CONTENTS
Thursday, April 27, 1995
(Motion agreed to.) 11845
Mr. Martin (Esquimalt-Juan de Fuca) 11866
Mr. Martin (Esquimalt-Juan de Fuca) 11867
Mrs. Dalphond-Guiral 11879
Mr. Speaker (Lethbridge) 11879
Mr. Gauthier (Roberval) 11882
Mr. Chrétien (Saint-Maurice) 11882
Mr. Gauthier (Roberval) 11882
Mr. Chrétien (Saint-Maurice) 11882
Mr. Chrétien (Saint-Maurice) 11883
Mrs. Tremblay (Rimouski-Témiscouata) 11884
Mrs. Tremblay (Rimouski-Témiscouata) 11884
Mrs. Brown (Calgary Southeast) 11884
Mrs. Brown (Calgary Southeast) 11885
Mr. Chrétien (Saint-Maurice) 11885
Mr. White (Fraser Valley West) 11886
Mr. White (Fraser Valley West) 11886
Mr. Chrétien (Saint-Maurice) 11886
Mr. Chrétien (Saint-Maurice) 11886
Mr. Chrétien (Saint-Maurice) 11887
Mr. Chrétien (Saint-Maurice) 11887
Mr. Axworthy (Winnipeg South Centre) 11888
Mr. Axworthy (Winnipeg South Centre) 11888
Mr. Gauthier (Roberval) 11888
Consideration resumed of motion 11888
Bill C-295. Motion for second reading 11912
11843
HOUSE OF COMMONS
Thursday, April 27, 1995
The House met at 10 a.m.
_______________
Prayers
_______________
ROUTINE PROCEEDINGS
[
Translation]
Mr. Peter Milliken (Parliamentary Secretary to Leader of
the Government in the House of Commons, Lib.): Madam
Speaker, pursuant to Standing Order 36(8), I have the honour to
table, in both official languages, the government's response to
16 petitions.
[English]
On Statements by Ministers today the President of the
Treasury Board will make a brief statement. I understand that
representatives of both the New Democratic Party and the
Progressive Conservative Party will make statements in the
usual course on this by unanimous consent. There will be a total
of five statements.
* * *
Hon. Arthur C. Eggleton (President of the Treasury Board
and Minister responsible for Infrastructure, Lib.): Madam
Speaker, 50 years have passed since the liberation of many of the
camps that symbolized Hitler's final solution.
Canadians began marking the 50th anniversary of the
liberation of Europe on June 4, 1994 when we remembered the
sacrifices of thousands of our countrymen on the beaches of
Normandy. Today we commemorate Holocaust Memorial Day.
While we mark the end of a tragic time in human history, we
must recognize we have all come a long way.
[Translation]
The Nazi holocaust victimized all of humanity. It showed how
blind nationalism, racism and bigotry can be.
[English]
The Nazi Holocaust victimized all of humanity. It showed
how blind nationalism, racism and bigotry, a violation of the
very basic democratic principles on which our society is based,
can lead to incomprehensible suffering and violence.
The names of the death camps liberated half a century ago
ring out as sacred prayers: Dachau, Buchenwald, Treblinka,
Bergen Belsen, Auschwitz-Birkenau. These places have
become holy ground. We must remember them because they
symbolize what humanity is capable of and remind us of our
obligation not only to millions of men, women and children who
fell victim to tyranny but to future generations around the world.
Canada remembers the suffering of Europe. We remember the
deaths of six million Jews and the victimization of millions of
other innocent people persecuted because of their religion,
ethnic origin, sexual orientation or political views.
Canada remembers the selfless sacrifice of thousands of our
soldiers who offered their lives for freedom, democracy and for
a better future for us today. We honour all of their memories by
ensuring we remember why they died. We honour their sacrifice
by working for the equality of humanity and being true to our
values of respect and understanding.
Canada remembers.
Some hon. members: Hear, hear.
[Translation]
Mr. Maurice Godin (Châteauguay, BQ): Madam Speaker,
the official opposition joins the government in giving its
unanimous support to the motion tabled by the Secretary of State
for Veterans. Fifty years have passed since the end of World War
II, a war the likes of which this small planet had never seen
before. We had to recognize that neither modern institutions nor
the new technologies had helped us achieve peace on this earth.
Toward the end of that great war, the whole world was
horrified to discover the existence of concentration camps, an
inhumane, cruel and barbaric practice. No words exist to
describe this atrocity and express our revulsion towards such a
monstrous scheme. There is no excuse whatsoever for
concentration camps.
(1010)
Millions of men, women and children perished under the yoke
of tyranny. They could only hope that other countries would rise
up and fight in the name of liberty and justice. That is the effort
11844
in which Canada took part. We and our descendants will never
forget the valour and courage of those soldiers. It is our duty to
ensure that these defenders of freedom will always be present in
our collective memory.
The collapse of the Third Reich revealed to the world the
largest extermination effort in history. Millions died in the
concentration camps set up by the Nazis in occupied Europe, in
their electrified barbed wire enclosures, blockhouses,
underground factories, experimental rooms, gas chambers and
herding areas. Thousands of convoys led victims on the road to
hell.
This planned destruction effort was carried out relentlessly
until just before surrender. Those convoys let to the internment
and slaughter of innocents. Arrival in camp often meant death
pure and simple or an even worse fate: forced labour
contributing to death. It was a tragedy to witness the torture and
slow agony of one's neighbour or be subjected to the same
treatment. Malnutrition and illness led to a point of no return, to
an exit from life. It is our duty to take a moment to imagine what
concentration camps were like, to better understand how crucial
it is that we remain steadfast in our firm commitment never to
tolerate crimes against humanity.
Fifty years ago today, trucks of the International Red Cross
drove into certain concentration camps, marking the end of this
hell on earth. Torturers fled. Today, 50 years later, it is our duty
to look at this tragedy as if it had happened just yesterday to our
relatives, children and parents, so that we never fall victim of
such madness. However-sadly for humanity-genocides and
organized exterminations continue. Last year, more than one
million Rwandans perished in a carefully planned genocide and,
to this day, those responsible for this crime go unpunished.
More recently, the slaughter of thousands of Hutu refugees by
the Rwandan Army at the Kibeho camp amounted to carnage.
The international community witnessed acts of unspeakable
cruelty in Bosnia, where ethnic cleansing was systematically
carried out. Such events make us wonder whether humanity has
learned anything from the lesson we were taught by history.
We must ensure that this kind of massacres among inhabitants
of this planet stop. We must remain hopeful that, one day, we
will all live in peace, free from these inhuman acts. To
commemorate the liberation of Nazi concentration camps is, of
course, to pay our respects to the victims, but also pay tribute to
all the men and women of this country who made that liberation
possible, our veterans, who deserve more than our admiration.
We owe them support, particularly when they paid with their
health. I hope that this government will take this opportunity to
ponder over the way veterans are treated. We cannot renege on
our promise to them.
Nor can we afford to relax our vigilance, lest atrocities like
those committed in Nazi concentration camps be committed
again. Such is the implacable lesson taught by history, a lesson
that we must in turn teach our children, so that we never forget.
The Bloc Quebecois, for its part, undertakes to do all it can to
ensure that this knowledge remains in our collective memory.
Together, let us keep this hope alive.
[English]
Mr. Jim Hart (Okanagan-Similkameen-Merritt, Ref.):
Madam Speaker, it is a great honour to address the House on
behalf of the people of Okanagan-Similkameen-Merritt and
my colleagues in the Reform Party to solemnly commemorate
the 50th anniversary of the liberation of the Nazi death camps.
We remember the men, the women and the innocent children
who perished at the hands of the Nazi tyranny and we honour the
many Canadians who fought for freedom and justice at a time of
darkness.
(1015 )
We recall the generation of men, women, and children that
had to endure the horrors of Nazi tyranny from the 1930s to
1945. For someone born after the war, the reality of this dark
period in the history of humanity seems hard to comprehend.
We see the pictures of the Warsaw ghetto, the trainloads of
innocent men, women and children being sent to the
concentration camps, the deadly gas chambers and the horrific
mass graves. As I recall these offences of the past I try to
imagine how man could commit these crimes against humanity.
I really began to grasp the magnitude of this tragedy when I
saw the numbers of people who died in this horrible conflict.
The death toll rivals the size of Canada in 1945. Though we do
not have all the names of those who perished, the world must
remember Yom Hashoah, Holocaust Memorial Day.
I would like to reiterate the pledge yesterday by the leader of
the Reform Party. He spoke for all of us when he stated: ``I
solemnly vow that we shall honour the memory of those who
perished in the Holocaust by remaining vigilant against those
who would divide us by promoting hatred and discrimination''.
Those who deny this event must be condemned. Besides
solemnly commemorating Yom Hashoah and the liberation of
the Nazi concentration camps, I would like to honour the tens of
thousands of Canadian men and women who fought for freedom
and justice. Too many left Canada to never return. In each battle
Canadians fought, and despite the odds and terrible toll they had
to pay, they never failed to display great courage and resolution.
It is a great tribute to our nation to know that most of those who
fought in this terrible war did so voluntarily.
It has been 50 years since the Nazi concentration camps were
liberated and the guns fell silent. Many soldiers and civilians
who experienced the horrors of this war are doing their utmost to
11845
make sure all Canadians and all humanity remember the cause,
the course, and the consequences of this conflict.
Yet in the years to come, as veterans and victims pass on, it
will be up to my generation and the generation that follows to
keep alive the memory. I feel entrusted with a sacred pledge to
be able to go to the Netherlands next week to represent my
constituents and the Reform Party in the Canada remembrance
ceremonies.
For my part, I vow to keep the memory alive and honour our
fallen soldiers and the victims of this terrible event. The people
and events we are honouring today must not be forgotten in the
dustbin of history. It must be remembered that those who forget
the past are condemned to relive it.
Hon. Audrey McLaughlin (Yukon, NDP): Madam Speaker,
today we rise in the House to remember. Half a century has not
erased the memory of the horror of the six million people who
were killed in Nazi concentration camps, nor the horror of World
War II, which led to this.
Those who fought for the liberation of camps are also
remembered today. We remember the families and individuals
whose lives were lost in those camps. We admire the strength of
those survivors, many of whom came to this country to help,
with courage, determination, and strength, to build this country.
As we remember today, there is truly a lesson for us all, a
lesson of courage and a reminder of how quickly prejudices and
biases can turn to hate. As Canadians, we must be diligent and
we must fight prejudice and racism. However, it is not enough to
simply issue statements. We cannot be silent in our
communities, in our homes or in our country. Silence and
complacency are not options. We cannot rest in the assurance
that the horrors of the concentration camps are simply a part of
history.
[Translation]
We must be vigilant, because right wing extremism and
fascism still exist in every country. We must ensure full
application of the laws which prohibit hate, and work together to
promote a strong and healthy democracy in Canada.
(1020)
[English]
The Holocaust in many ways is something that happened to all
of us. It is a part of our history and it is something we are all
responsible for in ensuring that peace, justice, and freedom in
every country in this world are more than just words.
Canada will remember. The world will remember.
Mrs. Elsie Wayne (Saint John, PC): Madam Speaker, I want
to join with my colleagues in the House in commemorating the
50th anniversary of the liberation of the Nazi concentration
camps. We must never forget the millions who were murdered at
the hands of the heinous Nazi regime.
I also want to take this opportunity to pay tribute to the many
Canadians who fought so that the future generations could live
in peace and freedom.
I shall never forget as a little girl, when I was only five years
old, when my brothers came in to tell my mother and my father
that they had signed up to go overseas. They were overseas in
France, Germany, and Italy. I will never forget the prayers and
the hard times my mother had, hoping and praying she would
hear from them. And I will never forget when I was a little girl
and we went to the train station to greet them when they returned
safe and sound.
If there was ever a war that needed to be won, it was the
second world war. It hardly needs saying that the world would be
a dark and different place today if the allies had not achieved
victory.
We must never forget the unspeakable horror the death camps
brought forth. They are a symbol of what can result from hatred
and racism.
Today we witness the suffering of innocents around the world
who are the victims of ethnically motivated conflict. Let us
remember what such hatreds can lead to and be ever vigilant in
our efforts to make sure it is not allowed to happen again.
Yes, Canada will remember.
Hon. Arthur C. Eggleton (President of the Treasury Board
and Minister responsible for Infrastructure, Lib.): Madam
Speaker, I would like to move a motion, with the unanimous
consent of the House, which I am pleased to say has four
seconders: the hon. member for Châteauguay, the hon. member
for Okanagan-Similkameen-Merritt, the hon. member for
Yukon, and the hon. member for Saint John. I move:
That this House solemnly commemorates the 50th anniversary of the
liberation of the Nazi concentration camps, remembers the lives of the millions
of men, women and children who perished at the hands of tyranny, and honours
the many Canadians who fought for freedom and justice at a time of darkness.
(Motion agreed to.)
* * *
Mr. Bob Speller (Haldimand-Norfolk, Lib.): Madam
Speaker, pursuant to Standing Order 34 I have the honour to
present to the House a report from the Canadian branch of the
Commonwealth Parliamentary Association concerning our visit
to Hong Kong from March 13 to 17, 1995.
11846
Mr. Paul Szabo (Mississauga South, Lib.): Madam Speaker,
pursuant to Standing Order 36, I wish to present a nationally
circulated petition that has been received by me. This particular
petition was signed by a number of petitioners from the St.
Marys area of Ontario.
The petitioners would like to draw to the attention of the
House that managing the family home and caring for preschool
children is an honourable profession, which has not been
recognized for its value to our society.
They also state that the Income Tax Act discriminates against
families who make the choice to provide care in the home to
preschool children, the disabled, the chronically ill or the aged.
Therefore, the petitioners pray and call upon Parliament to
pursue initiatives to eliminate tax discrimination against
families who decide to provide care in the home for preschool
children, the disabled, the chronically ill and the aged.
(1025 )
Mr. Fred Mifflin (Bonavista-Trinity-Conception, Lib.):
Madam Speaker, I rise under Standing Order 36 to present a
petition to the House.
These petitioners are all from Gambo in Bonavista North in
my riding. They note that whereas the majority of Canadians are
law-abiding citizens, that the majority of Canadians respect the
sanctity of human life, and that physicians in Canada should be
working to save lives, they humbly pray that Parliament would
make no changes in the law that would sanction or allow the
aiding or abetting of suicide or active or passive euthanasia.
Mr. Mac Harb (Ottawa Centre, Lib.): Madam Speaker, I
have a petition signed by many of my constituents of Ottawa
Centre who are calling on the government to take action in order
to deal with crime throughout Canada, mainly in urban centres. I
would like to lend my support to this petition.
Mr. Don Boudria (Glengarry-Prescott-Russell, Lib.):
Madam Speaker, I have two petitions to table. The first one is
signed by 58 people, mostly from Saskatchewan. These
petitioners are asking that the Criminal Code provisions to
prevent assisted suicide and euthanasia be maintained.
With those 58 signatories, the total number of petitions tabled
to date on this issue is 29,506.
Mr. Don Boudria (Glengarry-Prescott-Russell, Lib.):
Madam Speaker, I also want to table a petition on behalf of
another member. I know it is not customary to refer to the
absence of a member, but this is the case of the unfortunate
illness of the member of Parliament for Nepean. I am sure that I
speak on behalf of all of us when I wish her to come back to
Parliament very soon.
On behalf of the electors of the constituency represented by
the member for Nepean, I want to table a petition signed by 25
signatories who are asking that there be no additional gun
control measures.
* * *
[
Translation]
Mr. Peter Milliken (Parliamentary Secretary to Leader of
the Government in the House of Commons, Lib.): Madam
Speaker, I would ask that all questions be allowed to stand.
The Acting Speaker (Mrs. Maheu): Is that agreed?
Some hon. members: Agreed.
[English]
The Acting Speaker (Mrs. Maheu): I wish to inform the
House that because of the ministerial statement and pursuant to
Standing Order 33(2), Government Orders will be extended by
16 minutes.
_____________________________________________
11846
GOVERNMENT ORDERS
[
English]
Mr. Preston Manning (Calgary Southwest, Ref.) moved:
That this House recognize that since the inception of our national health care
system the federal share of funding for health care in Canada has fallen from 50
per cent to 23 per cent and therefore the House urges the government to consult
with the provinces and other stakeholders to determine core services to be
completely funded by the federal and provincial governments and non-core
services where private insurance and the benefactors of the services might play
a supplementary role.
He said: Madam Speaker, I rise to address the Reform motion
before the House, but before I do so I would like to say a word
about broken promises.
One of the reasons there is so much public cynicism about
politics and government is that governments consistently break
their promises. This Liberal government, for example, is not yet
two years old but already it has littered the political landscape
with broken promises.
11847
For example, there was the promise to base key federal
appointments solely on competence rather than patronage, a
promise routinely broken almost every week.
There was the promise by the now Deputy Prime Minister to
resign if the GST was not replaced within one year of the
election, shamelessly broken on October 25, 1994.
There was the promise not to alter federal-provincial
transfers without the full co-operation of the provinces, which
was broken by the introduction of the Canada social transfer in
the February budget.
There was the promise to provide a new blueprint-
(1030 )
Mr. Szabo: Madam Speaker, I rise on a point of order.
Two days ago a member rose in the House on a point of order
to indicate that the speaker was not addressing the motion on the
floor. I believe this is the same case. Therefore, I would make
the point that the member should be addressing the motion.
The Acting Speaker (Mrs. Maheu): Resuming debate with
the hon. leader of the Reform Party.
Mr. Manning: There was a promise to provide a new
blueprint for social reform. It was broken without apology or
explanation when the Minister of Human Resources
Development failed to deliver his green paper.
There was a promise not to increase the tax load on the long
suffering, overtaxed Canadian taxpayer. It was broken to the
tune of $500 million a year with the imposition of a 1.5 cent a
litre tax on gasoline.
There was a promise of a more open Parliament where MPs
would be free from party discipline. It was dictatorially broken
when Liberal MPs who voted against the government's gun
control bill were stripped of their committee positions.
The first part of the motion we are considering draws
attention to yet another broken Liberal promise, one of the most
serious of all. For the benefit of members, this is the connection
between broken promises and the motion.
When national medicare was introduced at the federal level
by a minority Liberal government 30 years ago, Prime Minister
Pearson solemnly promised Canadians, the provinces and the
House that the federal government would pay 50 per cent of the
costs. This was the fiscal promise on which medicare rested.
This was the condition insisted on by the provinces and
promised by the federal government, a promise without which
the provinces would not have agreed to national medicare.
The Liberals even wrote that promise into the old 1966
medical care act, section 5, which stated that ``the amount of the
contribution payable by Canada to a province in respect to a
medical care insurance plan is an amount equal to 50 per cent
of''. It then went on to list the various cost components of the
plan.
What is the state of that sacred promise today? Today the
federal government's contribution to health care funding is not
50 per cent as promised. It is now less than 23 per cent and
falling.
The Prime Minister and the health minister can profess their
undying commitment to the principles of medicare until they
retire from public life clutching their two-tier MP pension. The
truth of the matter is that every day, every hour in every
province, in every community, in every part of the country,
whenever and wherever Canadians draw on national medicare,
the government is breaking its fundamental promise to pay 50
per cent of the bill.
Because it is breaking that fundamental financial promise it is
slowly undermining the other principles of medicare. It
undermines accessibility as waiting lists get longer and longer.
It undermines comprehensiveness as more and more health
services are delisted from provincial insurance plans. It
undermines universality as the system evolves into a multi-tier
system with access to the various tiers being tied increasingly to
ability to pay.
The second part of the motion before the House proposes a
solution to this dilemma, which I will get to in a moment. Before
I do so I would like to clear away one of the myths of medicare, a
myth to which the Prime Minister and the health minister cling,
a myth which prevents a clear diagnosis of the problem and the
solution. That myth is that Canada has a one-tier medical
system to which all Canadians have universal access regardless
of ability to pay and opening up the Canada Health Act will lead
to a U.S. style two-tiered system where ability to pay is the key
to access.
The indisputable fact is that Canada already has a
multi-tiered health care system, access to which has been made
more restricted by rising health care costs and declining federal
support. The challenge is to reform medicare so that one of those
tiers contains all the essential health services required by
Canadians, financed by sufficient federal and provincial
funding so that no Canadian is denied access to those services
because of inability to pay.
(1035 )
How to do that I will discuss in a moment. Lest there be some
simple minded folk among us who still cling to the notion that
Canada still has a single-tiered medical care system, let me
submit evidence to the contrary.
I could quote from the exhaustive 1994 health care study by
Dr. Ralph Sutherland and Dr. Jane Fulton entitled ``Spending
Smarter and Spending Less''. On pages 98 and 99 of that study,
they discussed the myth of the one-tier system and dismiss it as
nonsense. They end by saying that the two-tier system is and
always has been a reality in Canada.
11848
They then go on to discuss how to make a multi-tier system
work for the benefit of all Canadians which is the real challenge
and real problem. Rather than quote extensively from the
academic or technical literature, I prefer to share with the
House a note I received just yesterday from a Canadian
physician to whom I put the question, does Canada presently
have a one-tier or two-tier system?
He says flatly that a two-tier system already exists. Should a
person be admitted to a hospital, he or she can obtain a private
room should he or she have the funds to pay for it or an insurance
program that covers it. Otherwise this is not available.
People can hire a private duty nurse for 24-hour care if they
can afford to pay for it. Many nursing and home care services are
also available should the patient be able to afford to pay for
them.
Recently midwifery has been introduced. Again this is only
available to those who can afford to pay for these services.
People can have access to procedures such as abortions in
private facilities if they are able to pay the private facility fee.
People who can afford to may have an insurance plan to cover
the cost of pharmaceuticals. Those who cannot afford to pay this
fee must pay for it out of their own pocket.
The Workers' Compensation Board in this province has
contracted many private facilities to provide services for its
clients in order for them to obtain these services more quickly
than possible in the public system and thus get them back to
work in a more timely fashion.
Members of the military have been flown to the base hospital
in Ottawa to have surgical procedures performed rather than
being on a waiting list. I have also recently learned that the
military purchases surgical procedures such as arthroscopies at
private clinics as it is cheaper than purchasing the same
procedures through the public sector.
As well, we all know the ultimate two-tier system is available
to those who can afford to pay for it by leaving the country and
having services provided in the United States.
Many leading edge technologies and therapies are not
available in this country. In order to obtain them one must leave
the country and purchase them in the U.S. A country of our
stature should be ashamed of the fact that it is not able to provide
those services.
He concludes by saying: ``As I hope is demonstrated by the
above examples, almost all aspects of health care in Canada are
two-tiered and available to people on a private basis except for
the physician's services. This and certain procedures which are
only available in public hospitals are the only services that are
not presently available in two tiers in this country''.
Why on earth the Prime Minister and the health minister
would continue to deny the existence of a multi-tiered health
care system or to pretend that the five criteria of the Canada
Health Act preclude such a system is beyond me. Childlike
belief in the myths of medicare at the highest levels of the
federal government must end if the problems of Canadian health
care are to be resolved.
The second portion of the motion before us indicates the way
in which Reform believes the government could guarantee
universal access for all Canadians to a set of essential health
services regardless of ability to pay in a multi-tiered system.
In order to provide secure funding for health care into the 21st
century, substantive discussions and negotiations are required
among all the key players: representatives of health care users,
taxpayers, health care practitioners, health care administrators,
health care insurers, the provinces and the federal government.
Reform proposes that these discussions and negotiations
should focus on completing a health care funding matrix such as
that shown on page 48 of the Reform taxpayers budget.
This is the type of framework for refinancing health care,
saving medicare, which the Prime Minister and the federal
government should have provided through that national health
care forum which they have not. This is the framework required
to produce meaningful amendments to the Canada Health Act,
amendments which the health minister continues to fail to
provide. This framework suggests that the first item on the
agenda should be a discussion of how best to divide essential
health services into core services and non-core services.
(1040)
The core services would be those health care services most
essential to Canadians, the financing of which would be
guaranteed by the federal and provincial governments up to
some minimal national standard. They would be those services
which make the most demonstrable contribution to improving
the health of Canadians and which must be provided in the most
cost effective way possible.
These core services would constitute the heart of medicare.
All Canadians would be guaranteed access to these services
across the country up to some national standard regardless of
their ability to pay.
Provinces and individuals would be allowed to provide and
secure services that went beyond the core services if they so
desired. The federal government would not be involved in the
financing of such services.
Services designated as non-core services, for example,
cosmetic surgery as distinguished from more necessary surgery
or
11849
fibreglass casts for broken limbs as distinct from plaster casts,
would be funded through a more flexible combination of
funding sources, including private insurance and user pay.
To those members opposite who will challenge us to elaborate
on what should be considered core and non-core services, I
would invite them to listen carefully to my medical colleagues,
the member for Macleod and the member for Esquimalt-Juan
de Fuca, and ask questions at the end of those remarks.
I would encourage all MPs to refrain from getting too deeply
into that discussion. It is not our role in the federal Parliament,
either constitutionally or practically. It is not the role of a distant
federal government that is paying less than one-quarter of the
bills to define those services. That is the old way. It is the top
down way. It is the Meech Lake approach to medicare. It is the
centralizing way and it is not the way of the future.
The definition of those services must primarily come from
health care users, the people who use them, from the
practitioners who actually practice them and from the
administrators at the local and provincial levels. We should do
everything we can through parliamentary committees, personal
speeches and dialogue, through the national health care forum to
facilitate those discussions and to listen. But we should not try
to dictate the final division of services.
After those discussions occur, our role will be to commit
federal funding to whatever Canadians define as core services,
up to some minimal national standard in co-operation with the
provinces.
There is no question in my mind that there is an urgent need
for health care reform in Canada, particularly in light of the
failure of the federal budget to eliminate the deficit. These
reforms are required to preserve the best features of the present
system; to prevent the funding system from being completely
destroyed by interest on the debt; to provide flexibility to allow
the provinces' health care administrators and physicians to
better adapt to the health care needs of Canadians.
Canadians are asking and will continue to ask: From whom is
the leadership for health care reform going to come? I would
suggest it is not coming from the federal government under the
current Prime Minister or health minister. They resist every
proposal for change. They resist the diagnosis that would lead to
real proposals for change. They charge anyone who advocates
change with being an enemy of medicare, which is a reactionary
position, or a proponent of U.S. style health care, charges which
are completely untrue. They are only dragged into the
discussion of health care reform at all by their officials telling
them that if they do not do something, the system is going to
collapse and they are going to carry the blame.
Therefore I suggest that the leadership for health care reform,
and it is occurring in many spheres, where the public is now
ahead of the politicians and the government, must come from
the patient user community, from taxpayers, from the medical
community, from administrators and local governments, from
provincial authorities, from the bottom up, not the top down.
If in 1960 Ottawa had had the monopoly it has today on setting
terms and conditions of health care services and financing, the
present medicare system would not have come into being.
Canadian medicare did not start in Ottawa. It did not start
anywhere near Ottawa. It started in Saskatchewan and it really
started there in an operational sense with the Swift Current
Hospital District in that province.
(1045 )
The concept was incorporated by the old CCF into its political
platform and then stolen by the federal Liberals. I can assure
concerned citizens and real health care reformers across the
country they will find allies and advocates of sensible change to
the health care system in the Reform caucus.
I urge all hon. members who wish to save and advance the best
features of Canadian medicare to support this motion.
Hon. Diane Marleau (Minister of Health, Lib.): Madam
Speaker, with all due respect to the leader of the third party, he
has certainly spoken of broken promises and has gone on at great
length about it.
Speaking of broken promises, during the election and
following I can recall the leader of the Reform Party stating: ``I
want to make it absolutely clear that the Reform Party is not
promoting private health care, deductibles or user fees''. Yet,
today what is he talking about? Deductibles, user fees, getting
more and more private. That was yesterday; this is today. Talk
about breaking promises.
I can recall the Reform Party rhetoric during the last election.
How does the hon. member explain his change of thinking or his
whole party's change in rhetoric? How, pray tell, would that
ensure that people who needed the care got it based on their need
and not on whether they could afford to pay for it.
Let us face it. This is from a party that does not advocate any
taxation increases whatsoever. Taxes are based on fairness. If
you make more money, you pay more tax. They are proposing a
tax on illness. The sicker you are, the more costly it is for you.
What kind of a system is that? I would like an explanation.
How would the leader of the Reform Party deal with people
who are very ill who, by the way, tend to be the poorest? Usually
those who are very sick cannot work anymore. He might be
charitable to a few and there would be these core services;
maybe you could have a band-aid if you could not afford to pay
11850
for it. What kind of medicare is he proposing except the
American style of system? And we know what that is about.
Mr. Manning: Madam Speaker, I would remind the minister
that while there is only a handful of us here in the House her
remarks on this subject are being carefully monitored these days
by the practitioners and administrators and particularly by the
provinces. The statements made here that completely deny the
reality of the health care system do no service to this House nor
to the government's position on the seriousness of the problem.
They create the impression that we literally do not understand
how the system works. That is a discredit to the minister and the
government.
From what the minister says, we can tell her views of what
Reform said during the election are based on what a clipping
service says Reform is about. They bear no resemblance
whatsoever to the positions we have articulated, particularly the
Reform colleagues with medical backgrounds.
With respect to her particular question of how we facilitate
the payment for services for people in this category of poor
services, the minister could not have been listening to what I
said. We say we should define a set of core services that are
essential to the care of Canadians. Those are the services to
which we would dedicate entirely the federal and provincial
contributions to the funding of medicare. Those services would
be brought within the financial reach of every Canadian no
matter where they lived, regardless of their ability to pay. The
non-essential services can be provided through other financing
sources such as insurance and even user pay. That is perfectly
clear.
These proposals have been presented by other health care
reformers in the health care field itself and in the provinces. It is
time for the minister to acknowledge them for what they are, not
to pretend they are something else.
(1050 )
Ms. Hedy Fry (Parliamentary Secretary to Minister of
Health, Lib.): Madam Speaker, the hon. member put forward an
eloquent speech, wonderful rhetoric. It shows a depth though of
the superficiality of the understanding of what health care is all
about and what the five principles of medicare actually mean.
I would not like to add any further rhetoric but to say that with
this lack of understanding would the hon. member like to
explain to me what he understands by the meaning of the term
``core services''. He bandies it about and uses it a lot. I would
like to know from him what he means by core services.
Mr. Manning: I have two comments. I appreciate the fact that
the member is concerned about superficiality. I would earnestly
suggest if she reads the speech the Prime Minister gave on this
subject in Saskatoon and if she reads the speeches that have been
given by the Minister of Health, we have a superficiality that
betrays the government's position today.
With respect to core services, we think core services should be
those services deemed essential to the health care of Canadians
as defined by health care users, practitioners, local
administrators and provincial governments.
I explained in my speech specifically that we should not try to
say what those services are. That is what got Ottawa into trouble
in the first place. It made a commitment to a whole range of
services which it could not continue to fund.
At every public meeting and meetings with the medical
community that I have had where I have put this health care
matrix up, you can get an excellent discussion and definition
from those people if you put up that matrix. I suggest that if the
minister and the member want to know, go and ask the people
whose opinion on that definition is the one that counts.
Mr. Rey D. Pagtakhan (Winnipeg North, Lib.): Madam
Speaker, certainly from what is before us in the opposition
motion on the national health care system the leader of the
Reform Party has made it clear at least today that he is for a
multi-tiered system. Therefore it is now clear to Canadians that
the Reform Party wants to destroy the medicare that we have
today.
Mr. Morrison: You destroyed it.
Mr. Pagtakhan: They can say anything, Madam Speaker, but
Canadians are serious. They are not laughing about medicare.
Canadians want to preserve medicare.
Does the hon. member believe that the single tier system is the
best system in the world in terms of cost effectiveness? If the
member does not believe that, I would refer him to the report of
the Surgeon General's office in the United States. It has shown
that indeed we have a lot of savings by having a publicly
administered single tier system.
The second point is when the member spoke about health care
funding I am not clear as to his understanding of funding for
health. Does it mean only public spending on health or private
spending on health? I can see from his speech that he would like
to shift the cost of health care spending from the government to
private individuals, the citizens. However, he has no proposal
whatsoever that will contain the cost of proper health care
spending which is the critical question facing Canadians to
preserve our medicare system.
Mr. Manning: In response to the first question: Is the current
system the most cost effective in the world? No, it is not. This is
obvious. This is not a matter for debate. Study after study has
indicated that the costs are out of control with respect to the
Canadian system and therefore it cannot be the most cost
effective.
11851
The fact that more and more Canadians are seeking health
care outside the Canadian system itself is evident that there is
something wrong.
(1055 )
The government itself professes a great abhorrence of the
American system. We do not agree with the American system.
We are not advocating anything of the kind. However, because
of the actions of the government, it is driving more and more
Canadians to subsidize the American system to the tune of
hundreds of millions of dollars a year because they will not stay
on the waiting lists here.
The hon. member is a physician himself. Has he ever sent a
patient to get health care in the United States because they could
not get it here or were on a great waiting list under our current
system?
The Acting Speaker (Mrs. Maheu): I am sorry, the time has
expired.
Hon. Diane Marleau (Minister of Health, Lib.): Madam
Speaker, I would like to thank the leader of the third party for
setting forth in his party's motion a proposal which I would
qualify as almost perfect, almost perfectly wrong that is. The
proposal demonstrates clearly that Reform Party members do
not understand how the Canada health system functions, what
challenges it faces, what is being done to address those
challenges, and what solutions are realistic and make sense to
Canadians.
In his medicare proposal and in his pronouncements on the
Reform Party's views, the leader of the third party has managed
to put together a package that will simultaneously increase
bureaucracy, decrease flexibility, maximize federal interference
in provincial jurisdiction and most of all, increase the cost of
health care in Canada.
How would the Reform Party pay for this? It is simple: It
would push people into buying private insurance, if it is
available and if they have the money for it, to cover things which
are presently covered by medicare. Worst of all, it would tax the
sick by permitting and even encouraging user fees.
The Reform Party proposal and pronouncements are not a
prescription for a healthy medicare system. They are a
prescription for disaster. Before dealing with the specifics of
this motion and of Reform's thinking on medicare, let me
question the proposals of the Reform Party.
Reform's so-called budget proposed surrendering additional
tax points to the provinces for health care. How precisely does
this square with its concern about a falling federal share of cash
contributions? Certainly not well at all. How would the Reform
Party deal with the fact that tax points yield different revenues in
each of the provinces? It obviously has not thought of that.
How would that party enforce the conditions and criteria of
the Canada Health Act? It certainly appears it would not.
What, if any, evidence do members of the Reform Party have
to support their expectations that provinces would agree on a
common level of basic or core health services everywhere in
Canada as they state they would on page 48 of their so-called
budget? Are they not aware that a number of provincial
ministers of health have already indicated that such an approach
is simplistic and they have no interest in developing a national
list?
Which is the federal role? To determine core services, as the
motion states, or to have provinces agree on a common level of
core services as stated in Reform's so-called taxpayers budget?
How would the leader of the third party coerce the provinces?
The Reform Party obviously has no answers for these
questions. That is the reason its arguments have no basis in fact
and are almost perfectly wrong. It is soapbox rhetoric which
could lead to the destruction of medicare, and we are not going
to have any of it.
Take this motion, for example. In dealing with federal
contributions to provincial health insurance plans, the hon.
member mixes apples with oranges. He does it all the time, so
this is nothing new.
(1100 )
The federal share of funding for health care was never 50 per
cent of total provincial government health expenditures. As a
result of cost sharing during the 1960s and early 1970s the
federal share nationally accounted for roughly 50 per cent of
provincial expenditures for hospital and medical care only. Even
then provincial governments were spending on health programs
for which the federal government did not share costs.
Let us look at some real numbers, not those fabricated by the
Reform Party. In 1975-76 after medicare was introduced the
federal contribution nationally amounted to 39 per cent of total
provincial health expenditures. In 1992-93 the federal
contribution, the sum of the cash in transfers to the provinces for
health, represented 32 per cent of total provincial government
health expenditures.
Another way to look at the numbers is to examine the federal
share of total health expenditures in the country. On this basis
the federal share dropped from 31 per cent in 1975-76 to 24 per
cent in 1992-93.
[Translation]
Let me repeat it again, so that, hopefully, Reform members
will understand eventually. In dealing with federal contributions
to provincial health insurance plans, the Reform Party leader is
mixing apples with oranges. The federal share of funding for
health care was never 50 per cent of total provincial government
health expenditures.
11852
As a result of cost sharing agreements reached during the
sixties and the early seventies, the federal share nationally
accounted for roughly 50 per cent of provincial expenditures
for hospital and medical care only. Even then, the provincial
governments were spending on health programs for which the
federal government did not share costs.
Let us look at the real figures, not those fabricated by the
Reform Party. In 1975-76, after medicare was introduced, the
federal contribution nationally amounted to 39 per cent of total
provincial health expenditures. In 1992-93, the federal
contribution, that is the sum of the cash payments and tax
transfers to the provinces for health, represented 32 per cent of
provincial government health expenditures.
[English]
These are all real and public numbers. They should be the
Reform's numbers because they are the facts.
Provinces administer the health care system. I want to make it
clear and acknowledge in the House what I have said elsewhere.
Provinces and territories are doing a good job of containing
costs but historically the costs of provincial health plans
increased in a less controlled manner. It is in part because of this
that the federal share of health expenditures has fallen over
time. If health costs had risen at the average rate of OECD
countries the federal share would be substantially higher.
Expenditures in the public sector are being controlled. Our
cost control problems are now in the private sector. Pray tell,
why would we shift more to the private sector so we can have
even higher and less control of costs?
In 1993 Canada spent $72 billion on health care. This
represented 10 per cent of our gross domestic product. Hon.
members are aware that with the exception of the United States,
Canada's health expenditures are the highest of any
industrialized nation.
There is enough money in the system. It is a question of how
better to spend the money we have. Of the $72 billion spent in
1993 approximately $52 billion was spent in support of public
health services while the other $20 billion was spent in the
private health sector. Lately the public component has been
growing at less than 2 per cent. On the other hand, private health
spending has been growing by more than three times that rate.
(1105)
The public sector or single payer system has enabled the
provinces and territories to better control the rate of increase in
the growth of health expenditures in the public sector. The
World Bank's 1993 world development report noted the cost
effectiveness and control advantages of public sector
involvement in health: ``In general the OECD countries that
have contained costs better have greater government control of
health spending and a larger public sector share of total
expenditures''.
The OECD review of health reform and development in
Canada also recognized the advantage of a significant public
sector involvement in health. From the 1993 OECD economic
survey of Canada: ``The structure of Canada's single payer
health system lends itself to effective supply management and
control. It seems the problems of the current system are not
related to its publicness''.
With respect to health expenditures in 1994, preliminary
estimates by my officials indicate public health expenditures
declined in aggregate by about 1 per cent in 1994, while private
expenditures increased at about the same rate as 1993. Under
these assumptions total health expenditures in 1994 were
approximately $73 billion for an aggregate increase of less than
1 per cent, or about $600 million. Expressed as a percentage of
GDP, total health spending probably declined to about 9.7 per
cent in 1994.
There are a number of reasons we have been more successful
in controlling health costs in the public sector than in the private
sector.
[Translation]
We have in each province a structure which provides the same
coverage to everyone. It is not necessary, therefore, to assess
individual risks. Payments to providers are made in a simple but
efficient manner. Financing of the system is simple; everything
possible is done to reduce costs. In fact, researchers from
Harvard University found that Canada only spends 1.1 per cent
of its gross national product on health care management.
If we spent as much as the United States do on that, health care
expenditures would increase by $18.5 billion. Americans spend
almost two and a half times as much as we do on that. And there
is no evidence that spending more would improve the health of
Canadians.
