HEALTH
Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with the Estimates of the Department of Health. We are on item 1.(b)(2).
Would the minister's staff please enter the Chamber at this time.
Mr. Tim Sale (Crescentwood): I wonder if, for the benefit of those who are not able to hear due to whatever in the House, the minister's response in regard to the Lorenzo's Oil issue and other issues that my colleague the member for Kildonan (Mr. Chomiak) raised, could the minister simply begin by clarifying that announcement for us?
Hon. James McCrae (Minister of Health): First, let me apologize to the House for being so soft-spoken earlier in Question Period. I was asked earlier on by the honourable member for Kildonan about Lorenzo's Oil, and I have some additional notes that I could refer to to tell honourable members what we are trying to do.
A number of weeks ago, I would place it in late March, early April, the issue of the noneligibility of Lorenzo's Oil came to my attention. I knew that it was a treatment recommended by a doctor, Dr. Greenberg, associated with the Metabolic Service at Health Sciences Centre. This physician felt that this was the only appropriate treatment for the young people involved.
As luck would have it, it was not something that was properly covered under our Pharmacare program, not properly covered because it does not have a certificate of compliance from the federal authority, which is one of the things you have to have in order for a product to finds its way to the Pharmacare drug formulary. But Lorenzo's Oil is not a drug, per se, it is a nutritional supplement.
There are some big words that I will refer to, and if Hansard would like to have those words spelled out we will do that subsequently. Lorenzo's Oil is otherwise called glycerol trioleate/glycerol trierucate, and do not hold me to this pronunciation, please. Adrenoleukodystrophy, otherwise know as ALD, is a hereditary, progressive, neurodegenerative metabolic brain disease associated with adrenal insufficiency. The only known effective treatment for the childhood form is bone marrow transplant. Over the past two years twelve Manitoba ALD individuals have been identified, and six could be eligible for bone marrow transplant. Preparatory to bone marrow transplant patients are being treated with a low-fat diet and Lorenzo's Oil. Up until now Lorenzo's Oil has not been approved as a drug by either the United States or Canadian drug regulatory authorities and, as such, it does not qualify as a benefit under Pharmacare or other provincially funded drug programs.
Children's Special Services is currently partially funding Lorenzo's Oil for one family, but that was done prior to determining that Lorenzo's Oil was not approved as a drug. Funding options were considered through the manufacturer, the hospital, external nonprofit agencies and research funding. There were found ways, apparently, in a couple of other provinces, i.e., Ontario and British Columbia, and I am not sure today how they managed to do it there, but probably similar to what we are doing here. In Ontario it was done through a research project. Anyway, it has been recommended after some consideration, and I requested that this consideration happen, that Lorenzo's Oil be provided to ALD patients prior to bone marrow transplant through Manitoba Health's Life Saving Nutritional Support Program. That program is the same program, as I said earlier in Question Period, as the Life Saving Drug Program, but this part of it covers nutritional supports.
This oil costs on average $500 a patient per month, and that is asking a lot for an average family, and I believe the families we are dealing with are in that category, and I have no wish, and neither does the honourable member for Kildonan (Mr. Chomiak) or the member for Crescentwood (Mr. Sale) or anyone else that I know of, to see that sort of hardship imposed on families who are already having enough trouble trying to cope with the problems associated with the disease in the first place.
Dr. Greenberg, director of Metabolic Services, Health Sciences Centre, has been advised of this decision and will be making the necessary arrangements for funding with Manitoba Health. I hope that gives the honourable member some of the background that he was looking for.
Mr. Sale: Mr. Chairperson, to the minister, I am sure that all members would want to express our thanks to you and your department for finding an appropriate mechanism to ensure that families will not face the kind of hardship that the family in Pine Falls was facing, and not only that family.
I should just tell the Chairperson and our record that I was approached on this a week or so ago by a pharmacist who had employed one of these young people who now have children with this disease, and the pharmacist himself was in tears, recounting the level of distress that the family had and the level of pain that the children were suffering. So I think this is humane and appropriate and the right thing to do, Mr. Chairperson, and I commend the minister and his department for so doing.
Mr. Chairperson, we were speaking when the committee rose last week about questions of federal financing, and I want to return to that and hopefully conclude that line of questioning to the minister. Mr. Minister, you indicated that you are going to be attending a provincial ministers' meeting later this month. Could you give us the timing of that meeting?
* (1440)
Mr. McCrae: It is hard, Mr. Chairperson, to nail this down for the honourable member today. I was just today looking at some correspondence between Minister Ramsey from B.C. and, you know, trying to set things up with the federal minister. I guess there is--I do not know what all the problems are. I know there are elections happening in Ontario and Saskatchewan. That may have some bearing, because a meeting on such an important matter with the federal minister should be attended by ministers from all the provinces. There was talk of, and even in the correspondence I looked at today, of a meeting in late June, and I am not able to give it more definition than that today, unfortunately.
Mr. Sale: Mr. Chairperson, I understand the minister's inability to pin that date down, given the realities of the elections, and certainly holding such a meeting without Ontario's minister present would not make a whole lot of sense. So I thank the minister for his answer.
I would like to ask the minister whether he and his staff pursued the question that I raised at the end of my questioning last day, namely, whether the government had a legal opinion as to the enforceability of the Canada Health Act subsequent to the end of federal budgetary transfers to support health at the provincial level. Does the minister have an answer to that question, Mr. Chairperson?
Mr. McCrae: Mr. Chairperson, no, there is no legal opinion on the point, at least not here in Manitoba. I think that I would have to repeat what I said last week, that I guess it has been viewed, certainly by me and maybe by others, that we have had a lot of legal opinions over the years, as we have discussed constitutional arrangements. They all, really in the end, amounted to not very much because a government operating within its authority can do things on a budget day that somehow leave us and our health system in a vulnerable position. I do not think we ask for a legal opinion because we feel very strongly that if there is little or no money on the table from the federal government, their ability to enforce the principles of the Canada Health Act is severally diminished if not totally removed. However, the idea the honourable member puts forward is something I will continue to consider. I do not know what there is for us to gain on that, but, if there is something, you can be sure we will examine whether we ought to be seeking that sort of legal opinion.
Mr. Sale: Let me say, Mr. Chairperson, I am puzzled by the answer of the minister. Let me say why. I think that both of us, in this discussion we have had about the overall policy of medicare in Canada, which I found very helpful and, I think, has be constructive and nonpartisan to an extent that is rare perhaps, I think it is a very useful discussion. I thought that the minister had concurred at some point--I cannot quote the particular line in Hansard, but I thought the minister had concurred that the federal role was vital in maintaining medicare in Canada, that without the federal active role through budgetary transfers, the federal voice would be either minute or still.
Therefore, there would be nothing which would prevent provinces that, unlike Manitoba, may not have a deep and abiding commitment to medicare and its five principles. So I asked the minister, was there an opinion on the question of the enforceability of the Canada Health Act without federal budgetary transfers precisely because I think that is part of that public education issue to which I think the minister and our side of the House have agreed was a vital thing for all of us to engage in, that is, to inform Manitobans, as best as we are able, what the consequences of the withdrawal of federal funding would be.
Obviously, they are severe financially, but if there is solid legal opinion that says there simply is no enforceability of a federal statute in an area of provincial jurisdiction without federal dollars, then I think that particularly if it is the government that has that opinion, the government's hand in working with its counterparts across the country in educating Manitobans and in lobbying for a sustained federal role, all of which cannot help but benefit Manitobans, the government's hand would be significantly strengthened if someone of the stature of Jack London or Roland Penner or Schwartz or any of the constitutional people at the faculty or any who might not have the kind of partisan identification that those particular names might have, but I think it would be useful, Mr. Chairman, if there was a person of stature who advised the government, and, frankly, although I understand the minister's smiling at this, it might be very useful if it was someone who had some cross-political lines; that is, if the opinion was not seen to be the opinion of a hand-picked expert by the government but was someone who had stature in the issue.
So I think this is a very important part of our public education campaign, to allow Manitobans to understand that this is not just shrill rhetoric on a few people's part, that medicare is over the day the federal transfers dry up, but, in fact, that this view is sustained by significant legal opinion which the government itself has sought. That is why I am continuing to push this question, Mr. Chairperson.
