces to deliver health care, the Liberal government has no idea how much money goes to the provinces. It does not know how much money is being spent on health care. The Auditor General pointed that out.
The reason being is that under the social transfer that money can be either spent on health, welfare or secondary education. How much of it goes to health? We do not know. What are the outcomes? There is no way under the Canada Health Act to measure whether it is being used in an efficient manner or if some of it is being wasted.
I would like to give an example. A couple of years ago the federal government put $250 million into new technology. Would a lawnmower be new technology? Would woodworking equipment in a hospital be new technology? Without being sophisticated health care administrators or doctors at any level, our answer would be no. However it shows the lack of safeguards and insurances built into the system to ensure that money is being spent wisely and in a fashion the program was designed for in the first place.
The money must buy change according to Senator Kirby and his committee. He said the health care system cannot go on the way that it has been going because we cannot sustain it. If we want to save the system, he suggested that we must be willing to pay for it. This is where we will part company with a lot of people on this one. He said that if we want this system we must ante up to the cash register.
He suggested that we could do it in a couple of different ways, but the final report came down to premiums for all Canadians on a progressive scale. People in the higher tax brackets would be paying more for that premium and people at the lower end would be paying less. It would boil down to people in our income bracket paying about $4 a day to preserve the system under the Kirby plan. People in the lower income brackets would be pay about 50¢ for that or the price of half a cup of coffee. Those are the decisions or observations he has thrown out there. Are we willing to pay for it? Before we jump up and start screaming that we are not willing to do that, we must examine a number of things.
First, is the statement made by members of other parties regarding the waste in government. There is no question there is waste in government and that those people over there have gone on a spending spree over the last number of years. I give them credit for some of the things they have done, such as deficit reduction, but there is no question that the spending side of it is something they do not brag about. That spending now is 25% higher than when they came to office. We must sort some of that out as well.
How much of it went to health care? We do know that the government put money into health care a couple of years ago. That money, as Kirby said, just disappeared. Nobody knows what happened to that money. It is, in a sense, unaccounted for.
We have spent a little bit of money on the military and not enough, of course. Some in the House are saying that we need more money for infrastructure in our cities. How much would that cost? It would be in the billions. Some are saying that the military needs a massive infusion of money. How much would that be? It could be $4 billion or $8 billion over a period of years. Some of us are suggesting that it must be billions immediately. What that precise number would be, I do not know, and I do not think anybody does, but we do know that money must come from some place.
We must be careful how we categorically reject that idea of a premium. When we are saying that we will find that money, that $5 billion a year that Kirby says must go into the system immediately on a sustained basis, can that money be found in government waste? I do not think we can find $5 billion in government waste today. Even if we take the two jets the Prime Minister bought that the Government of Canada did not need, that totals only $100 million. It is like C.D. Howe said, but we have gone from “What's a million?” to “What's a billion?” Well, a billion is a thousand million. That is a lot of money.
The Kirby committee suggested and rejected the idea of a dedicated tax. However, this might come with the Romanow report. The committee said that half of the GST, that is 3.5% of the 7%, should go directly into health care. It would be very transparent. We would know exactly how much was coming in from the federal government. However, the option other than a premium would be a dedicated tax. How would that work? Would Canadians categorically reject that?
The Prime Minister does not get out of bed in the morning, and he seldom puts his slippers on, unless he does a poll. The government has done a lot of polling on this, as have the think-tanks. What that polling has told the government is that 80% of Canadians support either a premium or a dedicated tax provided there are guarantees that health care will be there for you, Mr. Speaker, your children, my children and generations of Canadians who are coming behind us. This progressive decline in our health care system has all of us worried.
We only have to look to the south of us, which is how I opened the debate in the first place, to see how a system can come off the rails. We do not want that to happen in Canada, so I think that as Canadians we have to be prepared to make tough decisions. It reminds me of the 1980 election. There is a gentleman sitting behind me, the right hon. member for Calgary Centre, who as the prime minister at the time, going into that very tough election, proposed some tough dues for Canadians. What he suggested at that time was an 18¢ per gallon gas tax, which would have delivered the country from debt within five years, if I am correct. We as Canadians categorically rejected that. We said we would not do it. I can remember a friend of mine saying, and this is as true as I am standing here, “That's a case of beer a week for me. I'm not going to go for that”. But look where we have gone from there. The country would have been debt free. Now we are still burdened with a $550 billion combined debt in the country from over the years.