The second reason we are in a better position to control costs
is that there is only one purchaser in our provincial health
insurance plans. Governments have great clout when it comes to
negotiating the level of costs of services. They can set overall
budgets for hospital and physician services. In fact, they have
done so, as indicated by the figures I quoted.
[English]
As Minister of Health I want Canadians to continue to have
access to high quality health care at a price they can afford. That
is why I am working with my provincial and territorial
colleagues as well as other stakeholders to address cost drivers
in both the public and private health sectors. So much for the
first part of Reform's motion.
Let me now deal with the second part which calls for a listing
of core services. There is a remarkable degree of congruence
between the provinces. Among them there is broad agreement as
to what constitutes the core of ensured physician and hospital
services. There are some differences from province to province
11853
but these simply demonstrate the flexibility which provinces
can and do exercise in providing a range of additional benefits
to their residents. That is not wrong. That is a strength of our
system; a system characterized by sound consensus on what are
core services or medically necessary services.
The list of covered procedures and services of necessity must
be flexible. That is because the way we deliver health care and
the opportunities which new technologies and procedures create
dictate changes need to be incorporated over time. There is
almost no service not medically appropriate in some cases.
(1110)
For example, plastic surgery may be considered medically
necessary when it is intended to correct a medical condition.
Reconstructing a nose to correct a breathing problem is labelled
cosmetic surgery but clearly it is a medically necessary
procedure.
Other examples include removal of minor skin lesions when
cancer is suspected and tattoo removal in the case of abuse or
prisoner of war experiences.
For the most part in Canada we have left the definition of
medical necessity to professionals, not bureaucrats. The
medical necessity of a service is determined at the point of
delivery of the service. That is what the Canada Health Act has
allowed. It is based on the medical needs of the patient, not the
financial means of the consumer. That is the way it should be;
this is simple fairness.
Canadians do not want cash register medicare. This stands in
sharp contrast to what is happening with managed care in the
U.S. There, third party insurers tell physicians what they cover
and what they can or cannot do for their patients. So much for
clinical freedom.
This reality is one of the major reasons why a significant
portion of doctors who leave Canada to practise in the U.S. do
come back home.
The Reform Party says it stands for smaller government, less
bureaucracy. Therefore I find it strange it is suggesting a process
that would actually increase bureaucracy. Let there be no doubt,
producing the list of medically necessary or core services would
involve more bureaucracy.
Medical necessity is an integral part of the understanding and
operation of the Canada Health Act. It is at the very heart of the
principle of comprehensiveness.
In the Canada Health Act the words medically necessary are
used in conjunction with other conditions. This ensures that
once a service has been determined to be medically necessary
and insured by provincial health insurance plans it is accessible
in uniform terms and conditions by all residents of the province
and available to them when they travel across the country.
In a manner of speaking, these become rights of Canadians.
These are rights the Canada Health Act is there to protect.
Canadians expect they will have medically necessary services
available without point of service charges. They are right in this
expectation. This is why facility fees for medically necessary
services in private clinics are unacceptable and why I took steps
to address this problem in January.
A rigid list of medically necessary services encourages the
development of a second tier of health care delivery. It promotes
privatization and shifting the burden of costs from society to
individuals. These costs would then be borne by patients or by
their employers.
Reformers, who profess to know what is good for business,
should ask business people what they think about this idea. Let
them talk to the owners of small businesses, the independent
entrepreneurs who account for so much economic growth in our
country, who have tried to buy insurance to cover the health cost
of their employees. They know how costly it is already and they
appreciate how much more expensive it would be if they had to
cover more services and medically necessary services as well.
I ask Reform Party members, in particular the member for
Macleod who is a physician, to tell us which services they think
are not medically necessary, which services they think should be
deinsured and which services they think individual patients
should pay for.
Even the premier of Alberta is unable to provide a list of what
these should be. The government's agenda is a national one. It is
aimed at doing what is necessary to renew our health care
system to make it more efficient and effective. It is an agenda
based on better health outcomes, not better incomes.
The motion before us urges me to consult with provinces.
Since becoming Minister of Health I have made it clear I want to
work with provinces and territories and I have. I have met my
provincial colleagues. I talk to them on a frequent basis. We
have arrived at a consensus about the need to support the
principles of the Canada Health Act. Perhaps he should consult
with more provinces than he has.
(1115 )
I am prepared to continue this collaboration. Our next regular
meeting is scheduled for September, but I have already told the
provinces that I am ready to meet with them earlier. There is no
lack of willingness by this government and this minister to work
with the provinces, the territories and others to ensure that
Canadians continue to have the very best health care system in
the world.
11854
Mr. Preston Manning (Calgary Southwest, Ref.): Madam
Speaker, the minister concluded her remarks by expressing her
desire to co-operate, collaborate and work with the provinces,
and we applaud that. That is constitutionally correct and is the
only way the system will be fixed.
However in the course of her remarks she used an unfortunate
phrase. I trust it was a slip of the tongue when she asked
rhetorically how we can coerce the provinces into national
standards if we do not retain the present system.
Surely the minister is aware that she is losing her capacity to
coerce the provinces as federal cash transfers decline. She is
also aware that it is possible to have national standards without
coercion as we have, for example, in the field of education
where there is the universal standard that everyone under 16
years of age gets a free education. That was established as a
national standard without any national education act or coercion
on the part of the federal government.
This talk of coercing the provinces into national standards as
her financial position weakens is completely contrary to the
spirit of federalism and what she said later on. I should like to
give the minister an opportunity to withdraw that statement and
indicate that she did not mean in any way, shape or form to say
she favours coercion of the provinces, which is a polite word for
blackmail, into national health care standards.
Ms. Marleau: Madam Speaker, my response to that is to go
on to say that again they do not listen to what I am saying. I have
asked the Reform Party to explain how it would coerce the
provinces into having a uniform list of core services, and it
certainly has not answered that. Its type of top down solution is
not exactly what I am talking about.
We are getting a strange mixture of things from the Reform
Party. On the one hand I heard the leader of the Reform Party go
on at length about allowing the provinces to have more
flexibility to allow those in the regions to be better able to
deliver services. On the other hand his party is asking us to work
with the provinces to develop a hard line definition of what is
covered and what is not. There would be a list and we would
need a whole series of bureaucrats to make sure it is really this
and not that and therefore would not be covered. It always
astounds me because the Reform Party cannot have it both ways.
By the way, we enforce principles not standards. The Canada
Health Act talks about five fundamental principles. Those
principles have served us very well.
The type of fear mongering and statements made by the leader
of the Reform Party saying that our health care system is not
doing well are wrong. While I will admit that changes are
needed and we have to continue to work on it, the idea is for us to
shape the future of medicare. That is what the provinces,
working along with the federal government, are very much
working on to deal with the new technologies and to ensure the
dollars spent on health go directly to those things that are most
needed.
Change is difficult. It is not easy. Throwing more money at it
will not make it better. We will end up with a system like the one
in the United States. That is exactly what the Reform Party is
promoting.
Mr. Grant Hill (Macleod, Ref.): Madam Speaker, the
minister has gone on at great length to talk about our proposal
for a definition of core essential issues. She said that this was
some kind of nefarious scheme that had never been thought of or
heard of in Canada before.
(1120 )
Could the minister explain when the Prime Minister said
shortly after the budget on the Peter Gzowski program that we
must return more to basics in our health care system? That is not
an exact quote but very close to an exact quote.
Could the Minister of Health explain what the Prime Minister
was referring to when he said that we were trying to do too much
with our public funding? That is not a question the minister
should be able to dance around and avoid. It is a fairly
straightforward question.
Ms. Marleau: Madam Speaker, the Prime Minister has been a
member of Parliament for 32 years. He does not need lessons on
medicare from the Reform Party. Let us make that perfectly
clear. He was here when medicare was brought forward. He saw
the growth and the best of medicare. That is why he is such a
staunch defender of it. That is what we are talking about.
The member for Macleod talks about core or medically
necessary services and having lists. Certainly they are things
that have been talked about. The premier of Alberta talks about
them all the time and he has not been able to come up with a list.
I would understand if the member for Macleod would agree.
After all, he is and was at another time in his life a physician.
Does he not believe it is far better for physicians, medical
practitioners, to make that determination when they have
someone before them? They look at the evidence before them
and know what is medically necessary or not, or they should
know.
With the help of the Medical Research Council and many
other agencies we are proposing to look at evidence based
outcomes. Many procedures have been performed that perhaps
do not have any real value. Those kinds of procedures should not
be performed any more. We need to do a lot more research in that
field. A lot of it is being done and we will continue to do it. We
are proposing clinical guidelines so that there are fairly uniform
ways of determining.
11855
When we hear about an excessively high rate of
hysterectomies in one area versus another area when the
composition of the communities is essentially the same, there
is something wrong. We will work at addressing some very
serious discrepancies, but that is not to say that we should have
a strictly defined list. I still believe that patients, along with
their physicians and their caregivers, should be the ones to
determine what is medically necessary.
Mr. Paul E. Forseth (New Westminster-Burnaby, Ref.):
Madam Speaker, I have a question for the Minister of Health.
Canadians are faced with a fundamental dilemma: there is less
government money to go around to support medicare as we
know it yet everyone wants to preserve medicare.
How do we reallocate tax dollars and in general bring more
resources to bear on medicare in a climate of economic
restraint? A lot of our problem is really not internal to medicare
but rather the fiscal climate within which it is trying to operate.
Could the minister clarify the larger fiscal climate that affects
medicare and the solution to that dilemma? How do we address
the overall funding shortfalls for medicare that are getting worse
every day? It is a national problem. What will the federal
government do about it?
Ms. Marleau: I have said and I will repeat that there is
enough money in the system. However I will say there are some
areas where we have to set our priorities. Medicare is a priority.
It is a priority for the federal government and it is a priority for
most provincial governments. They have to base their financial
decisions on their priorities.
We are doing it here. We are working at setting our fiscal
house in order because we understand we have to do certain
things to preserve and protect the very sacred programs which
are constitutive to our identity.
(1125 )
That is what medicare is. It defines what Canadians really are
and it shows the values of caring and sharing which have helped
to build this great country. We will continue supporting these
solid values.
[Translation]
Mrs. Pauline Picard (Drummond, BQ): Madam Speaker, I
welcome this opportunity to rise in the House and speak to the
motion presented by our Reform Party colleagues, a motion that
concerns Canada's health care system. Although we are aware of
and condemn the federal government's unilateral withdrawal
from the funding of health care services in Canada, the Bloc
Quebecois cannot support this motion.
It is true that, as far as funding for health care is concerned,
the federal government has betrayed the provinces by reneging
on its commitments. It is true that, by continuing to impose its
standards in an area over which the provinces have jurisdiction,
while refusing to pay the real cost, the federal government acts
like the charming host who invites you out to dinner but leaves
you with the bill. We agree with our Reform Party colleagues
that we should condemn, loud and clear, the present
government's shameful withdrawal of funding from health care
programs.
By continuing the work started by the previous Conservative
government, which it deplored at the time, the present
government has made the advent of a two-tier and two-speed
health care system unavoidable throughout Canada. That is the
tangible result of these harsh but insidious unilateral cutbacks in
transfer payments to the provinces for established programs
financing. However, the Bloc Quebecois could never support a
proposal that the federal government become involved in
determining core and non-core services, a prerogative exclusive
to Quebec and the other provinces.
To establish a national list of core services would be a denial
of the authority of the provinces to determine the kind of care
they feel is necessary to maintain the health of the public that
depends directly on the provinces for those services. Another
reason why we cannot support this motion is that the Reform
Party proposes to open the door wide to private insurers.
Although federal cuts in funding for the public health care
system in Canada has led to a proliferation of private clinics
across the country, the Bloc Quebecois cannot support the
advent of a two-tier system, one for the rich and one for the
poor.
The present government's position on the management and
funding of Canada's health care system is at best ambivalent. To
me, it is clear the federal government can no longer afford its
ambitious plans for managing the health care system. The
trouble is, it does not come out and say so to the taxpayer, since
by cutting spending unilaterally in a jurisdiction it appropriated
at the time, the federal government has shifted the responsibility
for breaking the bad news to the provinces. It takes credit for
giving us the best health care services in the world, but it will no
longer provide funding to maintain the standards it has set and
compensate for the tax room it appropriated to pay the real cost
of the system.
We should not be surprised that the health care system is
coming apart at the seams, and mainly because of the federal
government's withdrawal of funding. However, the government
should be frank and make this clear to the taxpayers, instead of
trying to camouflage the whole situation with its new Canada
Social Transfer. It should stop trying to fool the public and give
the impression that the whole might be better than the sum of its
parts.
When the total amount of transfer payments is reduced in the
Canada Social Transfer, it means there is less money for
11856
education, less money for social assistance and less money for
health care. One would have to be very naive to believe, as the
Minister of Health seems to think, that this new approach will
make it possible to safeguard Canada's health care system
without involving a major departure from its main principles.
(1130)
In its last budget, the government introduced several
measures which are a threat to our social programs. It cut
transfer payments by $7 billion, which amounts to offloading $7
billion of its deficit onto the provinces.
The most recent cut in transfer payments is just one more in a
series of unilaterally announced cuts over the past few years, a
practice the members of this government used to protest loudly
against back when they were in opposition. Between 1977 and
1994, the federal government's share in social program
funding-health, education and social assistance-dropped
from 47.6 per cent to 37.8 per cent. The latest budget follows
suit with a draconian cut to the federal government's funding
share, which will have sunk to 28.5 per cent by the end of the
next two years.
After so many years of offloading to the provinces, the federal
government still has not learned that cutting transfer payments
is not helping to fix the financial problems of all of the
governments in Canada. By insisting on governing areas over
which its own Constitution gives the provinces exclusive power,
the federal government is preventing the country from finding
any real solution to its financial crisis, both at the federal and
provincial levels.
We are clearly witnessing the dismantling, the crumbling of
the health care system as we have known it up to now. The very
essence of the motion before us today bears witness to this. It
also confirms the dismal conclusions drawn at the provincial
health ministers' conference, which was held in Vancouver
earlier this month.
We all know that Quebec and the other provinces are facing a
dizzying increase in health care costs. This increase is due
mainly to the following factors: an ageing population; new,
more expensive, medical technology, and a significant increase
in spending on pharmaceutical products.
In the last budget, like other budgets before in which transfers
were frozen, the government substantially cut transfers to
Quebec and to other provinces for health care. Regardless of
whether these transfers are lumped with others in one envelope
called the Canada social transfer, the effect is the same: less
money will be available for health care and, in this way, the
government is eating away at the foundations of our health care
system.
Nobody in this House can ignore the radical changes being
made across the country to the health care system as we know it.
A two-tier and two-speed health care system is no longer a
prediction, but a reality.
I cite as proof the Prime Minister's latest statements, in which
he quietly and furtively introduced the new concept of
guaranteeing Canadians basic health care services only. By
alluding himself to essential minimum standards, which are
neither identified nor formulated, the Prime Minister is
acknowledging the evidence emerging everywhere in Canada of
a two-tier and two-speed health care system.
The two-tier health care system is evidenced by a trend,
which is well established in the system and which, without
drastic change, will become the norm. There will be a basic
service covered by health insurance and there will be the full
specialty service paid for by user fees, private insurance or some
other financial arrangement.
The two-speed system is already well established throughout
Canada: slow public service for those without the means to pay
and quick private service for those who cannot afford to wait,
but who have the means to pay the cost of a private clinic.
During his budget speech, the Minister of Finance solemnly
stated, and I quote: ``The conditions of the Canada Health Act
will be maintained. For this government, those [principles] are
fundamental''. The government is maintaining the obligation to
meet national standards, but, in the same breath, it is cutting the
means to maintain them.
(1135)
It is shameful double talk: we want to go to heaven, but
nobody wants to die. The government says it is up to the
provinces to organize themselves and all that. It would have us
believe that this is flexible federalism.
How can the government still think and argue that the
provinces will keep the same health services for the public?
How will Quebec and the other provinces successfully apply the
five main principles of the Canada Health Act, which Ottawa is
requiring them to do as it dumps billions of dollars of deficit on
them through cuts to social programs?
The government should be strong and come clean with
Canadians by telling them that, unfortunately, because of its
errors in the past, primarily in the Chrétien and Lalonde
budgets, it no longer has the means to maintain our health care
system as we know it. But no, the government is deceiving the
people by hiding the spectre of the demise of social programs
due to so many years of bad management, of diluting provincial
jurisdictions and of wastage, because it used its spending power
to centralize and unify.
Quebec and Canadian taxpayers hand significant sums of
money over to the federal government, and a portion of it was
always set aside for health care under the 1977 agreement. The
problem is that, for the past 12 years, the federal government
11857
has not been returning the amount due the provinces to them,
thus diverting money intended for health care. Instead, it
transfers to the provinces the deficit it has accumulated because
of its inability to bring its own expenditures under control. The
federal government must be sensitive to and, more importantly,
aware of the fact that, by increasing the tax burden of the
provinces in this way, it is creating a two-tier health system.
We believe in the general principles of universality,
comprehensiveness, accessibility, portability and public
administration of health care. What we denounce is the fact that
these five general principles are now seriously threatened in
Quebec and all the provinces by the federal government's failure
to honour its commitments.
Reducing or freezing federal transfer payments jeopardizes
our health system. When it was first passed, the legislation
governing established programs financing provided that 45 per
cent of health costs were to be paid via Ottawa. However,
because of the economic crisis in the early 1980s and the
catastrophic condition of public finances at the federal level, the
federal government began unilateral withdrawal action that will
result, in 1997, in federal contributions being half of what they
used to be. This withdrawal from financial commitments,
repeatedly described as unacceptable, unfair and inconsistent by
the Quebec government, did not lead to less interference from
Ottawa. Not only does Ottawa continue to impose national
standards, it interferes through parallel programs, thereby
causing costly overlap.
This results in constant pressure toward the introduction of
user fees and other billing methods, the curtailment of coverage
for certain services, a service tax on drugs, bed closures and
major budget cuts in hospital centres as well as disgustingly
long waiting lists in several areas.
This is to say that the very foundations of our health system,
namely free care, universality and accessibility, are in jeopardy.
What does the minister think of her government's withdrawal
from its commitments and the hardship caused to provincial
health ministries? I think that, if she pays any attention to what
goes on in her own department, the minister must be fully aware
of the serious implications of such action on our health system.
She must certainly see that all the leaks in the system will
inevitably lead to a two-tier system, a two-speed system.
Since she took office, the hon. minister has repeated over and
over that the Canadian health system is the best in the world and
that she cares so much for the health of Canadians that she would
never give up the five general principles laid down in the Canada
Health Act.
Reality, however, is something else altogether. If she does
not, as she claims, sacrifice these five general principles laid
down in the Canada Health Act, her colleague, the Minister of
Finance, on the other hand, certainly does not mind doing so.
(1140)
By taking the axe to established programs financing, the
Minister of Finance is eviscerating the health care system,
principles or no principles. They may swear that they are
committed to the principles set out in the legislation, but if they
do not provide the money needed to enforce them, what will
happen? The principles will fade away one after the other,
slowly but surely.
I freely admit that the Minister of Health may be committed to
the principles that guided the implementation of what she
always likes to refer to as the best health care system in the
world. However, I think that this commitment, however
profound, did not weigh very heavily in budget decisions. It
must be recognized that the minister failed miserably in her
attempt to secure the funds needed for the smooth operation of
the health care system.
In fact, the Minister of Health renounced her responsibility.
When the 1994 budget was tabled, she announced with great
pomp that the National Forum on Health promised in the red
book would be held under the chairmanship of none other than
the Prime Minister himself. The health care system was
supposed to be spared until the results of these widespread
consultations were known. Although the Minister of Health
succeeded in holding her forum, which was supposed to solve all
the problems, the Minister of Finance for his part did not beat
around the bush. Saying to hell with the forum, with
consultations and reforms, he decided that the remedy lay in
blind, uniform, unilateral cuts across the board.
The Minister of Health, who, like us, must see a two-tier
system developing across Canada, should have the courage to
rise in this House and denounce her government's unilateral
cuts.
It is not true that user services will remain the same. It is not
true that the provinces, to which the federal deficit hot potato
has been passed on, will perform miracles with shrinking
resources. The minister should agree with this analysis since it
reflects her own interpretation delivered in this House on March
9, 1992, when she was a member of the opposition.
What we must realize is that, by perpetuating the mistakes of
the past, the government is moving toward the position held by
the Reform Party, that is, a two-tier health care system that is
partly public and partly private. The difference is that the
Reform Party does it directly and openly by tabling a motion,
whereas the government does it in an underhand and
hypocritical manner by refusing to face reality and admit that it
can no longer afford to pursue its ambitions.
The government finds itself in that position because it does
not have the will to cut elsewhere in its spending and to review
its fiscal policy. The government is prepared to sacrifice health,
but it does not hesitate to maintain useless and costly duplica-
11858
tion, as well as family trusts, or to pay for costly ministerial
suites, among other things.
Whether it is through the government's approach or the one
proposed by the Reform Party, the Bloc Quebecois cannot
support the destruction of our health care program. If the federal
government no longer has the means to meddle in this field of
provincial jurisdiction, it should completely withdraw from it
and leave it to the provinces, with the tax room that goes with it.
In doing so, the government would at least save the
administrative costs of the federal programs which duplicate
similar provincial initiatives. Both the federal and provincial
governments would benefit, not to mention Canadians, who
would definitely get more for the same amount of money.
The failure of the health care program reflects the failure of a
centralizing federalism. That program can no longer be a great
tool to promote Canadian unity, as this government would so
dearly love. Let us do without symbols which we cannot afford.
Let us be realistic. The federal government must stop trying to
impose its utopian vision of an egalitarian Canada and withdraw
from those sectors, including taxation, which fall under
provincial jurisdiction.
This is the Bloc's position and this is why we reject the
motion.
(1145)
Hon. Diane Marleau (Minister of Health, Lib.): Madam
Speaker, first, I would like to thank the hon. member for taking
part in this debate and for having made a speech here, but I think
that she may have missed one or two things in mine. First,
Canada is second in the world regarding the overall sums spent
on health care. No expert, no economist anywhere would tell us
we should be spending more. Not a one. We know that we could
even do more with less.
I am sure that Quebec's Minister of Health agrees with me on
this point, because, this year, he is proposing a half billion dollar
cut, $545 million to be exact, I believe, to the health care budget
of the province of Quebec. So he too probably realizes that we
do not need to pump more money into the health care system, but
to better manage the amounts we do put into it. These things
need to be said because this year's transfer payment has not been
reduced but increased.
The Canada Health Act gives the provinces a lot of leeway. In
fact, they already have all of the freedom they could want,
except to levy user fees or charges for hospital care or medical
help.
The fact that the Canada Health Act prohibits user fees is
important, and Canadians should appreciate that this legislation
can help them, especially when they are sick.
The hon. member talked about overlap. The federal
government only employs 25 people to administer the Canada
Health Act. Is that overlap? In my opinion, we are doing quite a
good job, because we are working very closely with the
provinces to avoid overlap, especially in the area of health care.
The hon. member made a fine speech, but what I really want to
know is the following: Does the Bloc Quebecois support the
principles of the Canada Health Act or does it envision a
two-tier system? Does it want to bring in user fees? Exactly how
does the Bloc Quebecois intend to do things better or to change
things? Does the Bloc Quebecois acknowledge that the Canada
Health Act has served Canadians very well and that we
absolutely must build the system of tomorrow on the values it
contains?
Mrs. Picard: First of all, Madam Speaker, I want to thank the
minister for her questions.
I would like to remind her of the position of the Bloc
Quebecois. In 1977, when the five main criteria in the Canada
Health Act were adopted, agreements were concluded with the
provinces. The gist of these agreements was that the federal
government would transfer to the provinces the money they
would need to administer the health care system.
With respect to the cuts I mentioned earlier and to what I said
in my speech, I would like to point out to the minister that she
misunderstood entirely what I was trying to say, because I
always said the Bloc Quebecois supported the five main
principles of the Canada Health Act. However, we object when
the government cuts transfer payments and then asks the
provinces to do more with less money, when we know that the-
An hon. member: Oh, oh.
Mrs. Picard: Exactly, if you had not cut transfer payments,
Mr. Rochon would not have been able to-
Some hon. members: Hear, hear.
Mrs. Picard: Madam Speaker, I would like to quote from the
speech the minister made in 1992: ``Cutting back on the
transfers in these areas has not contributed to better
management of our health care system. We have literally forced
our deficit onto the provinces and said to the provinces they
have a choice: they can either increase their taxes or cut back on
their services. What we have seen in many cases is a mix of the
two''.
(1150)
In the same speech, the minister also said: ``Cutting back on
the transfers in these areas has not contributed to better
management of our health care system. They have only
contributed to the cutbacks and to the fear that we feel now
across the nation, as the middle income group, which is the
largest group of Canadians, are frightened and afraid of what is
going to happen to them in the future. Will there be a health care
system for them, will they be able to get the drugs that they need
at the prices they
11859
can afford to pay when they need them, when they get to be a
certain age. There is this feeling that perhaps the federal
government is letting go of its responsibilities in this matter''.
[English]
Mr. Paul Szabo (Mississauga South, Lib.): Madam Speaker,
in the comments of the hon. member for Drummond, the
statement is made that the federal government is attempting to
keep Canada together by using medicare. The member should
realize that medicare is not a vehicle to try to keep Canada
together. It is one vehicle that has kept Canada together and
makes it the best country in the world.
The five principles of the Canada Health Act are universality,
accessibility, portability, public administration and
comprehensiveness.
I ask the member which of those principles she does not
support and why does she feel medicare is not working?
[Translation]
Mrs. Picard: Madam Speaker, the Bloc Quebecois agrees
with the five main principles of the Canada Health Act.
However, and I repeat, we do not agree with dumping the deficit
onto the provinces by reducing transfer payments to them, while
they are facing increased health costs. The government reduces
the payments and then tells the provinces they have to manage
the health care system as usual, as the act provided in 1977.
I myself do not want a two-tier or a two-speed system.
However, if things continue the way they are going, the
provinces will be forced to find a way to manage to serve the
public and administer the health care system, because they
cannot manage it with the cuts in the transfer payments. This is
what is happening, and the government keeps on cutting. The
effect of this, at the moment, is that it is better to be rich and
healthy than poor and sick.
Mrs. Eleni Bakopanos (Saint-Denis, Lib.): Madam
Speaker, it is unfortunate the Bloc Quebecois can only repeat
that it is the government's fault. How is it that the Minister of
Health in Quebec cut $454 million from his budget, when the
federal government's transfer payment actually went up? The
blame need not always be placed on the federal government,
because provincial governments make their own choices. The
choice the PQ minister and government made was to cut in the
area of health care on the backs of the poor, just like you said.
Mrs. Picard: Madam Speaker, why did Mr. Rochon, the
Quebec Minister of Health, have to cut his administration in
order to continue to manage certain forms of health care?
Because there was a shortfall of $8 billion.
An hon. member: There you have it.
An hon. member: That is the truth.
Mrs. Picard: In terms of health care transfers since 1982-83,
Quebec will yet again be shortchanged by Ottawa, by $2.4 billion
between now and 1997-98. Then, with the increase in health
care costs and the cost of new technology, it is supposed to do
more with less? How can health ministers ensure that the five
main principles are applied if transfer payments and social
programs are cut. I do not understand how your constituents are
not fighting this. You have just cut social programs.
(1155)
[English]
Mr. Grant Hill (Macleod, Ref.): Madam Speaker, health
care is too important to be left to politicians.
I would like to quote the Prime Minister, as I did in the
question and comment portion of the debate. The Prime Minister
has said to all Canadians, in a public forum, that we must go
back to basics. I would also like to quote the health minister
when she said, in reference to the Canada Health Act, that we
will enforce the provisions of the Canada Health Act but we will
be very, very flexible.
On those two comments and those two reflections on health
care I am in wholehearted agreement. That statement will come
back to haunt me. I know I will be quoted as saying that I
wholeheartedly agree with the Prime Minister and the health
minister on all issues of health care. I agree with those
statements in particular.
When I say that health care is too important to be left to
politicians, how would I determine where health care should go?
I would line up in these halls 100 high school students and I
would make a speech in this Chamber, much as I am doing today.
I would ask the health minister to do the same, and I would ask
for the old-fashioned thumbs up or thumbs down on the
proposals of the health minister and my proposals. I would
determine whether or not I was on base with health care reform
or whether the health minister had it right. It is the old Roman up
or down. Maybe the pages could do it for me today.
If the Prime Minister and the health minister and I are so close
on the issue of health care reform-those were basic statements,
brand new statements, statements that have not been made in our
country for some years-where do we differ? Frankly, we differ
on the cause of the need for health care reform.
I will now go to a brand new survey from Statistics Canada on
government spending. The figures I am quoting do not come
from the Reform Party, they do not come from a strange source,
they come directly from StatsCan.
In 1994-95 the federal government will spend $1,522 per
person on servicing the debt. What will the federal government
spend on health care per person that same year? Two hundred
and sixty-eight dollars. That is the reason we stand in the House
today debating the future of the health care system. Anyone who
stands up and says that is not the reason is an ostrich, hiding his
or her head in the sand, ready to be plucked.
11860
Teenagers in Canada will not listen to that kind of nonsense
any longer. Fifteen hundred and twenty-two dollars per person
on debt servicing is squeezing the heart out of the $268 left for
health care.
Reformers are looking for specific, positive solutions. To do
what? To rip the heart out of health care? Not a chance. To
preserve and save this most valuable of our social programs.
Therein lies the problem. Therein lies the anchor. Therein lies
the noose for health care.
My focus with these words will be the Canada Health Act
itself. The health minister said: ``I want Canadians to know that
the Canada Health Act is alive and well and able to take on the
challenges of the future''.
(1200 )
I have another quote from Dr. Steven Stern of Ajax, Ontario:
``We must recognize the financial crisis in most provinces that
has rendered the Canada Health Act hopelessly obsolete and the
fantasy of supplying all medical services to all of the people all
of the time from ever escalating middle class taxation is a futile
hallucination''.
I believe the Canada Health Act is in trouble. I believe the
Canada Health Act needs help. I believe Canadians will no
longer allow rhetoric to judge whether the Canada Health Act
will survive.
What has broken down in the act? I will talk specifically about
provisions in the act that are failing. First, on portability, the act
guarantees services provided to Canadians outside the country
will be paid for at the same rate as if a person got sick in Canada.
That is broken. Snowbirds who travel to Florida and come back
to Ontario are paid $100 per day per hospital visit. There is not a
hospital in Canada that can provide $100 per day service.
Portability is broken.
[Translation]
In ``la belle province'', Quebec, there is a provision to the
effect that each doctor is entitled to a certain portion. Here in
Ontario, the portion is not the same.
[English]
Portability is broken and the minister knows it. The minister
knows the Canada Health Act is falling down in portability.
On accessibility and reasonable access, where are we with
reasonable access guaranteed in the Canada Health Act? One
specific breakdown is that Manitobans are waiting 60 weeks for
hip replacements when the norm is 12 weeks. Reasonable access
is toast under the Canada Health Act.
Comprehensiveness is another plank of the Canada Health
Act. How about the issue of what is medically necessary? Here
we have provinces unilaterally deciding to take test tube babies
off the medically necessary list and put on sex change. Those
two things might be discussible under the provision of
medically necessary. This is arbitrary and fragments health care
across Canada.
What about the bill's provision-this is not one of the planks
of health care but one of the very basic provisions of the Canada
Health Act-that there will be a prevention of user fees?
In the House I have mentioned to the Minister of Health-this
is not a unique thing to the province I will mention-that there is
a hospital in Wolfville, Nova Scotia whose facilities were being
shut down. It stated its facility was too important to be shut
down. The province stated it could not afford the facility any
longer but the staff was to keep it running. How were they to
keep it running? By volunteer nurses, by a fee for the syringe,
the local anaesthetic and the suture so that each patient who
comes in with a laceration now pays for those basic facilities. Is
it a user fee? Yes. Is it medically necessary? Yes. Is it the choice
of the people in Wolfville, Nova Scotia? Yes. Should they be
allowed to have that choice? Yes. It is their health; we should not
be leaving this issue to the politicians.
(1205 )
The act guarantees, and this is not commonly known,
reasonable compensation to practitioners who provide the
services. I know of three provinces which have broken
agreements with their medical practitioners unilaterally,
agreements signed, sealed and delivered. Is reasonable
compensation being given? The act is broken and there are no
repercussions for that.
If the act is broken and I ask the minister to stand up and tell
Canadians that what I have said is inaccurate or untrue, should
the minister be protecting this most valuable act? I think she
should. Her reaction is to reinterpret sections of the act. She has
gone on to define the hospital to include private clinics. She has
decided semi-private clinics do not deserve the funds they have
been getting. That issue is one that we may argue a lot but this
does not sound like going after the basic principles of the act to
me at all.
We have been over funding provisions. I hear members of the
Bloc say the federal government should not be withdrawing
funding. There is no question in my mind the federal
government has no choice. I do not think there is any point in
going back and deciding the reasons for these choices. The
federal government has no choice.
I listened to more rhetoric not so long ago in my province of
Alberta. The Prime Minister says the Canada Health Act does
not allow private health care. I shook my head when I heard that,
11861
recognizing that almost 30 per cent of what is provided in
Canadian health care is private.
I asked the Prime Minister about the Shouldice Hospital in
Ontario for hernias, about totally private laser eye surgery,
about physiosports medicine clinics, about chiropractic, about
cosmetic surgery that has been taken out of the fee schedule,
about laser treatment for snoring, sleep apnea and bad breath.
All these things are available so close to the House of Commons
privately and there is no room under the Canada Health Act for
private health?
We have two tier health in Canada now. We will end up if we
ignore the Canada Health Act, if we do not improve the Canada
Health Act, with universal access to nothing. The $1,522 of debt
servicing will choke that $268 and we will kiss it goodbye, and
that will be wrong.
This is not an answer that comes from me but I am now
elucidating the answer from my colleagues. My answer is to
give sensible Canadians choice over their most important
resource, their own health. That is why I would line up the 100
high school students.
A journalist phoned me the other day. He said: ``I will ask you
what you mean by your core essential services because I have
asked a whole host of other individuals in Canada and none of
them will tell me what they would take out of the core essentials.
I know you will do it because you Reformers are not filled with
political rhetoric yet''. I had the opportunity to tell him some of
the things I would take out.
For members opposite I will give a specific example of one
thing I would take out of our broad health care coverage and put
beyond the core essentials. This is actually being done in
Quebec. The members of the Bloc will not be interested in this.
Quebec has decided that psychoanalysis is no longer coverable
under health care. Psychoanalysis is the treatment where one
lies on the bed, the psychiatrist sits there and one comes in week
after week for years on end to figure out what was the matter
with one's psyche.
(1210)
Quebecers in their wisdom, I give them credit, have said
psychoanalysis is not something that should be covered under
our core essential health care budget. They pay for
psychotherapy which is much tighter, better controlled, involves
looking after something like anxiety or suicide, possibly giving
medication and a fairly rapid return to the workplace.
Outpatient psychotherapy is covered and with outpatient
psychoanalysis you are on your own. You can either get
insurance coverage or pay for it out of your own pocket. In their
wisdom they are doing what Reformers are suggesting.
Will this be a big bureaucratic process? Not on your life. This
is a process that will also be flexible. This is surely a process
that our national forum on health should have and could have
addressed.
I listened last night to the minister make a very good speech.
It was tight and controlled. I really credit her for this. She said,
using different words and phrases, virtually the same thing I am
saying. There are things we are doing today in health care that
are ineffective.
She said we must look at those things. That is what we are
talking about. Define the essential core. Look at the things that
are ineffective and set them aside. They are discretionary. They
may well be covered by private sources, insurance or other
sources.
We are not so far off. The rhetoric may put us a long way apart
but we are not so far off. Evidence based issues, let us call them
what I call them or call them what the minister calls them, core
essential, evidence based; not so far off.
The national forum on health, which has people with vast
experience from all over the country, should and could be doing
this very thing today.
My time is rapidly drawing to a close. I hear delight from
across the way. It is a shame because this debate in the House is
so important and has not been done for so long. I will be
disappointed if there is not a frank and open interchange on this.
There are other problems with health care beyond the federal
portion. There are problems with accountability. There are
problems with abuse. There are problems with our medical legal
system and there are big problems with our drug costs.
Each one of those deserves a good, frank expose as well. I
have colleagues who will talk about other innovations we think
might have some benefit for health care, funding changes that
might well be present. I ask each member to consider what will
happen if we ignore the $1,522 for debt servicing versus the
$268 being spent on our health.
Hon. Diane Marleau (Minister of Health, Lib.): Madam
Speaker, I thank the hon. member for Macleod. As I listened to
his speech I realized that we are a lot closer than perhaps is
apparent in many cases.
I listened to some of the interventions the hon. member made
and I will make a few statements to perhaps rectify some of the
misconceptions out there.
I have not ever said there have not been problems and that
there do not continue to be serious problems with other sections
of the Canada Health Act. Portability and out of country
portability is one of the areas we are working on. We are trying
to reach a solution with provincial governments. We believe in
working co-operatively with them.
11862
When it comes to Quebec and the portability issue there has
been considerable movement on the part of Quebec to address
some of the problems of people from Quebec travelling to
Ontario and not getting the coverage they should have.
(1215 )
There is an agreement of sorts in place to cover any treatment
here in the Ottawa Valley or in the Abitibi section up north. I am
hopeful, because I know that the Government of Quebec is
extremely interested in serving the people of Quebec, wherever
they travel. I would hope we can get some kind of an agreement
on that in the near future.
When it comes to accessibility and reasonable access, there
will continue to be waiting lists. Some provinces have done a lot
of work to address that. Not to be discounted, some provinces
have a central registry of where there are rooms available so that
hip replacements can be done. As you well know, there are
waiting lists, but often when the need is very great those people
jump to the front. When they get access to hip replacement it is
generally because their need is much greater. Although access is
not always perfect, everyone works to address the problem.
The member has talked about a place in Nova Scotia,
Wolfville. I do not have the particulars of Wolfville, but user
fees and facility fees have been and will be outlawed. Just go
back to my letter of interpretation in January. I would expect
that Wolfville would be addressed by that letter of
interpretation. If the member has any other information, please
let us know.
There are a number of other points the member made,
including Quebec's psychotherapists and what is happening in
the province of Quebec. They are working with medical
professionals to determine the medical necessity and what they
will cover. That is the beauty of what is happening with the
Canada Health Act. We encourage that.
These are the kinds of things that are happening across the
country. When one province gets one thing right, others often
follow suit.
The member spoke about the Shouldice clinic. Yes, it is a
private clinic, but it is covered by the Private Hospitals Act in
Ontario. There is an act in Ontario that governs that. Therefore,
people do not have to pay additionally. They get access.
We have to understand that while we have a good system, it is
not perfect. Any other suggestions the member may have would
help us. One of the things he seems to be proposing, at least as I
understand, is a system of user fees for certain procedures or
items, which would be based not on need but more on the ability
to pay. This is where we fundamentally disagree.
When a facility charges a facility fee and general taxpayers
are paying the physician fee, they are in essence subsidizing
queue jumping for those who have the money. That goes against
our principles. I would hope it goes against yours, although it
does not appear to do so. That is a tax on illness. That is not a fair
tax, at least in my book. Perhaps the hon. member can tell us
how he thinks a facility fee is fair.