Mr. McCrae: Mr. Chairperson, I do not mind if the honourable member does, because I value the concept and the reality of a national health care system. I will probably differ on the issue of how many dollars are going to be available, but I do think there should be dollars available from the federal government. I just do not know how many I should say that there should be available from the federal government.
* (1450)
The federal government has, in its own way, and I do not think it is a very good way, but in its own way, has tried to do a little bit of what the honourable member is saying, in the area of public understanding of the issues and so on, by virtue of its health forum which the Prime Minister talked about in the federal election campaign and wrote about in the red book, and that is one forum that even if we are not very satisfied with the way it has been set up and everything, we should make every bit of use of every avenue we can.
Now, Noralou Roos from the Manitoba Centre for Health Policy and Evaluation, whose opinions I respect--I do not know if representing Manitoba is the right word, but she is there from Manitoba as part of the health forum, and as I have done before, I would encourage dialogue between people like the honourable member and Noralou Roos because I think that can be useful in helping Dr. Roos get an important message to Ottawa. I am not trying to say I am giving up. I am not giving up. I am a strong advocate for a strong national health care system because, like so many others, I have friends and relatives in all parts of Canada. So I want people everywhere to have a reasonable expectation of a health care system that has embodied in it those principles in the Canada Health Act.
With respect to the honourable member's suggestion about the legal opinion, I am listening to him, and I will take very seriously what he has had to say as we prepare for our participation in the upcoming meeting, whenever it is going to be and wherever it is going to be. I do not know whom we should ask for that legal opinion right off the top of my head. As the honourable member was mentioning the names, what immediately came to my mind was the Minister of Labour (Mr. Toews), who was formerly the head of the Constitutional Law branch of the Department of Justice. However, he now will probably not be seen as truly nonpartisan since he occupies the Treasury benches along with the rest of us over here, but I certainly enjoyed working with the Minister of Labour when he was an employee in the Department of Justice. He certainly demonstrated his commitment to his country and his role in various constitutional discussions.
Somebody of the kind of stature the honourable member is referring to ideally would be the right kind of person to give us an opinion about this. Sometimes the trouble with asking for a legal opinion is that sometimes you do not know what you are going to get when it comes to an opinion. In the light of some of the discussions we have had already, if the federal government could make a case in a courtroom somewhere that there are so many dollars, which I know it can do--I ought not engage in this kind of discussion because I am obviously not a judge, and I am not a lawyer either. I do not want to put myself in their place. I will take very seriously what the honourable member has said, discuss it with senior personnel in the department and make a decision. Maybe sometimes we have done this in the past, gone in with other jurisdictions who share the same concerns and worked on issues, sometimes with some success, sometimes with no success, but I take very seriously what the honourable member is saying, and I will pursue this further.
Mr. Sale: I thank the minister for that response. One of the nice things about seeking a legal opinion is that you do not have to take it, nor do you have to publish it if you do not feel that it is favourable to the course you wish to take.
I simply believe that it would immensely strengthen the hand of those who are fighting for our medicare system, if the federal government's position could be seen to be as weak as those whom I have asked informally believe it to be, in regard to the constitutional position. I simply think that no court--I mean, my opinion is that no court will sustain their right to impose conditions when there is no budgetary transfer associated with the conditions, and it is not an area of federal jurisdiction. It just seems to be weak on so many grounds that it would be difficult to sustain.
Nevertheless, let me move then to the second issue that I would like to see if the minister has considered and see if he is willing to pursue a particular direction on.
We spoke at some length, Mr. Chairperson, about the question of the level of federal funding, and the minister has indicated that he might think that the level might properly be lower than I might think. Let me suggest to him a number which the public could well understand and which would be seen as reasonable in the light of the circumstances in which Canada's federal finances finds itself, and that is 1 percent of gross domestic product.
One percent of GDP is approximately $7.7 billion today. The federal transfer today, budgetary transfer, for health is approximately $6.3 billion, so it is approximately $1.4 billion, $1.5 billion, less than the budgetary transfer for health under EPF is this year.
We might well say that this would be a desirable target, one that Canadians could readily understand. It would be very easy to point out to the federal government and to Canadians that the cost of medicare to Canadians is approximately 6 percent of gross domestic product, 5.8 percent this year, to be exact. That would mean the federal government was transferring one-sixth of the costs of medicare, and in return for its one-sixth, it might be seen to have some voice at the table in regard to conditions.
If the one percent were appropriately indexed to the growth in the economy in the way that the former EPF formula worked, that is, the 1977-78 formula, which escalated EPF at the three-year moving average of the growth per capita, then the federal government would be seen to be what it claimed it was going to be in 1977-78, which is a permanent partner, albeit a minority partner, in the enterprise we call medicare.
So I would like to ask the minister, would he consider working with his colleagues to establish a position that the long-term desirable shape of the partnership we call medicare in this country would be a roughly one-sixth/five-sixths actual funding share, in which the government of Canada pays one percent of GDP, escalated as I have suggested, and the provinces, through their own source revenues and transferred tax points and all of that old history, pays the balance.
Would that seem like a reasonable position to the minister that he might lobby with his provincial counterparts to adopt?
Mr. McCrae: I am starting to enjoy this sort of discussion. I have not really engaged in it very much except as Constitutional Affairs minister when we discussed the various cost sharing matters back then as we worked toward the achievement of the Charlottetown Accord.
I do not know whether to agree with the honourable member or not because what he is saying is that, well, let us ask for a 1 percent share of GDP for this particular part of the pie and that this year, according to the honourable member's numbers he gave me, if I have got this right, would amount to an increased amount of about $1.4 billion nationally. That is great. I would like to do that and get our province's share of that $1.4 billion and then that 1 percent would be indexed to the growth of the economy, I take it, up or down, whichever way it should be going, and to get a national position on it.
The only trouble with all of that--it sounds good to me, by the way--is that history demonstrates that such arrangements do not withstand the test of time. I wonder, even if you could get a federal government to agree, maybe $1.4 billion to a federal government is something they could maybe work into an arrangement and give the impression that there, we have bought some peace on the health front for whatever length of time we can sustain that. So then along comes some other imperative next year--budget time.
* (1500)
Or if the honourable member is saying, well, let us enshrine that in the Constitution somehow, I do not think anybody has that much interest right now in opening up the Constitution, certainly not in the next few weeks.
So it is not a question of agreement or not on the numbers the honourable member is using, I suggest, although $1.4 billion to me is not a small amount but to a federal government it may not look as big. It is just that, how do you get a federal government to keep to its promise if it does make a commitment? The recitation of events the honourable member has given us demonstrates that does not happen, that federal governments do renege on long-term commitments. Long-term commitments like of the kind the member is referring to though is probably not as hard to live with year in and year out because it is tied, as the honourable member has said, to an index, i.e., the growth in the economy.
It was formulas like that that got changed around in the first place, so I think the honourable member can understand my frustration. But, you know, is 1 percent the right number to ask for? Why not ask for 2 percent? I mean, if a federal government is going to be in the mood to put more money into the pot to bring us up to the 1 percent then maybe they could be persuaded to bring it up higher, or maybe they would argue for something not quite so high. The problem with it is, because of the way things have gone either politically or economically or both, commitments do not seem to last, and how do you get commitments to last to give us some kind of comfort that you know the rules are not going to change on us?
I would really want to hear what my colleague would have to say about this, the Minister of Finance (Mr. Stefanson). I have not been privy to discussions with him on this nor have I read what he has said recently. But is 1 percent the right number? I do not really know. It is certainly better than what we have. What is it now? It is three-quarters of 1 percent now, so 1 percent is better, and the honourable member would like to see the stability of that. So would I, but is it achievable is the big question.
I guess I have been around here too long or something because I have seen too many commitments that have not withstood the test of time. So I hope that gives the honourable member some insight of my thinking. It is not as positive as I would like it to be on the point, but what the honourable member seems to have is another formula. Well, somebody else could come up with another one and another one and another one, and maybe we could negotiate one, but how long would it last is my big question.
Mr. Sale: Mr. Chairperson, I thank the minister for the thoughtful response.
