March 29, 1984

GOVERNMENT ORDERS

CANADA HEALTH ACT

LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

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

March 29, 1984

Canada Health Act

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.

[DOT] (M40)

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.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Eymard G. Corbin (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Questions or comments?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
PC

Benno Friesen (Progressive Conservative Party Caucus Chair)

Progressive Conservative

Mr. Friesen:

Mr. Speaker, I appreciate the Minister's positive statements in the closing debate as well as throughout the entire debate. One of the policies that she has underscored most consistently has been her opposition to extra billing and user charges. I understand her concern aboqt that very well. What is her position regarding the extra billing and user charges imposed on the clients of Dr. Henry Morgentaler?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, may I ask the Hon. Member to be more specific? I do not know what he is talking about.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
PC

Benno Friesen (Progressive Conservative Party Caucus Chair)

Progressive Conservative

Mr. Friesen:

It seems plain that Dr. Henry Morgentaler operates a business on a fee for service basis and it is supposed to be, in his jargon, health care. Does she support that kind of extra billing?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, I do not see why I should start naming doctors who extra bill or do not extra bill. Bill C-3 is very clear that extra billing is an overcharge on the patients that is totally against the law.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Biaikie:

Mr. Speaker, the Minister has indicated her intention to begin the process of setting up a national conference on health. I think that is a good idea on the face of it.

One of the amendments that was moved in committee, by me actually, concerned setting up a national health council. It was a suggestion that was made as early as the parliamentary task force, I believe, and was called for by the nurses. Is the Minister open to the idea of there being Isome permanent opportunity for dialogue and constructive discussions between all the players in the health care system and having something permanent come from such a conference?

In other words, if it is the will of the people who attend that conference that it not simply be a one-time event, would the Government be open to that kind of opportunity?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, the answer is yes. The idea of a national health council which was promoted so well during the debate in committee, particularly by the Canadian Hospitals Association, is a very good one. The first time I heard of it was

March 29, 1984

Canada Health Act

when I became the new Minister of National Elealth and Welfare six years ago. There are some groups who care about this idea and lobby for it.

However, when I put this idea to my provincial counterparts, some time ago now, they did not approve of it. Since it was some time ago, if the idea is suggested again at a conference in which they will be the key participants, perhaps all interested parties could see the interest in it. In such a case, we will surely entertain such a project.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
PC

Frederick James (Jim) Hawkes

Progressive Conservative

Mr. Hawkes:

Mr. Speaker, the Minister has had a request for a meeting with provincial ministers regarding some of the amendments in Bill C-3. Has she complied with that request? Does she intend to meet with them or will we pass the Bill before such a meeting takes place?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, the member refers to telegrams which were received from provincial health ministers in the last few days and from the minister from Alberta in particular, probably in the name of other ministers since he will be the host of their annual joint meeting next September. I immediately sent back one telex. Today I asked officials to send back another telex to explain what their main concern seems to be. From my own conversation with some of them it is what I addressed earlier today, namely, the new section on doctors' negotiations with the provinces. Their concern is that the committee members imposed that on the provinces. I think the original amendment put forward by the Tory Party would have imposed it, but we defeated the amendment in committee. We wanted it simply as a model to give the choice to the province.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
NDP

Cyril Keeper

New Democratic Party

Mr. Keeper:

Mr. Speaker, the Minister in her remarks acknowledged that the biggest weakness with this legislation is the lack of being able to deal adequately with preventive health care. She made particular reference to midwives. Given the fact that having a child at home in the case of a normal birth would save a great deal of money and at the same time adds to the bonding between mother and child, what can the Minister tell us that will assure us she is going to do something that will be effective in terms of making sure the opportunity to have a midwife in attendance is available to Canadians and that this conference will not be just a way of letting things slide?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, the Hon. Member touches on a perfect example, among thousands, of what health is all about in the sense that it is a provincial responsibility as to personal delivery services. The recognition of midwives in the child birth process can be given at any time by any province under the existing and the new Canada Health Act. But it is a totally provincial matter-totally. It is at the choice of province x, y, or z to set into motion whatever licensing-I do not have with me the details according to each province-is needed, to make it official either on a pilot project basis or across a given province according to its own priorities in health delivery.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Jesse Philip Flis

Liberal

Mr. Flis:

Mr. Speaker, I would like to congratulate the Minister of National Health and Welfare (Miss Begin) and also the Members from all three Parties who served on the committee for coming up with a first-class made in Canada health Bill and service. As the Minister pointed out, the delivery of the services now lies, and always did, in the hands of the provinces.

This creates many difficulties for a lot of senior citizens who live part time with children in one province and then part time with children in another province. I have many examples where senior citizens in their 80s and 90s live six months or three months in the Province of Quebec and then another six or three months in the Province of Ontario. They run into the problem of a waiting period to qualify for health services. One province has a three-month waiting period to qualify for medical services. Therefore, these seniors are in a bind. Do they have to go back to the province which still covers them to get the service? Are they faced with a province saying: "Sorry, you have to wait three months"? Does the Bill address this problem of so many senior citizens who have the right to live part time in one province and part time in another province?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, I will have to check the exact details of the situation but the general principle has been clearly established in this Bill. One of the five conditions is portability. The Hon. Member has a very good point. We did not hear much about portability. The media spoke much more about accessibility and comprehensiveness, universality. But portability raises quite a practical problem for border towns, towns exactly like Hull and Ottawa, for seniors who travel a great deal in the country to see their children and families.

I do not have the exact details but, in the case of an emergency, citizens are treated anywhere in Canada and that should not pose a problem. Again, details escape me right now. Officials of the provinces have been working, I think for at least a year now, on a detailed protocol of portability and the rules of the game both within Canada and outside. This Bill reinforces the concept of portability for all Canadians within the country.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
PC

John Albert Gamble

Progressive Conservative

Mr. Gamble:

Mr. Speaker, did 1 understand the Minister of National Health and Welfare (Miss Begin) to suggest in response to one of the questions asked by my colleague, the Hon. Member for Surrey-White Rock-North Delta (Mr. Friesen), that extra billing was illegal, to use her words? If, indeed, that is what she said, could she clarify that for the House, having regard to the specific provisions in the preamble to the Bill which clearly indicate that it is not the intention of this Bill either to abrogate or to derogate from any of the provisions of the Constitution Act of Canada, and having further regard to the well-recognized fact that the provision of medical services lies entirely within the control of the provincial governments?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Eymard G. Corbin (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Order, please. The time provided for questions and comments has expired. Perhaps the House will allow the Hon. Minister to reply. Is that agreed?

March 29, 1984

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
?

Some Hon. Members:

Agreed.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink
LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Miss Begin:

Mr. Speaker, I appreciate the courtesy of all Members. I will answer rapidly. The Hon. Member for Surrey-White Rock-North Delta (Mr. Friesen) asked me specifically about Dr. Morgentaler. To clarify that, I should say that Dr. Morgentaler's services are not insured services under provincial plans because he does not perform them in a hospital the way the Bill provides. The services that are insured must respect the Criminal Code and they must be performed in hospitals. I did say in answer to the Hon. Member that extra billing would be a breach of the Act. I repeat, and 1 hope the Hon. Member knows what extra billing means-

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO ESTABLISH
Permalink

March 29, 1984