Mr. Grant Hill (Macleod, Ref.): Madam Speaker, what has
been missed in all of this discussion is unless we define the core
essential we cannot decide whether or not a user fee has any
place in our system. For discretionary, elective things, surely
the minister would not deny those things to be done. That is why
we need the definition. That is why there cannot be this
airy-fairy situation where one thing is medically necessary in
one part of the country and one thing is medically necessary in
another.
On the issue of facility fees, the semi-private clinic, there is a
philosophical argument on that specific issue. If the procedure is
medically necessary, it must be paid for by public funds in
Canada today. If the procedure is medically necessary and it is
done outside a hospital and the costs generated to do that outside
the hospital are not borne publicly, where should they be borne?
I believe they should make no impediment whatever to the
public system.
(1220)
I ask the minister, although this is not interchange time, to
find me a country-without using the U.S. example, which is
commonly used and where that is not done-where that
produces a problem.
Mr. Harold Culbert (Carleton-Charlotte, Lib.): Madam
Speaker, I listened with great interest to my colleague for
Macleod. We had the opportunity of serving together on the
Standing Committee on Health.
I would ask the hon. member what his definition of core is. He
would know that there are criteria established presently from
one province to another about what is included and what is
considered outside those parameters.
Generally speaking, Canadians look on our medicare program
as one that is accessible to all Canadians for good health care,
regardless of their status in life. Surely my colleague is not
suggesting that we should revert to a system that is dependent on
how wealthy one happens to be, or a system such as the United
States currently has, where we know there are literally
thousands of people who are left outside the system.
I want to refer to one particular incident that I am well aware
of regarding efficiencies. Of course we must change from time
to time in order to be much more efficient. There is no question.
That is why health care has to be upgraded continually from that
perspective. That is exactly why the Prime Minister appointed
the National Forum on Health to study that whole scenario.
11863
Surely my colleague for Macleod is not suggesting that we
open up to some other system, for example the system that is
in the United States, which does not work. The medicare
program is so important for all Canadians, and treats everyone
from coast to coast on an equal basis.
Mr. Hill (Macleod): Madam Speaker, I appreciate the
opportunity to respond.
Let me give the member another example of something I
would take out of the core. It seems to be lost on the member that
the core must be defined. The core has the essential things.
Although I have some expertise in this area, I do not pretend
to be able to define the core perfectly. When health care started,
there was no such thing as joint replacement. The first joint
replacement literally came with health care.
The hip joint prosthesis ranges from $1,000 to $7,000. I would
decide which of the prostheses is cost effective for Canadians
and say that if you want a $7,000 prosthesis, pay for it yourself:
we in the public system will give the Chevrolet prosthesis; if you
want a Rolls Royce, you pay for it.
Ms. Hedy Fry (Parliamentary Secretary to Minister of
Health, Lib.): Madam Speaker, I rise to speak with a mixture of
emotions. There is some confusion, some humour, and some
sadness.
I am confused that members of the third party would bring
forth this kind of motion when it so clearly contraindicates
everything they have ever said in the past during their campaign
and even during their proposed budget earlier this year.
(1225 )
There is some pleasure because I am proud to be able to speak
for the system of health care we are espousing in this country
and in which we so firmly believe. And there is a little sadness
because one of the movers of this motion is a physician and has
shown such a lack of understanding of the system, the words, the
terminology and the principles that medicare is all about. It
saddens me that he should rise to speak to this motion when he
so obviously does not understand the system. I would like to
know why he does not understand it.
What we have heard is simplistic rhetoric. It is the kind of
thing we have come to expect from the third party: there is
always a simple answer; let us not confuse the complexity of the
question, let us just throw a simple answer at it.
What is so simplistic about it and what is so rhetorical about it
is in terms of the statement of the problem, which is not factual.
The statement of the problem is not based on fact at all. As the
Minister of Health said when she spoke earlier, the figures
quoted, which indicate a decrease in the percentage of payments
to the provinces from the federal government, are absolutely
untrue. The statement talks about total health care cost. It does
not show any understanding of what the cost the federal
government contributes to, as written in the established
programs financing, is all about. That cost is purely for hospital
and physician services. It is not for the whole bailiwick of health
care services, which each province has expanded or constricted
as it feels it wants. That is not what the federal government
sends the transfer payments for; it is purely for physician and
hospital service. That is the first bit of disinformation that came
about in this.
The second thing that is simplistic and rhetorical about the
whole thing is the solution, the constructive alternatives we
were given. They have absolutely nothing to do with ensuring
efficient, universal, affordable, quality health care in this
country. Universal quality health care is far more complicated
than giving a cute, uninformed speech. It is a complex issue.
Let us look at the preamble of the speech made by the hon.
member for Calgary Southwest. He talked about the fact that we
already have a multi-tier system. That alone shows a lack of
understanding of what is meant by the term comprehensive,
which is one of the five principles of medicare. It shows a lack of
understanding of what medically required services means. It
shows a lack of understanding of what the terms universality and
accessibility actually mean under the Canada Health Act. The
hon. member did not even read the Canada Health Act. He does
not even understand the definition of the terms.
The whole idea of having a multi-tier system is one of the
usual red herrings that are thrown at us. Of course we have
systems where there are always and have always been
non-medically required services that patients pay for. They
have always paid for them. If anyone wishes to have a face lift,
they can always pay for one. There are many instances where
people think they want something that is not medically required
and they go out and buy it. That does not constitute a multi-tier
system; that constitutes a system that operates outside of what
the Canada Health Act defines as the five principles of
medicare. The hon. member should go back and read the Canada
Health Act.
The other thing the hon. member said in his preamble was that
users should define full services. Users define full services? I do
not know that many patients would want to define what an
essential service is and what a medically required service is,
because they are not physicians. They may want to participate in
the decision making of what is appropriate in the treatment, but
they would not want to define what is clinically necessary and
clinically required for them. That is why they go to a physician
or a health care provider. That alone seems to me to be a rather
simplistic and very impractical solution.
What else do we have if we have started off with the first part
of the motion being based on a false premise? The whole
scaffold on which the argument is based is nothing more than
11864
smoke and mirrors. It is a weak scaffold because it is based on
lack of fact, lack of information, and lack of knowledge.
The hon. member said that we talked earlier on about the 50
per cent the federal government is supposed to transfer to the
provinces.
(1230 )
As the minister and I said earlier, we were never supposed to
transfer 50 per cent. In 1975-76 we transferred 39 per cent of
total health care. That 39 per cent constituted a greater
percentage toward hospital and physician services only which is
where it was supposed to go. Therefore, the rest of it is
nonsense.
That has not gone down a great deal when we look at the fact
that in 1992-93 the total percentage of transfer has gone down to
32 per cent and the provinces have expanded their total pot. That
again is a false presumption of what the percentages should
mean.
There again I think the mathematics and the understandings
were not done. If the figures were wrong and the assumptions
were wrong, is the whole concept we are debating today wrong?
It must be because it is based on a false assumption and a false
concept.
Everyone is saying that we need more money for health care.
The concept of more money does not seem to sit well with the
third party. The leader of the third party said in his budget
speech and in fact said in Saskatchewan that he would transfer
more tax points to the provinces. He would give them more
money.
Simple mathematics, and I am not a mathematician, tells me
that in taking away from one side of an equation there is surely a
corresponding addition to the other side. Therefore, if we take
money away from our big pot to give more tax points to the
provinces, what the hon. member did not factor in in his budget
speech is that he is going to be $10 billion deeper in the hole in
the deficit. How does that make sense with fiscal responsibility
and cutting the deficit to zero in one year that we were talking
about? It does not make sense. None of it makes sense.
It is widely recognized as a fact that anyone who understands
health care economics knows that throwing more money at
health care is not the answer. In fact the quality, the outcome, the
efficiency and the effectiveness of a health care system does not
depend on money. If it did, the United States which spends the
most amount of money not only per capita but as a percentage of
GDP on health care would have the best health care system in the
world. However, it does not.
At the moment the country that ranks the highest for having
the best health care system in the world is Japan. It spends a lot
less money than Canada spends as a percentage of GDP. Money
and a good system do not equate. Money in a health care system
does not equal outcome.
We know that many other things determine whether people
are healthy or not. They have to do with socioeconomic factors,
environmental factors, lifestyle factors and quality of life
factors. None of those things are part of giving people more
medical care. We can give people more medical care and we will
not decrease those outcomes one whit. Throwing money at the
health care system is not the answer.
The challenge is how wisely we spend the money we put into
the health care system so we can use the money for the
socioeconomic and other issues that determine health. It is one
of the big challenges we have to look at when we talk about
health care.
Let us look again at the third party using money as a criteria
for effective and efficient health care services. If we talk about
that then we are talking clearly about the fact that if one cannot
afford the health care system and more money has to be thrown
at it then people must pay for the health care system. Therefore,
we are back to this hidden or not so hidden agenda the third party
is talking about which is in fact finding a way to get the user, the
person who is sick, to pay for their health care.
It is a not so clever plot to say the system needs more money,
the system needs more money, the system needs more money.
Then we are going to have to say that if we are going to balance
our budgets, and we cannot find the money from government, let
us charge the people, the ill. Let us tax them. That is what is so
underhanded and so disturbing about this motion, the whole
concept that is underlying what we are talking about here today.
It is a typical mentality that comes from people who espouse a
south of the border policy on health care. We look at the United
States and the kind of health care it gives. Yes, there is a two tier
system there and yes of course people are allowed to buy health
care but it is based on one criteria, the pocketbook. Those who
can afford it can have unlimited access to health care. Those who
cannot afford it, we see what the outcome is.
(1235 )
At the moment the United States is sixth among the
developing countries in its health care outcomes. It does not
have the health care outcomes of a developed country because
those who cannot afford it, with poverty being the major
determinant of health, those people are sicker.
That is the way the Reform Party would have us go and it
concerns me. In fact, if we give the rich unlimited access to
health care what we see is that the number of interventions and
the amount of laboratory tests are greater as a percentage of
users in the United States than it is in Canada. The people who
are using them more are based purely on the people who are in a
11865
high socioeconomic bracket. In other words there are people
who are having care and interventions.
Open heart surgery is one example. The rich are getting more
open heart surgery. It does not fulfil the criteria of whether they
need it or not. The fact is they want it, they want to buy it and
they are getting it. I do not consider that to be good medicine and
I do not consider it to be good health care. I do not think we want
that situation in this country.
Let us look then at the solutions the third party recommended.
The solutions it talks about are core services. We all know on
reading the Canada Health Act and if we understand the
principles of medicare, that the definition of medically required
services is a provincial jurisdiction. The provinces have to
define medically required services. This is a good thing. The
provinces are where the regional disparities lie. Different
provinces have different health care problems. Different
provinces have different needs.
We talk about bottom up care. It is appropriate to have the
provinces deciding. That is what we have tried to do when we
have discussed how we give the provinces more decision
making in health care. It is to allow them to provide appropriate
services for people where they need it, when they need it and
how they need it. They know that better than the central
government.
We believe our role to play as the central government is to
bring about and co-ordinate what it is we see within the
principle that those medically required services are based on
clear clinical guidelines. This is why the health forum was set
up. The health forum is dealing right now with how we define,
how we look at outcomes. It is dealing with how we look at what
is the care and the criteria necessary to provide those outcomes
so that we are not guessing as the hon. member for Macleod
would have us do and set all sorts of criteria for who should get it
and what a core service is.
The hon. member for Macleod has decided that a core service
should be something that is on a list of items. A core service is
not an item. If we take for example the item of ultrasound for
pregnant women and say that only one ultrasound will be done
on a pregnant woman, that does not make any sense. Some
pregnant women clinically require more than one while others
only require one.
We need to look at clinical guidelines when we talk about core
services, not whether the item is a good idea or not, not to
generically define items. That will not give us good care.
Nor should it be like the hon. member for Macleod said to the
Calgary Herald when he defined who should get health care and
who should not and that if a woman in her past history had been
promiscuous and had her tubes blocked she should not have a
tubal ligation paid for by the government. What sort of
subjective, moral, paternalistic health care system are we
talking about here when we want to define core services that
way? That concerns me a great deal.
We also hear terms like private insurance. We all know from
the United States and Robert Evans of UBC has shown us very
clearly that multiple insurance systems and multiple payer
systems are more expensive. They are more inefficient and in
fact do not create the right kind of outcomes.
The United States has multiple payer systems. The
administrative costs are 25 per cent of the health care costs.
Recent studies have shown in the United States that if that 25 per
cent on administration could be rolled into a single payer
system, there would be enough money to give health care
services to the 37 million Americans who do not have it right
now. If the money spent on Massachusetts Blue Cross alone
could be decreased in administration there would be universal
health care in the United States.
When we talk about health care and about multiple systems,
we are talking about greater costs. We are talking about defining
who can no longer be insured because they are now chronically
ill.
In the United States someone who is chronically ill becomes
uninsurable. Even if that person has millions of dollars to buy
insurance, he cannot buy it. That person has to pay out of his
pocket. That is okay if he has millions of dollars but someone
who is a middle income worker cannot.
(1240)
The other term ``benefactors to pay'' as I see it is a nice term
for user fees. We are hearing all these little words that have been
put in so that it sounds wonderful. We are talking about a
two-tier system that in this country does not define what we see
as health care.
When we talk about health care we are talking about looking
at how we can save money on health care costs. Recent studies at
the University of Ottawa and Judith Maxwell have told us that
we can save $7 billion a year in health care costs if we do some
real things. For example we could shift from hospital based care
to community based care. We could look at how we set clinical
guidelines for care. We could look at how we help the
determinants of health so that the socioeconomic factors that
create illness in people are decreased.
There are many things we can do to decrease health care costs
without changing the five principles of medicare, without
having to make people who are sick pay. The only way the third
party can see for solving the problems is to define core services
with the kind of hidden agenda it is defining. Reformers are
talking about user fees and multiple insurance systems.
What is wrong with that solution is that every system of health
care in the world is based on some sort of rationale. The
rationale in this country has to do with clinical need and that is
the way we want to keep it. I do not ever want us to see where the
rationale for our health care system is the pocketbook. There-
11866
fore I strongly speak against first and foremost the problem
which is not factual and also the solutions put forward this
morning by members of the third party.
[Translation]
Mr. Pierre de Savoye (Portneuf, BQ): Madam Speaker, I
listened with great interest to the comments made by my hon.
colleague. I know that she is very knowledgeable about health
issues and that she really wants to ensure that the Canadian
health care system is in the best of shape.
I would, however, like to remind her and this House that
medicare was invented by Quebec a few decades ago through the
good services of Mr. Castonguay. That is why we as Quebecers
care about maintaining the essential characteristics of a good
health care system.
Of course, such a system needs predictable financing. The
Canadian provinces and Quebec have had to deal with the cuts in
established programs financing that have been carried out for
over a decade, in violation of the 1977 agreement promising
reliable funding to the provinces; they had to make do and, in
some cases, even improvise in health care matters. That is where
the shoe pinches.
By redefining the transfer of taxpayers' money to the
provinces, the federal government has gradually destabilized
the Canadian health care system. In fact, the federal government
has, unintentionally, I admit, contributed to this decline of the
Canadian health care system, which is already leading to a
two-tier system.
Basically, we have a right to ask the following question: Why
does the federal government not transfer to the provinces and
Quebec all the tax points linked to health care financing so that
the provinces and Quebec can determine themselves the best
way to provide services in compliance with the five fundamental
principles of health care?
I would like my colleague to give me her opinion on this.
(1245)
[English]
Ms. Fry: Madam Speaker, I thank the hon. member for
rewriting the history of medicare a bit. Some people would
argue that it was Saskatchewan and others would say it was
Quebec, but that is a moot point.
The hon. member mentioned money. We keep hearing about
money being a factor in providing effective health care. There is
an English saying that necessity is the mother of invention.
Because of necessity and because there has been very little
money, provinces have begun to be inventive. It is not an
invention that has decreased the quality of health care.
Something that has been necessary for many years which
neither the provinces nor the federal government faced up to was
that we needed to change our health care system to make it more
appropriate to the needs of people and to make it more
effectively and efficiently managed. As a result of the necessity,
people are beginning to manage the system.
The amount of money put into a health care system by any
study of any country does not equate to quality of care.
Otherwise, as I said, the United States would have the most
wonderful health care system in the world because it spends the
most money. Yet Japan, which spends the least, has the best.
There are more things that determine the health status of a
country and the health of individuals than money spent on
intervention and on medical care.
I spoke as well about the ways in which we could decrease the
cost of the system, improve accessibility and improve the ability
of patients to make decisions within their own health care
system. That is by shifting from acute care to community care,
by shifting and creating guidelines for care, by looking at
outcome analysis and by setting up technology assessment, by
doing all the things we are learning to do that some provinces
have already begun to do.
Judith Maxwell of the University of Ottawa is predicting in
her report that if we continue to do such things we will need to
put less money, almost $7 billion less, into health care. It is very
important to understand that and not fall prey to the rhetoric that
continues to say that we should keep throwing money at health
care in the hope that it will stick somewhere. It never has and it
never will.
All the studies on mortality, morbidity and quality of life are
telling us that is not what will create the outcome we are looking
for.
Mr. Keith Martin (Esquimalt-Juan de Fuca, Ref.):
Madam Speaker, what does hon. member think about the recent
comments of the British Columbia Health Association about
being significantly concerned about access to essential health
care services in British Columbia? This is not something
occurring solely in British Columbia. As the member well
knows, it is occurring across the country.
My party has proposed an alternative form of the Canada
Health Act. We would allow the provinces to have such
structures as private medical clinics. Not a dollar from Canadian
taxpayers would go toward paying for it. Members of the public
would have the choice to pay for the services, whatever they
happen to be, in private clinics. We must bear in mind that the
services would be offered to anybody in a public hospital or a
clinic.
11867
What is so wrong? How will private structures involving the
exchange of private moneys impede the ability of the public
sector to provide services? Also, why does the government have
such an aversion to choice when we have choice in almost
everything else in our lives?
Ms. Fry: Madam Speaker, I thank the hon. member for his
question.
What is wrong with setting up private clinics so that people
who want to pay can pay? We only have to look at the United
States where people who want to pay can pay and buy as much as
they want whether or not they need it and people who cannot
afford it have inadequate and inappropriate access to health
care.
(1250)
A major determinant of health is socioeconomic status.
Poverty is the greatest determinant of health. Poor people need
more services. We are basically saying that we have some false
savings here. We will not save any money. The people who need
the services more will be the people who cannot afford them.
They will still be going to the public sector. That is the first
point.
Second, if we look at the United States model, private clinics
have tended to create massive costs and inefficiencies in the
system. They have taken away clinical autonomy from
physicians who no longer have the ability to choose what they do
for their patients but have to ask a non-medical person, some
insurance adjuster, what they should and should not or can and
cannot do. That is not what I consider to be choice.
We have choice in this country. In the United States they are
not free to choose a physician. They are only free to go to a
physician who is under a particular insurance plan and works for
a particular insurance company. In Canada we are free to choose
a physician anywhere and everywhere we like.
We have what is known as access to anyone we want to see.
That is choice. In this country we are free to go to any hospital
we choose. We are free to have a bed in the hospital next to
anyone we choose to be with. We do not have to go to one for the
poor if we are poor. We can sleep under a bridge or lie next to
some multimillionaire in a Canadian hospital.
What the member is considering is wrong. If he does not
believe me, let him think about what happened in the United
Kingdom. I did my medical training in the United Kingdom. Its
wonderful easy answer was that it would take care of the poor
and those who could pay would pay. We have seen a two-tier
system in which the poor have been relegated to second rate
medicine. Physicians do not want to work in the areas where
there are large poor populations. The United Kingdom is
sending for physicians from developing countries to go there to
provide care. That does not create equality of care. That is what
is wrong.
Mr. Keith Martin (Esquimalt-Juan de Fuca, Ref.):
Madam Speaker, my colleagues will be dividing their time from
now on.
It is with great sadness that I am here today to speak on the
motion. It is with great sadness and anger that I listened to the
response of the government to the most important thing in
people's lives, their health.
The government continues to put forth the fantasy that
medicare can continue in its current form. This is criminal,
reprehensible and an outright lie. The reality is that medicare is
like a ship with holes in it that is sinking with its captain, the
government, saying all is well. Unfortunately when we look
inside where the people are, the patients, we find that they are
dying, suffering and in pain. That is exactly what is happening in
health care in Canada today. It is a profound tragedy and should
not occur in a country such as ours.
The provinces have found that demand is increasing. Costs
are escalating with an aging population and more expensive
technology. Also revenues are going down as was demonstrated
in the last budget with an $8 billion decrease in transfer funding
from the federal government.
Who is caught between a rock and a hard place? In reality it is
the patients who are sick, who are unwell. When they go to
hospital they discover that essential health care services cannot
be provided in a reasonable amount of time.
The provinces are hamstrung by the current Canada Health
Act. They are forced to engage in rationing. I will give some real
life examples from across the country. In Victoria, B.C., where I
live, 40 per cent of hip replacements for elderly people who are
in severe pain take 13 months. The British Columbia Health
Association is very concerned about the critical lack of access to
essential services.
In Prince George a very interesting and sad thing happened.
People going for surgery were given the option of receiving
autologous blood transfusions, which allow people to have their
own blood taken and purified for use in their next surgery. The
cost charged to each patient was $150. The reason for that was
the Red Cross and medicare system could not pay for it. They
gave the patient the option of using their own blood in a safe
fashion that would not subject them to HIV, hepatitis and a
number of other diseases.
(1255)
Two months after this came out the Ministry of Health said
that it could not be done, that patients could not be charged for it.
It prevented the Prince George Regional Hospital from doing so.
Now patients have to get packed cells for blood transfusions at
$500 a unit.
11868
In Alberta it takes three weeks for emergent and urgent open
heart surgery. The surgeons there say it is a miracle so far that
nobody has died, but it is going to happen.
The Prince George hospital, because of the funding cutbacks
that have been foisted upon the provincial government, is forced
to cut back its operating room days by 12 days a year, knowing
full well that it has hundreds of people waiting for urgent
surgery.
The minister said that doctors were returning to Canada. I had
a conversation with one of her close advisers the other day who
said that it was the bad doctors who were leaving the country. He
asked: ``Isn't that so?'' Half our neurosurgeons leave the
country. Eighty per cent of orthopedic surgeons in some cities
have left as well as 50 per cent of obstetricians and
gynecologists.
Dr. Joel Cooper of the University of Toronto, a world famous
cardio-thoracic surgeon, left. Dr. Munro from the Hospital for
Sick Children left. These world famous individuals left the
country not because they wanted more money but because, in
their words, they could not practise the way they were supposed
to and were sick and tired of having their patients suffer. That is
not adequate health care.
The reality is that the population is increasing and costs are
rising. The minister said that we do not have a two-tier system.
What nonsense. A billion dollars every year goes to the United
States. Why? It is because Canadians cannot obtain essential
health care services in a timely fashion so they go to the states.
Why do we not keep that money in Canada?
The minister said that private expenditures were increasing.
Of course they are increasing. Why? It is because people will not
wait for the current public system to provide their health care
services. They do not want to be in pain and they do not want to
die. The government is forbidding them from doing that and is
not accepting the fact that it cannot provide essential services in
a timely fashion. That is a travesty. It is also extremely arrogant
for the government to tell the public that it is forbidden to do
that. In effect the government is sacrificing people's health on
the altar of a dead socialist ideology.
We must recognize the financial crisis of today and the
decrease in funding. We must recognize that people cannot be
taxed more and that demand is going up. We must recognize that
the Canada Health Act is hopelessly obsolete and unable to
provide the same health care services to all people all the time,
especially essential health care services. Sick people are in
effect dying.
We must move to a new era. We will present constructive
alternatives. Let us make a new made in Canada health act. It
should not be one from the United States or one from England
but one from Canada. We do not want an American style system.
There is no resemblance whatsoever in what we propose to the
system south of the border.
First, we must get the federal government, the provinces and
the people together to define essential health care services for
which all people across the country will be covered regardless of
income. We may want to look at the Oregon model to begin with.
Second, let us allow the provinces to experiment with
alternative funding models, such as private clinics, private
insurance and the like. Why? It is because the system needs
more money to provide health care. It is true that it needs to be
revamped, but it also needs more money to reflect our current
fiscal crisis and fiscal crunch in health care.
(1300 )
This is not a threat to medicare, rather it will make it better.
What is so wrong with enabling private clinics to provide
private services in the private sector where only private dollars
will be exchanged? It will not in any way affect the public
system.
In fact the demand on the public system will go down so that
those people who are in this system will be able to get essential
health care services in a more timely fashion. Is it a two-tier
system? Yes, but we have one now. Is it unequal? Yes, but it
provides for better access for all people regardless of their
income. It ensures quicker access to those essential services that
Canadians are not receiving now.
It is time to move forward. It is time to move with courage. It
is not the time to delve into a morass of ideology but open our
eyes and work together. My colleagues and I are more than
happy to work with the Minister of Health in the interests of the
Canadian public and the health of Canadians, to develop a fair
and equitable solution and to provide better health care for all
now and in the future.
We are not the enemy. We are merely trying to ensure that we
have an improved system from coast to coast. Let us set up those
national standards. As individuals we are not going to do that
here, nor should we. We cannot nor should we play God. This
must come from members of the public. It must come from the
provinces. It must come from health care professionals. It must
come from the federal government.
Let us ensure that we have portability for these national
standards, that we have comprehensive coverage for essential
health care services for all people, that we have good public
administration of essential health care services, that we have
universal coverage for essential health care services for all
Canadians.
Last, let us ensure that we have essential health care services
provided in a timely fashion. The Canadian people are not
receiving their essential services in a timely fashion. One only
needs to go into the field, go into the hospitals, to see the people
who are not receiving them. Morale is the lowest it has ever
11869
been, as is the pain and suffering on people's faces when told
they have to wait 13 months potentially for their hip
replacement or three months for their urgent heart surgery. That
is not good medicine. That is bad medicine.
Ms. Hedy Fry (Parliamentary Secretary to Minister of
Health, Lib.): Mr. Speaker, typical of the third party is the
sentimentality, the rhetoric, the lack of any real fact but let us
spew it anyway. Let us do the emotional dance on people.
I would like to ask the hon. member if he could give me clear
statistical data which shows that the outcome in acute care is not
one of the highest and best in the world, that people who
clinically need care are not getting it.
We have to be very careful to clear the wood between need and
want. Health care is not a marketplace commodity. The
difference between what a patient needs for appropriate care and
what a patient thinks he or she wants is very different.
We provide the best health care in the world that patients
need. When we talk about people needing urgent care and not
getting it I would like to ask the hon. member if he can give me
clear examples of people who have increased mortality because
they need acute care and do not get it. That, Mr. Speaker, is not
true.
Mr. Martin (Esquimalt-Juan de Fuca): Mr. Speaker, I
cannot believe the hon. member is saying what she is saying. I
will repeat again, this is not rhetoric.
(1305 )
I just spent half of my speech giving the government
constructive solutions on what to do. My colleagues, Dr. Hill
and Mr. Manning have spent the last hour giving constructive
solutions to the government.
The Acting Speaker (Mr. O'Reilly): I have to interrupt the
member. Although he is complimenting them on doing a good
job, it is not the custom of the House to name members but to use
their ridings.
Mr. Martin (Esquimalt-Juan de Fuca): Mr. Speaker, we
have been giving constructive solutions. At the end of my
speech I stated that members of the Reform Party would be more
than willing to help get the Canadian health care system back on
its feet and to ensure that medicare is provided in a fiscally
sustainable fashion in the future. Obviously somebody is not
listening.
We talk about essential health care services and who is not
getting them. I can give the House cases. I have just mentioned
the three-week waiting list for urgent heart surgery in Alberta.
If that is not an essential health care service and irresponsibility
I do not know what it is. The physicians who are dealing with
these patients-the member knows because she is a
physician-would be more than happy to inform her that this is
completely inadequate. This is not something happening only in
Alberta but it is going on across the country. In Ottawa it is a
five-month wait for open heart surgery and in B.C. it is a
thirteen-month wait for people who are in severe pain.
What the member and the government have been saying is that
the government will decide what the patient needs. The
government will decide what the public can and cannot do with
their health care system and for their health. How arrogant to do
this when health care is that which is most important to all of our
hearts. That is irresponsible.
I would be more than happy to provide a long list to the hon.
member of situations that demonstrate the fact that our current
medicare system is not working.
Mrs. Sharon Hayes (Port Moody-Coquitlam, Ref.): Mr.
Speaker, I am pleased to rise to speak today to the Reform
Party's motion on the future of health care and medicare in
Canada and the nature and extent of the federal involvement in
that. The motion states:
That this House recognize that since the inception of our national health care
system the federal share of funding for health care in Canada has fallen from 50
per cent to 23 per cent and therefore the House urges the government to consult
with the provinces and other stakeholders to determine core services to be
completely funded by the federal and provincial governments and non-core
services where private insurance and the benefactors of the services might play a
supplementary role.
The Reform Party believes that a fundamental responsibility
of government is to safeguard the well-being of Canadians.
Principle 10 of our statement of principles says: ``We believe
that Canadians have a personal and collective responsibility to
care and provide for the basic needs of people who are unable to
care and provide for themselves''.
The Reform Party also believes that the current health care
system is inefficient and insufficient in providing this essential
service to Canadians. The current system must be reformed to
guarantee the continuation of care and the ability to address the
future real demands of our health care needs for everyone's
benefit.
As for the benefits now of parents, my parents, the people in
the House, people across Canada, our children and our
grandchildren, we need that ongoing credibility of a system that
right now is itself sick.
Throughout my speech I will compare and contrast the
Reform and the government approach toward securing the future
of our health care system. One area that reveals this contrast
between the Reform approach and the government approach is
the issue of consultation. The motion urges the government to
consult with Canadians and health care stakeholders about the
future of medicare.
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In its much touted red book, the Liberal Party committed
itself to ``establish a national forum on health in partnership
with the provinces and health care experts to find innovative
ways to control health costs while keeping medicare publicly
funded and accessible for all Canadians''. It sounds good but
to this day the government has broken its promise. It has not
fulfilled the commitment it has made, a commitment to consult
with Canadians about the future of medicare and the roles that
will be played by the federal and provincial governments and
other health care stakeholders. Because of the heavy handed
approach of the federal government in this area, the provinces
have refused to participate.
(1310)
Consultations are not always what they appear to be or what
they are announced to be by the government. For instance I
would like to remind the members here of the travelling
committee that was to consult Canadians on social policy
reform. What happened? A flawed attempt and a report that was
delayed and delayed and ultimately shelved.
Reform on the other hand has long advocated that the federal
government actively consult Canadians on vital and important
national issues such as the health care system. We believe
consultation must take place at all levels, with patients and
users, with physicians and health care professionals, with
administrators of those systems and with provincial
governments. We do not believe in the top down, Ottawa says,
approach. We believe that Canadians need to be part of the
decision making process, especially in an important system like
health care.
This Reform commitment to consultation is reflected in the
motion being debated today recommending that a consultative
process about the future of health care be actively and honestly
pursued.
Another area that reveals the contrast between the Reform and
the government approach is the area of federal funding. As noted
in the motion, federal funding for health care has fallen from 50
per cent to 23 per cent over the last years.
Health care was originally implemented in 1957 with the
Hospital Insurance and Diagnostic Services Act. The federal
government adopted this act under pressure from the provinces,
some of which had provincial insurance schemes. The act
established a shared cost system providing universal coverage
and access to hospitals to all residents of participating
provinces. By 1961 all provinces had joined this plan.
In 1977 this act was replaced with the Established Programs
Financing Act. This transferred money from the federal
government to provinces for both health and post-secondary
education funding. In 1984 the Canada Health Act came in
prohibiting extra billing and user fees and thus imposed
financial penalties on provincial governments which would
violate these things.
The history of health care politics is essentially the history of
the federal government demanding and expecting more and
more from provinces and providing those provinces with the
diminishing ability and the flexibility to meet those
expectations.
The present government has been in office for less than two
years and it is definitely continuing this trend. In 1995 the
government announced it was replacing the established
programs financing plan and the Canada assistance plan with the
new Canada social transfer. Under the previous system this
money was transferred separately. The Canada social transfer
will be a block fund provided through cash payments and
transfer points.
Under the new system federal funding for health care will be
reduced. In 1995-96 the federal government will transfer to the
provinces some $29.7 billion, approximately at the same level
that was the case for 1994-95 funding. Under this new system
funding under the Canada social transfer for 1996-97 will be
reduced to $26.9 billion and further reduced in 1997-98 to $25.1
billion. The government's approach to reforming health care is
to cut funding without consulting or receiving input from
Canadians.
In February Reform announced a taxpayers budget prior to the
government's budget. In it we would give provinces additional
tax room through the transfer of tax points, providing that the
provinces participate in an annual federal-provincial health
consultation. These regular consultations would ensure a two
way communication between the two levels of government
which would benefit and make better our health care system.
A first priority between the federal government and provinces
would be to agree on core versus non-core services. Core
services would be required to be maintained at a certain and a
common standard across the country. Such things that would be
necessary for core would be deemed desired by most Canadians
and required by the key players in the health care field, rather
than bureaucrats in Ottawa.
These services must be financially sustainable and available
over a long period of time. All such services would be covered
regardless of Canadians' ability to pay. Non-core services, on
the other hand, would be decided also by Canadians and would
be those the federal government does not have the responsibility
to fund, but would be the responsibility of private funding or
through insurance. Reform's approach is bottom up, not top
down consultation.
(1315)
As we would reduce federal cash transfers by some $800
million we would at the same time increase revenue levers and
flexibility for the provinces with a transfer of tax points to those
11871
provinces so that over time they would raise more revenue to be
allocated to their health care system.
Funding for health care systems would increase over the
medium and long term, steadily into the next century. This
would give greater peace of mind to Canadians. It would give
better flexibility to demoralized provinces and the result would
be a better medical system for everyone. Our approach
safeguards health care for the future while the government's
approach leaves the future of health care uncertain in reality and
in the minds of Canadians.
The shortfall in funding and uncertainty is of particular
concern to residents of B.C. The government's planned federal
funding for health care in B.C. does drop significantly. Federal
transfers in 1995-96 to B.C. are approximately $3.6 billion.
This is funding for health care, education and welfare under the
Canada assistance plan and established programs financing. In
1996-97 under the new Canada social transfer scheme funding
to B.C. will drop to $3.2 billion. Clearly something has to give.
Clearly such an approach will put the resources of the provincial
government under great strain.
I have heard some comment today about simplistic rhetoric. I
recall the government during the last election using what I
would say is worse than simplistic rhetoric, scare tactics. I
remember signs within my riding: ``Save Canada-Save
Medicare''. That kind of rhetoric when the government now puts
our medical system at risk is a testimony to what I say is unfair
representation by the government.
The Acting Speaker (Mrs. Maheu): Unfortunately the time
has expired. Questions and comments.
Ms. Hedy Fry (Parliamentary Secretary to Minister of
Health, Lib.): Madam Speaker, the hon. member made the
comment that provinces obviously do not like the system and the
way the Canada Health Act was imposed by the government on
British Columbia when it was breaking the act.
I would like the hon. member to name one province that has
not supported all the principles of the Canada Health Act
roundly within the last four months. I would like to know which
ones have not supported the federal government in ensuring the
Canada Health Act is effective and taking whatever steps are
needed. All of the provinces, as far as I am concerned, have
supported the concept. They believe in the system and in the
Canada Health Act. They support the five principles.
The last meeting of provincial health ministers with the
federal health minister reiterated that. Alberta said it will
support those principles.
Mrs. Hayes: Madam Speaker, I do not want to look to the past
but to the future concerning the workability of the Canada
Health Act and whether it is the provinces or Canadians who
look to the care of their health system.
I have talked to health professionals in my riding and they are
wondering how certain services will be addressed. I suppose we
could get into debate. Do Canadians want unlimited access and
attention for any or all complaints or health concerns, a system
that gives service to all the people all of the time? Do they want
long waiting periods? These kinds of things from the citizens of
Canada are coming to provincial and federal tables to be
addressed. What we see is a system which will not be able to
answer these things in future years.
(1320)
I know of men and women facing uncertainty. They are
waiting for tests to determine the extent of an undiagnosed
situation, perhaps cancer. They have sleepless nights. Seniors
are waiting for months with a decreased ability to walk or
breathe while they wait for operations.
I do not see how the government can say the present system
will continue to work with decreased funding to the provinces
with inflexible guidelines which will not allow caregivers to
give the care needed by Canadians.
Ms. Beth Phinney (Hamilton Mountain, Lib.): Madam
Speaker, the hon. member says she does not believe in top down
Ottawa directives to health care authorities in the provinces.
How exactly does she see the Canada Health Act and its five
principles of accessibility, comprehensiveness, universality,
portability and public administration as constituting top down
direction? The provinces and the territories administer the
health care system, not Ottawa.
Mrs. Hayes: Madam Speaker, I thank the hon. member for
her question. Rather than a constant delivery of services, what
we see in the health care system are differences between
provinces. There are different expectations among users at the
present time.
This would probably be more focused on the real needs of
Canadians if Canadians had a part in the process of deciding
which services they want to fund. For instance, we have heard
today that Quebec is no longer funding psychiatric services. I
know Canadians who expect that service to be funded. There are
other parts of Canada in which funding for abortions is
available. I know Canadians who disagree with that. Is it a top
down decision or is it a grassroots decision that these kinds of
procedures are being funded?
It is in those kinds of areas where-
The Acting Speaker (Mrs. Maheu): I am sorry, the time has
expired.
Ms. Maria Minna (Beaches-Woodbine, Lib.): Madam
Speaker, I am grateful for this opportunity to talk about
medicare and the Canada Health Act. I want to explain how and
why the government supports medicare and why we on this side
of the House will continue to support it.
11872
The Reform Party asks whether we have the will to uphold
the principles of the Canada Health Act. There are no grounds
for dire predictions that the federal government will not be able
to uphold the Canada Health Act or that Canada's health care
system will disintegrate as a result of the budget.
Let me remind the House how clear the budget speech was on
this matter. The Minister of Finance said no change would be
made to the Canada Health Act. The Minister of Health was
equally clear when she spoke to the Canadian Hospital
Association last March: ``There is no change in the
government's commitment or in my commitment to uphold and
enforce the principles of the Canada Health Act''. As the Prime
Minister said in Saskatoon, for Canadians these principles are
not negotiable.
The new transfers will be a block funding arrangement. That
may worry some members but let us not forget that block
funding for health and post-secondary education is 18 years old.
The established programs financing funding mechanisms put in
place in 1977 were a block funding arrangement. There is no
requirement for the provinces to spend the money on health.
What there is and what was nailed down in 1984 when the
Liberal government passed the Canada Health Act is the
requirement that provinces deliver health care services in
compliance with the five conditions of the act or face a
deduction from the money transferred to them.
Nothing in the budget will change the government's technical
ability to enforce the Canada Health Act principles. The
enforcement mechanism remains the same. If deductions from
transfer payments are necessary they will be made.
(1325)
Canadians can rest assured that Canada's social and health
transfer will not reduce federal ability to enforce the principles.
We will enforce them because these principles of universality,
accessibility, comprehensiveness, portability and public
administration are ultimately rooted in our common values.
They are Canadian values such as equity, fairness, compassion
and respect for the fundamental dignity of all. We will also
enforce the principles of the Canada Health Act because they
support an economically efficient health care system.
It is worth reminding opposition members the principles of
the Canada Health Act are not just words. They have meaning. I
want to touch briefly on each of these principles.
The first principle is universality, although residents in a
province must be insured by the provincial health plan to receive
federal support. What this really means is that we all must have
access to services. People cannot be deinsured because they
might be costly for the system to cover. We cannot be turned
away at the hospital door because we have not paid our quarterly
tax bill or provincial premium. If we need health care we will be
treated the same as anyone else.