The issues the minister raises are, of course, all of the issues of federal-provincial finance, and he is quite right to raise them in the manner that he does. I would just say that I am not suggesting a new formula. The formula I am suggesting is essentially the 1977-78 formula in which the cash portion of the transfer was all that was subject to escalation. The tax points were detached in that five-year period from '77-78 to '82-83. So I am suggesting returning to that formula, not inventing a new one. Nor is it a new idea to have a base amount. In the 1977-78 agreement that started this whole thing, the base amount was established as what the federal government shared with the provinces in what is known as the base year for EPF purposes, which is 1976-77.
So there was a base established of dollars which were then subject to escalation or, as you have pointed out, decreasing, although that did not ever happen. It is an elaborate formula, and there are floors and ceilings built into it but, nevertheless, I am suggesting that we return to that formula for two reasons. One is, the way that formula works, there cannot be, under that formula, an end of federal government fiscal transfers.
It is just not mathematically possible because the base is established and the escalation clause is established. It could only be changed if the federal government went in and tinkered with the formula which, of course, is what Trudeau did and what Mulroney did and now what Chretien is doing. The minister is quite right to point out that there is nothing that can stop a federal government from tinkering with federal legislation.
Against that, I think we have to take the point that Canadians are still immensely supportive of medicare. They do not want to see their medicare system dismantled. I couple the concern with establishing a new base with the political reality that if our fears about the constitutional question are correct, that is, if the federal government cannot sustain the Canada Health Act in the absence of transfers, and the federal government is clearly on the record many, many times saying we will sustain the Canada Health Act, then they are in a very awkward position. If there is substantial constitutional opinion that says you cannot sustain it without dollars, the question then becomes, what dollars are required to sustain it?
That is the question. I think it would be very helpful to go into a federal-provincial meeting with some sense of a target. I am not suggesting, by the way, that we say to the federal government you have to go up to $7.7 billion this year. We might agree to a five-year process to reach that. We would agree to anything politically. I think the critical point is, can we establish a base that is credible to Canadian people, that is credible to ministers of Health, that you can say we have taken action on this at least to save this critical part of our social safety net.
I despair of linking together post-secondary education, health and welfare under a thing called the Canada Health and Social Transfer, I think it is called, because there are no dollars identified for anything in there. Anybody can choose their base, and once we are into that new transfer program, then I do not know how we can say what dollars are for medicare unless somebody says this is the base.
So what I am urging the minister--and I do not have any particular attachment to 1 percent. It simply seemed like a credible amount to be able to inform Canadians and Manitobans that we are standing together on this program, and the federal government's share is 1 percent. It sounds to me pretty cheap, Mr. Minister, but it is better than what we have got now, and it is twice as good as what it is going to be two years from now under the 40 percent cutback that is coming over the next two years, because two years from now, on a pro rata basis, the federal transfer for health will be down to half, a little less than half of one percent of GDP.
I am taking the minister at his word that he is as deeply committed to medicare as we are, and I am trying to think through in this process of Estimates what a credible strategy would be for Manitobans to push this question, to take national leadership on this question. So that is why I suggest that we think about a target, and 1 percent seems a whole lot better than three-quarters of 1 percent if you are trying to sell something to the public.
* (1510)
Mr. McCrae: I think what the honourable member and I are trying to do is, while we are both looking to Ottawa to help us and to help this country with a national program, we are still, the two of us, trying to figure out what it is that drives each other as well, and that is fair. That is the way it should be, and to make matters even more confusing, we have a federal authority that looks at the realities it faces and says, so that it can appeal to whatever two sides there might be to this issue, we are going to work to sustain the health system, but we are going to be flexible about it. Now that should get everybody wondering what everybody else means too, and that is, I guess, the trouble with legislation and the way it is drafted sometimes. Even some constitutional wording can be as ambiguous as you want it to be.
For the life of me, I have trouble understanding why they did not have a sixth fundamental principle of medicare, that being that we have to be friendly, or a seventh, that we must be nice to each other. Let us get some definition around these expressions. I am not trying to be facetious. I think this is a serious problem because the honourable member's view of what a universal health care system and my view of what is a universal health care system might be different, might be somewhat different, might be a lot different, might be a little bit different or, on some issues, exactly the same. So then are we going to ask some judge or some group of judges to decide what "universal" means?
(Mr. Mervin Tweed, Acting Chairperson, in the Chair)
As a former Minister of Justice, I can tell you that sometimes I feel nervous taking a case to the courts because you might feel in your heart of hearts that you have got the gods on your side, but maybe the judge does not see it that way. So you are stuck sometimes with something you did not bargain for. So then, like, does universal mean that you get to have your tattoo removed? Is that what a universal system is and that it is available to everybody? That may be under the heading of comprehensiveness. But the point is, everybody does not have a tattoo, so is that fair? So should we put fairness in there too and then argue all day about what fairness stands for?
I think the drafters and the people who--[interjection] We could move from universal because I know there are people in this room, in this Chamber, the member for The Pas (Mr. Lathlin), for example, will argue that things are not universal and maybe others as well. I know they are not universal because I know that if it is harder for you to access, which is another word, than somebody else because of distance or whatever, you could argue that access is an issue. It does not mean you are going to win your argument, or it does not mean you are right, does not mean you are wrong, but you can argue it.
That is the beauty of being Canadian. We can argue all these things and argue them and argue them and argue them, and we just keep on doing that, but while we are doing it, there is always that little reminder, that we all stand for something here as Canadians. So that is why we still have the health system that we still have, because there is something there that we all seem to agree on, although it is a matter of degree, comprehensiveness. Public administration--for example, the member for Kildonan (Mr. Chomiak) is going to someday argue that any participation by the private sector in health care delivery is somehow straying from the public administration of a health system. I will argue the other way and that would be on philosophical grounds, I suggest, but that has been done already.
Portability, I am not so able to talk about that one, but accessibility is certainly one we hear about from time to time. Certainly our rural compatriots here have a good case as far as I am concerned for the issue of accessibility. The people in Killarney, for example, would no doubt want to raise the issue of accessibility when the obstetrics matter is raised for discussion in that neighbourhood. Just sheer distance can have an impact on what you or I might think of as accessibility. We can carry these things to extremes and have a full range of health services in every community in our province, and of course we would not have a health system very long if we tried to achieve those kinds of ends.
I want to get back, though, to the whole issue of a public meeting of the minds, or at least a public understanding, which I think the honourable member is crying out for but for different reasons. He is crying out for a better understanding of the health system because he wants the public to understand that this ought to be a national program, that there ought to be significant federal involvement and I agree with him about it, but I want to put a different emphasis on this too. While we are talking about all this, because I have a responsibility for one jurisdiction's health system here, I want to have a public understanding about need and about outcome, about getting value for the dollars that we Manitobans are contributing to the health system.
I do not want the honourable member's thrust, and there is nothing wrong with it, but I just do not want that to get all the attention and the reform issues that we talk about quite often, i.e., the outcome issues and the needs issues to get lost in a struggle over where the dollar is going to come from. As the honourable member recognizes, I am sure, the determinants of health ought not to be lost in the debate.
Let us take, for example, the building of a water treatment centre. Is that a health expenditure? I think maybe we have probably not counted it as a health expenditure so we would have more dollars to put into hospitals and doctors, but that is a very basic health expenditure. You could get a federal government, either in a public forum or in a courtroom, arguing that its support for an infrastructure system that guarantees clean water was somehow a health expenditure. So therefore you lost your case because you forgot to give us credit for all the money we put into this water treatment plant or that sewage disposal plant, which are fundamental health expenditures, it could be argued.
So the determinants of health are going to be part of the other side, and they should be part of our day-in and day-out endeavours to deliver a quality health system. I used to think of health care as doctors and hospitals, but I do not anymore and I am glad that I do not anymore because there is so much more that we should be thinking about.
* (1520)
So maybe that does not satisfy that one aspect of this that the honourable member is talking about, but you can be sure that these other matters are very much part of the health discussion, and the forum that the federal--I should tell you a story about this forum. Some of us provincial representatives were wanting to be part of that forum, wanting maybe even to have a co-chair from the provinces, and the federal minister was not too interested in that for whatever reason--you would have to ask the federal minister why--but when it came right down to it, then we were saying, well, why have a forum then? We are the ones that have to run the systems. Why have a forum if you are not going to allow for provincial participation? The answer was it is in the red book and there is going to be a forum. It does not matter whether it does anything or achieves anything, but it is there so you are going to get a forum.