An hon. member: But what did the Liberals do?
Mr. Greg Thompson: Of course we saw the other side of the story, which my political friend from Newfoundland would not want me to leave out. I think we can conclude that gas taxes in the next 12 months after that election went up by something in the order of anywhere from 36¢ to 72¢ a gallon. That is what I have heard.
My point is that it is reminiscent of that debate of over 20 years ago now. Canadians did not want to suffer any short term pain for long term gain. I would have to say that it is a tough thing to take to the electorate. I am not sure how accurate this is but an historian told me that at that time in our history there had never been a Government of Canada elected to office by promising less and not more. We would have to check our history. Can we believe that? As I look at the sloppy habits of behaviour that successive governments have gotten into over the years, I would say that the statement is probably true.
I think we have grown up a lot as a nation. I think we need to have an intelligent debate on this issue of premiums and taxes. If we look at the more advanced countries in the world in terms of delivery of health care, the European nations, particularly Sweden, Denmark, Britain, France and Norway, they all have good systems. Just about every one of those countries, without exception, has some sort of premium or tax involved in the payment of that system of delivery.
Senator Kirby has gone a long way in bringing that forward in terms of getting some intelligent debate out on that particular aspect of his plan. Now we are looking for the Romanow report, but I think we have to look very carefully at what the option would be if it is not going to be that one. I think most of us feel that there has to be a buy-in by the Canadian people, even in terms of smart cards, which is something that they are talking about as well, so that as individuals we know how much is being spent on health care for us and how much a particular service is costing.
I will conclude with this and I hope I get some questions from my colleagues. In regard to the American system there is an old expression that I think really sums it up: Americans are only one sickness away from bankruptcy. That is the system we do not want, but I think we have to approach this in a very mature, reasoned way. We have to look at all the options that are on the table before we conclude that one system is bad or that any system that might suggest a premium is bad and one that does not is good. I think we have room for some intelligent debate here. We look forward as this debate unfolds on the reports from Senator Kirby and Mr. Romanow. Certainly the government will have some tough choices to make and I hope we can contribute to some of the intelligent debate as the government makes those tough choices.
Mr. Speaker, I am very pleased to be sharing my time with the member for Western Arctic today and to talk in the important debate on the future of health care in Canada. Clearly this is something that all of us value as Canadians, probably more than any other program that is delivered.
I am happy to speak a little in relation to seniors today. Seniors constitute the fastest growing population group in Canada. We have one of the highest life expectancy levels in the world, 81.5 years for women and 76 years for men. We must be living right in order to continue living the extra years that we clearly are living.
In 2001 it was estimated that 3.92 million Canadians were 65 years of age or older. By 2026 one Canadian in five, which equals 6.7 million people, will have reached the age of 65. The fastest growth in the seniors population is occurring among the oldest Canadians, that is, those 85 years of age and older. I am happy to state that Canadians generally are living longer and are living their later years in relatively good health. In 1997 more than three-quarters of seniors living at home viewed their health as good, very good or excellent while only 6% reported their health as poor.
It is important to note that healthy aging is not just for those who are free from disease and disability. It includes the successful management of chronic conditions such as diabetes, arthritis or incontinence so that seniors can continue to function well and remain actively engaged in life.
Multiple factors influence healthy aging. They include adequate income, education, appropriate housing, satisfying relationships, and of course safe environments. Older Canadians have the potential to improve their health and their well-being because many aging related diseases are preventable.
The federal government is constantly working to develop strategies and initiatives to expand disability free years of life to reduce the complications of chronic diseases and to improve the health of seniors. Investment in health promotion and disease prevention strategies to maintain the health of those who are aging well and to improve the health of those with chronic conditions who are at risk for serious problems is very important. Solid evidence shows that these interventions can improve the health of seniors even very late in life.
Let me give an example of two major initiatives. Through the Canadian diabetes strategy, Health Canada is working with a wide range of stakeholders to address the serious impacts of diabetes on an ever increasing number of Canadians, especially seniors. This is because the prevalence of type II diabetes is approaching 50% among Canadians over 65. The good news is that type II diabetes is preventable, controllable and manageable.
Veterans Affairs Canada and Health Canada have partnered on a community based program called the falls prevention initiative to help identify effective falls prevention strategies for veterans and seniors. Approximately one in three seniors will suffer a fall this year. Falls within this age group are a significant burden on the health care system, accounting for $2.4 billion in direct health care costs. Care for seniors injured from falls represents 41% of these costs, or almost $1 billion.