Accessibility on uniform terms and conditions is the second
principle. It means we should not face any financial barriers in
receiving health care: no extra billing, no user charges, no
facility fees, no up front cash payment. If the service is
medically necessary we will get it at a time defined by medical
considerations, not by the size of our wallet.
Next is comprehensiveness. This principle recognizes
Canadians have a range of health care needs and that those needs
should be met. Scratch the surface a little more and we see that
comprehensiveness again means we practise fairness. It would
not be fair to ensure only some medically necessary services and
not others. I do not believe we can, nor should we try to, choose
at the federal level which service is medically necessary. We
should continue to interpret the Canada Health Act as required
coverage of all medically necessary services.
The government will continue to take the position that if a
province ensures any part of the cost of a service, it is an
indication it believes it to be medically necessary and all of the
costs must be covered.
Justice Emmett Hall in his original royal commission on
medicare recommended a very comprehensive package. Liberal
governments of the 1960s, 1970s and 1980s accepted the
concept of comprehensiveness, although not quite as broad a
concept as Justice Hall's. Liberal governments in the 1990s will
not turn their backs on this principle.
The fourth principle is portability. It means Canadians
maintain their health plan coverage when they travel or move.
The portability principle is rooted in one of the fundamental
elements underpinning our federation. It recognizes our right of
mobility. Canadians are free to work and travel anywhere in the
country without fear of losing their health insurance coverage.
Portability is what makes our national health insurance truly
national. Each separate health insurance plan may be provincial
in origin but is recognized nationally in every province across
the country.
The fifth principle is public administration. Our health
insurance plan must be operated by provincial governments on a
not for profit basis. In my view this principle never seems to get
the same attention as the others but it should. It is at the core of
our ability to contain costs in the system and thus to deliver
quality care at an affordable price.
One would think that of all five principles, the Reform Party
would be able to relate to this one. Public administration is the
means by which we ensure all the other principles. When health
insurance is operated and funded through government, we can
guarantee that health care is universal, accessible,
comprehensive and portable because we have direct control over
it.
11873
It is through public administration that we also demonstrate
our collective responsibility for our health care system.
Canadians are responsible for paying for their health care
system. We do it collectively through our taxes. We pay so that
everyone can benefit according to need. We have agreed to
provide this most essential of human services together. We must
not lose that.
Public administration also demonstrates something else about
Canadians, our pragmatism. We want value for money and
administering health insurance publicly is the best way to get it
in health care. We need only look to the experience of our
American neighbours to compare the efficiency of public
administration with private administration.
Not only does public administration make sure more of our
health care dollars go toward patient care, government can be
more successful than the private sector in keeping health care
costs under control.
(1330 )
In 1993 we spent about $72 billion on health care. This
represents 10 per cent of our gross domestic product. The public
component of that 10 per cent has been growing at less than 2 per
cent. Compare that to private health spending, which has been
growing at 6.4 per cent.
Over the last three years per capita spending on the publicly
administered part of our system has been declining. Since our
GDP has been growing, it is safe to predict that in 1994 and 1995
we will come in with less than 10 per cent of GDP devoted to
health care.
Saying the federal government wants to maintain the
principles of the Canada Health Act is not enough. We have to
know the public is behind us. We all know that as politicians we
cannot escape the will of our constituents. They put us in office
and they can take us out. The same is true for the government.
Canadians are all saying one thing to us very clearly: they want
us to enforce the principles of the Canada Health Act.
In Canada's health care system there are no first or second
class citizens. We enjoy rights and privileges as Canadians that
are the envy of the world. We can live wherever we want in
Canada and have access to health care when we need it.
The many values that make up Canada's social fabric are
reflected in the five principles of the Canada Health Act. They
reflect the Canadian concern for justice and equity in our health
care system and they are not going to disappear. Canadians,
including I am sure everyone in this House, will not allow that to
happen.
As I said a moment ago, we only need to compare ourselves
with the United States. They have been trying for years to get a
health care system. They have a private health care system that
people purchase from private companies. They spend between
13 per cent and 14 per cent of their GDP on health care. What
does this extra money get them? There are 38 million people
who are not covered at all, and millions more are minimally
covered. That does not sound like a great exchange: more for
less. Therefore, I do not see what good privatizing our health
care system will do.
I also want to point out there are countries that have allowed
extra billing. I know of one, Italy, that has allowed and allows to
this date extra billing and private clinics. However, it may
happen that a person is in a public hospital. The doctor will say:
``I need to do a surgery, which is very expensive; I can only do it
if you come to such and such a clinic, but it will cost you so
much money''. That is setting up two classes of services: if you
pay more, you get served faster, and maybe that specialist will
treat you there.
In this country it does not matter if one is poor or rich or even
homeless. If you require assistance or surgery you choose the
specialist or the doctor who will treat you. That is what a
comprehensive and accessible medicare should be about. We
need that kind of security, that kind of stability. Our health is the
most precious thing we have, allowing us to do all of the other
things we want to do. We talk about unemployment. If people
are insecure about their health they cannot study, they cannot
train, they cannot work.
This gives Canadians a sense of stability. They do not have to
worry or lose their homes and become paupers because they are
ill or their children or parents are ill.
Yes, we have a new world. We have a much larger population
of seniors. We need to look at different treatments. That is true.
That does not mean in any way retrenching one bit on the
principles of health care, not one bit. I would never support any
such direction. We must look at new treatments and new ways of
assisting people.
Preventative medicine in this country must become the norm,
and not, as it is now, a reaction. We are still treating symptoms in
many cases, and not dealing with preventative medicine. If we
were to deal aggressively with that over and above the costs we
now have, we would lower health costs in this country
considerably. We should be looking at how we can improve our
medicare system and our health system and its delivery through
preventative and other measures, and not diminish the
principles of health care. That is totally unacceptable. This
government would never support that.
We need to redouble our efforts to make sure even programs
like psychiatric services are considered to be fundamental
services. We have far too many children who are on waiting
lists. Yes, a province has decided that is not a necessary service.
11874
Maybe we need to look at that. It is a preventative service. This
is what I mean by looking at innovative ways of dealing with the
cost of medicare, not denying Canadians the right to access
medicare.
(1335)
[Translation]
Mr. Michel Daviault (Ahuntsic, BQ): Madam Speaker, I am
pleased to rise today to speak to the Reform Party motion
concerning our health system. This motion provides for the
compilation of a list of health care services considered as
essential, to be fully funded by the federal and provincial
governments, and a list of so-called non-core services, funded
by private insurance and some form of user fee.
Naturally, we are against this motion for reasons that I will
explain in my remarks. For one thing, the first part of the motion
reads:
That this House recognize that since the inception of our National Health Care
System the federal share of funding for health care in Canada has fallen from 50
per cent to 23 per cent-
While recognizing readily the federal government has reneged
on its commitment, we feel that what should be denounced is the
fact that the provinces were never compensated for this, and
therefore saw their tax burden increase.
In fact, the federal government's unilateral approach to
maintaining its status as a partner in the Canadian medicare
scheme is far from making all the provinces happy. The
provincial health ministers do not agree either on how to prevent
the Canadian medicare scheme from being affected by
reductions in services and in federal transfer payments.
As reported by Jean-Robert Sansfaçon in Le Devoir on April
13, the Minister of Health candidly explained, by paying a
simple lump sum, the Canada social transfer, instead of making
several different and progressively smaller payments for health,
education and social assistance, Ottawa will be able to maintain
a level of control that could otherwise elude it because of its
reduced contribution. As clever as it may be, the reporter added,
the Prime Minister's strategy is nonetheless grossly unfair.
Ottawa plans to reduce transfer payments to the provinces by
$7 billion over three years starting in 1996-97. In Quebec, these
cuts will jeopardize the health care system. During the health
ministers' conference held in Vancouver, the Minister of Health,
Mr. Rochon, released a study from his department indicating
that Quebec, which is already experiencing an $8 billion
shortfall, the equivalent of the annual budget for the Quebec
health services network, following the changes made to health
transfers since 1982-83, will be deprived of a further $2.4
billion in federal moneys, between now and 1997-98.
As pointed out by the hon. member for Drummond, who is
celebrating her birthday today and to whom we wish all the best,
the federal contribution is decreasing, having dropped from
roughly 45.9 per cent of Quebec's health expenditures in
1977-78 to 33.7 per cent in 1994-95. It can therefore be
estimated that, for Quebec, the most recent cuts in established
programs financing will result in a reduction of some 10.6 per
cent of the federal contribution to health expenditures.
This is typical of the federal government. It unilaterally
decides to withdraw from a sector which, in any case, does not
fall under its jurisdiction, without giving the provinces the
appropriate financial compensation for this withdrawal. The
Prime Minister said that this was an excellent system and that
the government wants to maintain it. Why then withdraw from it
if the system is so good?
The fact is that, once again, the provinces will have to
maintain this excellent health care program, but without federal
support. So, after imposing, back in 1984, the five great
principles of the Canada Health Act, the federal government is
now unilaterally and implacably withdrawing its financial
support, while keeping the power to impose national standards.
Let me remind you of those principles. There is first of all the
matter of comprehensiveness; this means that all health services
provided by hospitals, medical practitioners and dentists must
be insured. Two, universality means that all the people covered
by the provincial plan should have access to all insured health
services. Three, portability means that coverage of provincial
plans is transferable from one province to another, and that
health care services are also provided to insured persons who are
temporarily out of their home province. Four, accessibility
means that provincial plans must provide services on uniform
terms and conditions, which means that billing is prohibited. As
for public administration, it means that the health insurance plan
must be administered on a non-profit basis by a public authority
designated by the provincial government.
(1340)
In Quebec we have no trouble with the five criteria. As far as
we are concerned, they represent a minimum consensus. But
what does the federal government have in mind, especially when
we hear the Minister of Health spouting her earnest rhetoric as
the great defender of the integrity of the Canadian medicare
system? The cuts introduced unilaterally in the federal budget
are draconian.
Perhaps I may quote from a presentation by the Minister of
Health before the Senate Committee on euthanasia and assisted
suicide, in which she referred to palliative care.
11875
[English]
The minister said: ``I want to touch on 10 areas requiring
attention if the individual who is the focus of my concern is to be
provided with high quality care at the end of life. First, we need
better diagnosis and prognosis. We need provider training. It is
essential. We need fully developed teams of providers, ranking
from physicians and volunteer support networks to dealing with
problems of the end of life. We may even need to develop new
specialties in this area''.
[Translation]
She went on to say: ``Research into pain control and
management should be a priority. We need to know more about
comfort and the supports that focus on time of administration of
drugs and dosages. We must introduce support networks for
patients and their caregivers''. Finally, and this is perhaps the
best part of the speech:
[English]
``We need institutional development. There are not enough
palliative care centres, especially outside of major urban areas.
We need centres to coordinate community and home care,
staffed with professionals with a sense of outreach and mobile
forms of delivery''.
[Translation]
Not only does the federal government take it upon itself to
establish criteria, it also assumes the right to set priorities in
areas that come under provincial jurisdiction, and now the
Minister of Health, in response to the serious concerns she
formulated, is going to cut transfer payments to the provinces. Is
she doing the actual cutting? No. She is just taking orders from
the Minister of Finance.
In other words, Canada's health care system is adrift, and
although in Quebec there is still a very broad consensus in
favour of the main criteria of the Canada Health Act, we
understand why the Reform Party is suggesting ways to make
the system more efficient because, in the end, the debate is about
these main criteria. Will we keep doing what we are doing now,
which means making cuts in all services, something the Quebec
Minister of Health is forced to do because of federal cutbacks, or
should we de-insure certain services? I think our Reform Party
friends did well to raise this matter in the House.
The government has initiated major changes in health care
funding, and we have to look beyond the rhetoric of the Minister
of Health. In a speech to the Hospital Association on March 17,
1995, the Minister of Health once again recalled certain aspects
of the system: ``There is nothing in the budget that changes our
technical capability to enforce the criteria of the Canada Health
Act. The mechanism itself remains unchanged. If deductions
must be made from transfer payments, deductions will be made
either from the monetary portion of the new Canada Social
Transfer or, if necessary, from other monetary transfers''.
This is the so-called big stick. However, later on in her
speech, the minister herself opened the door to a two-tier
system. She said: ``On the other hand, we must be reasonable.
The government and I are not going to ask the provinces to cover
services like plastic surgery. In practice, we must allow the
provinces some flexibility in identifying the range of insured
services. However'', she admitted, ``we must realize that, by
excluding certain medical services from medicare, we open the
door to the privatization of coverage of health care services and
to a lessening of our ability to control costs''.
(1345)
Later, she alluded to her guilt, saying that as a politician-and
I agree with her, that is essentially what she is in this case-she
has to respect the wishes of Canadians, and Canadians are
sending the government a clear message that they want the
principles in the Canada Health Act to be upheld.
They are strangling the provinces, but are doing it under the
pretence of self-professed good intentions. However, as
Saskatchewan's Minister of Health, Lorne Calvert, said:
[English]
``We are asking, if the federal government unilaterally
withdraws more and more from funding to regions, how do they
plan to maintain the integrity of the system?''
[Translation]
Despite the many opportunities she has had this morning, the
minister still has not answered this question. The federal
government's share of health care funding is currently sitting at
around 23 per cent and we are willing to bet that it will shrink
even more. The net figure for health care, social assistance and
education transfers from the federal government is $29.7 billion
for 1995-96. This will drop to $26.9 billion in 1996-97, then to
$25.1 million in 1997-98. And the minister admitted in her
recent speech to the Canadian Hospital Association that a
portion of this is for health, but she did not break it down.
In perhaps an attempt to justify the scope of the cuts, the
Prime Minister pointed out that the United States spends 15 per
cent of its GDP on health; Europe, 8 per cent, and Canada, 10 per
cent. So, he asked in an interview on CBC's ``Morningside''
why Canada would not be able to do it, for example, with only
nine per cent of GDP?
Does the Prime Minister not know that the Americans have
private health care and that close to 40 million of them have no
health care coverage whatsoever? Does he also not know that the
11876
American government's attempt to implement a public health
care system is meeting with strong opposition from the private
sector?
I do not know if the government even realizes that, by
implementing such cuts, it is imperilling its own system. The
Prime Minister himself, by his statements on essential services,
is actually helping along the demise of the current system and is
paving the way for a two-tiered system.
Basically, this seeming desire to rationalize health care costs
is expressed in freezes and reductions in transfer
payments-and I would remind the minister that reference was
made in the same speech to an annual increase in health care
costs of approximately two per cent. These freezes and
reductions in transfer payments conceal the governments real
intention, which is to reduce the deficit on the backs of the
provinces.
So, how can the government still claim it is legitimately
justified in imposing standards and dictating policy on the
management and operation of the provincial health care
schemes? The government is passing itself off to the provinces
as upholding the law and wants to consult them to find out how
they should tighten their belts to cut costs and health services
while meeting federal standards.
I would point out that, in this context, the consultation was
between the federal Minister of Finance and the provincial
finance ministers. Then, once everything was all wrapped up,
the federal Minister of Health and her provincial counterparts
were casually told that they would have streamline their
systems.
The forum on health is surely another example of lack of
respect for the provinces. Minister Rochon has already
reiterated Quebec's opposition to the forum, another indication
of the government's intransigence with the provinces.
I would also recall a statement made by the former Quebec
Minister of Health, who is now the Minister of Labour in the
federal government and who is curiously absent from the debate
today. When she was Quebec's Minister of Health, she described
the government's behaviour in connection with the forum on
health as absurd. She went on to ask how the government could
imagine reviewing the health care system without the
participation of the provinces, which are responsible for
delivery of services. She felt it was simply out of the question.
In the case of the Minister of Labour, we could say that
customs change with time and speeches change with the level of
government.
(1350)
Under the 1867 Constitution Act, the provinces have full and
exclusive jurisdiction over health care. The federal
government's costly interference in this area, notably through
program duplication, was based on its constitutional power to
spend.
The federal government maintains that its involvement in
health care is justified by the fact that the implementation and
maintenance of medicare is a paramount issue of national
interest and part of the rights and benefits associated with
Canadian citizenship. Because of its debt, the federal
government is withdrawing financially while still upholding the
national interest and keeping the powers it gave itself.
According to Minister Rochon, the real solution would be for
the federal government to withdraw completely from health care
and transfer the tax points belonging to Quebec and, I would
add, to each of the provinces.
The second part of the motion reads as follows:
-therefore the House urges the government to consult with the provinces and
other stakeholders to determine core services to be completely funded by the
federal and provincial governments. . .
Several members of this House, both on the government side
and on the side of our friends from the Reform Party, have
mentioned exceptions, examples of programs or treatments
covered by special agreements.
I would also like to remind the House of the importance given
in Quebec to the five fundamental principles of health care,
which were the subject of major debate during the election
campaign. As you will recall, the former Liberal provincial
government, of which the new federal Minister of Labour was a
member, wanted to eliminate the newsletter Malade sur pied,
which lists the drugs that are covered or available. It also wanted
to charge $20 in user fees for chemotherapy treatments for
cancer patients. This directive provoked an outcry in Quebec.
As a result, the Liberals quickly suspended it and the new
government wasted no time in cancelling it.
We cannot eliminate all user fees. I know that Quebec charges
user fees for some services, but the cuts imposed by the federal
government force us to make unconscionable decisions, and I
think that the federal government must take the blame for the
health care cuts in each of the provinces.
The Quebec government is also considering the feasibility of
introducing a basic universal drug plan that would benefit not
only welfare recipients and seniors but the entire population and
cover all new drugs and treatments for diseases such as AIDS
and cancer.
In this regard, Quebec is still striving to ensure universal
access. By supporting these measures, we in the Bloc Quebecois
are telling the federal government that, if it cannot enforce these
principles we care about, it should give us our tax points and we
will deal with the matter. However, the federal government
should not tell the provinces what they should do-and not in
health care matters, in my opinion. As far as the other provinces
are concerned, if a western province wants to take a different
approach, it should be allowed to do so, provided it continues to
11877
negotiate with all the other provinces. The issue of portability
can be settled with or without the federal government, so that
Albertans can be treated in Quebec and vice versa.
I think that the federal government must bear the greatest
blame in this area.
In closing, I would like to remind you that we will oppose this
motion, although we wish to commend the Reform Party for
raising this issue in the House.
(1355 )
[English]
Ms. Hedy Fry (Parliamentary Secretary to Minister of
Health, Lib.): Madam Speaker, I was a little disturbed by the
last part of the hon. member's speech.
He can correct me if I am wrong, but I understood the member
to say that he would like to see national medicare disbanded and
provinces deal with provinces in terms of issues such as
portability.
This government is committed to Canadian medicare, which
is based on treating all Canadians equally as they cross from
province to province. I would really like to see whether the
member would like to elaborate on the dismantling of medicare
that I just heard or to correct me if I was wrong.
[Translation]
Mr. Daviault: Mr. Speaker, the hon. member probably forgot
the first part of my remarks. The point I am making is that we, in
Quebec, agree with the five principles, which we regard as a
minimum consensus. However, it is rather cynical for the
federal government to hide behind these five principles and cut
transfers to the provinces.
The hon. member said earlier that necessity is mother of
invention. I do not think that the federal government's goal in
cutting transfer payments to the provinces is to spur lazy
provinces to action. It is only trying to get out of a difficult
financial situation. This is not a health strategy but a financial
strategy and, in that regard, the health minister must submit to
the finance minister's wishes.
We feel we are at the crossroads. Quebec remains committed
to the principles of universality, accessibility, portability, and so
on. However, if the federal government cannot do its job, we, at
the provincial level, are prepared to go over its head and
negotiate directly with the other provinces to ensure the
portability of the system. The federal government should get
serious, uphold the five principles and provide the required
funding. It is true, up to a certain point, that money does not
guarantee the quality of health care, but when you cut-
Some hon. members: Hear, hear.
The Speaker: Dear colleagues, it being 2 p.m., pursuant to
Standing Order 30(5), the House will now proceed to statements
by members.
_____________________________________________
11877
STATEMENTS BY MEMBERS
[
English]
Ms. Hedy Fry (Vancouver Centre, Lib.): Mr. Speaker, I
want members to notice that I am smiling today to remind the
House that April is Dental Health Month in Canada.
This month provides an opportunity for all Canadians to show
off their teeth by sharing their smiles. I am proud to note that
Canadians enjoy one of the highest standards of oral health in
the world. This is thanks in large part to Canadian dentistry's
commitment to disease prevention.
For years now the Canadian Dental Association, provincial
associations, and local societies have sponsored many
educational activities and projects of interest to both children
and adults. These include mural displays, radio, television, and
billboard ads, newspaper supplements and free dental clinics.
Please join me in saluting the efforts of the Canadian Dental
Association and allied national and provincial associations for
their commitment to good oral health.
I would like to ask all the members of the House to just say
cheese.
* * *
[
Translation]
Mrs. Pauline Picard (Drummond, BQ): Mr. Speaker, it is
with pleasure that I inform hon. members of the launching of the
Schizophrenia Society of Canada's public awareness campaign.
The purpose of the campaign is quite clear: to change the public
perception of schizophrenia, and to replace misconceptions with
more factual information. The theme is quite catchy: if you
think it is hard to pronounce, imagine what is it like to live with.
This disorder affects one out of every 100 Canadians. To
combat the disease, we must become more knowledgeable about
it. The campaign by the Schizophrenia Society of Canada is
timely; it will improve our knowledge about schizophrenia, and
that is a major step forward.
11878
(1400 )
[English]
Mr. Lee Morrison (Swift Current-Maple
Creek-Assiniboia, Ref.): Mr. Speaker, I recently received a
letter from Darrell McKnight, a Fredericton man whose shotgun
was seized under order in council a few weeks ago.
His comments were so sensible that I will read them verbatim:
I don't purport to know more about law than the Attorney General. However,
when I was very young, my mother taught me that taking something which
belongs to someone else was wrong. It was called theft, and there used to be a law
against theft-even theft by government.
This incident is typical of the level of honesty and fairness we can expect from
the Attorney General. To call him a thief would not do him justice because he is
much more powerful and dangerous to this country than a common thief who
must break the law to steal from us. The minister just changes the law with the
stroke of his own pen.
That is what one ordinary Canadian feels about rule by order
in council.
The Speaker: I want to give all members all the latitude we
can in the House but the statements we make in here should be
attributable to ourselves, especially during Statements by
Members.
* * *
Ms. Maria Minna (Beaches-Woodbine, Lib.): Mr.
Speaker, I am proud to rise in the House today on behalf of the
students of Norway public school in my riding.
The young people of this school have taken up a very
admirable cause. They wish to see the establishment of
Igalirtuuq, a sanctuary on Isabella Bay, Baffin Island, for the
bowhead whale. The bowhead whale is in danger of becoming
extinct and so a sanctuary would help protect the species.
The 10 and 12-year olds at Norway public school have written
letters to the Minister of the Environment and circulated a
petition at a recent school open house. I will be presenting these
letters along with the petition to the Minister of the Environment
next week.
The students have worked very hard to inform themselves and
others about the bowhead and other types of whales. They want
to save the bowhead whale from extinction and they are asking
the House to help them.
I congratulate the children for their strong commitment to
their cause and I ask the Minister of the Environment to do
everything she can to set up a sanctuary in Isabella Bay so that
the bowhead whale may be protected.
Mr. Wayne Easter (Malpeque, Lib.): Mr. Speaker, I
congratulate the working group on seasonable work and
unemployment insurance on the excellent report ``Jobs with a
Future''.
As it correctly points out, there is no such thing as a seasonal
worker but only seasonal work. People who work in seasonal
jobs may have no other work available to them in the off season.
Seasonal industries and the people who work in them have
overcome the challenges of the harsh Canadian climate and
geography and have built on the base of our abundant natural
resources one of the most prosperous countries in the world.
Seasonal work currently provides jobs and livelihoods for
over a million Canadians. Seasonal industries and the people
who depend on them will continue to make major contributions
to our regional economies even as we move into the new
information economy. Unemployment insurance reform must
take into account these special circumstances of those employed
in seasonal work.
I encourage all members to read this well documented report
and support it soundly.
* * *
Ms. Paddy Torsney (Burlington, Lib.): Mr. Speaker, today I
rise to recognize the accomplishments of the Burlington Teen
Tour Band, role models to Canadian youth.
The Burlington Teen Tour Band is committed to excellence in
music and has achieved recognition both nationally and
internationally in travelling around the world as true
ambassadors for Canada and for our city.
On April 28 the Burlington Teen Tour Band is going to
Holland to represent all Canadians at the celebrations marking
the 50th anniversary of the liberation of Holland. Burlington is
proud of these youths and of their parents and many supporters
and volunteers.
While the band is in Holland it will be playing in the national
parade in Apeldorn and at the remembrance service at the
Groesbek war cemetery. I take pride in all the members of the
Burlington Teen Tour Band as they represent Burlington and our
country.
It is important we recognize the outstanding accomplishments
of Canadian youth. The Burlington Teen Tour Band represents
positive leadership for all Canadians. I salute it in its
accomplishments and send it my best wishes for a fabulous trip.
11879
[Translation]
Mrs. Madeleine Dalphond-Guiral (Laval-Centre, BQ):
Mr. Speaker, today is Yom Hashoah, which this year marks the
50th anniversary of the end of the Holocaust and the horror of
the concentration camps in Europe.
Millions of men, women and children perished under the yoke
of Nazi tyranny. Remembering the victims of the Holocaust and
the tens of millions of people of all nationalities who died during
the Second World War brings to mind how fragile life and liberty
are.
(1405)
Fifty years after the war, the world is still the scene of planned
exterminations. Mass killings and hatred are daily realities. To
forget is to allow ourselves to condone violence. To remember is
to be mindful of our collective responsibility to oppressed
nations.
* * *
[
English]
Mr. Ray Speaker (Lethbridge, Ref.): Mr. Speaker, on the
surface the Canadian economy appears to be sailing smoothly.
Yet, as the Moody's downgrade revealed, the buoyancy is
deceptive. Three indicators are pointing to rough seas ahead.
The first is our sinking dollar. Since the release of the
government's first budget our currency has lost more than 20 per
cent of its value versus the yen and the mark. The Bank of
Canada has only kept it afloat through high interest rates.
However, it is these high interest rates which have knocked
the wind out of our sails, housing sales, that is, which hit a
13-year low in March.
While the combination of high interest rates and a
depreciating currency roil the waters, the third storm cloud has
appeared on the horizon. Inflation is re-emerging which will
prevent the Bank of Canada from offering the interest rate relief
we all need as Canadians.
The message is clear. Unless the government charts a new
fiscal course for deficit elimination, not deficit reduction, our
economy will end up on the rocks.
* * *
Mr. Vic Althouse (Mackenzie, NDP): Mr. Speaker, when the
minister of agriculture appeared in front of the agriculture
subcommittee on grain transport it was strictly do as I say, not
do as I do. He said to prepare for the future. As our glorious
leader on this important challenge, he then retired to the rear and
complained about his administrative duties: how to make a
payout, to whom, why, when and for what land. Such problems.
He avoided any discussion of the long term transport
decisions already inflicted on agriculture by his government: no
Crow payments August 1; branch line deregulation by January
1; full rate deregulation by 1999; decisions that will increase
freight rates dramatically as rates rise to those of other products
and U.S. freight rates.
With that much bad news facing us in the trenches no wonder
our little general could not bring himself to look at or even alert
the troops. What vision, what courage, what a total
disappointment.
* * *
Mrs. Karen Kraft Sloan (York-Simcoe, Lib.): Mr.
Speaker, two years ago the first session of the United Nations
commission on sustainable development was held in New York.
It was agreed at that time that members would report on
activities undertaken to implement agenda 21, the global plan of
action for sustainable development.
I am pleased to announce that Canada delivered its second
report to the United Nations last week. This is a report to the
United Nations from all Canadians. It reflects Canadians'
efforts to embrace and promote sustainable development.
Canada has made progress this year in parks, agriculture,
forests and in conserving Canada's plants and animals. We are
developing Canada's resources and maintaining their health for
the future.
Canada continues this week to share its own experiences with
other United Nations members at the session, thereby helping to
further promote sustainable development among all UN
members and encouraging all member states to learn from each
other.
* * *
Mr. Derek Lee (Scarborough-Rouge River, Lib.): Mr.
Speaker, I welcome two distinguished guests from the Republic
of Croatia, Mr. Mladen Vedrish and Mr. Rodesh.
Mr. Vedrish is a member of the Croatian House of
Representatives and president of the Croatian Chamber of
Economy. Mr. Rodesh is a member of the Upper House. They are
in Canada today to help promote stronger cultural and economic
ties between our two countries. Specifically they are here to
discuss the potential for business relations between Canada and
Croatia and investment opportunities in Croatia.
11880
They will be meeting with members of the Canadian business
community and the newly established Canada-Croatia
Chamber of Commerce.
The government has taken a leadership role in developing
trade relations with new markets. Croatia is a new and
promising market that I know Canadians will want to participate
in.
I am sure all members join me in wishing Mr. Vedrish and Mr.
Rodesh much success in their endeavour to promote business
relations between our two countries.
* * *
(1410 )
Ms. Jean Augustine (Etobicoke-Lakeshore, Lib.: Mr.
Speaker, today marks the commencement of the first
multi-racial democratic election held in South Africa.
Last year, serving as a part of the Canadian observer team, I
was fortunate to contribute to Canada's effort to ensure the
election process was free and fair, an essential step in setting up
a post-apartheid, non-racial democracy.
President Nelson Mandela remains one of the great moral and
political leaders of our time. His lifelong dedication to the fight
against racial oppression in South Africa continues to inspire
individuals and nations alike.
On this anniversary I invite my colleagues in the House to join
me in welcoming to our country South Africa's first black high
commissioner, His Excellency Billy Isaac Letshabo Modise.
Canada remains committed to working to promote human
rights and security for all communities in South Africa.
* * *
[
Translation]
Mr. Michel Daviault (Ahuntsic, BQ): Mr. Speaker, this
morning we learned that the number of welfare recipients in
Quebec had increased drastically, from 550,000 in 1990 to
808,000 this year. To make things even worse, 188,000 of these
recipients, or close to 25 per cent of them, live in Montreal. That
city is in fact the main victim of the federal government's
negligence and incompetence.
This deterioration of the situation also confirms that federal
reforms designed to improve the plight of the poor have failed
miserably. This government only managed to make things
worse.
When will the federal government realize that it cannot
deliver and that it must provide Quebec with the necessary tools
to develop a real job strategy? This government's stubbornness
confirms that sovereignty is the only solution for Quebec.
[English]
Mr. Jim Silye (Calgary Centre, Ref.): Mr. Speaker, through
hard work and determination Reformers have finally made
perfect sense of the Liberal's promise to govern with integrity.
First, a cabinet minister can sue the government that employs
them provided it does not infringe on the rights of their children
to greet the Queen.
Second, $100,000 trips using Challenger jets are justifiable
only on the condition that the minister speaks at a northern U.S.
ivy league school.
Third, renovation costs exceeding $200,000 are justifiable
only if the word turbot falls under the minister's portfolio.
Fourth, if your father is a senator you are fair game, but if your
son-in-law works for Power Corp., back off.
Fifth, taxpayer funded, gold plated pensions for life are
justifiable because MPs make less money than the worst player
on the Ottawa Senators.
Now that Reformers have made perfect sense of Liberal ethics
and integrity we will focus our attention on understanding
Liberal math.
* * *
Mr. Mac Harb (Ottawa Centre, Lib.: Mr. Speaker, this week
the Schizophrenia Society of Canada launched its first annual
public awareness campaign.
This disease affects about 270,000 Canadians. That is one in
every 100 people. Sadly, 40 per cent of the people with this
disease will attempt to take their own lives; sadder still, one
quarter will succeed.
Schizophrenia is caused by a chemical imbalance in the brain
and often strikes young adults. It is one of the most common
forms of mental illness in Canada.
While there is much work to be done, progressive discoveries
are being made every day and more effective treatment
programs are being developed.
The Schizophrenia Society of Canada provides information,
advice and emotional support to those living with this disease
and their families. Along with my colleagues in the House of
Commons I congratulate the society for its continued
commitment and hard work.
* * *
Mr. Sarkis Assadourian (Don Valley North, Lib.): Mr.
Speaker, today, April 27, marks Holocaust Memorial Day. As
the Prime Minister of Israel said, it has been 50 years since the
doors of hell were opened.
11881
In Israel and around the world humanity remembers and pays
tribute to six million Jewish people, including one million
children, who were murdered at the hands of the Nazis during
the Holocaust of 1939-45.
This is the precise reason I introduced a motion on April 3,
1995, M-282, to designate April 20-27 a week to remember
crimes against humanity. At that time I called on members of the
House to view the Holocaust and genocide as more than crimes
against one group, but to see them as crimes against humanity.
I call on Canada and the international community to oppose
any oppression in all its forms, regardless of race or religion,
and to defend the rights of victims of hatred and crime.
* * *
(1415 )
Mr. Walt Lastewka (St. Catharines, Lib.): Mr. Speaker, this
time last year there was a debate in the House on Canada's
national sport, lacrosse.
At that time we not only reaffirmed the importance of lacrosse
to our culture and heritage, we named it as the national summer
sport while hockey would become our national winter sport.
This House actually came to an all-party agreement that
lacrosse and hockey would be our national sports.
Lacrosse has been part of our cultural heritage for many years.
The sport is indigenous to Canada through the First Nations and
existed here before Canada did as a country. Now it is having its
funding abruptly cut and the government is refusing to support
this important national treasure.
I call on Sport Canada and the Minister of Canadian Heritage
to review this decision. While all of us must tighten our belts to
get our fiscal house in order, surely our national sport deserves
better treatment.
_____________________________________________
11881
ORAL QUESTION PERIOD
[
Translation]
Hon. Lucien Bouchard (Leader of the Opposition, BQ):
Mr. Speaker, yesterday, the government took the unprecedented
step of tabling two orders concerning DTH satellite distribution
which are a direct reversal of the CRTC's decision. One of the
orders comes in response to the dearest wishes of the Power
DirecTv Group, by allowing the group to use an American
satellite. We know that one of the main shareholders and leaders
of the group is the Prime Minister's son-in-law.
My question is directed to the Prime Minister. Would he
confirm that the chairman of the panel appointed to advise the
government in this matter, Mr. Gordon Ritchie, is a former
associate of his principal adviser, Mr. Eddie Goldenberg, who
intervened directly in this case?
[English]
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, we have been through this a number of times.
We have demonstrated repeatedly that the action the
government took both in initiating a review of the exemption
order issued by the CRTC and in adopting the report of the panel
of experts chaired by Mr. Ritchie has been in conformity with
the views of many disinterested groups, at least in terms of the
commercial interests involved. These include Friends of
Canadian Broadcasting, the Consumers' Association of Canada,
ACTRA, groups which really are not involved other than as
important users of the system. Newspaper editorials have also
asked for this response.
If the Leader of the Opposition wishes to debate this matter on
the basis of process, then we will have something of substance to
talk about. So far, his only attack on this has been unbased
innuendo, which I think reveals more about him than it does
about our process.
[Translation]
Hon. Lucien Bouchard (Leader of the Opposition, BQ):
Mr. Speaker, a long answer that could have been shorter if it had
been the answer to the question.
The question is a question of fact: Is Mr. Goldenberg a former
associate of the chairman of the panel that drafted the orders?
The question is very straightforward. It is a question of fact that
will clarify the matter for the public, since the Prime Minister
took the unprecedented step-I do not think this has happened
very often in Ottawa, and I think it is probably the first time ever
in the history of the federal Parliament and the federal
government-of trying, and I think he did so in good faith, to
isolate himself as though behind a wall from a fundamental
decision by his government.
I therefore want to ask the Prime Minister whether he would
agree that his wall shows some serious gaps and whether he
realizes that the actions of his principal adviser, Mr.
Goldenberg, allowed him to do indirectly what his conflict of
interest guidelines prohibited him from doing directly?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, a lot of smoke but no fire.
[English]
The problem here for the Leader of the Opposition is very
simple. He has a report of a panel of experts, yes, chaired by
Gordon Ritchie, participated in by Roger Tassé and Robert
Rabinovitch, three former deputy ministers in the Public
Service of Canada. They produced a report which has been
generally praised in editorial comments and by other groups.
11882
The Leader of the Opposition has nothing to criticize in the
report. In fact, as I recall from the publication of the report on
April 6, the most telling criticisms came from the very party
he claims it was intended to benefit. Why? Because the result
of the report and the direction which was tabled yesterday really
give nothing to anybody except the right to apply to the CRTC
for a licence. That right is open to Power DirecTv. It is open
to Expressvu. It is open to everybody else.
(1420 )
Our intention has been to be very, very careful on process. We
invoked a process which was transparent and open. We have
initiated it with tabling a direction, a process which is statutory,
open to debate in a public forum, namely the House of Commons
and the Senate of Canada.
The Leader of the Opposition cannot find anything to criticize
in that process so he is left to asking about irrelevant details.
The Speaker: Colleagues, it is early in the question period.
May I please appeal to you to keep the questions and answers as
brief as possible.
Hon. Lucien Bouchard (Leader of the Opposition, BQ):
Mr. Speaker, it is very strange to hear the minister hiding
himself behind the process while they have put aside the
process, squashing a decision made by the CRTC. It is the first
time that has been done in the history of Canada. That is
something.
[Translation]
I have the following question for the Prime Minister.
Considering the fact that the order is tailor-made to meet the
demands of Power DirecTv, that this order is a carbon copy of
the draft prepared by a panel chaired by the former associate of
the Prime Minister's principal adviser and that this associate
personally intervened by speaking to the responsible minister, is
the Prime Minister not bothered by this impression that Power
DirecTv and his son-in-law were given preferential treatment?
[English]
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, the Leader of the Opposition keeps trying to find
something that would discredit the process but he does not
succeed.
The fact is the process was initiated yesterday in the House of
Commons. It is true it is the first time it has been used. I am sure
the Leader of the Opposition would admit it is a power that has
only recently been included in the statute, although it was
proposed that it was included in the statute by the previous
government. It is a relatively new power and was used in a
circumstance which itself was unprecedented, namely the
granting of the exemption order by the CRTC.
In the face of the exemption order being granted on August
30, many groups asked the government to act, saying there were
problems with this. If we had not acted in response to those
criticisms, I suspect that at least the Leader of the Opposition, or
perhaps his critic who often claims to speak on behalf of groups
like the Friends of Canadian Broadcasting, would be standing in
this House criticizing us for having not acted in the way we have
acted.
* * *
[
Translation]
Mr. Michel Gauthier (Roberval, BQ): Mr. Speaker, the
Toronto Star reported this morning that, through some strange
coincidence, the Minister of Canadian Heritage happened to be
in Edgar Bronfman's suite in Los Angeles when Seagram took
control of MCA studios. Following this transaction, Seagram
will have to secure Investment Canada's approval before it can
also get the Canadian subsidiary, the movie theatre chain
Cineplex Odeon, out of the deal.
My question, which is quite simple, is the following: Can the
Prime Minister explain to us what business a minister of his
government had in Edgar Bronfman's suite, when Investment
Canada will have a very important decision to make regarding
this transaction?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, Investment Canada will review this investment
proposal like it would any other. The Minister of Canadian
Heritage is not responsible for this issue, the Minister of
Industry is, I believe.
Mr. Michel Gauthier (Roberval, BQ): Mr. Speaker, the
Minister of Canadian Heritage is a minister of the government.
Mr. Bouchard: Supposedly.