That is maybe a humorous little story but I think it says a lot, too, about how much you do not know if you are not in the hands-on business of running a health system.
The federal government's budget for health is like equal to one of our smaller departments in Manitoba. Maybe that is not fair. I forget what its budget is, but it is very, very small, the federal health budget, because really they are involved in some standard setting and involved in testing of products and that sort of thing, and involved in aboriginal health, but the relationship to their budget, total, is infinitesimal next to what it would be at a provincial level.
So we are saying, I am saying to the federal government, do not try to preach to us too much about what it is like to deliver a health care system because you have never walked a mile in the shoes of any provincial jurisdiction. You have never had to run a health system, so you really cannot claim to understand all the ins and outs of health, so therefore all the more reason to allow for significant participation from the provinces on this. I think maybe they thought we were going to overpoliticize it or spoil their party or whatever, I do not know, but it did not add up to me because you should have provincial input into something like that.
Mental health issues are very important too and those issues form part of the honourable member's formula and that is a question for him to address when he gets to his feet again, but how do we know that the dollars that come to us from Ottawa, for health, anyway, are all going to areas that the federal government expects that they should go to? I am not sure what they expect it should go to, but suppose we decide to use health dollars to fund a program to clean up an environment which is causing a community to be sick. Is that a health expenditure? Is it a health expenditure to use money from Ottawa for something other than a hospital or a doctor? Well, I sure hope so because we are trying to fund some very, very important community-based types of health programs, and I am just not sure what strings are attached to those federal dollars. I suspect they are not very well tied on, those strings, and that we may be talking about something that is not quite as clear as it sounds in the first place.
Mr. Sale: The minister raised a number of points. I lost track of the number, frankly. That may have been the purpose; I hope not though. Let me ask the minister in a very clear way, I hope--will the minister work with his provincial colleagues to attempt to establish consensus on the level of federal finance, fiscal transfers, cash for health care that would make some level of intuitive sense to Canadians and would assure Canadians, then, that the federal voice was not being stilled? Just a straightforward question--will you work with your colleagues to establish a base from which, then, we might be able to save medicare as a national program, as some hope of surviving?
Mr. McCrae: The honourable member might hope for a yes or a no on that one, and I am sorry but I cannot do it quite that simply. I certainly do want to see a federal role and I would like to see it as strong.
The reason for that is that I do not think it is right, even today I do not think it is right that Manitoba should have a health system that is so much better than a health system they might have in other provinces. I do not think it is fair to those people in those other provinces that Manitoba does so much better. The honourable member may want to ask the member for Kildonan (Mr. Chomiak) to disagree with me on that point, but we are clearly one of the best ones in this country and I would like to stay that way. Yet, is it fair that we are so much better than they are in some other jurisdiction? Is it fair to those Canadians, and my fellow Canadians, in the other provinces? So rather than just saying yes, I put it in that way, and the reason I am hedging a little bit on making a clear, clear response is because I still want to be assured that if the federal government agrees to 1 percent of GDP for health, will it then cut in some other area which has a health impact?
I think the honourable member will understand that, but are we running a danger, a risk, if we do what the honourable member is saying that maybe we should do. Yes, for budgeting purposes, it makes it nice and for public discussion. The federal government can then say, well, we put in our 1 percent of GDP so we are okay, but we are going to cut back on infrastructure program to help pay for it. Does that not confuse the issues just as much as they are confused today?
So I do not know if I should insist on that sort of thing, because budgeting is such a funny business in this country. We claim, for example, to have balanced our budget here in Manitoba. We have people on the other side of the House saying, oh no, you have not balanced your budget. You used all these other revenues and their one times and all this thing and that, so you do not really have a balanced budget. And we say yes we do, and you say no you do not. That is the way the discussion goes.
So I will think about these things as I go forward. I will ask my department to address the issues the honourable member is raising as we prepare for our participation in the upcoming federal-provincial meeting.
Mr. Sale: Mr. Chairperson, I appreciate the minister's unwillingness to answer definitively. I realize the position he is in but simply say to the minister that this is a logical end of our discussion, that is, if the federal role is vital and if the federal role can only be enforced with dollars, then there must be some agreement about the dollars. I know these dollars technically flow through Finance, but they flow through Finance to your Estimates.
So yes, I think you do need to have conversations with the Minister of Finance (Mr. Stefanson), and yes, we need a strategy, and you do not want to detail it in Estimates to us. I understand that. I do think that unless there is a provincial position that says, there is a base, there is a formula, there is federal presence guaranteed, then your commitment to Canada's medicare system will ring hollow in the eyes of Manitobans and certainly in the eyes of members on this side of the House, because we cannot have it both ways. We cannot say we are committed to medicare in Canada and at the same time let the federal government do what it is apparently doing--in the stroke of a pen, over two years, cut their commitment by 40 percent to health care, to the point where Quebec will have no transfers by 1997-98. What are we saying?
Mr. Minister, you have raised legitimately the question about other provinces' health care systems. What are we saying to the people of Quebec who, I hope, will decide to stay in this country and, I am sure, you hope will decide to stay in this country? What are we saying to them when there is no more federal cash for their health care system? They lose nothing by separating in the health care area. There is no more federal transfer. There is nothing to come off the table for them by 1997-98.
(Mr. Chairperson in the Chair)
So it is not just in our interest; it is in every province's, including the poorest province's interest, that there be a base that the per capita transfer be assured to them and a mechanism that might have some currency for the federal government and perhaps for the provinces to ensure that would be an amendment to the Canada Health Act.
* (1530)
Many of us have long argued that if we are committed to medicare as a program nationally, then the funding arrangements for that program should be enshrined in the medicare act, not in a piece of fiscal legislation that can be treated by the federal government as though this is just finances over here, it does not affect health; Finance ministers will deal with this, it will not affect you. We heard that at various points in the past. Health ministers, you stay out of this; we will fix up the financing.
Well, we know the result of that now. So a mechanism might be to see if there was some consensus, at least, to argue the Canada Health Act is the proper place to have the transfer for health located, and the level of that transfer, of course, is going to have to be argued and debated, but I raise this simply to put the minister on notice that we, on this side of House, will be deeply concerned about the minister's commitment to health care if, when he goes to meet with his fellow Health ministers and the federal Health minister, there is no Manitoba position that says, first of all, the federal role is vital; and, secondly, the federal role has a floor; and, thirdly, we have a mechanism to offer to the federal government to make that effective.
I honestly believe, Mr. Minister, you would have the support of this side of the House if you went with that kind of a strong position, and I would say to you that if you do not go with the strong position, you will face public criticism because I know that you have said how committed you are to medicare, but that commitment has to have some teeth. I am suggesting that some of those teeth are likely best enshrined in the Canada Health Act and in the establishment of a floor under which transfers will not fall.
I would be interested in the minister's response to those remarks. I do not mean to be hard, but I think that is where we are going with this.
Mr. McCrae: Ultimately, Mr. Chairperson, we do reach a point, I think, where we have a difference, and maybe we are approaching that point, because at the end of the day, I will argue that we are only going to be fooling ourselves and our fellow citizens if we try to pretend there is more money in the pot, either federally or provincially, than there is.
As small an expenditure as expenditures for the federal Department of Health, federal expenditures on social transfers are very, very big, and they are still lacking in priorities when you go through the details of the recent federal budget. I say that in a critical way, but I think that we are engaging in some--I do not know what you call it--but we really are fooling the people of our country if we say we have very little money because we have spent it all in the last 30 years and much, much more, but we are going to protect everything.
The honourable member has to take his comments in concert with comments made by his colleagues in this place which is to spend more, and the honourable member has argued in the past that we can tax more. I do not know if he is still arguing that, but he has argued that. That is not on for the members of this side of the House. So if that is where the rubber hits the road, or whatever it is, then, yes, there is a division between us on that point. I cannot make more resources exist than do. I do not think I can, because we are committed not to tax the people more and we support a federal government in its efforts to ratchet down the deficit and the public debt for this country.
