Hon. Monique Begin (Minister of National Health and Welfare) moved
that Bill C-3, an Act relating to cash contributions by Canada in respect of insured health services provided under provincial health care insurance plans and amounts payable by Canada in respect of extended health care services and to amend and repeal certain Acts in consequence thereof, be read the third time and do pass.
She said: Mr. Speaker, this is probably the last time that an opportunity will be given to me as Minister of National Health and Welfare to speak on Bill C-3, which is being debated on third reading today. This Bill may not be a Bill which received unanimous consent from parties all over Canada, but it is a Bill of consensus, and that is important. That is the Canadian way of doing things, to make improvements to what exists, thereby building up what has been the social fabric of this country for so long.
I, therefore, would like to thank all Members of this House, and in particular, of course, the members of the Standing Committee who have devoted so many hours to meeting with witnesses, studying their claims and viewpoints and making their best efforts to improve the Bill. If I may, I would like to single out the Hon. Member for Provencher (Mr. Epp), the Hon. Member for Oxford (Mr. Halliday) and the Hon. Member for Winnipeg-Birds Hill (Mr. Blaikie), as well as my colleagues on this side of the House. I do not know if this is the tradition, but 1 believe it is very important for all Canadians to know that this Bill-without presuming the outcome of the vote-will be passed unanimously, based on indications given to me by all three Parties, and will not have expanded but consolidated, I believe for years to come, our health care system in Canada.
What this Bill accomplishes is modest, but it is an essential step. It has been a difficult decision to make. We would have preferred time to have settled the problem. However, time was rather against medicare in the sense of pressures from all sides, starting with the recession itself, which were pushing some of the players into overcharging patients, through extra billing by
some doctors and specialists and by user fees charged by some provinces. This Bill, therefore, is needed to clarify the existing rules of the game and to make sure that the weak spots, if I may say so, in the existing legislation will be consolidated, explained and defined in a way in which all Canadians, through a relatively simple, written piece of new legislation, can understand the rules of the game and know what their rights are. In that way they can protect themselves and will be able to see both the tremendous powers and the limitations of our health care system.
As I said, although it was a difficult decision to make, I believe this Bill is essential. Everyone will agree that I should name Mr. Justice Emmett Hall in particular, and through him all the key players, political and public, who have given Canadians over the last 25 years the medicare we know and enjoy, the medicare which is one of the best in the world. I am sure all Members will recall what Mr. Justice Emmett Hall said about the erosion of our health care system, an erosion which would have sooner or later made the house collapse because its foundation would have been too much eroded by the overcharges to Canadians.
I would like to say a word about the federal-provincial relations aspect of this Bill. Health in Canada is primarily, and I am sure everyone knows it now, a matter of provincial jurisdiction. Personal health services must be delivered by the provinces. In fact, I believe it is fair to conclude, after having travelled and heard witnesses from all over the country, that we have 12 different health care systems, including the two Territories, all functioning according to local traditions, but offering basically the same services to Canadians, and operating around the same five basic conditions of free accessibility and comprehensiveness of services, which means the basic list of ensured free services is the same for all Canadians wherever they live.
However, these services are delivered according to the corner of the country in which a particular patient lives. Patients who live in the far north will be transported to the best and closest hospital. If they live in downtown Toronto, in the suburbs of Vancouver or in the east end of Montreal, they will be transported downtown to the closest hospital. They will in both places receive the quality care we are used to in Canada and which we want to keep.
Federal-provincial relations are a major dimension of this piece of legislation. If I had had a chance to speak to my provincial colleagues to this platform, I would have liked to reassure every one of them that the meetings we had in January had been brought to realization by the amendments made to Bill C-3 in the standing committee of this House of Commons. I believe each of them would be rather pleased with
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what we have done. The members of the committee have worked together very seriously on this, and we have done our utmost to improve the Bill while respecting the basic rules of the game to which I had given my commitment. By that I mean, in particular, that in no way should we be imposing on the provinces, directly or indirectly, additional charges to the heavy financial burden they now have. Any Member who knows enough about the Bill can see that we have honoured that commitment.
We have tried to make it a better Bill, and I was pleased at the end of the committee work to hear senior officials, the people who have been implementing medicare in the last 25 years, saying spontaneously how pleased they were that it was not partisanship which had governed the work of the committee but excellent improvements made by the Opposition and the Government to make the Bill better. I think we can be proud of what will be a workable piece of legislation, which is the purpose of any Bill.
We have recognized the concerns of different players who at times may be seen by some of the parties in that complex system as "enemies", in the sense they would make demands on the system for money, equipment or for changes in orientation. We have tried to recognize their legitimate concerns without imposing anything on the provinces which is not our place to impose.
Perhaps I should refer in particular to one clause which is causing worries, it seems, in the last hours, although to my knowledge without reason. I am anxious that all parties have a chance to study carefully the revised version of the Bill with all its amendments, in particular Clause 12(2). In that clause we are adding a possible choice for the provinces who want it by defining a model process for negotiations between the medical associations and the provincial governments. This process originates from the medical associations, more precisely from the Canadian Medical Association. It was put forward first by the Official Opposition, and followed by a counter-proposal in which no mandatory dimension was included.
I know some Members would have liked to see a real process of negotiation enshrined in the law as the way to do things between doctors and provincial governments. We all know that we did not have that power under the Constitution; therefore we did not impose it on the provinces. It would have been wrong. Instead, we added to the old rule of the game, which has been there for 15 years, which says that doctors must receive reasonable compensation. That stands; it is the cornerstone of medicare in Canada.