Mr. Gauthier: Yes, supposedly. So, the Minister of Canadian
Heritage, a government minister, just happens to be in a
businessman's suite at the moment that a transaction is taking
place which will require the approval of Investment Canada, an
agency over which the government has some influence.
(1425)
Does the Prime Minister not feel that the Minister of
Canadian Heritage exercised poor judgment by putting himself
in a situation of conflict?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, the Bronfman Group's investment proposal will come
before the government and will be evaluated in accordance with
the laws of the country and we will see what will happen. The
appropriate minister and commission will examine the case and
make a decision. The government will then decide whether or
not to approve the deal.
11883
Many businessmen, citizens and opposition members speak
to the minister every day, under all sorts of circumstances. That
is normal. Because, before making a decision-
Some hon. members: Oh, oh.
The Speaker: Order, please.
[English]
Mr. Chrétien (Saint-Maurice): Mr. Speaker, a decision will
be made when there is an application. I do not know if we are
faced with an application but with any investment made in
Canada from foreign interests trying to buy Canadian concerns
there is a review process. The review will be there. There will be
a decision and that is it. That is the law of the land and the law
will be respected.
Mr. Preston Manning (Calgary Southwest, Ref.): Mr.
Speaker, as has already been referred to, the Seagram company
acquired an 80 per cent interest in the movie giant MCA.
Investment Canada may be required to make a ruling as to
whether Seagram should be regarded as a Canadian company.
While all of this is going on, the Minister of Canadian Heritage
was apparently in Los Angeles being wined and dined by the
principals to the deal.
Did the Prime Minister personally know about these
meetings? Has he had the ethics commissioner determine that
the minister has not once again put himself in a conflict of
interest situation?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, the hon. member may know there is an issue here as to
whether or not Seagram is a Canadian company. If so, then the
transaction is not reviewable by Investment Canada.
I want to assure the hon. member that that determination,
which will be made according to legal principles by Investment
Canada, is done entirely without reference to the Minister of
Canadian Heritage as if that were relevant.
Mr. Preston Manning (Calgary Southwest, Ref.): Mr.
Speaker, the question was about ethics and not the regulatory
decision.
Power Corporation's DirecTv involving the Prime Minister's
son-in-law just got the government to reverse a ruling of the
CRTC for which the Minister of Canadian Heritage is
responsible. Now the Bronfmans and Seagram board member
Paul Desmarais who are closely related to the Liberal Party
appear to be seeking the minister's help to get Investment
Canada to leave them alone. We fear that the Minister of
Canadian Heritage may be ending up as some sort of errand boy
for an emerging Liberal family compact in the communications
field.
What assurances can the Prime Minister give that the
government's decisions in this rapidly developing
communications field will not only be free from political
influence but will also be free even from the appearance of
political influence?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, the marriage of convenience between the Bloc and
Reform is one formed in the gutter I must say.
Some hon. members: Oh, oh.
(1430 )
The Speaker: I know today is Thursday, not Wednesday. I
would ask hon. members to please be very judicious in their
choice of words. I would go back to the floor to the hon. Minister
of Industry.
Mr. Manley: Mr. Speaker, the process is really the assurance
that the leader is looking for. I offer him a reminder of last
Christmas when Canadians across the country told us loud and
clear that they wanted competition. We have taken moves in the
context of the DTH file to ensure that there is competition.
The member raises the issue of ethics. Surely he understands
that the best assurance that ethical principles have been lived up
to is a clear and transparent process. That is the process we
invoked. We invoked one that was open to public debate and
discussion. We have listened in a public manner to the
submissions of Canadians from coast to coast.
If he disagrees with the submissions that we heard from
hundreds of Canadians, from editorialists, from artists and from
broadcasters then let him say so, but let him not criticize it on
the basis of innuendo. It is below him.
Mr. Preston Manning (Calgary Southwest, Ref.): Mr.
Speaker, the Prime Minister will know from history books that
the Liberal Party evolved from a group of reformers in
pre-Confederation days who fought against the family compact,
a closely knit group of elites, many of them related to each other,
who subverted responsible government to protect and advance
their personal and collective interests.
If the Prime Minister is really committed to integrity, surely
he does not want to allow such a clique to develop around his
government.
My question is very simple. How does the Prime Minister
propose to prevent the formation and activities of this Liberal
family compact, la clique du château libéral, from undermining
the integrity of his administration?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, when I spoke in the House yesterday on this matter I
said I did not participate in any discussion in committee or in
cabinet. When the decision was made I was not there. I have
absolutely no conflict of interest.
It is true that somebody who is earning his living working for
the corporation in question is my son-in-law. This is why I
11884
abstained in the discussion even though it had no conflict of
interest at all. I know some people want to attack me but I have
been standing proudly in the House for 32 years. Everyone can
look at my record.
It just so happens there is a lot of controversy in Canada
because there is not enough competition. We had complaints in
December because there was an exemption to make sure there
would be no competition. My colleagues in the cabinet, without
my presence, using the laws of Canada, have made a ruling
which is clear. Everybody who wants to can apply for a licence
and it will be reviewed under Canadian law. I will not intervene.
However, I will not go down to the level of people who do not
have the decency to realize that a Prime Minister of Canada has
the right to have his daughter well married.
* * *
(1435)
[Translation]
Mrs. Suzanne Tremblay (Rimouski-Témiscouata, BQ):
Mr. Speaker, my question is for the Minister of Industry.
By issuing unprecedented decrees, the government has
reversed the CRTC's decision to license Expressvu and has
allowed Power DirecTv to use an American satellite, rather than
use a Canadian one exclusively, to broadcast its programs. The
Minister of Industry has confirmed publicly that the Prime
Minister's principal adviser, Eddie Goldenberg, intervened
directly in the matter.
How can the Minister of Industry claim to have disregarded
the financial interests at stake for the Prime Minister's
son-in-law in discussing the Power DirecTv file with Eddie
Goldenberg?
[English]
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, again the opposition is grasping at straws.
The hon. member is correct. I did confirm that I informed Mr.
Goldenberg on the status of the file. That is normal. I received
no submissions. Certainly I have never discussed the matter at
all with the Prime Minister. I can assure the House of that. Nor
did I receive, as the member describes, any pressure from Mr.
Goldenberg in any respect with regard to this file.
What I did receive were hundreds of submissions through the
review panel from Canadians from coast to coast who said:
``Please review the order that was issued in August by the
CRTC''. When the report of the panel was issued it was again
supported not only by editorialists but by many of the groups on
behalf of which the hon. member claims to speak in the House of
Commons and committee, groups like ACTRA, the Friends of
Canadian Broadcasting, the Canadian Council of the Arts.
I do not understand what her problem is. If we did not listen to
those groups she would be on her feet criticizing us for not
having done so.
[Translation]
Mrs. Suzanne Tremblay (Rimouski-Témiscouata, BQ):
Mr. Speaker, how does the Minister of Industry explain Power
DirecTv's failure to apply to the CRTC for a license, which it
could have done since last July, other than by the fact that Power
DirecTv had been assured that the government would issue a
customized order enabling it to take over Canadian airwaves
with an American satellite?
[English]
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, this is a case of the more noise, the less substance. As
the hon. member knows, the condition of the exemption order
which required that all content be carried through Canadian
satellites excluded essentially everybody but Expressvu from-
Some hon. members: Oh, oh.
Mr. Manley: They are getting louder and louder, Mr. Speaker.
It excluded potentially everybody but Expressvu from-
Some hon. members: Oh, oh.
The Speaker: Order. The hon. Minister of Industry may
finish.
Mr. Manley: The effect of the exemption order was that
essentially nobody but Expressvu could possibly have carried on
the service.
If Power DirecTv had got what I assume it wanted, the
government would have tabled a direction that would have
changed the conditions of the exemption order to authorize
Power DirecTv to operate under an exemption order. Then it
would have been able to do it right away. It did not get that from
the panel. In fact it got an obligation to apply to the CRTC for a
licence which had already set conditions that put it essentially
out of business in Canada.
The whole hypothesis of the member's question is entirely
unfounded, but is obviously inherently contradictory. She does
not understand the case.
* * *
(1440 )
Mrs. Jan Brown (Calgary Southeast, Ref.): Mr. Speaker,
my question is for the Prime Minister.
The government abused Investment Canada over the Ginn
Publishing affair and it is poised to do it again over the Seagram
acquisition. The government blamed the Tories for the Ginn
Publishing deal but it cannot blame them this time.
11885
The Minister of Canadian Heritage attended meetings in Los
Angeles with MCA and Seagram prior to this transaction being
filed officially with the securities commission or cleared by
Investment Canada.
Does the Prime Minister not understand that as a result of
these meetings the Minister of Canadian Heritage appears to be
influencing Investment Canada's decision?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, I guess this is just my day.
Again we have a false hypothesis. With respect to the issue
that is before Investment Canada at the present time, it is one
simply of fact, whether or not Seagram is a Canadian controlled
corporation. If so, then the transaction is not reviewable by
Investment Canada.
The hon. member implies by her question that somehow or
another the Minister of Canadian Heritage ought to be able to
know in advance of a visit to a facility such as MCA that a
takeover is about to be launched. If he has the ability to see in
advance, then my suggestion would be that perhaps he would
have succeeded very well as an investment counsellor.
How could he possibly have known in advance that this
transaction was to occur? It is a ridiculous question.
Mrs. Jan Brown (Calgary Southeast, Ref.): Mr. Speaker,
the insidious backroom family connections continue.
Investment Canada has confirmed that the ADM for cultural
affairs in the department of heritage is directly responsible for
the Seagram file. He also has family ties with the Bronfmans. He
is-
The Speaker: I appeal to the hon. member to put her question
now.
Mrs. Brown (Calgary Southeast): Mr. Speaker, why is the
Prime Minister allowing this sensitive issue to be handled by an
individual who is in a direct conflict of interest and whose
family stands to benefit from the decisions made?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, the Minister of Industry, who is responsible for
Investment Canada, has explained very clearly that there is a
process.
There will be an application from the buyers of this complex.
They will have to establish very clearly something that is very
easy to understand: Is this company Canadian controlled or not?
It is a matter of fact. Investment Canada will review this. If it is a
Canadian company it means the huge corporation will be
controlled by Canadian interests. I do not see anything wrong if
that is the case.
If it is not the case and it is an American concern, it will have
to follow the same route as any other foreign investment.
Therefore, it will be decided by Investment Canada. Investment
Canada will look at the books of the Seagram corporation and
decide if it is Canadian or not. It is not my decision. It is for
Investment Canada to decide.
* * *
[
Translation]
Mr. Pierre de Savoye (Portneuf, BQ): Mr. Speaker, Power
DirecTv needed an exemption order from cabinet, since the use
of its partner's American satellite violates current CRTC rules.
Moreover, because of such exemption orders, the federal
government could be liable to court action, this according to the
CRTC's secretary general.
Will the Minister of Industry recognize that, with this
made-to-measure order for Power DirecTv, the government is
allowing that company to use DirecTv's American satellite, thus
avoiding having to pay tens of millions of dollars in fees for
using the Canadian satellite?
(1445)
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, I want to say two things. First, the legal opinion which
the government received does not support CRTC's contention.
Second, the process which we undertook yesterday is of a
parliamentary nature. If the hon. member has suggestions to
make regarding the handling of this issue, we are prepared to
listen.
Mr. Pierre de Savoye (Portneuf, BQ): Mr. Speaker, we know
that legal opinions are usually debated before the courts, which
raises the following question: How can the Prime Minister, as
head of the government, accept a decision which not only
favours his son-in-law's interests but, more importantly, which
makes his government liable to court action?
[English]
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, I am sure the hon. member knows there are often
differences of opinion among lawyers. I can assure the hon.
member our view is that the government acted entirely legally
and is not subject to any civil suit for the actions it has taken in
issuing a direction in pursuance of its powers under the
Broadcasting Act.
However, I want to make clear that our objective in this, as I
have stated several times in the House on previous days, is to
create a competitive environment for direct to home satellite
services, a level playing field. We think the direction we have
tabled is the best means of achieving it.
Again, since there is a parliamentary process invoked here, if
members in either of the opposition parties think there is a better
way to do it, they may want to suggest changes to the direction.
11886
Mr. Randy White (Fraser Valley West, Ref.): Mr. Speaker,
the backroom family connections continue. Investment Canada
has confirmed the assistant deputy minister for cultural affairs
in the department of heritage is directly responsible for the
Seagram file. Surprise, surprise.
He has family ties to the Bronfmans. He is Victor
Rabinovitch, the brother of Robert Rabinovitch, who wrote the
DTH satellite directive that benefits Power Corp and who works
for the Bronfmans.
Why is the minister allowing this sensitive issue to be handled
by an individual who is in direct conflict of interest and whose
family stands to benefit from the decisions?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, let me help the hon. member to understand the process
that is being invoked here.
The public servant in question does not work either for
Investment Canada or for Industry Canada. Until it is
determined that Seagram is not a Canadian company, there is in
fact no role to be played by the Department of Canadian
Heritage in the matter.
If Seagram is a Canadian company, the transaction is not
reviewable by Investment Canada. As far as I can tell, the
consequence of that would simply be that the sequel to ``Jurassic
Park'', which I know is one of the hon. member's favourite
movies, could perhaps qualify for the Oscar for best foreign
film.
Mr. Randy White (Fraser Valley West, Ref.): Mr. Speaker, I
do not have to go very far in the House to find ``Jurassic Park''.
This morning when asked about the heritage minister's trip to
Los Angeles to meet with MCA and the Bronfmans, the ethics
counsellor admitted that he had no knowledge of the trip.
Considering the strong ties of the Bronfman family to the
Liberal Party and the decisions that lie before Investment
Canada, we have yet another problem of conflict of interest.
Why did the minister fail to consult again the ethics
counsellor on an issue that affects the integrity of the decisions
made by the government from ``Jurassic Park''?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, now I will have to inform my cabinet ministers that
when they go on trips they should ask the permission of the
ethics counsellor.
Come on, look at the facts. This Canadian company of the
Bronfman family, a great business success in Canada, has
expanded into the United States. We should not be ashamed of
that.
If it is still a Canadian company, it does not have to apply to
Investment Canada. If it has too many interests outside Canada
and has no more Canadian interests, it will have to apply.
(1450 )
There is no mystery. Why do they use innuendoes to try to
destroy the reputations of people when the process is completely
open and when we want to introduce some competition in the
communications system of Canada?
I know le désespoir of these guys on the other side of the
House. They do not have anything to say. They are trying to find
fault when there is no problem. That is why the Canadian public
is not responding to them and why they are so low in the polls.
* * *
[
Translation]
Mrs. Francine Lalonde (Mercier, BQ): Mr. Speaker, my
question is directed to the Prime Minister.
In January 1995, nearly 5,500 Quebec households applied for
welfare for the first time. More than 40 per cent of these new
applicants were young people under the age of 25. Altogether,
sadly enough, we have a record 808,000 people in Quebec, 25
per cent of whom live in Montreal, who must turn to welfare as a
last resort.
Considering that 40 per cent of new welfare recipients-
Some hon. members: Oh, oh.
Mrs. Lalonde: Mr. Speaker, the people I am talking about do
not have the same lobbying power as those who were referred to
repeatedly just now, but I would like to be heard just the same.
Some hon. members: Hear, hear.
Mrs. Lalonde: Considering that 40 per cent of new welfare
recipients were either on unemployment insurance or were
denied access to UI, would the Prime Minister agree that these
cuts in unemployment insurance totalling $5.5 billion over three
years are simply--
The Speaker: Hon. members, we should be listening to
questions and answers today.
The Prime Minister.
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, like the hon. member I too deplore this state of affairs
in Quebec. And that is why, since we came to power, we have
discussed the need for job creation, and we have had some
results. Nearly 100,000 new jobs were created in Quebec since
we formed the government, and unemployment in Quebec
dropped by 1.3 per cent over the past 18 months.
11887
Unfortunately, at a time when Quebec has the most serious
social problems in Canada and unemployment is increasing, the
Government of Quebec only thinks about independence,
separation and the Constitution. And while it does its political
fancy footwork, the poor in Quebec are paying the price. That
is what is so unfortunate. We want to talk about job creation,
while it dreams of separatism at the expense of the poor in that
province.
Some hon. members: Hear, hear.
Mrs. Francine Lalonde (Mercier, BQ): Mr. Speaker, it is
because these people are not as well connected, and because we
are convinced that only sovereignty will give Quebec a chance
to deal with the terrible scourge of unemployment.
Some hon. members: Hear, hear.
Mrs. Lalonde: Does the Prime Minister not realize that the
federal system has failed us in this respect and that the situation
will go on deteriorating under the Canada Social Transfer, which
will further reduce federal funding for welfare assistance?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, as a result of changes in unemployment insurance
benefits, 250,000 families in Quebec now receive an additional
$1,000 since the changes in the program came into force.
I am glad that we are starting to talk about these problems,
because Quebecers like me, and other Canadians as well, are
sick and tired of hearing about the Constitution and separation.
At last we are going to talk about the real problems of
Quebecers: unemployment and employment. If they would only
stop bothering us with all this talk about separation.
* * *
(1455)
[English]
Mr. Barry Campbell (St. Paul's, Lib.): Mr. Speaker, my
question is for the Minister of Public Works and Government
Services.
There is concern in the greater Toronto area about the future
of Harbourfront Centre, one of Canada's premier cultural,
entertainment and recreational facilities.
Given the financial challenges facing the centre, would the
minister provide an update on his recent discussions with
representatives of the centre and on the status of the upcoming
Today's Japan Festival?
Hon. David Dingwall (Minister of Public Works and
Government Services and Minister for the Atlantic Canada
Opportunities Agency, Lib.): Mr. Speaker, the hon. member
will know that in the past the Government of Canada has made
contributions to this important cultural and tourism facility in
the city of Toronto.
As a result of our fiscal situation and as a result of the
financial pressures the group at Harbourfront is facing, I invited
both parties to get together to see whether or not discussions
could take place to see if we could find solutions to the
problems.
Metro Toronto members of Parliament have been very helpful
in providing suggestions and directions as to the ways in which
we may proceed to find solutions to a very difficult situation.
I report to the hon. member that I am reasonably confident, as
I stand here today and negotiations proceed, we will be able to
find some common ground between ourselves and Harbourfront
to ensure the facility and, most important, the Today's Japan
Festival will be able to continue in the weeks ahead.
* * *
Mr. Ken Epp (Elk Island, Ref.): Mr. Speaker, yesterday
during question period the Prime Minister admitted that he
consulted no government officials in regard to the Power Corp.
deal.
In an interview the heritage minister indicated that there was
no reason to consult. The Prime Minister has just now repeated
again that there was no need to consult.
In view of the fact that in these affairs Liberal insiders stand
to gain millions and maybe billions of dollars, why not ask the
ethics counsellor to put the thing to rest, to have a free and open
investigation?
Right Hon. Jean Chrétien (Prime Minister, Lib.): Mr.
Speaker, the ethics counsellor told me that I am acting
absolutely properly.
Mr. Ken Epp (Elk Island, Ref.): Mr. Speaker, during the
campaign the Liberals said that they wanted to rebuild trust. We
would like them to do it.
The way to do it is to have an independent investigator make
an investigation and rule on the matter. Why does the Prime
Minister resist having the ethics counsellor apply his skills to
resolving the problem?
Hon. John Manley (Minister of Industry, Lib.): Mr.
Speaker, the member needs to understand that he is asking for an
investigation when we have in fact launched a process.
The process began yesterday with the tabling of a direction in
the House of Commons. It is a process that includes Parliament.
Parliament has the right to discuss the direction and to propose
changes.
I have yet to hear from members of the Reform Party. Is it that
they oppose competition? Is it that they oppose licensing? Is it
that they oppose that part of the revenue of DTH undertakings
11888
that should go to Canadian production? Which of those three
things is it that they oppose?
* * *
[
Translation]
Mr. Maurice Dumas (Argenteuil-Papineau, BQ): Mr.
Speaker, my question is for the Minister of Human Resources
Development.
Since last Friday, Communication-Québec, MP's offices and
even the PMO have been flooded with calls from obviously very
concerned pensioners. According to the Consumer Help Office,
approximately 258,000 pensioners will see their old age pension
cheques reduced by 50 per cent.
(1500)
How can the minister explain that so many seniors received or
will receive this year a pension cheque not including the
guaranteed income supplement to which they are entitled?
[English]
Hon. Lloyd Axworthy (Minister of Human Resources
Development and Minister of Western Economic
Diversification): Mr. Speaker, I have no idea who is behind
these unfounded rumours or where they come from, although I
have my suspicions as to who is behind them, and I may be
looking at them right now.
I would hope the hon. member would use his good offices to
assure that there will be no 50 per cent reduction in seniors'
pensions. In fact, just last month we increased them. On the
basis of the improvement in the consumer price index, we
improved seniors' pensions.
[Translation]
Mr. Maurice Dumas (Argenteuil-Papineau, BQ): Mr.
Speaker, does the minister deny that the Department of Human
Resources Development's difficulty in processing requests is
creating hardship this year, mostly among seniors?
[English]
Hon. Lloyd Axworthy (Minister of Human Resources
Development and Minister of Western Economic
Diversification): Mr. Speaker, if in some cases there have been
overpayments or problems that do not fit the regulations, of
course we will be sending out these letters. But to make the
kinds of exaggerated claims the hon. member has, purely to
frighten and scare people, is frankly not the responsibility of a
good member of Parliament.
Some hon. members: Oh, oh.
Some hon. members: Order.
The Speaker: My colleagues, today, as on other days, but
especially today, I want to draw your attention to the presence in
the gallery of a man who has brought great distinction to our
country. As a matter of fact, I would say that he gives us part of
our identity. I want to introduce to you the world renowned
Canadian photographer, Mr. Yousuf Karsh.
Some hon. members: Hear, hear.
The Speaker: This concludes question period, but I am going
to hold a short reception in my chambers, 216-N, and I would
invite you, my colleagues, to come with me and meet Mr. Yousuf
Karsh.
* * *
[
Translation]
Mr. Michel Gauthier (Roberval, BQ): Mr. Speaker, I ask the
Leader of the Government the typical question for a Thursday.
What is on the agenda of the House for the next few days?
[English]
Hon. Herb Gray (Leader of the Government in the House
of Commons and Solicitor General of Canada): Mr. Speaker,
before some members of the House go to the Speaker's reception
for Mr. Karsh I would like to present the weekly business
statement.
On Friday we will call third reading of Bill C-43, concerning
lobbyists. This will be followed by Bill C-67, the veterans bill,
and by Bill C-70, the income tax bill.
On Monday we will call the motion in my name concerning a
special joint committee on a code of conduct for
parliamentarians. If this is completed before the end of the day,
we would return to Friday's business at the point where it left
off.
(1505)
Tuesday shall be an opposition day. On Wednesday we will
take up the business at the point of progress where we left off on
Monday, followed by Bill C-41, concerning sentencing, and Bill
C-54, concerning the old age security pension.
Mr. Speaker, this is the weekly business statement.
_____________________________________________
11888
GOVERNMENT ORDERS
[
Translation]
The House resumed consideration of the motion.
11889
Mr. Bernard Patry (Pierrefonds-Dollard, Lib.): Mr.
Speaker, in 1984 the members of this House unanimously
adopted the Canada Health Act. It was a particularly
noteworthy event for two specific reasons. This legislation
guaranteed quality health services to all Canadians, regardless
of their income or their place of residence.
Furthermore, this piece of legislation was adopted
unanimously by the members of all the parties. Everyone felt a
national health insurance scheme was invaluable.
[English]
This government's commitment to universal health care
remains unshaken. The Canada Health Act and the system we
have built under its framework is a defining feature for our
society. The essence of medicare is not to be found in the
mysteries of a funding formula. It is certainly not to be found
simply in the amount of money we spend. Rather, it is to be
found in providing quality health care equally to all Canadians.
[Translation]
The five main principles underlying the Canada Health Act
are: universality, accessibility, comprehensiveness, portability
and public administration. They are rooted in values of fairness,
social justice, compassion and respect for human dignity. These
values are shared by all Canadians. They are part of our social
fabric.
Some claim that our health insurance system is too costly and
that we can no longer afford the luxury of a government funded
system. On the contrary, I believe that our health insurance
system is no luxury but a necessity and that public financing of
this system helps keep health care costs under control.
In investing in health in general and in health care services,
our government is helping to keep Canadians healthy and fit.
They will be able to meet the economic challenges of the 21st
century. Studies indicate that many days of work are lost to
illness or accident. They all reach the same conclusion: these
days lost have a negative effect on workers, society and the
economy.
[English]
A health care system that Canadians can access without fear
of financial hardship encourages people to seek medically
necessary treatment before an illness or injury becomes life
threatening or debilitating. Early diagnosis and treatment are far
less expensive than chronic care, both to the individual and to
the system. Such a system does not encourage patients to seek
inappropriate care.
For those who think in terms of the bottom line, the principles
of the Canada Health Act support an economically efficient
health care system. These are economies of scale obtained from
governments being the only buyers of medically necessary
hospital and physician health care services and of the entire
population being the customer base. A system that is publicly
administered saves this country billions of dollars annually in
administrative overhead. In hospitals and in clinics this frees up
the resources in time to practise medicine, not administration.
(1510)
Finally, medicare produces a healthy population, which in
turn means a healthy and productive labour force. This is a
reciprocal relationship between business and the health sector.
A healthy business sector means economic growth. Economic
growth means jobs. Jobs reduce unemployment, and less
unemployment means a healthier population and reduced health
costs. In other words, a healthy Canada is a wealthy Canada.
[Translation]
The fact that the Canada Health Act is both to flexible and too
rigid was also deplored. Yet, according to the Canadian
constitution, it is up to the provinces and territories to provide
and administer health care services. Consequently, the
provinces and territories must identify their own priorities and
manage their resources.
Under the act, the provinces and territories must provide the
required medical and hospital services. However, nothing
prevents them from providing other types of services. This
means that a province may pay for the costs of prescription
drugs or dental care for children, while another may finance air
ambulance services.
As long as it abides by the five basic principles underlying the
Canada Health Act, each provincial or territorial government is
free to provide additional services at its own cost, or experiment
with different structures. The basic criteria governing federal
financing under the Canada Health Act are the five principles
previously mentioned. The government is not prepared to
compromise on these principles.
[English]
The basic criteria for federal funding under the Canada Health
Act are the five principles mentioned earlier. It is these that the
government is not willing to negotiate.
The first principle is universality, meaning that all residents
of a province must be insured under the provincial health plan if
it is to receive federal support. We as Canadians believe we must
all have access to medically necessary services. People cannot
be deinsured because they might be costly for the system to
cover. They cannot be turned away at the hospital door because,
for example, they have not paid their quarterly tax bill or even
their provincial premium. Any one of us needing health care will
be treated the same as everyone else. This is what is meant by
equity.
Accessibility on uniform terms and conditions is the second
principle. We should not face any financial barriers in receiving
health care, no extra billing, no user charges, no facility fees, no
upfront cash payments. If the service is medically necessary, we
11890
will get it at the time defined by medical consideration and not
by money.
[Translation]
The principle of comprehensiveness is a recognition that
Canadians have a number of needs which must be met. It would
be unfair to insure only certain medical services. We will
continue to contend that the provinces and territories must
insure all medically necessary services.
However, comprehensiveness does not mean uniformity. It
does not mean that the provinces and territories must all meet
health care needs in exactly the same fashion. These needs must
be met, but there is some flexibility as to how this can be
achieved.
Portability means that Canadians are always covered by
medicare when they travel or move within Canada. This is what
gives our health care system its national dimension.
[English]
Canadians enjoy the freedom to work and travel anywhere in
the country, without fear of losing their health insurance
coverage. Each separate health insurance plan may be provincial
in origin but is recognized nationally in every province across
the country.
The fifth and final principle is public administration. Our
health insurance plans must be operated by provincial
governments on a non-profit basis. It is at the core of our ability
to contain costs in a system and thus to deliver quality care at an
affordable price.
Public administration is the key to ensuring all the other
principles. When health insurance is operated and funded by the
government, we can guarantee that health care is universal,
accessible, comprehensive and portable because we have direct
control over it. Public administration not only ensures that more
of our health care dollars go toward patient care but it also
makes governments more successful than the private sector in
keeping health care costs under control.
(1515)
In 1993 we spent about $72 billion on health care. This
represents 10 per cent of our gross domestic product. The public
component of that 10 per cent has been growing at less than 2 per
cent. Compare that to private health spending which has been
growing at 6.4 per cent.
[Translation]
However, complying with the provisions of the Canada Health
Act does not prevent the provinces and territories from adopting
innovative strategies to meet the challenges in providing health
care services.
For example, British Columbia has set up emergency
response teams, New Brunswick has established an extramural
hospital and Quebec has achieved excellent results with its local
community health centres. All these initiatives have solved
different problems and demonstrate how flexible the legislation
is.
The Minister of Health even recognized that private clinics
offering medically necessary services can be an effective way to
give such services, provided that the medically necessary
services are fully covered by provincial or territorial health
plans. What is totally unacceptable is, first, physicians
extra-billing for services already covered by provincial or
territorial health plans and, second, charging user fees for
medically necessary services covered by provincial or territorial
health plans.
[English]
In this era of fiscal restraint, Canadians want value for money.
We pay for our health system collectively through our taxes. We
all pay so that everyone can benefit according to need. There are
altruistic human reasons and hard economic arguments for
doing so. Whichever we support, the system works to our
benefit. This government is committed to preserving the Canada
Health Act because in spite of what its critics may say, it works.
[Translation]
For many of us, health care insurance is an essential part of
the Canadian identity. We belong to a nation where all citizens
are equal. Anyone in Canada can rely on reasonable access to
health care services, not on the basis of wealth but according to
need. Every Canadian can rest assured, now and in the future,
that he or she will not be ruined financially by a serious illness.
The Canadian health care system has no equal in the world.
Treatment priorities are set in light of medically necessary
services and not according to the patient's wealth.
The Canadian government takes very seriously its role as a
defender of universal health care. The Minister of Health has
expressed her strong opposition to facility fees, extra-billing
and any other sign of a two-tier health care system. Canadians
have entrusted their government with protecting their health
care system. As the Prime Minister has repeatedly said, this
government intends to show that it is worthy of this trust.
Mr. Philippe Paré (Louis-Hébert, BQ): Mr. Speaker, I think
there is not one Canadian or Quebecer who questions the
importance and value of the five principles set out in the Canada
Health Act. However, the greatest threat to these principles, in
my view, is the underfunding the Government of Canada has
caused these past few years by phasing out financing in these
areas.
Does the hon. member for Pierrefonds-Dollard recognize
that this seriously threatens the principles he referred to and
with which I totally agree? Reduced funding from the federal
government may well place the provinces in a situation where,
11891
while recognizing these principles as normal and necessary,
they can no longer uphold them.
(1520)
Mr. Patry: Mr. Speaker, I thank the hon. member of the Bloc
Quebecois for his question. I am very pleased to hear him say
that he came to the same conclusion as I did, in that he agrees
with the five principles I listed earlier.
There is a real problem with underfunding but it lies in the
fact that social and health programs are provincially
administered in Canada. Every province made its own choices.
It is now up to these provinces to make new choices to cut their
costs within the health system as we know it.
In certain parts of the country, provinces have allowed non-
essential services to be provided to their citizens. I think that the
ball is in the court of the provinces now.
[English]
Mr. John Williams (St. Albert, Ref.): Mr. Speaker, the hon.
member may congratulate the Bloc for endorsing the five
universal principles. However, I hope he will not congratulate
the Reform Party because we do not endorse these five
principles.
I would like to know what the hon. member is trying to do
when he acknowledges there is a serious reduction in the amount
of money being put into health care by this government. The
provinces are cutting back as they try to balance their budgets.
There is a significant reduction in the amount of cash going into
the health care system, yet the Liberals with their heads in the
sand seem to think it is business as usual. They seem to think
that health care is going to continue on as it has been,
uninterrupted without any problems while they cut back on the
cash without having any opportunities or initiatives allowing the
health care system to resolve its own problems through the
market forces or whatever.
When will the Liberals get their heads out of the sand and
recognize there is a real problem in health care that is caused by
the lack of funding? When are they going to allow this additional
funding either through taxpayers' dollars or by letting the
marketplace put some money into it?
[Translation]
Mr. Patry: I thank the hon. member of the Reform Party for
his question.
I will answer the second part of his question first. There is no
way that government will ever grant the Reform Party its wish
for a two-tier health system, with one system for the rich and
another for the poor. That is out of the question.
Extra billing and private clinics lead to a two tier system: one
for the rich and another for the poor. The government in office in
Ottawa will do no such thing because it is against its principles.
As for the first part of his question, I think that it is up to the
provinces; they can and must cut their costs, which have become
astronomical. There are certain things that must be looked at,
costs, hospitals, provinces and even physicians, and I am one
myself. Therefore, it is within the medical and social service
community that the solution should be sought, and not in terms
of the accessibility per se of the services.
[English]
Mr. Hugh Hanrahan (Edmonton-Strathcona, Ref.): Mr.
Speaker, it is my pleasure to address the issue of established
programs funding in regard to health care.
The issue of established programs funding is of great concern
to the constituents of my riding of Edmonton-Strathcona.
While Alberta is battling its debt and deficit problem without
increasing taxes, it is also doing it with less and less resources
from the federal government. Since health care is Alberta's
largest single area of government expenditure, I feel it is of the
utmost importance to debate this issue.
In 1993-94 the federal government provided transfers of
$40.5 billion to the provinces. The majority, approximately 71
per cent of these transfers, was for the established programs
financing and equalization program. Out of this $40.5 billion,
tax transfers were approximately $13 billion. It is the
established programs funding, the tax transfers which I wish to
spend most of my time discussing today. However, before we
can discuss these transfers, it is important to look briefly at the
equalization program.
(1525)
Alberta has been deemed a have province. According to a
recent study by a University of Calgary professor, it has paid in
$139 billion more than it has received since Confederation.
An hon. member: We want it back.
Mr. Hanrahan: Albertans are gracious individuals and they
have felt that being part of Canada has had its costs, but they also
feel the benefits have outweighed these costs. I agree with that
attitude, yet I also find that many Albertans are rethinking this
attitude of generosity.
Another area that has become extremely contentious,
particularly in Alberta and B.C. is the established programs
funding. This funding is an arrangement between the federal
government and the provinces relating to the funding of
post-secondary education and health care. I will try to limit my
comments solely to health care due to time limitations.
First, the Reform Party has no intention of dismantling
medicare, nor do we want to create some form of a U.S. style
11892
two-tier health care system. Instead, the Reform Party argues
that our health care system is already gravely ill as its costs are
going out of control in relation to the funding available.
Our intention is to ensure the long term viability of health care
in this country. Health care is an issue which lies at the heart of
most Canadians. It is Reform policy to ensure that no Canadian
is denied adequate health care services for financial reasons,
regardless of where they live in Canada.
Currently, provincial governments possess the legal and
constitutional responsibility to provide health insurance and
services. They do not however, possess the authority to take the
administrative steps to control medical costs and/or raise
additional revenue for health care services. Reformers believe
that this arrangement puts both the federal and provincial
governments at odds with each other, rather than allowing them
to get on with the job of providing improved quality health care
to all Canadians.
In fact, the Canadian Medical Association has argued that the
country's health insurance system will be colliding with the
economic reality in which it, the health care system, cannot be
maintained in its present form. I believe this collision has
already begun. This is apparent if we look at the federal budgets
throughout the 1990s.
We have seen virtually a non-stop series of cuts and freezes in
the federal government's transfers to the provinces. This has
pushed the federal government into a corner. It realizes that it is
risking losing control over national standards in health care
should the cash transfers to any province cease entirely.
This problem is further troubled by the fact that federal
provincial relations regarding transfers has been marked by
decisions which have nothing to do with the search for balance
or fairness in the use of our resources. I refer here to the national
energy program and the recent gas tax that hit Alberta harder
than any other province.
Miss Grey: And public utilities.
Mr. Hanrahan: Yes. It is for this reason that the Reform
members of Parliament believe the only viable solution to
safeguard our health care system from a fiscal crisis is to
redefine the Canada Health Act. It should allow the provinces to
find solutions that make the most sense for their region, through
exercise of their constitutional jurisdiction over health care. The
role of the federal government should be to provide financial
support and equalization through the taxation and transfer
system and to ensure that no Canadian is denied health care for
financial reasons.
The Reform Party advocates amending the health care act to
restore to the province the administrative jurisdiction the
federal government has expropriated through the use of its
spending powers. In other words, we will leave it in the hands of
the provinces where it belongs.
What worked yesterday does not necessarily work today.
What was taboo in the past is possibly accepted today. This
applies to the federal transfer payment system which, after
having its successes, is now coming up against its failures. Few
people would dispute that to rectify the inefficient allocation of
resources it is urgent that we put our public finances on a more
solid footing to create an economic environment that will
contribute more to efficiency and growth. However, the way to
achieve this may not be compatible with certain political, social
or provincial expectations.
(1530)
As just stated, the federal government would seem to be
feeling more and more trapped by its policy of imposing
national standards and its desire to reconsider the refinancing of
transfer payments.
We must continually remind ourselves it is the provinces and
not the federal government that have the constitutional
jurisdiction to operate the health care system. It is the provinces
and not the federal government that provide the bulk of health
care funding. It is the provinces and not the federal government
that have the greatest expertise in health care delivery.
We on the Reform side of the House have to move ourselves
away from the corner and into the forefront of health care policy
issues. The way to do this is to focus the federal government's
role on making no strings attached transfer payments to bring
adequate health care within the financial reach of all provinces
and citizens.
The provinces in consultation with patients, health care
workers and taxpayers should be left to explore new options for
greater health care efficiency without fear of being penalized by
Ottawa.
We ultimately should be transferring additional tax points
based on the notion that each province will clearly define what
its core level of basic services will be. This list can ultimately
and should differ from province to province. This would be our
version of national standards to which the federal government
could rate the provinces on their record against their core level
of services.
Not only would we like to have a clearly defined level of basic
core services but would also expect the provinces to shift more
toward a community based development philosophy of
delivering health care. This process and approach is to work
with a community to address unmet needs and issues of concern
to that specific community. It is based on the principle that the
community affected by an issue is in the best position to
articulate its needs and desires and to devise appropriate
strategies to address these needs.
11893
The core services and community based development
approach, linked with the no strings attached tax point transfer,
would ensure accessibility for everyone in a cost effective and
efficient manner. This accessibility will ultimately be redefined
to recognize that long waiting lists for essential services are
a denial of access.
Ms. Maria Minna (Beaches-Woodbine, Lib.): Mr.
Speaker, I am having some difficulty understanding the logic of
the hon. member for Edmonton-Strathcona. He is talking about
transferring tax points with no strings attached. This is
transferring more money to the provinces, giving them carte
blanche and letting them decide what their core programs would
be. Each province would decide what its core program would be
and we would have different core programs from province to
province.
He says he does not want to create a two tier program. I do not
understand how the member can say that he would have an
accessible health care system across the country where one
province's accessibility would be defined in one way and
another province differently. It is quite conceivable that in some
provinces health care would not be accessible to people who are
poor because they would have to pay certain types of
remuneration or what have you.
I do not understand what the member is actually asking.
Basically the current health care system structure has allowed
the provinces to administer their health care systems as they
wish as long as they are able to respect the five conditions. That
is not so difficult. Those are not very difficult conditions to
respect. His colleague earlier said they do not endorse the five
principles. They are pretty broad.