I can go into the long story, but I probably will not, the long story about my own experience in watching governments over the years, and I think I was there and relatively aware of what was going on when governments began to get us into the dark, deep, black hole of debt and the tax-and-spend philosophy. I was, in my own defence, there arguing against that approach. So, just for those who thought I might have been arguing that we should spend too much in those days, that was not true. So that is where I think it is going to come ultimately, and I think it has been played out in recent elections and will be played out perhaps in future elections.
Let us look at Saskatchewan, for example, where the party identities--it is fairly paradoxical, as a matter of fact, what is happening in that province where it is argued by many that it was a Conservative administration that got into some heavy spending and it was a New Democratic administration that is doing something about that. We will find out soon enough but apparently with the support of the people to get a handle on finances.
We cannot talk about our health system, our education system or any of the other ones as if there were no fiscal realities. We pretended for a long time that fiscal issues did not matter, that, you know, these things were so important to us that we could ask our children to pay for them and our grandchildren. There was no moral problem doing that until recently, I believe, the people of this country have said enough of that sort of approach. Those people are the ones we are supposed to be governing for. We are governing for the future. Well, you can get me right back on the track that, well, if you do not address the health issues, there is not much of a future anyway. I think we are addressing the health issues. We are doing it within a framework that is responsible, certainly in Manitoba.
Mr. Chairperson, I know the challenges are not going to go away in the next few years, that is for sure. Our ability as a province could be threatened depending on the economic circumstances that happen in the next few years, but I feel confident that governments, more quickly or not more quickly, are moving in the right direction. Even Ontario, which got off to a very bad start because they failed to recognize the realities and thought they could solve the problems in Ontario with the traditional, i.e., the approaches of the last 25 or 30 years, you could just spend more and get yourself out of all that trouble, it did not work. In the later years of the Ontario administration they started addressing the realities. Unfortunately for them, they had to take some pretty drastic measures, far more drastic that anything we have had to take here in Manitoba. British Columbia, maybe some of the same lessons learned there, but I think the Saskatchewan situation looks a little more like what is happening right here in Manitoba, to me.
All I am saying to the honourable member is do not question my wish to have a strong national health system. You can always question my government's way of going at doing that, but my goodness, I am a Canadian like everybody else around here and hope to enjoy the benefits of being Canadian like everybody else. It comes down to, are we going to have a better health system by asking the federal government to continue to borrow money in order to give us more so that we can strengthen our health system.
* (1540)
It is a good thing to ponder, but while we are pondering it let us make sure we are spending the dollars well. There is ample evidence that we have not been over a long time, not only here but across the country. We have been spending it all on expensive high-end, tertiary, et cetera, types of care. Let us do a better job of spending the dollars we have.
We are going down that road now and I claim Manitoba is well out in front there, but the other provinces are coming right along with the same idea--to get some value for the dollars we are spending. I guess the federal government can also say that to us when they want to justify if there is a reduction in their share. They can say we cannot afford to give you more anyway but just in case you do not buy that argument, you are not doing a good job running the health system anyway so we are going to give you a little less and maybe you will smarten up.
The debate will just go on and on. That is okay, because I think Canadians really do spend a lot of time thinking about the social service network that we have in our country. They should because that is what sets our country apart from so many others. If we are going to have a difference of opinion, I think it is going to be on that point. I will operate on the presumption that there are only so many dollars and the honourable member will say, no, but we can find some more. We will be interested to see how the debate goes from there.
Mr. Sale: I think there is not a lot of sense in continuing this line, because I think the minister understands that the federal role is vital, the federal role comes at a price. The question of the level of the price is open for debate, but the fact of the price is not. If there is no price, then the federal role is not there. I think we have had that discussion. I take it it has been a useful discussion.
I would say on the question of the federal affordability that I would simply return to the idea that a developed nation led by any government which could not find 1 percent of its gross domestic product to contribute to health care has got screwy priorities. Whether we can get to that in two years or five years is open for debate.
In terms of, is there money available, I will not get into the macroeconomic issues, but a credible interest rate policy, a credible monetary policy in this country, has widely been seen as necessary to making those monies available.
Even as conservative an institution as the Royal Bank of Canada last week issued a report which pointed out that the federal government, under the previous government and under the previous head of the Bank of Canada, had made the '91 to '93 recession significantly worse by its monetary policies and added immensely, far more than we are talking about in health care costs, they had added to our debt and our deficit far more by their wrongheaded monetary policy.
I do not want to get off onto that, but I would just say to the minister, we are not talking about a big sum of money here in order to stabilize the federal role. I think that politically it would pay us great dividends to go into those negotiations with a sense of what that role ought to be and a sense of the ballpark in which we would want to play it out.
Otherwise we will be finessed, as we have been finessed over and over again, by federal bureaucrats and federal ministers who make exactly the speech that the minister just made--the cupboard is bare, the cupboard is bare. I do not think the cupboard is bare. I do not think a developed nation can say to its people, the cupboard is bare for health care but there are other things that we can continue to do. I do not want to continue that particular debate. I think we have had a useful exchange on that, and I hope that it has been useful to the minister. It has been to me.
I want to end with just one question, and I hope it does not get us off into a long discussion, but the minister made the point in the second day of Estimates of this committee that a number of nations had a higher health status and yet spent less money. He referenced, in particular, Scandinavian countries and Japan.
I just want to make a comment that there is a lot of evidence emerging that that has not much to do with their health spending. I think the minister has, in other ways, said this as well, that public health expenditures, public policy, etc., is more related, as you have said, to the determinates of health, and the determinates of health are what determine health status, not spending in the acute care system. That is not a reason to underspend in acute care, but it is a reason to recognize that you cannot raise your health status in a country by simply spending more money in acute care, that the payoffs are very small.
I would just like to ask the minister if he would concur with the views of a number of eminent experts, and I cite Fraser Mustard and the work that Mustard has done, as one place that you might look for such expertise, and he has a long bibliography of people. The body of opinion is simply that what seems to be a really basic determinate of health status is what is called power distance. An example of power distance is income disparity. The nations that have relatively lower income disparities between their wealthiest and their poorest seem, on the whole, to have the higher health status. It is a sense in which income and employment policy and the sense on the part of the citizen that they have some control over their lives, that they are not at the whim of employers who lay them off in a moment's notice or the whim of governments who change the rules on a moment's notice.
The sense of the social contract, the social solidarity that is characteristic of Japan and Sweden, to take two quite opposite kinds of societies with very different views of themselves but nevertheless both have a very clear sense of social contract, that compact patterns of income distribution, characteristic of both societies, and a high commitment to employment as a public policy that full employment is a public policy, a goal, an up-front goal, that those nations have a higher health status.
I would ask the minister if he could respond to the question of what his government is really doing about the first chapter of Health for Manitobans - The Action Plan. What is the minister really doing about that first chapter which has all the health determinate stuff in it? The second chapter has all the institutional arrangements in it. We have talked a lot about the institutional arrangements for financing at the federal level, what about the health status questions to which you, yourself, referred in terms of Japan and Sweden as an example? When are we going to see a clear strategy on this, that your department leads on?
Mr. McCrae: I just want to put in a little postscript to the previous discussion, and then maybe talk about some of the things the member last referred to.
I think that people like Senator Carstairs should get a copy of the discussion between the honourable member and myself, read it carefully, and play a role in Ottawa. The honourable member was not, but I had the opportunity to experience several years of the presence of Senator Carstairs here in this house, who often spoke about things like education and who spoke about things like giving the kids a reasonable start in life, and during our constitutional discussions put a very heavy emphasis on the protection of our social programs and preserving the strength of the federal authority in all of these things.
The discussion between the honourable member and me is simply that. Without that third party involved in a significant way--by saying these things, I am not trying to bring in members of the Liberal caucus in the Legislature here. I am making a very pointed suggestion to the former member of this place who is now a senator sitting as a Liberal in Ottawa and who may be able to use her influence there on this point.