We are also addressing the issue of palliative care and end of life care. Senator Carstairs is the special minister responsible for palliative care and has established a secretariat on palliative and end of life care to coordinate and facilitate the development of a strategy to improve the end of life care for Canadians.
The Canadian Institutes of Health Research were established in 2000 to create and disseminate new knowledge to improve the health of Canadians, provide more effective health services and strengthen the health care system. The Institute of Aging is focusing on advancing knowledge with respect to understanding the aging process; promoting healthy aging; preventing and treating age related diseases and disabilities; improving health policies and systems; and understanding the social, cultural and environmental factors affecting the life of older Canadians. This work will yield valuable knowledge in specific areas of concern such as population, public health, cancer, circulatory and respiratory diseases, arthritis, diabetes, health services, and gender and health.
We are taking further action to close the gap in health status between aboriginal and non-aboriginal Canadians by putting in place a first nations health promotion and disease prevention strategy, with a targeted immunization program and by working with our partners to improve health care delivery on reserves.
Good health cannot be achieved alone. Health Canada's work with the provinces, territories and non-governmental stakeholders provides an opportunity to influence and support health initiatives in our communities. It is necessary to work together to respond to aging related issues.
At their June meeting, the federal, provincial and territorial ministers responsible for seniors discussed a wide range of issues posed by an aging population. They identified healthy aging, seniors wellness and elder abuse as priorities needing further attention. Ministers directed their officials to identify actions to help their governments as well as the Canadian society as a whole to prepare for these challenges and opportunities of our aging population. They reaffirmed also that enabling Canadians to maintain health and wellness in later life is a shared priority by all.
Increasing public awareness as well as encouraging and supporting initiatives such as active living, healthy eating, injury prevention and smoking cessation are key contributors to the health, independence and quality of life for today's and future seniors.
In April 2002 Canada along with 156 countries endorsed the Madrid international plan of action on aging which was presented at the United Nations Second World Assembly on Aging. The Madrid plan sets out three key policy themes: one, older persons and development; two, advancing health and well-being into old age; and three, ensuring and enabling supportive environments.
Canada was instrumental in significantly influencing the contents of the international plan of action on aging. We are looked upon as being a leader in aging policy and program development. The federal government is now examining its existing programs related to aging and seniors in order to determine its own domestic priorities.
Seniors play an important role in Canadian families and in our communities. It is a role that is best assumed and enjoyed when seniors experience good health. That is why we are all working together continuously to help the people of Canada maintain and improve their health.
Mr. Speaker, I am pleased to have the opportunity to speak to this important debate today. I am very excited by the government's renewed commitment in the Speech from the Throne to close the gap in life chances between aboriginal and non-aboriginal Canadians.
In consideration of the debate I want to focus on aboriginal health issues. This is an approach that I have been advocating over my many years as a member of Parliament. I am thrilled to have the opportunity to work with the Minister of Health and her department in their commitment to close the health gap for our first nations and Inuit people. We know there is still a long way to go in closing this gap and, although progress is slow, it is being made.
Mortality and morbidity rates have fallen and the gap in life expectancy between aboriginal and non-aboriginal Canadians has decreased in the past 25 years. The life expectancy of status first nations women on and off reserve, for example, rose from about 66 years of age to 77 years of age. However that is still five years less than the Canadian average of 82 years of age for women nationally.
The health status of aboriginal people, particularly those living on reserve, still remains much poorer than that of other Canadians. Aboriginal people are still at greater risk of chronic disease. The rate of diabetes is four times higher, arthritis is three times higher and suicide is six times higher, especially among young people. Those are astonishing rates.
On some reserves conditions are such that the challenge of improving health outcomes is very complex. We are mindful that any long term solution requires an integrated and complementary approach. Factors, such as education and income, environmental factors like housing and water supply, and lifestyle factors like diet, exercise, smoking and alcohol intake, all influence the health status of first nations people and Inuit.
Work in improving the health of aboriginal people at Health Canada and with its partners is not just part of the government's broader commitment to improve life chances for aboriginal people. It is dependent upon the work of other federal departments and agencies, provincial and territorial governments and aboriginal communities to act on the broader determinants of health.
In my riding of the Western Arctic the health and social services department of the government of the Northwest Territories has put in place an action plan of commitments under the leadership of Minister Michael Miltenberger. This plan includes five areas and all residents of the Northwest Territories.