(1535)
I would like to know from the member exactly what kind of
medicare system the Reform Party envisions. If it sees one
different for every province with accessibility varying without
any national principles, however broad, I have some difficulty
with that. I would really like to understand where the provinces
are now hampered in the administration of the health care
system.
The Acting Speaker (Mr. Kilger): While the hon. member
for Edmonton-Strathcona is on his feet replying to the question
from the hon. member for Beaches-Woodbine I wonder if he
could refresh the memory of the Chair on whether he is splitting
his time with a colleague.
Mr. Hanrahan: Mr. Speaker, we will be splitting our time.
I thank my colleague for her question. With respect to the
distinction between provinces, she is aware that already
happens. From the investigations I have made with various
medical people they suggest there are health problems relatively
unique to certain areas, to certain provinces, to certain
communities. In those areas they should be able to direct as
much of their resources as possible. We are trying to localize it
to the people most affected.
With respect to the core area, that is something which we have
to debate as a national government, a national society, and we
have to come to some agreement as to what is universal from one
end of the country to the other. However, there are certain
aspects which do not require that.
In terms of accessibility, the essential core agreements must
be available to all regardless of income. I believe I made that
relatively clear in my speech.
Mr. John Williams (St. Albert, Ref.): Mr. Speaker, one of
the five principles Liberals keeping talking about is the publicly
funded one to the exclusion of all other input of cash into the
health care system. I want to ask the hon. member for
Edmonton-Strathcona if he feels their proposition of refusing
any other means of funding health care will preserve our health
care or should we allow other moneys into the program?
Mr. Hanrahan: Mr. Speaker, if we do not allow other moneys
into the program, if we continue the decline in financing for
medicare which has been occurring over the last number of
years, combined with increase in the interest on the debt, we will
find there will be a no tier system, not a two-tier system. There
will be no medicare for anyone.
This is an attempt to save medicare.
Mr. Speller: Do you want a three tier system?
Mr. Hanrahan: I said very clearly in my speech that is
exactly what we do not want. We want to save the basic elements
of medicare for all Canadians regardless of income.
Miss Deborah Grey (Beaver River, Ref.): Mr. Speaker, on
this business of a two-tier system, do we want it or do we not
want it, we have had it for years. Let me draw to the member's
attention that we have a two-tier health care system right now.
If my friends would like to get out their wallets or their purses
or whatever, I would refer them to their benefits card from the
public service health care plan. Mine says: ``D.C. Grey, hospital
level three''. As soon as we see other levels we ask whether this
is a two-tier health care system or a one tier system. Members
opposite shun that and talk about the fact that we could never
have a two-tier health care system. My card says level three, so
how many tiers are we looking at here?
Let me also draw to their attention that MPs pay exactly zero;
zero comes off their paycheques every month.
(1540 )
Anyone in the gallery who works for the public service or
anyone who works in our offices, anyone who is a public
servant, has the option to have a level three health care card. My
11894
staff members have those. They pay if they are single $5.32 a
month; if they are a family they pay $10.35 a month. I got that
today from our pay and benefits clerk in the comptroller's
office.
If we are to talk about two tier health and be so sanctimonious
about it, that we in the Reform Party will only have an American
system in two tier health, this is nonsense. We cannot beat
around the bush because that is fact. We pay zero for this level of
hospitalization. Public servants, people who work for us in our
offices, pay $5.32 or $10.35 a month. That is two tier or
spending differently. MPs are off the hook again; zero comes off
our paycheques for that. We have some serious problems in the
country and that is one tiny example.
We are in favour and believe every Canadian should have
access to health care regardless of their ability to pay. That is a
fact. That is important across the country. It comes down to how
we will pay for that. The country is $550 billion in the hole and
yet the health minister this morning said it is just going along
fine and we have lots of money.
Deficit spending in the late sixties and early seventies has dug
us into a hole so deep that if we do not get this thing under
control even the size of the Chamber would not hold the cash we
owe. It is rising at a rate of $1,500 per second.
For people on the government benches to say we are dreaming
on this side of the House and everything is as safe as could be
forever, that is not true.
My friends across the way know it. We cannot be eating up
interest rate payments at the rate we are paying and expect
everything and the status quo to go along as it has.
There are discrepancies in the system right now. The system
needs to be fixed. There are many tiers, many levels of health
care. Let us admit it rather than having a shade pulled over our
eyes and trying to go out to Alberta and scare the daylights out of
us and my health care minister. Do not try to frighten anybody.
Do not accuse Reformers or the Bloc of fearmongering.
We are dealing with the facts. We have serious economic
problems. We do have a two tier health system. My friend from
Winnipeg this morning, a doctor, said he was all in favour of the
Liberal plan of health care. He was specifically asked whether
he had ever in his medical practice referred one of his patients to
the Mayo Clinic. I suspect he did. I suspect there were many
times in his medical profession because I think he was an
excellent doctor who would tell someone they needed to get to
the Mayo Clinic fast. Winnipeg is plenty close to the Mayo. I bet
he referred lots of patients there.
I bet the doctor from Vancouver Centre who lives close to the
American border, in someone's best interest if they could afford
to pay, would send them down to the Mayo Clinic, California,
Seattle or wherever for health care if they could afford it. This is
happening all the time.
To say we are just fearmongering in the Reform Party, forget
that. Let us get on with solving the problem.
They also talked about our position in the campaign. That was
$150 billion ago. The national debt is now at $550 billion, $150
billion more than when a lot of greenhorns walked into this place
not even a year and a half ago. The debt and the interest on it are
chewing so quickly that if we do not get this problem under
control it will destroy the national medicare program more than
anything else.
Is there a mix of health care plans? I was really surprised as a
westerner when I first came down here to discover that even
though I in my teaching career had been paying for my Alberta
health care forever people in Ontario do not even pay for their
premiums. That sounded pretty strange to me. They do not in
Manitoba either.
Mr. Harvard: Why should we?
Miss Grey: Why should we, he says. I guess if everything is
self-financing and self-funding and the country is in great
shape, sure, let us offer freebies.
We continue to pay for health care premiums and I do not
think people mind that because they know the service they get is
absolutely terrific. Some provinces charge health care
premiums, others do not. That is the way it is.
(1545 )
Some people have private insurance to supplement their basic
coverage. That is the way it is. People who can afford to pay are
perfectly entitled to do so. In my province, some can afford to
get eye laser surgery at the Gimble clinic either in Calgary or the
new one in Edmonton. Those people say: ``I want to pay for it. I
will step out of the queue of those waiting for laser surgery,
perhaps at the University of Alberta Hospital, and I will get it
done at the Gimble clinic. I will pay my $1,200 and I will free up
a spot in a public institution for somebody who is waiting in the
line''. That is not reprehensible. That is the way it has been for a
long time.
Somebody says: ``Yes, it is reprehensible''. What about
people who live on welfare? Do we who have jobs say: ``Isn't it
dreadful about all of those on welfare''. No, we are grateful to
have a job and we will pay our taxes. We will make sure those
who are needy in our society are able to collect welfare. Surely
that is not reprehensible.
Would my friend over here quit her job right now as an MP
and not pay taxes any more because she does not think her tax
money should support welfare for the people who really need it?
11895
Of course not. Well, she is thinking on that. Those of us who pay
are blessed. We are able to pay our taxes and we want them to go
to the more needy in our society. Why should we not do it with
health care? It makes perfect sense to me.
The hon. member should not hog the line-up. She has her
place in the queue. If she is in there and says that she gets health
care because, or maybe she is demanding child care, who
knows? She is making $60,000 a year. I would say let her pay her
own babysitters. This is nothing different. If you are able to pay,
pay and step aside for someone who may be a little more needy.
Perhaps not so sanctimonious but maybe a little more needy.
We are under no illusion here. We have some serious
problems with health care. Federal cash transfers in support of
health care are projected to go down to zero in the next 10 to 15
years. This is from a government, a Liberal government.
Medicare is having its 30th birthday. It is wheezing and gasping
its last breath on its 30th birthday.
There are real problems. Funding? Sorry, the well has dried
up. Under successive Liberal governments year after year we are
deficit spent and we are really sorry but the well has run dry. The
Liberals cannot go to the Canadian public and say: ``Sorry that is
just the way it is'' yet pretend, give speeches, go on CBC and
CTV News saying: ``We have all the money we need for it''. The
minister said that today. I hope they show a clip of that on the
national news tonight. There are a lot of people, a lot of
taxpayers who know that is absolute fantasy.
It would make sense to prepare for that day. We know we have
problems. Let us prepare for that day. Let us be ready for it
rather than just saying: ``Do not touch it, do not do anything to
it''. We are in bad shape financially and we need to make sure we
move ahead and solve the problems instead of just complaining
about them.
In my province of Alberta there have been huge cuts. I want to
let the hon. members know that in 1970, 25 years ago, the whole
budget for Alberta was $1 billion for everything, not just health
care. In 1982, 12 years later, the entire budget was $12 billion.
We had some boom years in our province. With the oil boom we
went from a $1 billion budget to $12 billion in 12 years. That is a
lot of money. Imagine what happened. Hospitals sprang up all
over. We were spending two to three times per capita on each
Albertan as many other provinces were doing. Many of these
cutbacks may just be bringing us back to some of those levels.
Recently I underwent major surgery at the University of
Alberta Hospital in Edmonton. My experience there-I can only
talk for myself-is that for major surgery, for a hysterectomy, I
waited my time in line. I did not want to go to the National
Defence Centre and jump the queue. I said: ``I will go. I pay my
health care. I pay premiums in Alberta. So I will take my turn
and just go in with the regular run of the mill people''. I was
asked: ``Do you want a room of your own?. It is $40 a night''. I
thought: ``That is cheaper than the Relax Inn so sure I will book
in for it''. Little did I know because I have never been sick and
am grateful for that, my health care card, level three for which I
pay the goose egg, absolutely nothing every month, covered my
room. I was grateful for that.
The people in that hospital were professional. They were
kind, looked after me and treated me really well. I am standing
here, two months later, fully recovered and recuperated. Perhaps
I am an example that the health system works. However, let us
make sure that we do not let it get any sicker or in any worse
shape than it is already.
(1550)
Health care is worth it in this country. Regardless of the fact
that members say there are no tiers in it, let us shed some tears
for the system and make sure we make it right.
Ms. Maria Minna (Beaches-Woodbine, Lib.): Mr.
Speaker, I would first like to correct the first statement the hon.
member made with respect to the two-tier system for MPs
versus our staff.
The two tiers do not exist. Medically necessary physician or
hospital services are the same. There is no difference. One gets
the same hospital and the same doctor. The only difference is
there is a TV in the room which one can decline. The hon.
member chose the TV but she could have said no. The medical
care is not different. There is no difference between the hospital
one goes to, the doctor one gets, the services one receives or the
nurses who serve us.
I heard today from the hon. member and other colleagues
about core medical services and that core services should be
identified. I am trying to understand what the difference is
between core services and medically necessary services as
defined in the Canada Health Act. What is the real difference
between core and medically necessary? I think they are one and
the same and that we are playing with words here.
I would like the Reform members to define for me what core
services are and how it differs from what we now have in the act.
I am very proud to pay my taxes. I do not consider welfare to
be charity. I consider welfare to be the right of needy people who
have fallen on hard times.
Miss Grey: Needy people.
Ms. Minna: Absolutely. I am quite proud to pay my taxes to
help those people. I do not consider it charity which is why I am
not for workfare or any such thing. These people have a right to
be assisted by the system and the government. They have paid
taxes before and they have earned the assistance.
With respect to the Gimble clinic, laser surgery and stepping
out of line, I do not want that system. Before we know it we will
have a system where the people who can afford it will always be
stepping out of line. The best specialists can charge more money
because profit as a motive will always be working in the best
clinics. Before we know it we will end up with a two-tier system
11896
no matter how we look at it. I have seen it happen in other
jurisdictions and it will happen here. It is not necessary.
The publicly administered health care system is the most cost
effective system in the world. It saves money because the
motive is not profit, it is to deliver the best possible system to
the citizens of the province.
Those are my comments and some of my questions. I would
really like to understand what core services are to the Reform
Party as I have not quite understood that yet.
Miss Grey: Mr. Speaker, I appreciate the member's remarks.
What part of this two-tier system does the member not
understand? It just baffles me. I am usually not at a loss for
words and my friend knows that. Anybody who has ever known
me, and my family certainly knows, I am usually not stumped
for something to say, but I can hardly believe it. I can hardly
believe that someone would say we get the same hospital care
and there is no difference in it.
Somebody who says that the Gimble Eye Clinic is only for
people who can afford it should know they have been doing this
for years. People go to abortion clinics. The minister talks
regularly and incessantly about facility fees and that she will not
allow them in Alberta. What about the people going to
freestanding abortion clinics right across the country? Is that a
facility fee? Sure it is. Somebody talked earlier today about
Quebec psychoanalysts being de-insured now. This goes on and
on.
Core services and medically necessary services are things that
are absolutely essential. These could be life saving devices or a
hysterectomy, if there is cancer, all those types of things. If
someone wants to get a nose job, if it is necessary, is affecting
one's breathing, let us let the medical profession determine this.
However, if one just wants to go in and get plastic surgery, a nose
job, a face lift or whatever other lift one might want, those are
the kinds of things that the medical community is quite capable
of deciding which is core and which is not core.
(1555 )
Those procedures which are life saving are core. But it is not a
government's responsibility to sit in the House of Commons and
make those decisions. Let the medical profession do it.
There are very capable doctors on the government side as well
as over here. Let them decide and then we will support that.
Mr. Reg Alcock (Winnipeg South, Lib.): Mr. Speaker, I was
interested in the last few remarks made by the member opposite
when she said: ``Let the doctors decide. Let the physicians
decide. Let the people who are responsible for delivering the
care decide''.
That is exactly what we do. That is exactly what the Canada
Health Act does. Her proposal would put a bureaucrat in their
place. There would be a schedule or a list decided by someone
other than the physician, someone other than the person who is
providing the care. That is one reason why we do not support the
proposal that party brought forward today.
I want to step back a little bit and look at exactly what the
Reform Party is saying today. The members sat down, thought
this out and put it into their political planning that they would
have this debate today. They stood up and put forward a motion
which states:
That this House recognize that since the inception of our national health care
system the federal share of funding for health care in Canada has fallen from 50
per cent to 23 per cent and therefore the House urges the government to consult
with the provinces and other stakeholders to determine core services to be
completely funded by the federal and provincial governments and non-core
services where private insurance and the benefactors of the services might play a
supplementary role.
Some hon. members: Hear, hear.
Mr. Alcock: I am pleased that the members recognize that I
can read.
I would like to balance what members opposite talked so
strongly about, of putting greater control in the hands of the
province, against a statement made not too long ago by another
Reform member in the human resources committee. The
statement made was: ``Well, I come from a have province. We
contribute money to Confederation. Should we not be able to
dictate the kinds of services those people in the poor provinces
get?'' At the root of my feelings about this debate is what it says
about us as a country.
We made a decision a long time ago that we were going to
provide health care. We were going to see that every person no
matter where they lived in the country, no matter what their
income level, would be entitled to basic health care. We made
that decision as a country. We have followed through on that
promise.
Reform members talk so loudly about supporting the wishes
of their constituents. There is no other service government
delivers that the people value as much as their health care
system.
The Reform Party reminds me of the old story about the
doctor whose only answer to a query was: ``Take two aspirins
and call me in the morning''. On every policy issue that is
debated its members say one thing: ``We have a deficit. We do
not have the money for it so we have to cut somewhere. We have
to get out of it''. It strikes me that a party that has been around
here for a while which has some intelligent, thoughtful people in
it, could think a little harder about what they are really saying.
We spend between 4 and 4.5 per cent of the federal budget on
health care. In doing so, we buy ourselves one of the finest
health care systems in the world. This is the point of attack
11897
Reformers have chosen to solve the deficit problem. It is not
funny. It is tragic that they would attack a service that is so
valuable to so many people who have so few options.
It is fine to talk about the wealthy individual who can walk
into any place in the world and buy what he or she needs.
However we also have to think about the person who cannot do
that. It is something that has been a part of our values for all my
working life, and hopefully will be for all my life.
(1600 )
There is another aspect to this. I think we have to ask the
Reform Party to be a little more intellectually honest. In the
proposal put forward it talks about the fall from 50 per cent to 23
per cent. I suppose it is done to heighten the fears it might
engender in people or to heighten the arguments that can be
made about the role of the federal government and what the
federal government has or has not done. However, that is simply
not true. It is false information, which the party has put on the
record in order to strengthen its debate.
The fact is that the first number refers to the federal
government's share of spending on hospital and physician
services, our contribution to medicare. The second number
refers to the federal share of total health spending, things like
non-prescription drugs, cough drops, et cetera. The Reform
Party knows this, and its researchers should know this, and to
bring it forward simply discredits the debate it wishes to have.
Reform members talk about creating a list of services, which
presumably some bureaucrats in Ottawa would manage, having
consulted with doctors, and they would tell us what medical
services we could have and what medical services we could not
have.
The Reform Party has been accused on occasion of looking
south for its policy initiatives. I do not want to spend all of my
time walking through that particular model, but I would like to
note a couple of things.
I had a recent experience in the United States. I lived there for
a few years. I met a man in Los Angeles, quite a wealthy man,
who had a very serious cancer of the jaw. He received very good
medical service. Following a technique that is available here in
Canada, they replaced his jawbone with a piece of bone taken
from his thigh. It was marvellous. It was truly a wonderful piece
of work.
He walked out of that hospital and was told that was it, his
insurance was now cancelled. Despite the fact that he is wealthy
and despite the fact that he has the resources, he cannot at any
price buy service. In the system the Reform Party promotes, he
cannot buy service for the rest of his life.
I would like to give another example. This happened to my
nephew, who lives in Los Angeles. He drove to another state on a
vacation and he fell and cut the palm of his hand on a piece of
glass. He cut a tendon, so it was a little more serious than just a
cut in his hand. He was rushed to the local hospital and they
looked at it and put a compress on it and said: ``Your insurance
only covers this immediate service. To get the tendon repaired
you have to go back to a health jurisdiction that your insurance
respects''. He had to drive some 500 miles to get a fairly serious
repair. He could have lost the function of his finger.
When we talk about letting the provinces decide and when we
talk about letting individual hospitals decide, are we not talking
about a system that says that a person may not be able to get
service because the level of coverage in their province does not
cover them for all of those things? Is that not exactly the kind of
divisive force that the Reform Party promotes when it talks
about the have provinces being able to dictate the level of
services in the have not provinces? I reject that.
Frankly, in this country we have a very serious problem. We
are seeing an increasing polarization between those who are
well to do, who can take care of themselves and live a
comfortable life, and those who are not so fortunate. We are fast
building a community not unlike those we see around large
cities in the U.S., walled cities, walled communities, which have
a wall built around them to keep the bad folks out. We are
building a society that is less inclusive, less caring, less
Canadian than the one I believe in. The Reform Party needs to
consider very carefully what it is promoting when it talks about
the destruction of our health care system.
One of the discussions the Reform Party brought forward in
its motion is the idea that we would have a matrix of services or a
list of services. It is interesting that the provinces and the federal
government do not want to impose a list of services. They do not
want it because they want to do what the member for Beaver
River said in her closing remarks: they want the decisions about
care to be decided between the doctor and the person who needs
the care. The federal government believes that. It is enshrined in
the principles. The provinces also want that.
(1605)
The member who spoke just before the member for Beaver
River made a comment about universality. It is odd to me that
the Reform Party finds universality such a difficult concept to
understand. All universality means is that everyone has access.
If they do not want to have universality, as they have been
stating, despite the agreement, who are they going to exclude? If
they are not going to have universality, who then is outside of
that universal range?
Mr. Williams: Nobody.
Mr. Alcock: They cannot have it both ways. They cannot say
they are opposed to universality and they are not going to put
11898
anybody outside. That is all universality means: that we are
going to cover everybody, we are going to give everybody
access to the services.
The leader of the Reform Party made a speech on medicare not
too long ago. I would like to talk a bit about it. Perhaps the
members can get ready to jump up and down, as they do.
There was a suggestion that we might want to ask the member
for Beaver River to try to define where facelifts are free.
The leader of the Reform Party, in his speech not so long ago,
said that the real long run threat to medicare is the financial
threat caused by deficits, debts, and skyrocketing interest
payments. Skyrocketing interest payments on the national debt
eat up the federal government's ability to finance any and all
social programs, including medicare.
Miss Grey: Hear, hear.
Mr. Alcock: Mr. Speaker, I thank the hon. member for Beaver
River, once again, for giving me a standing ovation.
Take two aspirins and call me in the morning.
We have a problem so cut the deficit. That is their only
solution. Do not look at what is happening within the services
that are being provided, do not call upon the medical community
to find more efficient and more effective ways to deliver
services. Cut the deficit. Cut the funding.
The member for Beaver River called upon me to talk a bit
about the Liberal approach to this. The leader of the Reform
Party talks about cutting the deficit. In fact, total savings from
our Liberal budget will be $29 billion over the next three years.
This budget represents, by everyone's criteria, the strongest
fiscal action taken by a government, certainly since the war
years.
I was on a local radio show with a fellow by the name Peter
Warren back home, who has been on the air for 25 years. I asked
him if he had ever seen a tougher budget, and he said no.
This government is living up to its promises to be fiscally
responsible, but it is being fiscally responsible in a morally
responsible way. It is not throwing the weakest people out of the
boat. It is not saying let those folks who can afford it go off on
their own and do what they want and forget about the others. It is
saying we are all in this together, we are all part of the same
family, we are all part of the same country, and we will solve
these problems.
One of the issues the Minister of Finance talked about over
and over again was fairness, that we would do this, we would
swallow the tough medicine, we would make the tough
decisions, but we would do it fairly.
In the speech of the leader of the Reform Party he talked about
how the Prime Minister's speech contained no workable
framework or plan whatsoever for the reform of medicare.
(1610 )
I do not know where the leader has been. He has not been in
the House that much, but certainly has people who can read, who
can talk about the council, who can look at the work the minister
has been undertaking to work with the provinces, to work with
people to find solutions for what are some very difficult, very
complex issues that confront all of us.
The federal government is already engaged in discussions
with all the key players. A number of provinces, the conference
of the Ministers of Health, the federal-provincial advisory
committees, bilateral meetings with health organizations, and
consultations with Canadians through the National Forum on
Health, ensure that all parties are informed and working
together to ensure that Canadians have access to a responsive,
effective, and affordable health system.
There is another aspect to this. If the member for Beaver River
wants to talk about the cost, there is a very significant cost to
poor health. There is a very significant cost to poor children.
There is a very significant cost to unhealthy children.
The fact is that universal access means, yes, that my children
get coverage, which I can afford to pay for, but it also means that
those who cannot afford it get coverage. It means that we also
care about their public health needs. It means that kids go to
school stronger, more fit, more physically active and more ready
to learn. It also means that people are able to pursue careers. It
means that people are more able to be productive, working and
contributing to society. Good health care is a foundation of a
healthy community. To risk destroying that in the cavalier way
the Reform Party does is irresponsible.
The Reform Party has been accused at times of speaking in
code. I want to add a bit more code to the discussion. The leader
of the Reform Party said: ``Reform therefore favours the
decentralization, localization, and personalization of health
care delivery'', and to amend the Canada Health Act to provide
this kind of flexibility.
Is it not interesting that mere minutes ago, when I talked about
the problem that my nephew had in a different state trying to
access health care, the members opposite said: ``Oh no, we do
not mean that''. Then what does decentralization mean? What
does localization mean, except specific services in a specific
area? What does that do if I do not come from that area, if they
are not insured in my area?
11899
Do we really build a system where certain Canadians have
certain kinds of services and other Canadians have different
kinds of services when it comes to our health? Is that really
what we are promoting?
What does personalization mean? Does it mean user pay?
Does it mean the ability of those who can pay will pay? Does that
not just promote a greater fracturing of the community?
The Acting Speaker (Mr. Kilger): I have been somewhat
generous with the time. I have taken into consideration the
applauses and so on and so forth. I would ask the member for
Winnipeg South to summarize in the next minute and a half.
Mr. Alcock: Mr. Speaker, I appreciate your alerting me to the
time.
I would simply like to say that I want to thank the members
opposite for bringing forward this resolution. I reject its
intention absolutely and completely. I am saddened by the
position that they have taken on so vital a service to this country.
I do appreciate the opportunity they have provided me to stand
up and say how strongly I and my party support health care and
medicare in this country and reject the position taken by the
party opposite.
[Translation]
Mr. Ghislain Lebel (Chambly, BQ): Mr. Speaker, I listened
with great interest to the member's speech. His views are
diametrically opposed to those of the Reform Party.
(1615)
However, some of the issues raised by the Reform Party are
not totally erroneous. I do not agree with the hon. member when
he says that the Reform Party's views are irresponsible. I do
think that, unfortunately, our debt ratio will force us to make
some hard choices, as is already the case with the UI program,
for example.
We learned today that the number of welfare recipients in
Quebec climbed to 808,000, with a more or less corresponding
decrease in the number of UI beneficiaries. It is pretty easy to
figure out that those are UI exhaustees who have now joined the
welfare rolls. If the Liberals continue to close their eyes, as they
have a tendency to do, instead of tackling the issue of the
national debt, we will have to make even harder choices in the
future. We will have to cut our social programs, including
medicare.
This Liberal government set aside a tidy sum for things such
as the purchase, by the Department of National Defence, of four
secondhand submarines, which will of course have to be
upgraded with state-of-the-art detection systems, the very best
enemy detection systems. Given what is happening with the
frigates that have to be refitted, we can expect this government
to once again spend billions of dollars. If the government
stopped spending uselessly, it might be able to delay cutting into
social programs.
But this is not what the government does. Consequently, I do
not agree with the hon. member's comments on the Reform
Party vision. I am not a Reform member either, but I do think
that our debt ratio is dangerously high. This is the real threat for
our society and, without going as far as the Reform Party, I do
believe that the provinces, which are closer to the taxpayers, are
in the best position to assess their needs, and should therefore be
the only ones to decide which medical services to provide.
The other day, in Quebec, we had-
The Acting Speaker (Mr. Kilger): Order, please. I hesitate to
interrupt at any time, but particularly during the period of
questions and comments. When I called the question and
comment period, I noted that a number of members wanted to
ask questions of or make comments to the member for Winnipeg
South.
This is the period that permits an exchange of viewpoints
between members from both sides of the House. In noting the
number of members wishing to debate the hon. member for
Winnipeg South, I would ask the hon. member to ask his
question and conclude his remarks so that I may give the same
opportunity to others who have indicated their desire to speak. I
hope you will trust in my being as reasonable and fair all the
time.
Mr. Lebel: Mr. Speaker, I understand very clearly and I will
be quick. I would ask the member for Winnipeg South if the
solution, which would not be entirely that of the Reform Party
or, at the other extreme, the Liberal Party, if it could not be a
joint one with respect to expenditure cuts, particularly in the
area of defence, that might satisfy everyone?
The Acting Speaker (Mr. Kilger): I thank the hon. member
for Chambly for his co-operation.
[English]
Mr. Alcock: Mr. Speaker, I thank the member for his
question.
I absolutely agree with the member. All sorts of areas have to
be looked at, evaluated and tough decisions have to be made.
That is what we are doing. That is what the budget which was
tabled here not so long ago was all about. That is why people in
every constituency across the country are feeling the pinch. It is
because we have made some of the toughest fiscal decisions
made by a government, at least in the last quarter century.
The difference comes in this way. I was in a provincial
legislature that supported health reform. We said that we have to
get costs down in health care. We advocated very strongly and
the health care professionals worked very hard to do exactly
that.
11900
(1620)
Procedures which used to cause a week or 10-day stay in the
local hospital near me are now done in one night. Many are done
on an out patient basis. All sorts of reorganizations have been
undertaken in order to reduce costs, be more efficient, deliver
better service, faster and cheaper. However, we have not made
the reform of saying one person can have health care but another
cannot. That is the difference in the Reform approach and what
we are doing.
Change is a fact of life. There can always be change. There
can always be improvement. We can always do things
differently. But as Canadians we made a commitment that we
would be in this together. That is the difference.
Mr. Lee Morrison (Swift Current-Maple
Creek-Assiniboia, Ref.): Mr. Speaker, I wish the hon.
member for Winnipeg South were the minister of fisheries
because I have never seen so many red herrings dragged through
this Chamber in the brief year and one-half I have been here.
Mr. Williams: Call them turbot.
Mr. Morrison: Yes, perhaps turbot. We were supposed to be
debating the Reform Party's motion on the reform of the
Canadian health care system. We heard a dissection of the
American health care system which is totally irrelevant to the
discussion being held here today.
We heard the hon. member saying that we must have good
health, that good health is so valuable. Who is arguing? Let us
get down to basics and talk about the motion instead of dragging
in these straw men, setting them up and kicking them down.
I wish I had the hon. member's gift of eloquence but I thank
heaven I do not have his gift of logic. He will not stick to the
issue. He wants to know what local administration of health
means. I can give him a good example.
I was born and raised near Swift Current, Saskatchewan in
what was known when it was first formed 50 years ago as health
region number one. It was the first medicare system in Canada.
It was an experiment. My family helped to create it. They
worked hard for it. It was a great success and do you know why?
Because it was run by a bunch of country doctors and municipal
reeves. It did not have a giant bureaucracy leaning over its
shoulder telling people what should or should not be done. It was
a wonderful system.
When the Canadian medicare system was finally set up some
20 years later the results of that experiment were ignored. It was
thrown out the window. A massive federal bureaucracy was set
up to oversee the medicare system we had worked so hard for.
Our system was efficient, it was effective and by God it was
cheap. Nobody went without medical care. If we did not have the
specialists available in our rural area to do certain procedures,
we sent them somewhere and we paid the bills. That is what
local control means.
In this day of marvellous communications we do not have to
go that small. However surely to heaven we can put it at the
provincial level where politicians have to respond directly to the
people who elected them, where the system is run by the people
who are most directly concerned. That is what local control
means. That is anathema to the Liberals because they are the
great centralizers, the great controllers.
Mr. Alcock: Mr. Speaker, I will only take a minute to
respond.
I would urge the member to get a copy of the Canada Health
Act. There is nothing in the Canada Health Act that prevents
local involvement, local control. We have medical regions in my
province. The hospitals have boards. There are some
restrictions. The Canada Health Act states that the provinces
will pay for any service that is medically necessary. We cannot
decide in a local region to de-insure somebody for a medically
necessary service. We cannot make that decision because we as
Canadians made a decision that everybody in all parts of the
country would have access to medically necessary services.
(1625)
The member raises the spectre of a huge bureaucracy
centralized in Ottawa that makes all these decisions. Does the
member know how many people it takes to administer the
Canada Health Act? Has the member ever bothered to check the
size of this huge bureaucracy? There are 25 people who make the
decisions about the Canada Health Act.
I have nothing against local control and local involvement.
That is something we promote. We went around designing a
series of health regions with elected boards and everything else.
It was done in British Columbia and Manitoba. However, that is
very different from saying that we will have a two-tier system
where the rich get one kind of help and others do not, or that rich
provinces will have a particular kind of health care system and
poor provinces will not. We are all Canadians who want to see a
country that includes and brings everybody into the Canadian
family, not one that kicks a few out.
Mr. John Williams (St. Albert, Ref.): Mr. Speaker, I am glad
to participate in the debate on the Reform's motion on health
care today. I would like to try to put to rest some of the
misconceptions and untruths by our friends on the other side of
the House.
We have heard so much about the two-tier system. The
two-tier system has already been created.
Someone who has money can get something fixed today. He
can go south to the United States and get any medical treatment
11901
he wants. It alleviates the necessity of the Canadian taxpayer to
pay for it. It costs, but the person can have it right away.
The other is our Canadian health care system which will
deliver non-emergency services sometime down the road in
maybe a year or more. That is the health care system we have
today. It is the one which is eroding and deteriorating
significantly. It is being starved for cash by this government.
The government clings to its five universal principles that it
cannot ensure and guarantee any more. That is the two-tier
system which exists under this Liberal government and the
two-tier system we are opposed to.
Now we are in a financial crunch. The system is broke and is
falling apart. People are in desperate need of surgery and are
having to wait a long time. One per cent of Canadians are
waiting for elective surgery. This is not 1 per cent of those who
are sick. According to the Fraser Institute, today 1 per cent of
Canadians are waiting for the health care system to deliver and it
cannot.
Those who have money can go across the line and spend
money in another country. This is equivalent to importing which
is detrimental to our economy. They can buy any service they
want. Therefore, we have a two-tier system. It is not the one we
would propose or that we even like. In fact it is the one we are
totally opposed to.
However we are saying that there is a guaranteed need. The
Reform Party is absolutely committed to ensuring that all
Canadians have access to medical services and they should be
able to have it now.
Someone may want more than the basic minimum and may
want to pay for a longer hospital stay or a private nurse at their
bedside. I say be my guest, at your cost.
(1630)
There are many ways that we can resolve the problem.
However, before we talk about resolutions let us continue to
look at the problem.
I have a letter from the Sturgeon Health Unit in my riding. It is
dated September 9, 1994. It is a generic letter to its patients:
Dear Home Care Client:
As you may be aware, the increased demand for home care services has far
exceeded the available resources. There is decreasing access to acute hospital
care. Increasing numbers of people in the community need high levels of
support to compensate for disabilities.
In order to continue to provide essential, basic service to those in greatest
need, we have asked home care co-ordinators to review their caseloads and
reduce services where possible.
We recognize that assistance with homemaking enables many clients to
remain at home longer. Currently, however, homemaking will be limited to
those people who would face an immediate move without the service. This
means that families may have to provide more assistance or purchase the
service. The Home Care Program recognizes the significant contribution family
caregivers make to home care clients and regrets the increasing expectations
placed on families. It is hoped that increased funding will soon follow the
demand for community based care.
Sincerely,
Carol Sims, R.N.,BScN.
Director, Home Care
The letter says there is decreasing access to acute hospital
care. That is not Reform policy. That is not because of Reform
Party actions. That was happening in 1994 and it is happening in
1995. It is happening in the country now under the government
and it accuses us of proposing a two tier system. The letter says:
``In order to continue to provide essential, basic service to those
in greatest need, we have asked home care co-ordinators to
review their caseloads and reduce services where possible''.
Only those in serious need will be looked after. The rest will be
passed over to the families to look after because the government
does not have any money.
This is not a letter from someone who is peripheral to health
care. It is not a letter from someone being denied health care. It
is a letter from the very heart of our health care operation where
decisions are being made to deny health care services except to
those most in need.
We have a two tier health care system today. We have it in the
worst possible way. That is exactly why the Reform Party put
forward this motion which says things must change. It is not
because we simply want to change things; we recognize the
health care industry is sick and needs to be revitalized. We are
asking questions about how that should be done.
I said earlier the Liberal Party seems to be stuck with its head
in the sand on the five principles: universal, affordable,
comprehensive, publicly funded and publicly administered. The
Liberal Party says that is it, the debate is finished and there will
be no more discussion. In the meantime the government is
cutting back the money it is prepared to put into the health care
system by the billions. In the last budget the Minister of Finance
cut it back again and said: ``Provinces, it is all yours. Remember
that you must abide by our five principles that we refuse to let
you off the hook on''.
In Alberta the Minister of Finance gave a severe warning. He
said unless it stops these practices that do not meet the definition
of the five basic principles, Alberta will be cut back on its
funding.
(1635 )
We all know that every province is providing these same types
of services where doctors, hospitals and clinics are charging
additional fees. For some reason Alberta was singled out as the
big bad ogre and was told to toe the line or it would be cut back.
The Minister of Health said nothing, not a word, about the other
provinces.
11902
Alberta is wrestling with reduced budgets and less money to
resolve the problems. It is being innovative. It has reorganized
its system. I will not say I think it has resolved every problem
the best way it should but it is trying and it is doing its best
to grapple with a system with less money to ensure the services
are there for those who need it.
With respect to the two tier system in order to reduce the cost
of health care, we must introduce that dreaded word
competition. That is deemed the code word for the American
style of health care but I say there is no competition in the
United States. That is a closed shop. It may be privatized but it is
a closed shop and there is no competition.
If we are to control the cost of health care we must introduce
competition. Competition can show up in many different ways.
Competition means that we have a choice. If we have a choice
between A or B and we decide to always choose B, then A
disappears through lack of funding.
We find our health care costs are 50 per cent higher than those
in Europe. In the last few days they have made some references
in the Liberal camp to the fact that we are trying to bring health
care costs down because Europe has a wonderful system and it
only consumes 5 per cent or 6 per cent of GDP, but we are up
closer to 10 per cent of GDP. Why is that?
I was in the UK last summer. To give an anecdote, my sister
who lives over there had surgery a year ago and had to attend the
outpatient department in a large hospital. When I say a large
hospital, I mean a large hospital. It serves .5 million people.
We had to be at the outpatient department at 11.10 a.m. and
after we had been there my wife and my sister and I were to go
shopping and so on. I thought: The day will be gone before we
get out of the hospital; an appointment at 11.10, they will see us
at 1 p.m and by the time we get out of the doctor's office it is 2
p.m and it is time to go home.
I could not believe it. My sister had seen the doctor and we
were back out on the street at 11.30 a.m., 20 minutes after her
appointment time. I was amazed. How did this happen? I
investigated to find out.
Medicare is free there. What has changed since I had last seen
medicare there is the UK has introduced a couple of things. One
is internal markets and the other is called social charter.
The social charter basically says any government
organization that deals with the public in a monopolistic
environment has to publish minimum standards. These
minimum standards are not enforced on them but they have to
decide their own minimum standards and publish them.
In the outpatient department of this hospital the minimum
standard that the hospital had published was to see its patients
within 30 minutes of their appointment time. It sounds good to
me. It went a little further. It said that if the hospital cannot see
the patient within 30 minutes, fill out this card, pop it in the mail
and the hospital will not get paid for providing the service.
(1640)
All of a sudden we have accountability. Right there we have
accountability. If it cannot meet its minimum service standards
it does not get paid. Now it has a challenge to provide service.
Two out of five principles, publicly funded and publicly
administered, which the Liberal government has, totally and
absolutely fall down.
Until one provides competition there will never be service.
That is why we have to wait a year or more for surgery.
Competition ensures it looks after its patients. That is the type of
thing we are trying to start a debate about in this country, that
provided accessibility.
I talked about the concept of internal markets. Every hospital
is required to get on to a true and proper cost accounting basis,
just like business. That is all; we are not asking them to do
something impossible. We are asking them to do their
accounting by the same rules as business. Then when the
regional health units have a budget to look after their clients,
they have to spend money. Let us take something quite
expensive such as bypass surgery.
They will choose the hospital that meets and exceeds
standards, that can provide the service and also does it for a
lower fee. Now we have hospitals competing on price. That
ensures that each hospital keeps its costs down. That is how we
introduce cost savings and bring health back into the medicare
system.
Health care in the UK to the consumer is still free but the UK
has introduced internal markets, social charters and it has
competition. The health care system in the UK is costing a half
to two-thirds of what it does in this country.
The Liberals cling to the idea that only publicly administered
and publicly funded hospitalization and medicare is the way to
go as we watch it crumble before our eyes. The UK was the
pioneer of socialized medicine. Fifteen or twenty years ago it
was in the turmoil we are in today as far as trying to afford health
care services. It introduced these new ideas and has been able to
improve the service, improve the quality and ensure
competition. By allowing competition it has also allowed
private funding to come into health care.
When I say private money, is that such a dirty word? We all
say we cannot have profit in medicare. I defy anyone to find
anybody in the health care industry to say they will continue to
do what they are doing for nothing.