* (1550)
Goodness knows, she has talked about these things enough times. I want to know if Senator Carstairs has changed her mind because on all of these matters that were so fundamentally important to her when she was here and seeking to be the Premier of this province and so on, now there is virtual silence on the part of the senator. I hope that the powers that be will make sure that the honourable senator is aware of this discussion going on here today, and if she means anything she ever says, maybe it is time for her to start showing us that she means what she says and that she is not simply a grandstander herself. That is the postscript to the last discussion. I felt moved to say those words because I feel strongly about that.
Mr. Chairperson, I am afraid that when we get into a discussion about circumstances that prevail in Japan or in Sweden, countries with whom we sometimes make comparisons, I guess we need to look at the whole picture and I need a clearer understanding of the whole picture, because in some countries, you know, a determinant of health might be the issue of employment, for example, but it is kind of ironic that in some countries where they have a higher level of unemployment, they still have the kind of conditions the member talked about whereby they still are able to maintain their relatively good level of health status, even in places where there is higher unemployment than other places, and in other places where they have something closer to full employment they, too, have good health status.
So not everything matches directly, for some reason, depending on the country, I guess. I understand that something else that seems to me would be important would be the issue of debt and the cost of servicing that debt. I am led to believe that in Japan that burden is not as high as it would be in a place like Denmark or Sweden or somewhere like that, maybe Sweden is a better example, where they have a higher level of debt and maybe a similar level of health status. Debt, though, is important because we know very well every day we are up over $600 million this year in our budget that has to be spent to service debt.
An Honourable Member: Very sad.
Mr. McCrae: Very sad. Sad hardly even describes the way I feel about that kind of expenditure going for debt. All it says to me is that we must have had a horrible, horrible depression and had to borrow a lot of money to get ourselves out of that mess, except we did not. We had a recession during the early '80s and we had one more recently, but we borrowed and spent like proverbially drunken sailors at a time when we did not need to do that, when we had sufficient revenues to run a good, quality service to the people in our province and we got into all this debt, and now we do not have some $600 million to spend on building towards improvements to the determinants of health or for that matter for the acute care sector of our health system.
In retrospect, stupidity, national stupidity, you could call it, what we did as a country, but I am in a position and I know the honourable members on this side of the House, certainly the member for Turtle Mountain (Mr. Tweed) and the member for Portage la Prairie (Mr. Pallister), I know they have been saying it for years as well, absolutely stupid to be spending so much money you do not have.
Now, here is where the philosophical differences emerge in a big way, in my view. I know that New Democrats would speak against excessive profligacy. I know they would, and yet we claim that they have supported that sort of thing over the years too. So there is a definite difference in opinion and philosophy.
We do not have all these hundreds of millions to spend on creating better socioeconomic conditions for people to live in, although when you do that, you improve the health status. There is enough evidence out there to show that happy people and people who are not idle all the time and people who spend their time working at constructive endeavours are healthier people. We know that. So why can we not spend $600 million of this year's revenues on building appropriate labour-creating, job-creating endeavours? [interjection] I am getting a little help here, and it is much appreciated.
We are really taking from future generations. Instead of adding to their quality of life, we are taking from them. I get really upset when I am accused of being part of a government that is responsible for that. We get into a debate about all of the borrowing of the last seven years that had to be done. Well, may I suggest that if we had not been facing half-billion-dollar-a-year debt repayment charges, our government would not have had to do that, and to be criticized for not balancing the budget in those years is kind of a sophistry, I believe.
In any event, I do digress a little bit. I do not want to get anything started here, but I think I just did. The point is, the comparisons that we make, not all of them are immediately understandable to me. Maybe they are to the honourable member who has more experience in this than I do.
Surely, there are differences even between Sweden and Japan, where they both enjoy what we call a better health status than we do, but there are differences in those countries, and I wonder how relevant those differences are. Diet, to me--I am told that the diet in Japan is something that might have a lot to do with their health status, that here in our country and in the United States and in some European countries, we are into this fast-food sort of generation, and we all know that is not very good for you. Maybe these other countries have not got into that as much.
I wonder if the honourable member can elucidate a little bit about that for my own information. Do those things matter? Does the debt level in Sweden versus the debt level in Japan--how does that figure into the equation when we are talking about health status and those types of things?
Mr. Sale: I am no expert on this, Mr. Chairperson, either. I simply read a lot of stuff, but I think the Health department is in a position to provide that kind of information to the minister, and I would just reference the most recent OECD studies, that do attempt to unpack what are the determinants and what are the relationships. The minister is quite right, the nutritionist is obviously a key one that we have known about for a long time.
The thing that I would like just to close off with is, first, to thank the minister for this exchange. I found it helpful. I think it has been useful to us, and if he feels that in sharing the exchange with others, I would broaden the audience from Senator Carstairs to include the odd other person, I would be happy to see it shared, if he thinks that would be useful, and I encourage him to do so.
* (1600)
I would just ask whether the minister has listened to the tape or read the record of Dr. Fraser Mustard's presentation to the health conference that his predecessor, the Honourable Don Orchard, convened about, I think, three years ago now. I know the conference was taped, and I have the tapes of Dr. Mustard's presentation as well as the text. He, I think, captures at least at that time, three years ago, the best and most up-to-date sense of what it is that produces higher health status and what does not. He is a wonderfully entertaining speaker, and I hope the minister's staff, if the minister has not heard the tape or seen the material, I hope the minister's staff would make that available.
I think that as a province, if we listen to what Mustard and the experts that he cites, who come from around the world, have to say about improving health status, and what are the cheap and effective ways of doing that, we would see some different policies in all our provinces.
In particular, we would see a different approach to maternal and child health, not in clinical terms but in social program terms. We would see infant stimulation programs targeted at low-income mothers and low-income families, in a very broad way. We would see parent-child centres in lower-income neighbourhoods, to help parents learn how to do the simple things, like read effectively to their children, so that they develop language skills before they come to school.
A program that was developed in Israel and interestingly brought to Arkansas by Bill Clinton, a strange way to get to North America, but nevertheless there it was, in which the lowest income, most at-risk mothers are often people who are not comfortable reading. They may have some literacy skills, but they do not have great skills often so reading to their children is something they find difficult. They also may not simply have access to books to read. Very cheap program, they taught the mums how to read a story to a child. That is, you do not hold the book up and read it. You hold the book, and you read it. They helped them with their literacy skills. Amazing things happened for those children in terms of preschool readiness levels. Not much to do with health, in an obvious way, but everything to do with health in the kind of way that the minister and I have been talking about.
I think that Mustard's work is seminal work. I think it is really useful stuff, and I hope the minister would ask his staff to provide an appreciation of the range of strategies and, in particular, the very low expenditure strategies that are possible in there, which I think we could well afford within the modest resources that we have available to us.
So I do not ask the minister to respond to that, but I want to thank him for this exchange, and I hope that it has been useful.
Mr. McCrae: I appreciate the honourable member's comments, and not that I want to talk too much or anything, but I just want to make a brief response to what the member had said when he talked about the young people and Dr. Mustard. I have had the pleasure of meeting Dr. Mustard, and I will ask my staff to see if we can track that down. I am sure we can.
By the way, new at the table in front of me today is Associate Deputy Minister Frank DeCock, who is playing a very important role in our relationships with our partners in attempting to achieve those better outcomes and to address things like health status and determinants.
I do not want this debate to end without a reference to the issue of when the honourable member mentions maternal and child issues. For us to pretend that maternal and child issues in the area of health should not somehow include a discussion of aboriginals' conditions--and we cannot talk about it because we get into trouble when we do. There are those who say, oh, you are fobbing it off to the federal government, or it is a racist thing to do.
I will tell the honourable member about an experience I had, to tell him why I am very sensitive about this and fairly passionate about this. I was engaged as a Justice minister at a conference dealing with youth crime and was branded by a participant as a racist for raising the issue that there was a higher level of crime in communities where there was a higher level of aboriginal population. I was branded as a racist for saying that.
My response at the time was, well, you know, if that is going to keep us from talking about it, because somebody wants to be nervous about how somebody else is going to respond, then we will just carry on for another hundred and fifty years in our country, and not address very, very significant problems.
(Mr. Mervin Tweed, Acting Chairperson, in the Chair)
I am not proud of the record of our country in this area, and I guess, we will just have that same record for another hundred and fifty years if every time somebody opens his or her mouth to talk about the realities of it, they get criticized for it.