We added a possible model which all Members thought could be tested, promoted and eventually become the way to do things in Canada. It will work only if the parties want it to work. It will be for provincial medical associations and provincial governments to decide if it is workable. If not, they can choose any other model of labour relations with the medical associations to reach reasonable compensation for doctors. I think this is a key point and I wanted to stress it.
Why do I single out only one occupation in the health system? I do so in a way to do justice to people who are key players in the system and who have been more or less outside of the federal-provincial political scene. They have expressed their views differently but I want them to know, together with other players, that I think they have been heard, that they have advanced their cause and we have to honour a commitment to them by proposing, wherever provinces want to use it, a possible new model of labour relations which can literally respect the dignity of both parties.
Mr. Speaker, perhaps I may be allowed to say a few words about my home province. I must say I was disappointed when Quebec opted for political confrontation instead of a dialogue on Bill C-3. I thought it was most unfortunate but I am happy that we have been able to allay the fears they had raised in the health services field in Quebec, and I think that now, the word has gone out that there was no problem and no reason to be alarmed. I am glad that in the process, Quebec officials came to meet with our officials at my Department here in Ottawa, and the point was clearly made that there would no longer be user charges in Quebec for patients or convalescents, and I am referring to what might be called the short-term chronically ill. This practice which started with the separatist Government was spreading, unfortunately, and the Quebec Government, and I am referring to Mr. Levesque's Government, has acknowledged that it was against the Health Insurance Act, and that in Quebec, patients who must stay in hospital for longer periods of time, for instance, three, four or seven months, before going home, can no longer be charged user fees, irrespective of the length of time they must stay in hospital. I believe this is important, and that we should all be glad we were able to deal with this problem and with a practice that goes counter to the philosophy of health insurance.
Mr. Speaker, I see my time is running out, and I would like to finish my comments regarding the future.
I am sure members of the committee, who were not necessarily specialists in health matters but who have become specialists in health matters after all the briefs they read, the witnesses they heard, the reading they did on the Bill, including the amendments and the background documents, would agree that most participants, if not all, spoke of that Bill as the first step. Some even went overboard and said it was not even important, but everyone agreed that it had to be done. Well, it takes time to pass a Bill through the House and it will be done very soon. It will be behind us very shortly.
I think one of the great advantages of this Bill and its process was to put health back on the map of Canadian concerns. I think Members will share the view that probably because of the recession, having such an expensive proposal, everybody preferred not to talk about it in order not to do it any damage. But all the participants have really said far more
March 29, 1984
than the Bill itself. They have said that we have to fix these financial barriers and get rid of them, but; and they each had a "but". They wanted to speak of where health was going. Depending on where they come from in the system, they wanted to speak of costs that should or could be reduced by allocating resources differently and using them in the most effective way.
Being a woman, I am sure no one will mind if I refer to the nurses, as a group of players par excellence who are somewhat in second place in the system, if I may say, in terms of social prestige. They are still a key participant and probably spend the greatest number of hours with patients who are in the hospital. The nurses spoke of the lifestyle and asked if the environment and lifestyle was helping the cause or not. They spoke of aging and challenged us to see if we were ready for new demands on the system from an aging Canadian population. They spoke of death and how dying has lost its human aspect. They spoke of the palliative care units and how their own role could be very different.
In turn, consumer groups spoke of self-help and asked why ordinary Canadians who are not particularly knowledgeable on technical health matters could not still make a contribution and in some way control their own health. In other words, they are no longer passive.
Women question the way the conventional hospital-based birth process takes place. Is it the only way of doing it? They talked about midwives as another method in the birth process. The discussions always concerned choices as opposed to everybody being put into one mould and having to follow one procedure.
It has been very important to have the chance to debate health in Canada, to debate its orientation and the need to speed up the reorientation of health toward health promotion and prevention, as well as establishing where our great system needs improvement or more money and specific areas ensuring that we do not lose the excellence and momentum we have built.
Therefore, I would like to reiterate, since the need for the dialogue has been expressed so clearly, that to respond to such an obvious need and to move ahead with innovative ideas, I am proposing to initiate a national conference on health to provide an opportunity for dialogue with all the interested groups. None of the existing processes permits all the groups to get together in a workable manner and this conference would give everyone a chance to be equal in expressing their views.
I do not intend to dictate how this forum will be organized. I hope that all Members of the House who have done such a good job in committee would find the forum a way to remain connected to the health system. This will be a conference of all interested parties and partners in the health system. Its organization and planning will be undertaken jointly. My officials will soon be in touch with all those who are interested in order to plan the content and launch the conference.
Canada Health Act
Let me conclude by saying that we do not want this to be simply a meeting; we would like to see these discussions have a real influence on what will happen in the health field. I have listed but a few of the topics which it could cover.
This is almost an emotional moment for me, due to what this health Bill represents for Canadians, as well as the difficulties attached to it because of the contradictory interests and problems of so many parties involved. I will finish by reading from a handwritten letter by an Ontario physician who said: "As a physician, I urge you to continue your work and to actualize the Canada Health Act. Please resist the temptation to compromise-" The letter continues.
That is what we have all done. I hope we have done our work well, which I am sure we have, so that Canadians will enjoy the best health system in the world for years to come.
Subtopic: CANADA HEALTH ACT
Sub-subtopic: MEASURE TO ESTABLISH