11903
Everybody is in for the paycheque, the profit they make on
the sale of the equipment, on the hospital they build, and so
on. That is why the other thing we have to introduce is a real
and true market. Market makes the right decisions.
We have seen it time and again. My riding is a perfect
example. Health care built a brand new hospital four or five
years ago at a capital cost of $50 million. It sat empty for a
couple of years before the operating money could be found to
open the doors. Now it has been downgraded from a hospital to a
health care unit. This is in the city of St. Albert. All these were
political decisions. They were not market decisions. We have
wasted millions and millions of dollars on these kinds of
decisions.
(1645)
Access to health care is not available today, even though
universality is talked about. The definition of universality does
not mean access because people are waiting up to a year and
sometimes longer for elective surgery.
Affordable? Yes, we want to ensure that all Canadians in any
part of the country have access to health care. That can be basic
health care. There can be a deductible charge of 5 per cent or $5
or $10 to make people think because as soon as it is free, there is
abuse.
Yes, we want to ensure that health care is available for all.
However, we totally disagree that publicly funded, publicly
administered, non-competitive, political decisions by
bureaucrats, politicians and committees are the only way to run
a health care system.
There are all kinds of situations in the private sector. From the
food we grow to the vehicles we drive and the buildings we live
in are all provided at standard or above standard by the private
sector. It is done on a competitive basis. It ensures the highest
quality and a variety of choices for the consumer.
In conclusion, I strongly endorse the Reform Party proposal. I
would like to see a national debate on health care. I would
strongly ask my Liberal colleagues to re-examine, and I have to
say it again, their heads in the sand approach to publicly funded,
publicly administered health care that has proven it does not
work.
The Acting Speaker (Mr. Kilger): We will go to questions
and comments. I would ask you to keep your questions and
comments brief so that I might recognize as many members as
possible.
Mr. Dan McTeague (Ontario, Lib.): Mr. Speaker, I am
pleased to have the opportunity to question my learned
colleague from St. Albert.
Where are these great waiting lists the member talked about?
Who are the thousands of people who have gone to the United
States in search of services? I have one of the largest ridings in
the country. I do not have these large numbers telling me about
this. On the contrary, I hear a lot of people complaining about
the provincial government and the way it administers services.
It is interesting that the hon. member used the Fraser Institute
to support some of his information. Really, that is the Pravda of
the political right in this country.
While I agree with some of the comments the hon. member
made with respect to the home care issue, I would hope he would
take the time to read the Canada Health Act. Under the Canada
Health Act our requirement is only to deal with hospital services
and MD services. If we want to talk about the home care issue,
we have to go beyond the act. Therefore, he is really speaking
out of context.
All the provinces, including Alberta where the member comes
from, support the five principles. It is interesting that the
comment has been made that the province is not in agreement
and in particular that the member is not in agreement with the
five principles. Could he tell us which part of the five principles
he or the Reform Party is prepared to abandon? I presume he is
speaking on behalf of the Reform Party since he is a member of
that party.
I also want to point out to the hon. member that when we
compare ourselves to the United States where competition and
market forces exist, 39 million people in the U.S. have
absolutely no protection and are in no position to get sick.
Another 39 million in that same jurisdiction where this great
aura of competition exists are also underinsured.
Does the position the member has taken here today really deal
with whether or not members of his party are prepared to
understand the full implication of what they are lamenting here
today? Before the hon. member answers that question, there are
some other examples which I think have to be taken into
account.
(1650 )
Dental services are not covered in Canada. Most people will
not go to a dentist to get necessary treatment because they are
concerned about the possible costs being assigned to them.
Mr. Grubel: How do you know that?
Mr. McTeague: I know that for a fact because my wife is a
dentist. That is the evidence I am prepared to support because I
am speaking from truth, unlike my hon. colleague's friends over
there.
My concern is with the hon. member. I would like-
The Acting Speaker (Mr. Kilger): Order. I hope I am not
overreacting. I know members feel very strongly about each and
every issue we debate. I think there would be unanimous
agreement in the House that the issue being debated today is of
critical interest to all Canadians and all parliamentarians here in
the House, particularly those taking part in this debate.
11904
As to the matter of truth and who has the best ownership of
truth, there is certainly no sole ownership and I will leave it
to all of us to debate. I would ask members to be very judicious
in their selection of words. Would the hon. member for Ontario
please conclude and ask his question to the hon. member.
Mr. McTeague: Mr. Speaker, I take that under advisement.
Can the hon. member tell me what he really means when he talks
about competition and its full implications on Canadians given
that we have a universal, acceptable system that is working for
the benefit of all Canadians?
Mr. Williams: Mr. Speaker, I will answer the question of
what I mean by competition.
I gave the United Kingdom example, not the United States
example, where the cost to the consumer is absolutely free. Yet
even the United Kingdom has developed internal markets where
hospitals can compete against each other in delivering price,
service and quality. These are the three fundamental elements of
service one finds when there is competition. If we eliminate
competition, we find waste, mismanagement, poor service and
declining quality. These are the things we have in our health care
system today because of lack of competition.
I said nothing about the American situation except that I did
not even consider it to be a competitive market. I used the
United Kingdom as an example. It is the cradle of social health
care systems in our western world.
The hon. member's first question was on which of the five
principles we would abandon. We would abandon the 100 per
cent publicly funded principle. We would still ensure that health
care was largely funded by the taxpayer, but we are not saying
there should be an ironclad guarantee that it has to be 100 per
cent. I believe publicly administered elimination of competition
is totally detrimental to our system.
Mr. John Harvard (Winnipeg St. James, Lib.): Mr.
Speaker, I think the member for St. Albert really does not get it
especially when he advocates competition among insurers. The
evidence is absolutely overwhelming that when there is a single
public insurer as we have in this country, that is by far the most
efficient and cost effective system. The one way we can control
costs is when we have one public single insurer.
I was watching an American doctor on CBC television last
night. Perhaps the member also saw him. His name was Dr.
Katz. He spoke about the American system with competition
among insurers which the hon. member champions. He said that
the doctors and insurers cherry pick. They are not interested in
you if you do not have money and are not wealthy. Can you
imagine a system in this country where there was competition
among insurers? Does the gentleman from St. Albert really
think if he had a long history of heart trouble, the competitive
system would be interested in him? Of course not.
The system with competition among insurers is only
interested in the healthy and the young. You talk about
privatizing the system. That is what you are talking about.
The Acting Speaker (Mr. Kilger): Order. I would like to
remind members to direct their interventions through the Chair.
Mr. Harvard: Mr. Speaker, I want to make one more point.
When we privatize the system there is no trouble in taking costs
off the public books. We could transfer $1 billion or $2 billion,
perhaps even more from the public books, that is medicare, over
to the private sector. When those costs show up in the private
sector, because of wasteful competition the cost will not then be
$1 billion or $2 billion, it will be $3 billion or $4 billion.
(1655)
The hon. member is dealing in illusion, is that not true? That
is my question.
Mr. Williams: Mr. Speaker, if the hon. member for Winnipeg
St. James does not understand how competition works, then I
would propose that he is the one who is under complete and
absolute illusion.
I will refer to the point made earlier by the member for Beaver
River in talking about health care and will use the point of the
member for Winnipeg St. James who is a government member.
Why are members of Parliament entitled to a benefit under the
public service health care plan that costs us absolutely nothing
yet all other members of the plan, be they civil servants, have to
pay $10.35 a month as family members? That is the first of this
two-tier system which is creeping in.
Not only that, the member for Ontario has told us that dental
services are not covered under health care. Why not? Why
would people not want to have dental plans if they want to have
their health plans? Because the country cannot afford it. We
must realize that there will be abuse of the system unless there is
a fee for use, however small.
I will finish on the last point the hon. member made. The
member for Winnipeg St. James may think that one single
insurer, be it the government, is the most efficient way to run a
program. I am sorry but I think he does not understand the first
simple fact about economics which realizes that competition
gives the best quality and the best service at the lowest price.
That is the point.
Mr. Ronald J. Duhamel (Parliamentary Secretary to
President of the Treasury Board, Lib.): Mr. Speaker, it seems
to me there is a certain amount of confusion in the member's
mind and I do not say that unkindly.
Would the member take the time to rapidly identify the
expectations from the federal and provincial governments in the
11905
ideal health care system he described? Many of his expectations
in his comments do not belong to the federal government,
constitutionally speaking.
Just to give a very quick example about the confusion, in the
Canada Health Act there is no prohibition on profit. There is a
section where it is not possible to have a health care system that
makes a profit. It must be operated on a non-profit basis.
My colleague seems to confuse the two in the Canada Health
Act on that particular feature. I get the impression that my
colleague is looking for a Pizza Pizza health care system. That is
what it sounds like to me. Would he care to comment?
Mr. Williams: Mr. Speaker, my comments were made in all
seriousness and had nothing to do with pizza whatsoever. I was
merely trying to make a point that competition provides the best
service and the best product at the least price.
As I said, in the United Kingdom, not the United States, the
cradle of social health care has introduced internal markets
where one health care institution competes against another. In
that way they are seeing the price come down, the service go up
and the quality remain high. At the same time the taxpayer is
getting a better deal and a better return on his investment. That is
in the United Kingdom. It has nothing to do with the United
States. It is still absolutely free to the consumer.
My point is there are many options. The hon. member asked
me how I would see the ideal system. The federal government is
retreating from funding of health care from 50 per cent down to
23 per cent and falling rapidly. Surely it should recognize that its
insignificant contribution it is now making will force the hands
of the provinces to go their own way. Therefore because it is a
provincial responsibility under the Constitution I feel they
should be making up their minds on how it should be done.
(1700)
[Translation]
The Acting Speaker (Mr. Kilger): It is my duty, pursuant to
Standing Order 38, to inform the House that the question to be
raised tonight at the time of adjournment is as follows: the hon.
member for Notre-Dame-de-Grâce-Access to Information
Act.
[English]
Mrs. Dianne Brushett (Cumberland-Colchester, Lib.):
Mr. Speaker, I will share my time with the hon. member for
Winnipeg North.
It is a great pleasure for me to participate in the debate on
health care today. There are few issues which we speak of here
which touch as many Canadians as health care. It is a central
issue to the people of my riding, as it is to all Canadians. They
appreciate the security which our health care system gives them
and they firmly believe that commitment must be continued.
As we are in a time when there are questions about the
commitment, some in the House favour steps which I believe
would move us down the road to a two tier system, one for those
with money, another for those without. Some in the House
favour the balkanization of health care with a withdrawal of
federal government from any real role in the health care field.
How much support is there really for either of these
perspectives? From what I hear from my constituents, not very
much. They support the leadership which the federal
government has taken on health care issues.
Leadership does not mean rigid centralization. In my remarks
today I want to emphasize the flexible nature of federal
co-operation in health care. More specifically, I want to talk
about the Canada Health Act. This law is not a straight-jacket on
the provinces; not now, nor has it been, nor will it be in the
future.
The Canada Health Act is a very short piece of legislation. At
its heart are five principles grounded in common values which
we hold as Canadians, values very close to the hearts of every
Canadian. They represent the essential ground rules that most
Canadians expect the provincial and territorial governments to
respect when it comes to guiding principles of the Canada
Health Act. Let me talk about each one of them and the reasons
for which every one still matters to the federal government and
to every single Canadian.
The first principle is universality. Quite simply, the federal
government provides financial support to provincial health
insurance plans, plans that cover all citizens. People cannot lose
their health insurance because they might be too costly for the
system to cover or because they may be unemployed or because
their health may be a high risk.
The second principle is accessibility. This means we should
not face any financial barriers in receiving necessary health
care: no extra billing, no user fees, no facility fees. If the service
is medically necessary it will be delivered on the basis of
medical considerations, not financial considerations.
The third principle is comprehensiveness. It recognizes
Canadians have a range of health care needs and that those needs
should be met. The Canada Health Act requires that all
medically necessary services be covered.
The fourth principle is portability. This means Canadians
should maintain their health coverage when they travel.
The fifth principle is public administration. Our health
insurance plans must be operated by a public authority
accountable to provincial governments and operated on a
non-profit basis.
11906
At various times since the act was passed in 1984 there have
been issues that have brought these principles into focus.
Between 1984 and 1987 extra billing and user charge penalties
were levied against several provinces.
(1705)
More recently, extra billing has occurred in British Columbia
and we have acted by making deductions to the transfer
payments. We now see other questions emerging, for example,
as the Government of Alberta pushes its agenda of private, for
profit health care.
These principles do not extend to dictating how provinces
should run their system or what they should cover. Since the
beginning of federal support for health care in 1957, decisions
regarding what is a medically necessary service have been up to
each of the provinces to determine. After all, they manage the
system. They have the constitutional authority. They work with
the appropriate medical experts and also pay a substantial
portion of the cost. It is not for Ottawa to say this procedure or
that procedure must or should be covered.
It is better to leave the responsibility of determining medical
necessity to the provinces and to physicians who deliver
services and are aware of the circumstances under which they
are delivered.
The Canada Health Act also leaves much to the discretion of
provinces; ensuring the services of health care professionals
other than physicians, charging for semi-private or private room
accommodations requiring prior consent for elective health
services provided out of province, and financing for a variety of
methods not including those that require point of service
charges.
Remember, the Canada Health Act does not force a province
to comply to its requirements. The provinces can accept the cash
penalties and allow the non-compliant situation to persist.
These facts alone show that any claims of rigid centralization
are simply not founded. That will continue to be the case as we
renew the health system.
The federal government and the provinces recognize the
health system has to change. Provincial authorities are trying
many different ideas in their efforts at renewal. They will
continue to experiment but as long as they adhere to the five
principles of the Canada Health Act it is unlikely there will be
any disputes.
Not one of the principles in the Canada Health Act prevents us
from looking at innovative solutions to health care issues. They
simply define the limits of the system in a way that Canadians
who rely on the system want it to continue. It is not a free for all.
Canadians believe some limits are necessary and useful to
preserve our accessible and comprehensive health care system
which is available to all Canadians.
The federal government is equally committed to finding
better ways to achieve our health goals. The most high profile
element in that approach is the National Forum on Health. This
was a red book commitment and it is a commitment that we have
met.
The forum was created to help us adapt our health care system
to the new social and economic realities of today. It will create a
vision for health in the 21st century. It is made up of 24
Canadians, health care professionals, volunteers and health care
consumers from across the country. It is chaired by our Prime
Minister, with the Minister of Health acting as vice-chair.
Canadians understand these issues, as does the forum. They
want to spark a frank and open dialogue with each citizen about
the challenges that will influence the kind of health care we will
receive in the future.
There is the impact of technology, the impact of new drugs, of
aging and emerging possibilities thanks to research and great
technological innovations. Our challenge is to deal with them in
a thorough, comprehensive and sensitive way.
We anticipate an open process of consultation that reflects the
attachment Canadians feel toward health issues and the
commitment to finding real solutions. The government believes
the National Forum on Health represents an excellent
opportunity to address the future of health of all Canadians in a
comprehensive and open way.
The forum is not going back to square one. It is working
within the principles of the Canada Health Act quite simply
because those are fundamental values that every Canadian has
asked the government to respect, to maintain and to deliver on.
(1710 )
I want to end my remarks by saying that despite the ill
informed critics, the Canada Health Act is still a valuable piece
of legislation, one that enjoys the greatest support of the public.
It is probably the greatest factor that binds Canadians together
today. It is the underpinning of a system based on universal
access to high quality, efficiently run health care. It is not a
monument and our task is to find new and efficient ways to
achieve better health goals for all Canadians.
As we undertake this process the federal government will
continue to be an important source of the funding that keeps the
system going. It will continue to be a staunch defender of the
Canada Health Act. It will still work with medical practitioners
and professionals, but we will protect the system.
The federal government intends to play the national role in
health care that Canadians have asked us to do and that
Canadians expect we will do. The Canada Health Act will be an
important and flexible part in the role of health care in the
future.
11907
Mr. Rey D. Pagtakhan (Winnipeg North, Lib.): Mr.
Speaker, I am pleased to address this motion put before us by
the hon. leader of the Reform Party:
That this House recognize that since the inception of our national health care
system the federal share of funding for health care in Canada has fallen from 50
per cent to 23 per cent and therefore the House urges the government to consult
with the provinces and other stakeholders to determine core services to be
completely funded by the federal and provincial governments and non-core
services where private insurance and the benefactors of the services might play a
supplementary role.
I hasten to say that by laying out his party's true agenda for
health care in Canada, the leader of the Reform Party has
dispelled any doubt that his party stands against medicare as we
know it today with its five principles of universality,
accessibility, comprehensiveness, portability and public
non-profit administration.
So many times in the House we have heard members opposite
insist they support medicare. What we have in this motion is the
Reform Party's advocacy for a multi-tier health system, one
standard for the rich and one standard for the poor.
His motion proposes governments get together with
stakeholders to determine core services and non-core services.
The member further proposes that only core services be
completely funded by governments, while non-core services be
left to patients who, in the Reform Party vision, should pay out
of pocket for supplementary health insurance.
The Acting Speaker (Mr. Kilger): I wonder if I could draw
the attention of the colleagues nearest the member for Winnipeg
North. A microphone very close by is also open and we
sometimes have some difficulty hearing interventions. I ask for
your co-operation.
Mr. Pagtakhan: This kind of approach by the Reform Party
of cost cutting simply will not work.
I call the attention of the member opposite to a recently
published book entitled Public Finance in Canada. It states that
increased cost sharing in government medicare plans, where the
policyholders can afford them, have great potential for reducing
health care spending. However, it adds for such plans to be
effective governments will have to ban the development of
supplementary health insurance that will turn the patient's share
of cost into a third party payment.
Simply put, increased cost sharing will have to be made
mandatory and applied to all insurance plans, public and private,
which would require increased government regulation of the
health insurance industry.
I am perplexed that the Reform Party with its penchant for
less government involvement is now calling for the very
opposite. Is this a deliberate change of policy or a lack of
understanding of the dynamics of health care financing in
Canada?
(1715 )
The Reform Party is proposing a return to user fees. One very
noted Canadian health care economist said that this is like a
zombie, not to be resurrected again. User fees deter necessary
care just as much as frivolous care. Reformers are showing signs
that they have not even read the literature.
I am proud to be a member of the Liberal Party of Canada,
which in 1919 conceived the idea for a national medicare plan. It
is a party that in government gave birth to its reality. It is a party
that when in government again nurtured and restrengthened the
national health policy with the passage of the Canada Health Act
of 1984. It is the legal centrepiece of our medical system as we
know it today and a system that bans user fees and insists on
equal access for all citizens regardless of their financial means.
The proposal by the Reform Party might not pose a problem
for those with six or seven figure incomes but for me, for my
Winnipeg North constituents and for the vast majority of
Canadians it is utterly unacceptable. Inevitably we would be left
with a system in which only the financially fit would survive.
That sort of social Darwinism is anathema to the government.
The government is not looking to make Reform Party style
compromises where the health of Canadians is at stake. Yes, this
government has acknowledged the need to contain health care
costs, which in 1991 were roughly equal to 10 per cent of the
gross domestic product.
The difference between the government approach and the
policies embraced by the party opposite is that the government
is not prepared to surrender the principles of medicare to fiscal
constraints but instead is working to balance fiscal
responsibility and the preservation of medicare.
The solution is not easy. The government believes in a more
imaginative approach than simply wielding a broad scalpel and
cutting away indiscriminately at medicare as the Reform Party
proposal would do.
Utilizing alternative modalities to achieve desired health
outcomes and substituting equally effective lower cost
treatment approaches for the traditional are parts of a strategic
approach to meaningful reform of the health care system.
For example, more patients could be managed at home on an
outpatient basis rather than in hospital. Patients could be
encouraged to see their family physicians before consulting
specialists. Medications could be used instead of surgery where
possible. Other health care professionals could substitute for
medical doctors in defined areas of treatment. Some of these
approaches may require legislation to ensure that health care
professional substitution does not compromise standards.
11908
Another means of controlling expenditures without
compromising quality of care involves eliminating costly waste
in our system. Just as certain established medical routines, such
as annual physicals and routine chest radiographs of
tuberculosis patients on follow up have been discredited as
effective and efficient health policies, other diagnostic and
therapeutic routines should be scrutinized. There could be a
greater reliance on physiotherapy and less on orthopaedic
surgery.
Physicians should not hesitate to debate the issue of human
resources supply in relation to the per capita needs of the
community nor the issue of arranging funding so that moneys
will be allocated according to patient needs and not the
provider's level of activity.
All of these elements and many more constitute an effective
health care reform strategy which would ultimately yield greater
dividends for all Canadians in contrast to the quick fix,
multi-tiered system the Reform Party proposes.
The government has positioned itself as a staunch defender of
medicare as we know it but that does not mean it is committed to
the status quo. It means that the government will continue to
explore creative and cost effective options for maintaining
health care for all Canadians in accordance with the five
principles of medicare.
That is why the government has launched the National Forum
on Health chaired by the Prime Minister. That is why the Canada
health and social transfer program is now being negotiated
between the provinces and the federal government, giving
provinces the flexibility to deliver the health care system but, at
the same time, maintaining the five principles of medicare.
Then and only then can we ensure the crown jewel of our social
programs survives and is strengthened. We can also ensure the
quality of health care for all Canadians, rich or poor.
In conclusion, I appeal to the Reform Party to withdraw its
motion rather than face the certain defeat it merits from the
majority of the House, who have been sent here by the vast
majority of Canadians to be their voice and their guardians and
to defend, preserve and strengthen medicare.
(1720 )
Mr. John Williams (St. Albert, Ref.): Mr. Speaker, I was
quite eager to note the emphasis the member for Winnipeg South
put on one of the principles of their pillars of health care,
accessibility. If I may read again from the letter from the
director of home care at the Sturgeon Health Unit, Carol Simms:
``There is decreasing access to acute hospital care''.
I would like to ask the member for Winnipeg South if this is
the type of access he wishes to guarantee where people who have
need of access to an acute care hospital cannot get it under this
system? Is that the type of access he wishes to guarantee for
Canadians?
Mr. Pagtakhan: Mr. Speaker, of course that is not the access I
would like to see happen. We recognize the problem and it must
be solved. But their treatment for the problem is wrong. That is
the difference between the Reform Party and the Liberal Party.
We must explore the means to solve the problem, not propose
a solution that will create another problem where the ultimate
result is even an greater lack of accessibility to the health care
system.
Mr. Alex Shepherd (Durham, Lib.): Mr. Speaker, I was
interested in the comments from the last exchange. The hon.
member for St. Albert mentioned his concern about home care in
his riding.
I read an interesting article the other day. It said that the
evolution of the medical practice involves more home care.
Patients are better taken care of in their home environments and
to some extent actually display better recovery rates. I wonder if
what he is looking at is not a problem but a possible positive
solution to some of the problems in health care.
Mr. Pagtakhan: Mr. Speaker, I thank the hon. member for his
comment and question. Before I entered Parliament in 1988, I
presented a paper in Australia at the International Congress on
Cystic Fibrosis. My paper was about home care treatment of
patients with cystic fibrosis, giving them intravenous
antibiotics at home. It can be done. We were able to decrease the
health care cost sixfold. At the same time, even more important,
we were able to enhance the quality of care for these patients.
I congratulate the hon. member on his insight as to the
importance of home care. We must provide the resources for
home care and not misplace our focus on a wrong approach as
the Reform Party is trying to propose.
Mr. Herb Grubel (Capilano-Howe Sound, Ref.): Mr.
Speaker, as a professional economist before coming to Ottawa I
had taken some interest in the economics of health care. In 1992,
I published two editorials on the subject in the Medical Post.
Today I would like to share the most important insights about
the problem of health care I have gained from these studies and
suggest some policy initiatives based on them. These ideas are
my own and not necessarily those of the Reform Party.
I believe the public provision of health care through the
present Canadian system is bedevilled by a fundamental
problem which is due to the absence of a deductible and of
co-insurance. This problem is amenable to relatively easy
solutions once political and ideological rhetoric is put aside.
11909
Of course, the system has other problems. There are no patent
solutions. Some of these problems involve fundamental issues
of technology, incentives, values, ethics and morality. I will not
discuss these today.
(1725)
I would like to remind everyone that the Canada Health Act
has created a gigantic system of insurance. Every Canadian
contributes premiums through general taxes. Benefits are
provided to anyone without the need to pay financial deductibles
and co-insurance. As everyone knows, our system has produced
a wonderful world in which every taxpaying Canadian is eligible
to receive free of any charge general medical care, specialized
services and hospitalization. Congratulations Canada.
In my view, one of the most important reasons for the
financial problems which undoubtedly now are haunting our
system stem from the absence of deductibles and co-insurance.
I have reached this conclusion because the absence of restraint
on demand stemming from this completely costless service has
resulted in very large increases in demand. This is not a
universally accepted proposition. Therefore, I would like to
illustrate its validity by making reference to two historic
experiments of public insurance systems that failed because of
the absence of deductibles and co-insurance.
The first involves the government automobile insurance
monopoly introduced by the NDP government in British
Columbia in 1972. It started with great fanfare, having no
deductibles at all on any repairs on cars, on the grounds that
even small scratches and dents on cars ultimately lead to more
serious problems. Therefore, it was argued it was wise to
encourage repairs of such damage at no cost since some
shortsighted owners might be discouraged from having the work
done by a deductible of $50 or $100 or whatever it might be. The
rest is history. The policy was cancelled by that same caring,
foresighted NDP government because it was simply too costly.
The second experiment involved the British government,
which in the early days of the public health scheme argued that
no one in Britain should suffer because he or she did not have the
money to pay for medication. I have heard the same arguments
here about access to health care. I wonder why the rhetoric from
members of the Liberal Party has not also extended to
medication. After all, some people are suffering because they do
not get all the medication they want just like that. They may
have to spend some money.
The universally free dispensing of medication was ended after
only a short time. Costs had become much higher than had been
anticipated by a study of demand, a study which had been
conducted under conditions when people paid for their
medication. Studies have shown that if the cost is free it is easier
to go back to the pharmacy to get medication rather than look for
it in the medicine cabinet. People ended up with huge stocks of
medication which were finally flushed down the toilet at an
extremely high cost to society.
These two examples are instructive for Canadian medicare.
The policy of having no deductibles or co-insurance in
Canadian health care was motivated by the noblest of intentions,
just like they were in the case of automobile insurance and free
medication in England.
We need to take care of the needs of the most poor in society
and we must prevent serious problems which might develop if
small ones are neglected. The two experiments were terminated
because of the universal law of demand. The price was too low
and demand became too high. I believe that what we are seeing
after 20 years of operation in Canada is exactly the same
situation. That is one of the main reasons why the Canadian
health care system is in such financial trouble.
There is a fairly straightforward solution: introduce user fees.
However, there is a strong resistance in Canada to the use of this
instrument.
(1730 )
We heard them just a few minutes ago. The arguments are the
traditional ones: care about access for those who cannot afford
it, and those who, even if they can afford it, are stupid enough to
let illnesses go and the consequences will be more costly than if
they had taken care quickly of the illness symptoms at the
beginning.
Some even argue, somewhat more sophisticatedly, that the
inconvenience of visits to physicians and the risk associated
with all medical procedures represent a strong deductible and
co-insurance. Others argue that the deterrent effect of such
measures is small and not very cost effective. This is the
position taken by my colleague at the university of British
Columbia, Bob Evans, a professor of health economics, one of
the most highly respected and best known economists in
Canada. I disagree with him.
The arguments against deductibles and co-insurance involve
empirical judgment on the way in which these incentives are
introduced. I would now like to propose and outline briefly a
scheme for the introduction of co-insurance and deductibles,
which I have published in the Medical Post. It can be
summarized quickly as follows.
Every doctor visit or treatment by a Canadian elicits a
government notification of the cost involved. One gets a little
postcard saying that your visit on such and such a day cost
society and you $30. At the end of every tax year, the value of the
medical services consumed is added as income when we file our
income tax.
Think about what this would do. The poor would have access.
Universality of access would be preserved. In the end, the poor
would not pay anything. One of the most cherished, basic,
11910
fundamental characteristics of our system would be preserved,
one I think is worth preserving. Of course, the better off who
have income tax to pay would as a result pay a share of the cost
they have incurred on society.
Now I must state something that immediately comes up
whenever I discuss this in a public forum. Of course there would
have to be a ceiling to the amount of money that individuals
would have to add to their income tax as income and on which
they pay taxes. I do not even want to venture what it is, but
maybe nobody would have to pay more than 5 per cent or 10 per
cent of their income.
One of the most important things that every health care
system must present is protection against the catastrophic
consequences of serious illnesses. That could be preserved and
will be preserved by the proposal I have just outlined.
One of the biggest problems I have is with the idea that these
incentives of people paying their own money, in a way, having a
deductible and co-insurance, would not work. Just recently I
received some information about experimentations that are
going on in the rest of the world. I would like to share these ideas
with members.
I found the following. Most health economists agree that the
primary reason why health care costs are rising is that the money
we are spending in the medical marketplace is usually someone
else's. More than a decade ago, the Rand corporation discovered
that when people are spending their own money on health care,
they spend 30 per cent less, with no adverse effect on their
health.
Now it turns out that in the United States some employers are
experimenting in putting this principle to work. Please do not be
turned off by the idea that I have just mentioned that this is
taking place in the United States.
Let me set the stage. Here are companies whose names I will
read off that have for their employees systems of health care that
are superior to that available to every Canadian. They have
health insurance from the first dollar. They have catastrophe
insurance. They are employed. They are very well taken care of.
(1735)
Here is the experiment: Forbes magazine pays each employee
$2 for every $1 medical claim they do not incur up to a
maximum of $1,000 a year. For every time they look at what it
costs to go to the doctor and they decide not to go during the
year, they can earn as much as $1,000 extra income. Forbes'
health costs fell 17 per cent in 1992 and 12 per cent in 1993.
Another example: Dominion Resources, a utility holding
company, deposits $1,620 a year into a bank account for the 80
per cent of employees who choose a $3,000 deductible rather
than a lower one. The result is the company has experienced no
premium increase since 1989, while employers face annual
increases of 13 per cent.
Another example: Golden Rule Insurance Company deposits
$2,000 a year into a medical savings account for employees who
choose a $3,000 family deductible fee. The result is in 1993, the
first year of the plan, health costs were 40 per cent lower than
they would otherwise have been.
Take the United Mine Workers, a union that is very concerned
about the welfare of its members. Last year they had a health
plan with first dollar coverage for most medical services. This
year they accepted a plan with a $1,000 deductible. In return,
each employee receives a $1,000 bonus at the beginning of the
year and employees get to keep whatever they do not spend. As a
result, the mine workers still have first dollar coverage plus all
the catastrophe insurance coverage and all that, but now the first
$1,000 they spend will be their own money rather than their
employer's money.
These plans are popular with employees. They can save
money in an amount directly related to their own effort. They are
not deterred from seeking medical care by the traditional out of
pocket deductible. They can usually use their medical savings to
buy services not covered by traditional services, and they are
usually not restricted to certain doctors, as they would be under
a managed care plan.
We have here very strong evidence that deductible
co-insurance works. It works in ways that satisfy the people
who are involved.
Let me try in my own words to explain what are the
fundamental benefits. These experiments have permitted
individual employees to feel clearly and voluntarily that under a
wide range of conditions they would have gone to the doctor if it
cost them nothing, but when faced with the true cost of the
doctor visit they preferred having the money instead.
It is important to note that under these medisave schemes that
I have just described individuals retain the benefit of full
protection against the consequences of serious illness. They are
making these choices with their own money. We have just
deleted the distortion the zero deductible and co-insurance
system has introduced into the incentives of the individual.
They are being misled by the system into believing that for them
and society the cost of going to the doctor is zero. It is not.
As we can see, individuals like it if they are given the choice,
the freedom to do so. They prefer it. And the system itself saves
money. It is an opportunity that I believe we in Canada can also
take advantage of. Of course there have to be modifications,
because we want to preserve the current system of universality
of access and all the other aspects we have just discussed.
11911
(1740)
Let me conclude by suggesting that these well documented
experiences provide strong support for the effectiveness of
introducing deductibles and co-insurance into the Canadian
health care system through the tax system I just sketched. It
could be modified and create more positive incentives by giving
every Canadian a $1,000 tax offset against which the cost of
medical services would be deducted. I think that very quickly
after such a system is introduced people would know about it
and they would pay attention to these things.
However, I believe these are details. I want to add to the
current debate over the possible reform of the health care system
the idea of using deductibles and co-insurance for routine
medical services, administered through the tax system, while
the system continues to provide universality of access and
protection against catastrophic health costs.
Let me repeat: It is possible that this scheme-which not only
I have proposed in the Medical Post editorial, but which has
been proposed by the Fraser Institute competition for the
reduction of the cost of government and has been proposed by
other doctors who wrote to me after my publication-may very
well be a way in which Canada can have all the wonderful
qualities of our system we now have and create incentives for
greater efficiency and prevent the demise of the system, which
otherwise might collapse under the threat of excessive financial
costs.
The Acting Speaker (Mr. Kilger): Questions or comments. I
just want to remind the House that at 5.46 p.m. I will suspend the
debate to move on to private members' hour.
Mr. Dan McTeague (Ontario, Lib.): Mr. Speaker, I will ask
two very direct questions to the hon. member, given that time is
limited.
The system he is proposing is a claims bonus system. In my
view, it contradicts the public health preventative care policy we
are concerned with in this country. Someone who might, for
instance, suffer a headache and does not go to a doctor or a
health care facility might otherwise wind up with an aneurism,
which of course will be more expensive to the health care
system. That is only an observation, but it connects with my
previous question.
A more important point is the one the hon. member made
concerning deductibles. I am wondering if the hon. member has
discussed this with his colleagues, including his leader, who
during the 1993 campaign cited: ``I want to make it absolutely
clear that the Reform Party is not promoting private health care,
deductibles or user fees''. I think the hon. member has to check
his facts and perhaps check with his leader. Could he please
respond to that?
Mr. Grubel: Mr. Speaker, I thank the hon. member for this
silly remark.
We are talking about something that has potential, regardless
of what my leader said a year ago. I do not care. I present this as
my personal opinion. Every time I go on a radio program or any
time I present it to a general audience, they ask why we are not
doing this. It is because of silly remarks of the sort I just heard.
Mr. McTeague: Your leader said it.
Mr. Grubel: My leader had not had the opportunity to hear
what I had to say when he made this remark. It takes time for
these ideas to spread.
I think it would be very much in the interest of Canada if
members from the other side opened their minds just a little bit.
There might be ideas out there that they have not thought of that
would do exactly the same thing they want to do, except it would
save the system at the same time.
Let me read something. Some critics claim that these medical
service accounts that have been experimented with in the United
States will encourage people to avoid preventive care. Yet
experience shows that the reverse is true.
I wonder if the member would please listen.
Medical service accounts make money available immediately
when the medical need exists. This allows people to make
purchases they might not make if they had a traditional
deductible requiring an immediate out of pocket payment.
Therefore his objection to this scheme is simply incorrect. We
would preserve exactly what we have now. It is not a traditional
deductible system.
On the other hand, it is quite clear that I am prepared to
continue to support a system which has no co-insurance and no
deductibles if ways can be found to finance it.
The Acting Speaker (Mr. Kilger): It being 5.46 p.m., it is my
duty to inform the House that pursuant to Standing Order 81,
proceedings on the motion have expired.
I have a statement concerning private members' hour for
tomorrow, Friday, April 28, 1995. I have received written notice
from the hon. member for Winnipeg Transcona that he will be
unable to move his motion during private members' hour
tomorrow.
[Translation]
As it has not been possible to arrange an exchange of positions
on the order of precedence, pursuant to Standing Order 94(2)(a),
I ask the clerk to drop this item to the bottom of the order of
precedence.
Pursuant to Standing Order 94, private members' hour will be
suspended for tomorrow, and the House will continue with
consideration of business before it at that time.
11912
[English]
The House will now proceed to the consideration of Private
Members' Business as listed on today's Order Paper.
_____________________________________________
11912
PRIVATE MEMBERS' BUSINESS
[
English]
Mr. Chuck Strahl (Fraser Valley East, Ref.) moved that Bill
C-295, an act to provide for the control of Canadian
peacekeeping activities by Parliament and to amend the
National Defence Act in consequence thereof, be read the
second time and referred to a committee.
He said: Mr. Speaker, I am very pleased today to have the
opportunity to speak to Bill C-295, which I will refer to as the
peacekeeping bill. It offers a golden opportunity for all
members to rationalize and focus Canada's peacekeeping
efforts. I am especially pleased that the House leader for the
government affirmed his intention on April 6 to treat all private
members' bills as free votes. This means that all members will
be able to make up their minds purely on the merits of this
legislative suggestion.
This is a breath of fresh air in the House. I sincerely hope
members speaking to the bill today and those voting on it later
will have taken the time to study it thoroughly. Free votes may
mean a little extra work for individual members of Parliament
but as an exercise in democracy free votes help to establish the
credibility of the House.
Bill C-295 is a good idea, worthy of all party support because
it would not cut off or even reduce Canada's peacekeeping role
in the world. Rather, it would affirm and institutionalize the role
of peacekeeping in Canada's foreign policy and strengthen
Canada's place as a leader among the United Nations.
Neither would it reduce the power of the government to make
decisions about the deployment of Canadian troops. The bill
deals strictly with peacekeeping and allows cabinet full
authority to act on a temporary basis. However, it also places the
responsibility for our long term commitments squarely where it
belongs, in the capable hands of the Canadian people through
their members in the House of Commons.
At the moment there is no legislation governing Canada's
peacekeeping effort. Legally peacekeeping is still regarded as
sort of a side show, an informal duty that Canada undertakes
almost as an afterthought. However, in reality peacekeeping has
become one of the most visible aspects of the Canadian forces.
Certainly Canada's international reputation hinges to a large and
increasing degree on its peacekeepers.
However, the only legislation that acknowledges this reality
is the National Defence Act which allows cabinet to place
Canadian soldiers on active service and pay our soldiers as if
they were at war. This is purely an administrative necessity and
it does not even address the modern questions about
peacekeeping that demand attention.
(1750 )
I quote from the defence policy review tabled last fall:
Defence policy cannot be made in private and the results simply
announced-Canadians will not accept that, nor should they. Nor should the
government commit our forces to service abroad without a full parliamentary
debate and accounting for that decision. It is our expectation that, except in
extraordinary circumstances, such a debate would always take place prior to any
such deployment.
I agree wholeheartedly with this recommendation which was
made by an all party committee of the House. I assume it should
become parliamentary policy and I note the government allotted
three hours on March 29 to debate the renewal of Canada's
commitment in the former Yugoslavia. The government has
thereby acknowledged that Parliament does have a role to play
in making these important decisions.
Unfortunately the effectiveness of that role is questionable
because the matter was not put to a vote on March 29. Although
20 members of the is House spoke to the issue that day, the input
from those MPs was not as effective as it could have been
because it was just a take note debate. The motion put before the
House was non-votable. We have no idea of the consensus of the
Canadian people. The debate was not brought to its logical
conclusion. Some people have speculated the decision was
finalized before the debate had begun.
Would it not have been better if at the end of that debate,
where the pros and cons of the peacekeeping proposal had been
discussed in this most public of forums, we had considered this
issue important enough to stand up and be counted? Canadians
deserve to know our position on this important subject. We are
ready to move past the old ways of doing things where this
House rubber stamps decisions which have been made in the
bureaucracy. Canadians want and need assurance that it is their
members of Parliament who actually make the decisions in
Ottawa.
Failure to bring a debate to its proper conclusion on such an
important topic as this results in a patchwork policy which does
not seem to make sense. Bosnia is an example. The UN has
44,300 people on the ground from 38 nations. It is the largest UN
mission ever. The operation began over three years ago and has
continued at great expense and high risk to Canadians in a
situation where neither side seems to appreciate the value of
Canadian peacekeepers.