This goes back beyond that conference I attended. As a court reporter working in Manitoba, in Manitoba courts throughout the province, in the rural and remote areas too, I could see exactly what the honourable member and I have been talking about, economic circumstances not being as good as some other areas, those lead to poor determinants of health, higher incidence of crime, higher incidence of substance abuse, higher incidence of alcoholism and drug abuse and all those things.
So all I am doing, by raising this today, is appealing to honourable members, to, let us please discuss these matters, because even though it is clear the Constitution again talks about the federal government's responsibility for aboriginal Canadians and lands reserved for aboriginal Canadians, it is still our problem. It is everybody's problem. I do not think anybody wants to see these problems go unsolved. I do not, and I would hope that others would join with me and my colleagues in government in finding a way to bring parties together.
My greatest frustration as a minister in this government for seven years is that I have not been able to bring federal and aboriginal leaders together to get anything done. Sometimes they do not even want our involvement. That is there too. But, as a Canadian, I say that is not an area that Canadians are proud of today. There is nothing really, really significant happening with the new government, and I thought Minister Irwin had all the right intentions, said all the right things, but I do not see the forward movement that I would like to see. I wanted to put that on the record because I am very sensitive to those concerns, not only from a humanitarian point of view, but, if you look at the dollars being spent in the acute sectors of health, you could so easily see those dollars being spent at the primary end of things and get a far better job done, no matter what your level of government happens to be. I thank the honourable member for staying around for that little lecture.
Mr. Kevin Lamoureux (Inkster): It has proven to be fairly interesting, the dialogue and discussion that was going on between the Minister of Health and the member from Crescentwood.
One of the things that I did as a result of that dialogue is I pulled the Manitoba Estimates out, of revenues that are coming into the province. I understand and I appreciate the sensitivity in terms of how government establishes priorities by the way in which, quite often, where they put the dollars, those scarce dollars, which we have or that we collect, into the many different programs, departments and so forth that are out there.
* (1610)
During the most recent provincial election, we heard a lot at the door in terms of the whole question of EPF funding and the federal government's cutback on EPF and what role. I have heard a great deal of minutes being spent on how important it is, at least during these Estimates, that the federal government play an important role in the future of health care, not only in the province of Manitoba but, in fact, throughout all of Canada.
In many of the discussions that I had, for example, at the doors, people were of the opinion that hundreds of millions of dollars were being cut out of health care. Some were even of the opinion that what we were talking about was within the province of Manitoba where we are losing hundreds of millions of dollars from the federal government transfer payments out of health care, which really and truly is not the case. We are talking about an overall percentage of the cut that has been happening to all of the provinces through EPF funding.
One of the things that I have learned over the last number of years is that you can do a lot of things with numbers, with revenues that come in, and one of the best examples of that is to take a look at the whole issue of the gambling and revenues that came into government on gambling, and how government was able to explain its priorities with the way in which it spent those dollars.
I would look and want to see some sort of debate, possibly, in terms of how we believe the federal government might be spending its dollars, the priorities that it is in fact setting. One, of course, might be of the opinion, for example, if you listen to Question Period after Question Period or some of the rhetoric that is espoused by so many, that we are doing pretty bad with this federal budget. No doubt, the federal budget does hurt us in many different ways.
When I speak strictly with respect to the revenue, I look at page 6 of the document that this Minister of Finance has brought in. Equalization payments, a program in which Manitoba has been a major benefactor, has received a substantial increase year over year. I appreciate, in particular, the comments that the member for Crescentwood (Mr. Sale) put on the record with respect to equalization payments. It is how the province of Manitoba is doing relatively compared to other provinces throughout Canada, and that in itself is what determines equalization payments.
Ultimately, we believe that the federal government has a good priority in terms of dealing with the so-called have-not provinces, ensuring that we have the finances to be able to provide adequate social programs to our citizenry in each and every province.
Ultimately, it is up to the province in terms of how it is that we are going to spend that equalization payment. For example, if the government of the day wants to say look, we want more emphasis put onto health care, then government can use some of that equalization payment to finance more health care expenditures. If we believe that the federal government has to take more of a proactive approach in dealing with health care across the country, then ultimately one could argue that maybe the federal government has its priorities wrong and it either has to cut in other places, raise taxes or increase its deficit.
I have heard the current Minister of Health comment on that extensively in terms of the options that governments have to face in today's society. Unfortunately, the bottom line from his perspective is, it is scarce dollars that are there. You cannot spend as governments of all political stripes have spent, particularly during the '70s--of all political stripes across Canada.
If we believe that the federal government does need to take a firmer commitment, I am wondering in terms of where it is that we believe the federal government should be taking that money from. In the $1.798 billion that it provides, it gives us somewhat of a breakdown of where that money is going. Are we suggesting, for example, that in some of those areas, the federal government should be cutting back and allocating more into the EPF financing, that that, in itself, would alleviate some of the concerns. Are we saying, for example, that they should pull out of Culture, Heritage or Agriculture or Finance, Government Services, Justice, Labour and go down the line? Are we saying that the federal government needs to increase taxes? Are we saying that it has to increase borrowing? This current government would say, of course, no, they should not be increasing borrowing. Are we saying that in fact that they have to have cuts?
Mr. Chairperson, we have seen the cuts that the federal government has brought forward, and as I pointed out, hurts in many different ways. But yes, it is a question that does deserve some sort of debate inside the Chamber, and that is the federal government's ongoing role in Health, and the money that it does hand over to the province, and the biggest block of that money is through equalization payments. Is it better, or is it in our best interests, as Canadians first and foremost, that maybe we start tagging some of that money? Out of that $1.798 billion, $1.04 billion is through an equalization payment that is anticipated in coming.
(Mr. Chairperson in the Chair)
Are we suggesting maybe that some of that money should be tagged, or are we suggesting other dollars that are being transferred over from other departments should be cut back and more given into health care? I believe, as the current Minister of Health no doubt would concur, that we are all taxpayers, and our constituents do not necessarily distinguish, well, the provincial government has given us a break on tax relief and the federal government has decided to increase the taxes, or vice versa, that people genuinely feel that before you come to us to ask for additional tax dollars in whatever form it might be, ensure that we are spending what current monies that we have in the best way that we can, that we are establishing our priorities.
This government has placed high priority on health care and we have seen the health care in terms of the budgetary dollars that have been allotted over the years. Albeit, we have had criticisms in the past of this government. The government has demonstrated that health care is in fact a high priority through the way in which it has found the resources to give to the health care budget. But many of the things that have occurred from within that health care reform or change that I alluded to earlier we would no doubt call into question, the ways in which this government has spent it.
I do think that when we talk about the EPF that we have to be, and no doubt in our minds we will understand the politics of the many different issues that are out there, health care being one of those issues, I would challenge anyone to indicate that the federal government has absolutely no concern nor any compassion about preserving our health care system. Each and every one of us have heard the current Prime Minister and his claim to want to ensure that health care is going to be there in the future, and the current Minister of Health.
If we believe, as I heard this afternoon from particularly the member for Crescentwood and the minister, that the federal government needs to play a larger role, maybe we should also be talking about other than just saying we want them to play a larger role, but to give direction on how they can be playing a more significant role.
It is not good enough just to say, let us add more money to it without providing those alternatives. I know that I too could likely be criticized for some of the things that I have done in the past when I said, well, we should be spending or putting more resources into a particular area and possibly at least at times not necessarily offering where those resources could be coming from.
The question that I would ask the Minister of Health is, there is a line transfer actually through the revenues from EPF, and I am wondering if the minister actually has some sort of a graph that would demonstrate the reduction of EPF funding over the last 12 to 15 years for the Department of Health.
I also wanted to make reference to two other lines that are presented in the main budget that the minister provided, Minister of Finance (Mr. Stefanson), and that is of course under Other, there is Health $4.8 million, which is an increase from the previous, and under the Canada Assistance Plan, there is Health at $14.6 million, an increase from $12.9 million.
* (1620)
If I can get some sort of an explanation on those two lines and as I indicated, you know, a 15-20 year--I understand that the concern with respect to the EPF is something that has arisen over the last decade-plus. So I would appreciate a graph of sorts just to show the actual decline.