The first area improves the services to people. The second area improves the services to staff. This includes human resource development and planning. The third is improvements to system of wide management which will see a joint leadership council to provide leadership to the health and social services system and a system wide planning and reporting model. The fourth improves support to trustees of the leadership model for health and social services. The fifth improves system wide accountability by establishing clear accountability and action reporting.
We all have work to do and I am encouraged that the Speech from the Throne makes a number of specific commitments to take further action to close the gap in health status between aboriginal and non-aboriginal Canadians. These commitments are forward looking and positive and will work to support first nations people in laying the foundation for good health.
By putting in place the first nations health promotion and disease prevention strategy, the government will work to reduce the incidence of disease and mitigate the life threatening and disabling consequences of disease. A targeted immunization program that will ensure first nations' children on reserve have access to early childhood vaccinations will be an important part of disease prevention.
The first nations and Inuit health system delivered through Health Canada is the foundation for the federal government's delivery of health services to first nations and Inuit. Health Canada operates this large and dynamic health system providing a wide range of health care services. In the Speech from the Throne the government also specifically committed itself to working with its partners to improve health care delivery on reserve.
The first nations and Inuit health system provides services including nursing services, prenatal and children's programs, public health disease prevention, addiction services and environmental health services in over 600 first nations and Inuit communities.
In addition, Health Canada provides supplemental health benefits to over 700,000 first nations and Inuit individuals both on and off reserve in order cover the costs of prescription drugs, dental services, vision care and other benefits, including medical transportation to access medical services away from their home communities.
The federal government currently spends $1.3 billion per year to address the health care needs of first nations and Inuit. As well, provinces and territories cover the costs of physicians and hospital care. Greater coordination of the provincial and territorial governments to ensure efficient and seamless service delivery is the priority.
The government's goal is to work with first nations and Inuit communities and with the provinces and territories to renew, improve and close gaps in health services on reserve.
As for the broader health system, Health Canada recognizes that change and renewal are needed to provide high quality services to first nations and Inuit in the most efficient and effective way possible. This task has many challenges.
In its health delivery system role for first nations-Inuit, Health Canada faces many of the same pressures that are currently being felt by the provinces and territories. This includes nursing shortages in my riding and doctor shortages, rapidly increasing costs of prescription drugs and expensive new technologies. We also face challenges posed by such factors as remoteness, lower health status and a first nations and Inuit population growth rate more than twice the national average. Many of the communities in my riding are accessible only by air travel and people only have access to a doctor once a week, perhaps less than that, and a nursing station with one nurse the remainder of the time.
Amid considerable cost pressures, Health Canada has made progress in controlling expenditure growth. For example, the non-insured health benefits program has been successful in reducing its rate from 20% in 1991 to 5% and 8% in recent years. This does not go without challenges. There are many things to consider under the first nations non-insured health benefits system for aboriginal people. I must say that there are challenges and those are the things that we struggle with.
In collaboration with the Assembly of First Nations and the Inuit Tapiriit Kanatami, the national first nations-Inuit organizations, Health Canada has been working to develop and implement an overarching accountability framework. This framework is intended to ensure the most effective and efficient use of resources and better health programs and outcomes for first nations and Inuit people.
However our focus has not only been delivering our fundamental programs effectively and sustainably. We have also looked to improving and building upon that foundation.
Recently the government developed a home and community care program to provide core home care services on first nation reserves and in Inuit communities. Seventy-seven per cent of eligible communities have completed initial program planning activities and 37% of communities are already accessing home and community care services with over 180,000 clients.
Canada's aboriginal population is young. Thirty-five per cent of aboriginal people are under the age of 15. This means that aboriginal health care must have a strong focus on children. Childhood development from birth to age six lays the foundation for lifelong health and well-being. The focus on children and youth becomes more and more important as we see an increasing incidence of childhood diabetes and as we also work to combat tuberculosis in our communities.
Speaking of children, I welcome the commitment in the throne speech to put in place early childhood development programs for first nations, including an expansion of aboriginal head start. Aboriginal head start has proven to be a very successful program in first nations communities. It teaches our children simple life skills at an early age that will carry them through their school years.
In addition, the government has committed to improving parental supports and providing aboriginal communities with the tools they need to address fetal alcohol syndrome and its effects. FAS and FAE are disabilities caused by drinking during pregnancy. It is a completely preventable cause of birth defects and developmental delays that leave these children and their families with a legacy of profound and lasting challenges.