Last July I attended the funeral of Corporal Mark Isfeld, one
of the Canadian soldiers killed by a land mine while performing
his peacekeeping duties in the former Yugoslavia. His family
and friends and all Canadians knew peacekeeping frequently
means lives are put at risk. Mark was one of nine people who
11913
have made the ultimate sacrifice in service to their country in
that war torn zone.
Our peacekeepers are honoured to represent Canada on
missions overseas and I am honoured to be represented by them.
However, it needs to be said that the mission in Bosnia has no
foreseeable end and it seems to have a diminishing hope of
success.
I refer now to a different situation. A few weeks ago a
Canadian, former Major General Lewis MacKenzie,
investigated Canada's oldest peacekeeping effort. Canada has
been in Cyprus for 30 years, since 1965. The original UN
mandate was just three months. Three full decades later the UN
is finally thinking of withdrawing, only because other nations
are starting to mutiny. Canada, of course, soldiers on.
Both of these situations tax the very idea of reasonability.
They also tax our resources and denigrate the reputation of the
United Nations. At the same time we look at a nation like
Rwanda where genocide was attempted last year, or Burundi
where unrest is threatening to boil over again into mass
slaughter, perhaps another attempt at genocide. However, the
UN sits on its hands and Canada's hands are also bound in part
because so many of its resources are committed in so many other
places in the world.
The obvious disparities between these operations show that
Canada's approach to our peacekeeping function is not rational.
We lack an orderly process by which we can sit down together
and weigh the increasing numbers of peacekeeping requests we
are receiving. We need a way of ordering our priorities to make
sound decisions about where to become involved, what to do
when we get there, how much to spend and, most important,
when to call it quits.
Major General MacKenzie made a good suggestion:
Perhaps what is required is a deadline. What if the UN were to say we will
give you a set period of time, say three years. You sort your problem out during
that period or we are out of here.
(1755 )
This is a celebrated peacekeeper saying we need a new
mechanism for dealing with Canada's peacekeeping decisions.
It certainly would have helped in the case of Cyprus. We need
guidelines and mechanisms so that all Canadians whether they
are taxpayers, men and women of the armed forces or members
of Parliament will know what we are committing ourselves to
when we go overseas.
The peacekeeping bill provides the mechanism we need. Let
me describe the basic elements. It is a very simple bill, worthy
of the support of all members of the House.
In summary it says that when Canada is approached by the
United Nations to participate in a multinational effort the
government should develop a peacekeeping plan and present it
to the House by way of a motion.
The elements of that plan are very simple: estimate the cost of
the mission, its location, its duration and its role. That is it. The
House would debate it for less than five hours. It would pass the
resolution and the mission would be in full force.
If the government had to act immediately it could do so by
joining the mission without any debate and sending as large a
contingent of troops and materiel as it needed to. A
peacekeeping mission is carefully defined in this bill as more
than 100 soldiers sent under a UN mandate for more than one
month.
This means soldiers deployed with a UN mandate would not
require legislation approval. The cabinet needs that authority
and ability. It means that fewer than 100 Canadian forces
personnel acting for more than a year would not constitute a
mission. They as well could be sent by the cabinet.
A thousand soldiers on a mission lasting less than a month,
something that we had to do quickly, would not require
parliamentary approval.
When we get into major commitments for long periods of time
Bill C-295 would come into play. Once Parliament has approved
a peacekeeping plan that plan would become the mission's
mandate. If the mandate expired the mission would
automatically be over and the troops withdrawn. If a situation
called for the mission to be extended that process is also
contained in the bill. The government would simply come back
to the House with amendments to the plan and pass a new
resolution.
This simple process in many ways mirrors a letter I received
last May from the Minister of National Defence which detailed
the criteria for Canada's peacekeeping commitments. He said
there must be an achievable mandate. The principal antagonists
must agree to UN involvement. Are the lines of authority clear?
Is the mission adequately funded? What is the risk for
peacekeepers and the rules of engagement?
Laws are simply a codification of what is necessary and
reasonable. The things the minister mentioned are both
reasonable and necessary considerations. Now it is time we
codified these requirements into a law that allows Parliament to
have significant and effective input.
I can think of important benefits to this idea. The first is
participation. Through the political process Canadians would
decide Canada's priorities, where Canada should be involved
around the world. There would be a special benefit for the
government of the day in that it could lay before Parliament a
peacekeeping plan from which it could gauge support for a
mission before we actually made the commitment in the
international arena.
11914
Also, the debate would allow all political parties to endorse
a proposal in an official way through a vote. Having endorsed
a mission a party would be reluctant later to criticize a plan it
had helped finalize.
The second benefit is preparedness and co-ordination. The
government as well as our international partners would know
beforehand exactly what Canada is prepared to do in each
situation and other nations could prepare accordingly. Our
national defence people could better prepare for a mission if
they knew its parameters in advance.
The third benefit is budgetary. By putting a cost ceiling on all
our missions we would know how much the country will allot for
peacekeeping and in these days of tightening budgets the ability
to fix our costs as much as possible ahead of time is vital.
If governments had to return to the House for more money the
political hurdle this would pose in some cases would cause the
government to be more careful about the money it spent and
committed to in the first place.
Governments need to be held accountable for the money they
spend and certainly the current government needs to recognize
that the budget for peacekeeping is like other departmental
spending plans for which they present estimates to the House.
We simply must be able to keep to the budget allocated by
Parliament.
(1800 )
Some people will argue political situations change so rapidly
that Canada cannot make firm commitments ahead of time. I
would answer that firm commitments ahead of time could in
themselves positively affect the political and military decisions
others will make.
Firm decisions will allow us to direct our circumstances and
set our own course rather than have external events lead us
around by the nose. As General MacKenzie implied, by giving
generous but firm guidelines ahead of time, we may even
influence warring factions to resolve their differences in a
timely fashion.
In any case, the bill is flexible. It allows for the government to
make corrections in midstream, to extend, for example, a
peacekeeping mandate. Having said that, all of us elected to this
House know our first duty is not to satisfy the wishes of other
nations. The government's first duty is to satisfy the Canadian
people that our foreign involvements are necessary and fiscally
prudent before running around the world putting out other
people's fires. For Canada's peacekeeping function to continue
to be legitimate in the eyes of Canadians, it must pass the test of
continuing public approval.
We also need a bill that touches on other areas of Canada's
peacekeeping function. This bill does that. It refers to the
command structure of Canadian forces and requires that our
troops be placed under the command of other Canadians. As we
know, a major complaint about the UN is the notoriously low
quality of its commanders. We feel that Canadians, especially
Canadian soldiers, will feel more secure with Canadian
commanders.
Even here we have constructed this bill to allow some
flexibility. Clause 6 states that cabinet may delegate that
command structure if it wishes to another body for periods of six
months at a time. At least cabinet would have to make a
conscious decision to place our troops under someone else's
care.
We also talk about the neutrality of our armed forces.
Neutrality is a precious commodity in this world. Once we give
our reputation away for neutrality it is very difficult to restore.
Canada is known and welcomed around the world for its
fairness, impartiality and even-handedness. We should not be
seen to be installing and deposing governments, even
non-democratic governments, at the behest of the UN. It is not
our role to take political sides in political disputes.
Our peacekeeping task, our role, our function is to enforce
ceasefire agreements and to deliver humanitarian aid, thereby
earning the respect over the long term of all sides in the dispute
rather than breaking the bounds of neutrality in a short-sighted
way and turn half of a population against us. This is a delicate
task. It can only be accomplished if our armed forces continue
our traditional neutrality in peacekeeping roles.
There has been some question about the use of deadly force in
peacekeeping situations, situations in which our peacekeepers
have felt ashamed of themselves and deeply frustrated by their
inability to protect themselves and others. My bill helps to
resolve this problem by allowing our peacekeepers to use deadly
force in self-defence, in defence of innocent civilians or to stop
serious abuses of human rights where deadly force seems to be
the only way to do it.
What is an army for? An army exists to pit force against force.
That is its only purpose. Even peacekeepers are an army that
moves physically into a dangerous area to provide a physical
check on another armed force. But we fight a different battle
than either of the antagonists. We are warriors stepping between
other warriors in a battle for peace, risking everything in our
striving to end war and deliver hope where little exists.
We cannot ask our soldiers to go into these types of situations
completely unprotected. Although we must minimize our own
use of deadly force, I feel it is justified in the situations I have
just outlined where it will clearly forestall an immediate
situation that is obviously worse. However, I acknowledge this
is a difficult area.
Let me sum up by talking about Canada's identity. Canada is a
young country. As such, its personality, if we want to call it that,
is still developing. Different nations seem to be known for
different things. When we think of Switzerland we naturally
11915
think of neutrality. Germany is an industrial giant and Sweden is
perhaps a classic welfare state.
What do people think of when they think of Canada? I would
say that other nations long ago recognized Canada's peaceable
nature, her natural co-operativeness and her concern for
stability in the world. We offered a novel idea, that there is a
third option between defeat and victory.
(1805 )
The UN requested our assistance as peacekeepers. Canada did
well and the public supported it. We have continued to respond
proudly and generously for 40 years. In doing so, we have
defined our own nature, shaped our identity and become
comfortable with our role in the international community.
We are peacekeepers. It is a role that receives applause around
the world. A peacekeeping bill would formalize this positive
definition of Canada. It would cement it in the minds and hearts
of Canadians. I can think of no more noble role than being a
peacekeeper, no higher legislative aim than to entrench this
function as a formal element of Canada's identity.
It is said that we reap what we sow. If that is true, and I think it
is, what kind of harvest do we reap, what kind of fruit grows
when peace is sown? Peaceable people co-operate more. The
food of peace is better health, prosperity, long life, happy
relations, improved working conditions. To strive for peace is to
strive for all that is necessary for humanity to thrive on this
planet.
Finally, in addition to those tangible benefits of peace, the
fruit of peace is also hope. That precious seed of hope is sown in
peace by those who make peace. I trust that all members of the
House would see fit to formalize Canada's peacekeeping
identity by voting to submit the peacekeeping bill to committee
for consideration.
Mr. Fred Mifflin (Parliamentary Secretary to Minister of
National Defence and Minister of Veterans Affairs, Lib.):
Mr. Speaker, I am pleased to speak on Bill C-295, an act to
provide for the control of Canadian peacekeeping activities by
Parliament and to amend the National Defence Act in
consequence thereof.
I have no doubt that the bill was motivated by the concern of
all members for the well-being of the Canadian forces personnel
and for a wise and sound decision making process on the part of
the government.
Unfortunately I have to say that after close study of the bill, in
my opinion it might on serious consideration make the process a
little worse than the situation that we now have in place. For that
reason I oppose it.
Before describing the details of my opposition, I have a
general observation to make that applies to much of the thinking
that emanates from our hon. colleagues on the Reform benches.
It is a tendency that I see reflected in this bill to look for
American models in matters of public policy in Canada.
This tendency skews the vision and certainly on our part. I do
not believe we can make policy on the basis of the trends and
obsessions of our American neighbours, as much as we respect
and admire them. We are not them and their examples are
foreign to our needs and purposes.
The government has gone to great lengths to ensure a made in
Canada defence policy. In fact, members of all parties were
members of the special joint committee that put together an
outstanding report. I say this not in any sense of gloating but in
modesty. Ninety-five per cent of it is reflected in the white
paper. It is a Canadian defence policy and one that reflects
Canada's needs and aspirations. I for one-I am sure I am joined
by many others-would want to keep it that way.
Bill C-295 would restrict the prerogative, the speed and the
discretion of the crown to determine Canada's contribution to
the United Nations for reasonable peace operations. Like other
military operations, peacekeeping is carried out under the
authority of the Minister of National Defence under the National
Defence Act. It provides that the minister has the management
and direction of the Canadian forces and of all matters
pertaining to national defence. The bill would remove the
responsibility and the discretion not only of the minister but also
of the government respecting military operations.
As a result, the bill would adversely affect the speed with
which the government can respond to UN requests for assistance
in peace operations as well as the timeliness with which it can
respond to changes in the peacekeeping mandate.
One of the major problems cited by many former Canadian
UN commanders is that it takes too long for the international
community to become involved in times of crisis. Most recently
Major-General Romeo Dallaires has been an eloquent and
passionate advocate of the need for speed in emergencies,
claiming that he could have saved tens of thousands of lives had
he received the troops he needed when he requested them.
Bill C-295, which would add another layer in the decision
making process, would ensure that it would take still longer for
Canada to become involved and to provide help. In an
emergency we should treat it like one and act urgently. The bill
would also create an unworkable structure for the management
of international Canadian forces operations. All potential
operations are evaluated against a series of guidelines that
include the broad political and foreign policy context, the
overall mission requirements and, of course, our own military
capability.
11916
(1810)
[Translation]
The 1994 defence white paper outlines certain key principles
intended to help the government assess the various factors to be
considered before deciding whether Canada should participate
in a mission. These guidelines are based on the peacekeeping
experience we have acquired over the last 40 years. They also
illustrate in a careful but pragmatic way the new international
world order that has followed the end of the cold war.
The white paper highlights the key principles that must guide
the design of all peacekeeping missions. These principles are as
follows: first, there must be a clear and enforceable mandate;
second, there must be an identifiable and commonly accepted
reporting authority; third, the national composition of the force
must be appropriate to the mission, and there must be an
effective process of consultation among mission partners;
fourth, in missions that involve both military and civilian
resources, there must be a recognized focus of authority, a clear
and efficient division of responsibilities, and agreed operating
procedures; finally, with the exception of enforcement actions
and operations to defend NATO member states, Canada's
participation must be accepted by all parties to the conflict.
[English]
Canada's experience also suggests that successful missions
are those that respect certain essential operation considerations.
Some were touched on by the hon. member. The size, training
and equipment of the force should be appropriate to the purpose
at hand and remain so over the life of the mission. There should
be a defined concept of operations, an effective command and
control structure and clear rules of engagement.
To look at another aspect, I believe Bill C-295 would give up
Canadian sovereign command of Canadian forces elements and
would create in its place an unworkable command and control
relationship. In this area, in particular, I have problems with the
intent of the bill.
Canadian forces personnel now serving on peace operations
are always commanded by a Canadian. Command of Canadian
forces personnel is no longer given up to allied or UN command,
as it was during the first and second world wars. Canadian units
and personnel can only be placed under the operational control,
not the operational command, of the UN or other multinational
commanders for specific tasks.
The practical difference between the two is that when
Canadian forces are deployed under operational control,
changes to the task assigned or significant changes to the area of
operation cannot be implemented. For example, the UN would
have to seek Canadian approval to deploy Canadian forces
UNPROFOR personnel to the former Yugoslav republic of
Macedonia from Croatia, should the need arise. Such approval
would not be required under operational command.
On the other hand, a non-Canadian commander who only has
operational control cannot assign separate deployment of
components of a unit. For example, the force commander of
UNPROFOR who has operational control of Canadian forces
personnel cannot unilaterally assign, for example, B company of
2-PPCLI to the British battalion. Such a deployment would
require Canadian national approval. If the commander had
operational command, there would be no requirement for such
Canadian approval.
Currently, commanders of Canadian contingents are directly
responsible to the chief of defence staff for the Canadian
contribution to the overall mission and tasks of any given
operation abroad. The subclause of Bill C-295 which calls for
the Canadian commanding officer to be placed under UN or
other international command would be contrary to current
practice and would mean less, not more national control,
something my instincts tell me is far from being the intent of the
bill.
(1815)
[Translation]
Bill C-295 would restrict Canada's capability to contribute to
the strength of a fast reaction force on standby. As the hon.
members probably know, the Minister of Foreign Affairs and
myself have launched an initiative to assess the short, medium
and long term implications of a United Nations fast reaction
force and a possible Canadian contribution to this effort in the
future.
Let us come back to Major-General Dallaire's plea for rapid
deployment to Rwanda and in response to other international
crises. Whether or not Canada participates in a given mission,
when the decision is made to participate, timeliness is often
crucial. This bill, if passed, would slow the decision-making
process down almost every time there is a crisis.
[English]
In summation, I regret I do not support Bill C-295. I know the
hon. member has put a lot of work into it and I appreciate the
comments he has made. However, under the guise of providing
greater control by the Parliament of Canada of international
peacekeeping operations, I believe it tends to confuse certain
key concepts, some of which I have alluded to. It reduces
national authority over our peacekeeping troops abroad. It
significantly restricts one of the government's prime assets, the
flexibility and ability to manoeuvre and shape our resources to
suit rapidly changing requirements in dangerous times.
[Translation]
Mrs. Maud Debien (Laval East, BQ): Mr. Speaker, I rise
today to speak to Bill C-295. This bill provides for the control of
11917
Canadian peacekeeping activities by Parliament and amends the
National Defence Act in consequence thereof.
Bill C-295 has three main objectives: first, to enhance
parliamentary control over the involvement of Canadian forces
in international peacekeeping missions; second, to limit it to a
neutral or non-combatant role; third, to control the placing of
Canadian forces under UN or other non-Canadian command.
I would like to stress at the outset that the members of the
official opposition are glad to have the opportunity to discuss
such changes to the way the Canadian forces participate in
peacekeeping missions. And we would like to thank the hon.
member for Fraser Valley East for giving us the opportunity to
express our opinion on these matters.
Much of the content of Bill C-295 is in step with the concerns
already expressed by the Bloc Quebecois, as much in the debates
in this House as in the dissenting report we submitted regarding
the Canadian foreign policy review.
I would briefly like to reiterate the Bloc Quebecois' position
on the issue being discussed today. Firstly, I would like to stress
that the official opposition believes that one of the most
important roles of the Canadian forces on the international scene
is to support peacekeeping operations and to take an active role
in them. This is one of Canada's crowning achievements which
has helped earn us our reputation.
Nevertheless, we believe that, in the future, Canada should
select more carefully the operations in which it will participate.
Recent peacekeeping missions have, as you recall, had their
difficulties, of which Canada should take note. Examples are the
missions to Rwanda and the former Yugoslavia, or even the
situation in Haiti, which reminded us of the need to ensure that
our operations serve to further legitimate democratic causes and
are meticulously planned.
(1820)
The conflicts I just cited as examples clearly show how
important it is to define, under the auspices of the United
Nations, specific objectives and mandates for each mission
beforehand. The Bloc Quebecois also recognizes that we need to
give the Canadian forces special status, in order to maintain the
credibility of our operations.
At the same time, Canada should review its current military
alliances and adapt them to strategic missions in accordance
with the needs of the United Nations. This approach would
inject new life into these organizations and would make them
more effective in protecting safety and in resolving conflicts. It
would also make it possible for Canada to meet its public
security objectives, which are crucial to its own domestic
security.
Furthermore the official opposition feels that Canada should
encourage the creation of a permanent contingent that would be
at the disposal of the UN to carry out its peacekeeping missions
abroad. The number of personnel assigned by Canada to these
peacekeeping missions should be limited. Unfortunately, Bill
C-295 is silent on this point.
Finally, as we have said many times before, for instance in our
dissenting opinion, we believe that Canada should put its
decisions to participate in peacekeeping missions to a vote in the
House of Commons, and do so as soon as possible, if there is
enough time. We are of course delighted to see some of our
suggestions reflected in the bill before the House today.
However, some sections raise a number of problems, and we
would like to suggest some improvements.
For instance, in clause 4 of Bill C-295, there seems to be no
provision for the eventuality that Canadian forces might be
asked to take part in peacekeeping operations at a time when
parliamentarians are not sitting in this House. On the other hand,
with respect to the order that would place the officer in
command of the Canadian forces under the command of the
United Nations or an international organization represented by
an officer of another state, in subclause 6(3), the bill provides
that the order would be laid before the House of Commons on
any of the first three days on which the House sits following the
day the order is made. Perhaps the same provisions could be
included in clause 4?
Furthermore, clause 4 makes no provision for renewing the
mandate given to Canadian forces. Perhaps it would be
advisable to add a provision to that effect. Still in clause 4, and
more specifically in subparagraph 4(1)(v), the Minister of
Defence is asked to specify a maximum planned expenditure for
the mission.
We realize such provisions are necessary. Canada's financial
situation demands that we act responsibly. However, instead of
immediately patriating military personnel once the expenditure
limit previously approved by the House has been exceeded, this
clause should provide for increasing, always by a resolution of
the House of Commons, the resources allocated for an operation
in exceptional cases, such as emergency humanitarian aid.
We also have some questions about the scope of subclause
5(3). This subclause mentions three circumstances in which
Canadian forces would be allowed to use deadly force. We must
ensure that Canadian military personnel take part in
peacekeeping rather than peacemaking missions. Would it not
be more prudent to make the rules specifying the circumstances
in which force may be used subject to criteria set by the UN?
Otherwise, we might have a situation where the participation of
Canadian military personnel in peacekeeping missions would be
subject to criteria that are different from those for other national
contin-
11918
gents. These questions show how important it is to specify the
scope of subclause 5(3).
As for clause 6, I have two comments. First, in clause 6(3), we
want all references to the other place deleted. As you know, the
Bloc Quebecois considers it a waste of public funds to maintain
the other house, which should be abolished as quickly as
possible.
(1825)
As our final amendment, to clause 6(4), we believe that the
renewal should be submitted to the House of Commons and not
to the Governor in Council. This amendment is in keeping with
the spirit of the bill, which attempts to involve Parliamentarians
more in decisions pertaining to peacekeeping activities.
In closing, I would once again like to thank my colleague for
Fraser Valley East for allowing us to debate this important
question. I assure him that the Bloc Quebecois supports the
principles underlying Bill C-295. For this reason, we support
the bill in second reading.
We would like the questions raised by the opposition to be
given serious consideration so improvements may be made to
the bill before its passage at third reading.
[English]
Mrs. Carolyn Parrish (Mississauga West, Lib.): Mr.
Speaker, I am pleased to have the opportunity to participate in
the debate on Bill C-295, an act to provide for the control of
Canadian peacekeeping activities by Parliament and to amend
the National Defence Act in consequence thereof.
I will take a few minutes this afternoon to talk about the
context of the bill, namely the nature of Canada's current
involvement in peacekeeping activities and the way in which we
currently manage our participation in the operations. I should
also like to look at a number of specific details in the bill and
explain why I cannot support the changes the bill proposes.
Since World War II successive Canadian governments have
argued that a safer, more secure international environment is
key to Canada's own security and prosperity. As a responsible
international participant and as a major trading nation, Canada
is concerned with the dangers of a spillover of a localized strife
and the threat it poses to the larger international community. At
the same Canadians desire a reduction or end to the widespread
human suffering in situations where there are strong indications
that outside assistance can make a difference.
To this end Canada has worked with other countries to create a
stable international environment. One of the instruments we
have used in this effort has been peacekeeping, a technique of
multilateral conflict management and resolution that has proven
exceedingly useful over the years, and at which Canada has
excelled.
Canada's contribution to peacekeeping is rooted in the belief
that a stable international order sustained by substantial
multinational consensus is the best foundation for Canada's
long term peace and security. Hence, we willingly make
available well trained and suitably equipped military personnel
for peacekeeping and related operations.
However, our commitment to peacekeeping cannot be taken
for granted. Canada carefully examines all requests for
peacekeeping assistance and turns down those it regards as
inappropriate. Our record of support is unparalleled, but that
does mean our decision to take part in such missions is
automatic. Canada has declined opportunities to participate in
the third UN Angola verification mission, the UN Aouzou Strip
observer group and the UN observer missions in Georgia and in
Liberia. In recent years Canada has also significantly reduced or
withdrawn contingents from Cyprus, Western Sahara, Somalia
and El Salvador.
Traditionally the international community has turned to
Canada for peacekeeping resources, not only because our
foreign policy has been inclined to support involvement but also
because our armed forces are flexible, multipurpose and combat
capable. Our personnel are well trained, suitably equipped and
have a very impressive track record. The world has come to
depend on Canada for peacekeeping.
Canadian participation must always be placed in a larger
international context. Our decision to join in a mission is a
unilateral one and any changes to the way we operate would also
be unilateral. However, the actual mission is always multilateral
and complex. With many partners affecting our understanding
we become team players when we join. This is an important
consideration because UN Security Council resolutions are not
always absolutely precise in specifying all the aims, duties or
roles of a mission. Decisions evolve as circumstances change.
I should like to turn now to a discussion of some specific
provisions of Bill C-295 which in my mind are not workable.
(1830 )
Clause 8 of Bill C-295 requires that once the aims of a
particular mission have been achieved the Canadian
contribution is to be terminated. The bill is not clear as to how
the UN objectives or those expressed in the resolution might be
reconciled. Yet the withdrawal of a Canadian contingent based
upon an arbitrary expiry date would have two undesirable
effects. First, the entire Canadian contribution might prove
pointless if withdrawn too early. The second and more serious
impact is that withdrawal could be counterproductive to the
mission as a whole and thereby in itself threaten peace and
security.
11919
I also question those provisions of the bill related to active
service. This bill would deem members of the Canadian forces
assigned to peacekeeping missions to be on active service for
all purposes. The bill proposes that the National Defence Act
be amended so that an officer or non-commissioned member
assigned to a mission that is subject to the proposed
peacekeeping act shall be deemed to be on active service for
all purposes.
Quite simply, this proposal is unnecessary. Pursuant to an
order in council dated April 6, 1989, all regular force members
anywhere in or beyond Canada and all reserve force members
beyond Canada are currently on active service. Moreover, all
members of the regular force have in fact been on active service
continually since 1950.
There is therefore no legal requirement for individual orders
in council placing members on active service as a consequence
of a particular peacekeeping operation. These orders in council
are simply a parliamentary convention. But convention though
they may be, the practice certainly reflects the government's
desire to consult more frequently with Parliament concerning
the general thrust of Canada's peacekeeping policy and practice.
As members well know, there have been two substantial
debates on international peacekeeping commitments since this
government came into power, the first on September 21, 1994
and the second just recently on March 29.
Bill C-295 does not adequately address the scope of UN
peacekeeping operations or chapter 7 action taken by the UN
Security Council. This is the third element of the bill with which
I have serious concerns.
The definitions and structure imposed by the bill do not
accord with international treaties and the UN charter
obligations. In trying to encompass the broad range of
operations that may be authorized or directed by a UN Security
Council resolution, the definition of a peacekeeping service in
clause 2 of the bill is very imprecise.
The Secretary General of the United Nations, Dr. Boutros
Boutros-Ghali, in his June 1992 report to the Security Council
defined four terms: preventive diplomacy, peacemaking,
peacekeeping, and peacebuilding, all of which contribute to the
maintenance of international peace and security. Each of these
UN concepts can, and most often do, entail the use of military
force. However, civilian personnel such as elections officials
and civilian police are also becoming common in UN
peacekeeping operations. The problem with Bill C-295 is that it
does not provide a clear delineation of which operations are
covered, nor does it offer any specific rationale for applying
such regulations only to Canadian forces.
I would also like to question the section dealing with the rules
of engagement. Bill C-295 creates overly simplistic legal
obligations for rules of engagement and the use of force. Rules
of engagement are always issued to armed Canadian forces
personnel participating in international operations. They often
operate under UN rules of engagement, although these are
always drafted in conjunction with the Canadian forces staff at
National Defence Headquarters as well as the Canadian
contingent commander.
In this way, UN rules of engagement reflect a distinctly
Canadian approach in structure, terminology, and interpretation
of the mandate within which the rules operate. Occasionally,
when the UN is slow to produce an acceptable set of rules of
engagement, Canadian forces will operate under Canadian rules
while permitting the UN to maintain overall control of an
international operation.
Clause 5(3) of the bill restricts the use of force to
self-defence. However, this restriction cannot, unless
specifically authorized by a UN Security Council resolution,
extend to the protection of civilians, even if they are subject to
the actual or immediate threat of deadly force or if they are
threatened with a serious abuse of human rights. All rules of
engagement must be carefully analysed, taking into account the
specifics of the mandate. That mandate could require
troop-contributing states to use force for reasons other than
those specified in the bill.
The issue of neutrality in Bill C-259 is also insupportable.
The blanket requirement in subclause 5(1) that Canadian forces
be neutral and not engage in combat is itself contradicted later in
paragraphs 5(3)(a), (b), and (c) of the bill. The authorization this
later subclause gives would violate the neutrality provisions
because force could be used to protect one civilian group against
the actions of another. There may be cases in which combat is
the only means of restoring peace. Once again, this bill, if
implemented, would restrict the flexibility of our Canadian
forces in what are often very fluid and unpredictable
circumstances.
(1835)
In conclusion, I think that the same argument could be applied
to the bill as a whole. The provisions of Bill C-259 foreclose
options and restrict the flexibility of the Government of Canada
to direct and manage the peacekeeping operations it undertakes.
I urge all members of the House to give careful consideration
to how this bill would affect the ability of our Canadian forces to
perform the tasks they have been assigned. This bill, however
well meaning in its intent, would, in my view, have a detrimental
effect on Canada's ability to undertake peace operations.
Out of respect for the admirable work that our Canadian
forces are doing on a day to day basis and with their interests in
mind, I cannot support this bill.
11920
Mr. Jim Hart (Okanagan-Similkameen-Merritt, Ref.):
Mr. Speaker, it gives me great pleasure to stand in the House
today and support Bill C-295, put forward by my colleague for
Fraser Valley East.
The part of this bill I would like to address is clause 4, dealing
with the authority of the House of Commons. As everyone in this
House knows, much to the distress of the Liberal government,
the Reform Party strongly endorses the notion that the House
must be accountable to Canadians, and not just financially
accountable. Everything we do in the House must reflect the
desires and expectations of the people. Only under the most
extreme circumstances should Parliament act without
consulting the people who elected us. This is especially true
when Canadian lives are at stake.
Last year I had the privilege of being a member of the special
joint committee reviewing Canada's defence policy. During this
year of intense research and consultation with Canadians, we
made a number of recommendations in our report, entitled
``Security in a Changing World''. This is one of the
recommendations, and I quote:
Defence policy cannot be made in private and results simply announced.
Canadians will not accept that, nor should they. Nor should the government
commit our forces to service abroad without a full parliamentary debate and
accounting for that decision. It is our expectation that, except in extraordinary
circumstances, such a debate would always take place prior to any such
deployment.
This recommendation was endorsed by all members of the
committee, including those sitting opposite today. Though there
have been eleventh hour debates on peacekeeping in the former
Yugoslavia and the government's white paper on national
defence did recognize many of the special joint committee's
recommendations, this specific recommendation was
overlooked by the minister and the government.
Currently, cabinet has the full authority to designate soldiers
to be on active service for war or for peacekeeping activities. If
Parliament is not sitting, section 32 of the National Defence Act
requires that the House reconvene 10 days after placing soldiers
on active service. Strangely, the government is not required to
hold a debate on this. The notion of accountability is
conspicuously absent. Canadians have no say in committing our
troops to life threatening circumstances.
Clause 4 of Bill C-295 provides a method for full
parliamentary review in the spirit of the special joint committee
report and holds the government accountable for all
peacekeeping commitments. Clause 4 states: ``No Canadian
forces shall serve or be committed to service in peacekeeping
service or continue in such service beyond the time or
expenditure limit previously approved by the House of
Commons, pursuant to this section, unless the Minister of
National Defence has moved in the House of Commons a
resolution'' outlining five criteria that must be debated and
passed.
This opportunity for debate is essential. Since the end of the
cold war the government has designated more troops to active
service than any time since the Korean war. While we are very
proud of our international recognition as peacekeepers and in
some cases peacemakers to the world, the missions we have
engaged in are becoming increasingly dangerous and uncertain
in purpose. Canadians should be proud of our peacekeepers,
because our troops are indeed the best in the world.
(1840)
The first criterion in the resolution authorizes the specific
mission for peacekeeping service. This is extremely important.
The House of Commons must be told exactly what the specific
mission is.
When I talk to my constituents about defence issues many ask
me what our specific mission is in hot spots such as the former
Yugoslavia. They also ask why we are still there when the troops
are fired on and held hostage by the combatants. They seem to
realize there is no will for peace in that troubled nation and
wonder exactly what we are doing to resolve the conflict.
This brings me to my second criterion. Bill C-295 would
ensure the resolution specifies the objectives, duties and role of
the mission. This is important in the new peacekeeping roles we
find ourselves in.
In the former Yugoslavia it is often unclear what objectives
we are striving for. The classic peacekeeping role of keeping
two warring factions apart from each other while they negotiate
a final peace or maintaining a ceasefire to which all parties agree
is absent in Bosnia. In a conflict such as this where all warring
sides clearly do not want peace and look at our troops as
occupiers, it is difficult to ascertain exactly what our objectives
are.
If we are to send peacekeepers into dangerous situations such
as this it is imperative Parliament pass a resolution specifying
the objectives of our troops, what objectives they will be
attempting to meet.
Canadian troops cannot be pawns in any conflict. We must
have a clear role spelled out. This is particularly important when
communications between Canada's peacekeeping forces and the
Canadian public are weak.
The third criterion of the resolution defines the state or area in
which the mission is to operate. Only Parliament should have
the authority to specify where our troops are to be committed.
The fourth criterion in the resolution specifies the date on
which the authority expires. It is essential for Parliament to
decide the exact date on which the mission ends.
11921
Some of our former commitments have seemed unending in
scope. Our service in the former Yugoslavia is on a six-month
term but other peacekeeping missions, such as our mission to
Cyprus, lasted 30 years.
Giving Parliament the authority to determine the date on
which the authority is to expire for a mission also gives
Parliament the opportunity to cancel or renew the mission.
Parliament will be able to evaluate the mission and decide
whether we have accomplished our objectives. It can also
re-evaluate the conflict and assess whether it has changed in
scope and whether we still have a role to play.
In common with the fourth criterion is the fifth. It specifies a
maximum planned expenditure for the mission. Peacekeeping
missions, like anything else the government does, must have
financial bounds. The nation does not have a bottomless purse.
We must determine what we can afford.
Clause 4 of the bill also provides for a five-hour debate on the
resolution before the question is put to the House. As with any
bill, the resolution can pass with or without amendments and it
can also be defeated.
The time for Parliament to become accountable to the
Canadian people for designating our troops on active duty is
now. We must be the ones to decide and those who represent
them in Parliament are their voice.
I strongly urge all members of the House to support Bill
C-295.
The Acting Speaker (Mr. Kilger): The time provided for the
consideration of Private Members' Business has now expired.
Pursuant to Standing Order 93, the order is dropped to the
bottom of the order of precedence on the Order Paper.
_____________________________________________
11921
ADJOURNMENT PROCEEDINGS
[
English]
A motion to adjourn the House under Standing Order 38
deemed to have been moved.
Hon. Warren Allmand (Notre-Dame-de-Grâce, Lib.): Mr.
Speaker, on March 13, I asked the Minister of Justice if he would
order a full review of the Access to Information Act as
recommended by the information commissioner in his 10th
anniversary report. In response, the Minister of Justice said that
he was considering such a review and hoped to come forward
with reforms in due course.
(1845)
In 1986-87 I was a member of the justice committee which
made an extensive review of this act. It issued a report entitled:
``Open and Shut'' which made 87 recommendations for
amendment. Unfortunately, none of those recommendations
were implemented by the former Conservative government.
Recently the information commissioner made similar
recommendations in three documents entitled: ``The Access to
Information Act: 10 Years On''; ``The Access to Information
Act: A Critical Review''; and ``Information Technology and
Open Government''.
The basic principle of this act is that Canadians should have
the right to information about their government and to
information compiled and held by the government. Of course,
this is information paid for with taxpayers' money.
For years prior to the Access to Information Act the
government's general policy was to say no whenever
information was requested and only to say yes by exception. The
purpose of the Access to Information Act was of course to
reverse this process. There would be exceptions, of course, for
national security, for privacy and for cabinet confidence, but the
general rule was to make information available.
The ``Open and Shut'' report concluded that the act had major
shortcomings and weaknesses which should be corrected. As I
said, the committee made 87 recommendations to do that.
Among those recommendations were first, that all
government institutions, including much of our parliamentary
process, be included under the act.
Second, it was recommended that all crown corporations
except the CBC be included under the act. These institutions are
not included under the act at the present time.
Third, it was recommended that all persons in Canada, not just
citizens and residents, have access to the act.
Fourth, it was recommended to entrench the status of the
information co-ordinators who are present in every department
to facilitate the operation of the act and to give those
co-ordinators senior rank in the departments.
Fifth, there were several recommendations with respect to the
exemptions. We said that the exemptions should be subject to a
significant injury test. We also recommended narrowing certain
exemptions.
With respect to the cabinet confidence exemption we said that
it should be covered under the act, but subject to a class tested
discretionary exemption. In other words, cabinet confidences
would not automatically be outside the scope of the act.
We also said that the information commissioner should have
the power to issue certain binding orders in some cases,
although generally he would still act by recommendation only.
We made recommendations that the social insurance number be
restricted in its use by outside agencies.
11922
We recommended that the time for answering information
requests be reduced from 30 to 20 days. We also recommended
that there be legislation to protect whistle blowers within the
Government of Canada.
Those are some of the recommendations which were made in
1986-87 in the ``Open and Shut'' report. I would like to ask the
government again tonight if and when it intends to move on the
recommendations made in ``Open and Shut'' in 1986-87 and
also on the recommendations made recently by the information
commissioner in his 10-year report.
Mr. Russell MacLellan (Parliamentary Secretary to
Minister of Justice and Attorney General of Canada, Lib.):
Mr. Speaker, the hon. member for Notre-Dame-de-Grâce has
asked about the government's intentions with respect to reforms
of the Access to Information Act.
The act is now 12 years old and much has changed since the
act was first adopted. At that time access to information was
seen as innovative and statutory rights to government
information was thought to be a bold step.
Now we are fully in the information age. Canadians are
increasingly purchasing computers and equipping them with
modems. They are on the eve of the convergence of the
television with computers. Those who have a television will also
have the mechanism by which to retrieve information from the
world at large. The Internet has completely changed our earlier
notions of what access to information means.
The Access to Information Act was studied by a
parliamentary committee in 1987. The information
commissioner issued extensive recommendations to reform the
act on the occasion of its 10th anniversary. The information
commissioner also released background information studies he
had commissioned, including one on information technology
and open government.
The federal government recently adopted a blueprint for
improving government services using new technology. It has
created the Information Highway Advisory Council which is
scheduled to report to the Minister of Industry in the spring.
Federal and provincial governments are engaged in a variety
of pilot projects designed to provide more government
information and services electronically. In the United States the
department of justice has issued a draft consultation paper on
electronic access to government information.
These initiatives are making more government information
available than has previously been the case. This information is
being provided outside the Access to Information Act and
therefore with less red tape, more quickly and at virtually no
cost to citizens.
All commentators on the Access to Information Act agree that
what is needed most of all is a change in attitude that results in
more government information becoming routinely available
without requiring citizens to request it under the expensive and
sometimes slow process of the Access to Information Act.
Progress is being made. There is no question that the Access
to Information Act needs reforms. The minister has promised
that the government will come forward with reforms.
The Liberal Party has made open government a promise in the
red book. The minister has indicated that the Department of
Justice is at work identifying areas where reforms could be
made. We need to take the minister at his word. Reforms are
coming. While precise details and dates are not now available,
these will unfold in due course.
[Translation]
The Acting Speaker (Mr. Kilger): Pursuant to Standing
Order 38, the motion to adjourn the House is now deemed
adopted. Accordingly, this House stands adjourned until
tomorrow at 10 a.m., pursuant to Standing Order 24.
(The House adjourned at 6:52 p.m.)