Consistent with the government's commitment in the Speech from the Throne, Health Canada is actively building partnerships with first nations and Inuit organizations and communities. We are moving toward the development of strategies to improve the effectiveness and sustainability of first nations and Inuit health.
Together we are working at finding solutions to these challenges and we are continuing our efforts to close the gap in the health status between aboriginal people and non-aboriginal Canadians.
There is no higher priority than the health of our citizens across Canada. As members can see from the statistics, we have a major challenge in dealing with the health of aboriginal people across the country.
I submit to the House that this debate is important in dealing with the health care of aboriginal people.
Mr. Speaker, it is a pleasure and a privilege for me take part in this take note debate. However I have to question why we are even debating this. It is startling to me that we have a government that has been in power for a decade, with three majorities and three mandates, and it has put nothing more on the table on how to deliver health care. Here we are in the House at the government's call to debate health care.
I have no problem debating health care. In fact I really enjoy it and it is long overdue that we have a debate not only on health care but on health care reform and how to sustain it. That is needed and it is long overdue.
I listened very intently when my hon. colleagues from the Liberal Party put forward what they thought was rational debate on health care. I have failed to hear any new, innovative ideas about which we could have a true debate. It is very frustrating to me. We have been asked to come here to debate new ideas about reforming health care so we can sustain it into the 21st century and the government really has nothing on the table to debate.
I would like to talk a bit about what is going on with health care and what needs to be done to sustain it. In the throne speech we thought we would get a glimpse of the vision of the government and its plans for the future of health care. We saw absolutely nothing. There was very little vision and virtually nothing when it came to health care reform.
What do we see from the government? We see more studies. The Kirby report was delivered on Friday of last week. We have the Romanow report coming up next month. It is interesting that, since 1993, the government has commissioned enough studies that amount to $243 million and absolutely no reform. It is something that has to stop. We absolutely have to do more than just study health care. We have to implement it.
Some of the reforms and studies that have been going on in the provincial jurisdictions amaze me. I can point to the Clair Commission out of Quebec and the Fyke report out of Saskatchewan. Ontario, New Brunswick and B.C. are doing their own. Then there is the Mazankowski report of Alberta. It is frustrating to see the opposition coming from the federal side when we talk about some of these reports, especially the one in Alberta because it is the only one where we have seen a government actually implement the report.
We saw the report of the national forum on health in 1999, but it has sat on a shelf and nothing has been done. It was not that good things could not have happened in 1997, but they did not. Whether we will get somewhere with the Kirby Commission and the Romanow Commission has yet to be seen. It depends on whether the government will actually implement them. We hope that happens. What is actually happening in the meantime?
I just received a note, Mr. Speaker, I will be slitting my time with the hon. member for Peace River.
The Environics Research Group released a study two weeks ago. It said that eight out of ten Canadians want significant reforms to Canadian health care. That is absolutely amazing.
The Canadian Alliance Party felt that something had to be done in health care as well so we commissioned our own study after the last election because we did not think any government or any party really hit the nail on the head when it came to health care. We did that over the last couple of years. We came up with what we feel is a very clear policy that coincides with what we think Canadians are feeling.
Canadians are saying they want a timely health care system, one they can access in a timely way; one that is of high quality when we get to access it; one that is sustainable for their kids and their grandkids; and one which they can access regardless of their financial means. That system should take its eyes off itself and put them on the patient it is there to serve. It has to be a patient driven system. We need a government that realizes that the patient comes first because the patient is the one who is paying the bill. This needs to be looked at as we sustain health care in the future.
I talked a little about the Liberal legacy. The Liberals pulled money out of health care and watched the system drift into a crisis. We have seen the cracks get so wide in health care that it is shameful. The most unhealthy place to work in the country is within our facilities where moral is poor and the stress of the workplace is unbelievable. At the same time, waiting lists for people trying to get into the system are unacceptably high. We have over a million people on waiting lists right now who are trying to get into the system.
We have nurse shortages that have grown to unbelievable proportions. We know that we will need 113,000 new nurses between now and 2011. We need 2,500 doctors a year just to keep up with the present demand and that demand is growing more and more.
Just by watching the news media every evening, we see week in and week out the problems in health care, whether it is the lack of doctors in emergency rooms or ambulances that are held and are unable to deliver services according to their mandate, as one article stated last week. Every week one hears something new and astounding.
On top of that there are the cracks in the system where the employees of that system are frustrated. The nurses unions and health sciences people are striking. Doctors are striking in different provinces. We are seeing major problems.
Canada ranks 18th of the OECD nations in the number of MRIs, 17th in CT scanners and 8th in radiology equipment. If we cannot be first, I would like to know why. We should be first. That should be the goal. We should be striving for that. Canadians deserve to have the best health care system in the world, and they can have it. There is absolutely no reason why we are not.
In a 1988 poll, 43% of Canadians thought the health care system was fundamentally flawed. Last year that same poll was taken and that 43% had risen to 77% of Canadians who thought it was fatally flawed, and it is. Our health care system is ailing.
The Kirby report came out on Friday. I would like to make mention of a couple of things on which that committee worked hard. It tackled some complex problems that were politically charged. It was very thoughtful about its deliberations and we should applaud that 300 page report and some of its aspects.
Romanow was commissioned to do another report. The Kirby committee started two years ago. Romanow happened after that. In fact, we scratched our heads and wondered why the government would do that? Why would it spend another $15 million on a commission when it already had a Senate committee doing a very comprehensive study? Nonetheless, another $15 million has been spent.
The big question is whether it will actually be implemented? Will it go anywhere? Those are the questions we have to ask as we go forward.
Some things that have come out in the Kirby report are health care related. He has tried to sustain the health care system in the long run and has tried to expand it. I will mention a little more about that in a few minutes.
The thing that really puzzles me about the report is the new money that he has asked be put into it. Romanow likely will ask for the same thing. We said that back in 1997 when we said that it needed an injection of $4 billion a year. That is not new. What is amazing to me is we had a Liberal Senate committee struck to look into health care, yet it came forward and suggested we needed to raise taxes. When it comes to the kinds of changes that are needed for health care, that is fair ball. However I guess a leopard does not change its spots. When a committee dictates that we should raise taxes for this new money, then all of a sudden that puts on a political hat, and we dare not play politics with health care anymore.
It very frustrating to see the Kirby committee recommend a 1.5% increase in GST or national health care premiums. Where it gets the money is up to the government in power, not to Mr. Kirby. How that money is raised or where it comes from should be decided by the government in power. Throwing money into a broken system gives us a larger broken system, so that is not a solution we should be embracing.
It is absolutely amazing to see this kind of a report come forward when no study was undertaken even within the Kirby committee's deliberations to study from where the money should come from, yet this is one of the recommendations in the report.
If we do not add accountability into our system, if we do not reform it to a place where we hold the users and the providers more responsible and actually implement some of the reforms needed in our system, we will lose it. A health care system needs that efficiency. Any new money that goes into health care needs to have that as its ultimate goal. If not, we will lose it within a very short number of years.
It is very important that we keep that in mind when we look at implementing some of the changes that have been brought forward by the Kirby commission. We dare not allow another thing in health care, and that is what happened in the mid-1990s when we had unilateral cuts by this government in health care. It destabilized health care and put an unbelievable burden on the provincial governments to provide health care, which is their mandate.
My time is going very quickly and I would like to just make mention of what needs to take place when it comes to fixing the system.
When we fix the system, we do not expand a broken system to fix it. One thing Kirby also mentioned was that we should go into a pharmacare, home care and palliative care. Although those are limited within his report, we need to get the fundamentals right and we need to fix the system before we expand it and make it weaker. We really have to be careful of that.
When it comes drugs and what is happening with the Canadian drug problem, first, we do not debate that in this House. We do not debate the kinds of massive problems we have with addiction to prescription drugs, which is a reality that we need to talk about much more in this House. If the government had come with that as something to debate today, we would have had a really solid debate on some of the changes that need to take place.
However we agree with some of the things that are in the report, which are more placements for medical school and health care technologists. We absolutely need that. We also agree that there should be some sort of guarantee to the patients. He is focusing more on patients and the importance of putting patients first in his report. We have been saying that is long overdue.
There is absolutely no question that we have to get on with reforming the system, but we have to do it in a way that is sustainable to the system. One of the flies in the ointment of the Kirby commission is that most of what he talks about is provincial jurisdiction and that instead of taking the big stick approach with the provinces, we have to take the collaborative approach. What will be interesting, when we come to implement this, is to discern the difference between the provincial jurisdiction and the federal jurisdiction.
Looking forward, the government owes it to Canadians by acting quickly on these reports. We are calling for the action to take place within 90 days of Mr. Romanow's commission. That absolutely must take place. We dare not put these reports on a shelf and debate health care without recognizing the need to implement these reports.