Mr. McCrae: Mr. Chairperson, I believe if a graph of the kind referred to by the honourable member for Inkster, does not exist, I would be surprised if it did not, but if it does not I can give the honourable member an undertaking to find one or to make one available to him as soon as we can do that.
I listened carefully to what the honourable member was saying, and I feel that his comments all taken together amount to a helpful approach to what we are trying to do here in Manitoba and across the country. If the honourable member would not mind, I could give him the benefit of a little bit of my own personal experience. The one piece of advice that I would give would be, do not go out of your way to defend the federal government when it is a Liberal government and you are a provincial Liberal. We have learned that it is not a bad idea to be right in there standing up for your province's best interests regardless of what kind of government there is in Ottawa.
The honourable member, I think, will know what I am talking about. I have been through four elections now and only one of them was an election in which I did not have that particular problem to deal with. When I say "problem to deal with," it is a real one, and I do not blame anybody. I am just saying that those are the dynamics of Canadian politics, and, for what it is worth, considering the source and all the rest of it, I say to the honourable member, you do not need to get up there and defend the levels of federal contributions under EPF or any other program because it will not do you any good, politically that is.
On the other hand, there are reasons if you see a decline. All we are really discussing is the degree, the amount. I think, in total terms, everything taken together, we are seeing and will see declines in revenues from Ottawa. The reason for that--well, the honourable member shakes his head. Well, then he supports the levels of debt that we have, and I am sure he does not want to say that. The levels of debt are too high. Something has to be done about the debt. There is only one federal government and that government has to deal with it.
The honourable member was trying to say that, talk about that, and he is right. No matter which government is in office in Ottawa right now, they have to deal with that. The people of this country demand it. Okay? So all I am saying is, let them deal with it, do not go out of your way to defend that bunch, because I would not want to be defending a federal government under the present circumstances or I would not have to defend again a federal government at the provincial level. You do not need to. They are there to do their job and we are here to do our job. Sometimes our interests are not exactly the same. Even when your party affiliation is exactly the same, your interests can be different. Your spheres of jurisdiction can be different.
Well, enough lecturing for the honourable member. He does not really need any lectures from me anyway. I agree also with something the honourable member said about compassion. I do not believe any politician who says, I have more compassion than the other guy. I certainly do not believe it from the New Democrats, and I am not speaking to the New Democrats in the Chamber today, I am speaking very generically. I have listened to New Democrats spew forth all these high-sounding words and phrases ever since they became a party, about how they care so much about their fellow creatures. I was not buying it then and I am not buying it now.
The reason I say that is that I differ from the New Democrats on their basic philosophy on how to redistribute the wealth of the nation. That is very understandable, but I will not, in the name of an argument about compassion, accept any New Democrat or any Liberal or any Social Credit or whatever else there is, Reformer. Nobody is going to have a corner on that particular market, and that does not matter, which party you are from.
So I think the honourable member was talking about that, too. I think every government gets elected and does its best to do its job, even in the light of severe criticism. Even Bob Rae probably thought he was doing the right thing, think about it. And the judgments have been and will continue to be made from time to time. But never once would I suggest that Bob Rae or any individual member of his group had the wrong instincts or the wrong motives. They wanted to do right as best they knew it. Well, some populations need to be protected from their governments, and some populations need that protection more than other populations.
I say with all due respect to Mr. Rae and his colleagues that I think they got off to a terrible start and improved some as they went along, but the damage was done, and well, I am not a fortuneteller, so I better not go any further with that discussion. Never once, in all my discussions, with Mr. Rae and his colleagues--even, Michael Decter, who worked closely with Mr. Rae, I never once questioned his motives either.
If that helps lay the groundwork for the discussion, that is great. I did say what I said about Senator Carstairs, though, and I did so because of my own working experience with Senator Carstairs, and all I want her to do is to remember the things that she said when she was seeking elective office, as opposed to the things she said since receiving appointed office. There are differences in approach, obviously, that maybe have something to do with how one gets where one arrives.
All I am saying is that all of those lessons that we were taught here in this Chamber by the former member for River Heights about caring for the children and about spending appropriately at times and places where it is a good investment and how protection for our health and social services ought to be enshrined in a strong, central government and how all this ought to be guaranteed forever in a constitution, and that will sure take care of all of our needs--I want Senator Carstairs to remember she said those things when she was an elected representative, and I wonder what she is saying today.
I think the honourable member for Inkster (Mr. Lamoureux) made references to the debate and discussion that the member for Crescentwood (Mr. Sale) and I were having. It is kind of fundamental where we go from here, it is true. I find it more and more important for people like the honourable member for Inkster to just be very straightforward, not only here where I always feel that he is, but in his dealings with his federal counterparts too.
I am not here to make them out to be people who are not working for the best interests of our population here in Manitoba, but when it came to the federal budget my main complaint was not on the fundamentals so much as the one fundamental problem that budgets seem to lack any attention to priority detail. When I say that there are all kinds of areas you might call little areas of spending where it just seems like they said take so and so percent off this department's budget and so and so percent off that one. Well, maybe it is because the federal government is so big that is the way they have to do things, but it does not make as much sense as it should at a time like this.
* (1630)
I would be happy to compare our provincial budget with that one to show where there are priorities. The honourable member identified them in his comments. Health is a major priority or the major priority for every provincial government. It just happens to be the biggest priority for the Manitoba government and I think the honourable member made reference to that and I appreciate that.
I am not here to whine about how many dollars are not there from Ottawa. I am here though to make the point that there is a level of hypocrisy or apparent hypocrisy that exists when the federal government says we are going to still insist on certain fundamentals in health care. We do, I say sincerely, come dangerously close and closer every year to a point where the federal government will not be heard any more on the issue. The member for Crescentwood sounded very, very concerned about that and I am too.
I do not have all the answers myself as to how it is the federal government is going to preserve for itself any kind of authority to deal with issues like the threat of the two-tiered system or the threat of the looming private hospitals in Alberta or some such thing like that. What can Ottawa realistically do if it is facing a provincial government that wants to go even further than that? It is not happening here, but it could happen elsewhere as the federal role diminishes and diminishes.
I am happy the Minister of Labour (Mr. Toews) is not far away from the sound of my voice here. His name came up in the discussion earlier on when we were talking with the member for Crescentwood who suggested that maybe we should get Roland Penner or Jack London to give us some advice on the whole issue of whether Ottawa has any clout left in light of declining contributions to our EPF. The member for Crescentwood was asking if we should somehow get together with other provinces or go it alone or to get a legal opinion is what he was talking about as to whether there cannot be something done about the approach being taken by the federal government.
I reminded the honourable member, I mean, he mentioned Rolly Penner and Jack London, and these people are extremely well known, it is true. But I also threw into the hopper the name of the Minister of Labour (Mr. Toews) who has a pretty significant background in the area of constitutional law, having headed up our Constitutional Law branch.
I could have mentioned two or three other members of our caucus who, I would think would [interjection] Well, exactly, the member for River Heights (Mr. Radcliffe), the member for Riel (Mr. Newman), the member for Lac du Bonnet (Mr. Praznik) might also, all of them put together--
Mr. Chairperson: Order, please. Could I ask the honourable minister as he is speaking to address towards the Chair so that the microphones could pick him up. We are having a little bit of trouble getting you.
Mr. McCrae: I do apologize for that but I always think of members of the government party as sort of equal members in the Chamber, too, and ought to have the attention of the speaker and the eye contact and so on, but I know that we all need to be heard in this Chamber.
Anyway, I digress a little bit. I recognize that, but as it turns out maybe we should not ask the Minister of Labour or the member for River Heights or the member for Riel or the member for Lac du Bonnet to give us a legal opinion because it might be deemed by somebody to be somewhat, you know, political.
The honourable member for Inkster (Mr. Lamoureux) suggests that. Now I would never would have come right out and said that word to describe an opinion offered by any of my colleagues in this House, but I do not even know if that is the right approach, but I do intend to talk with my colleagues about this because is a legal opinion really what is going to put billions of dollars back into the coffers? I do not know how many legal opinions in the past have moved billions of dollars at one time.
But showing his usual infinite wisdom, the Minister of Labour (Mr. Toews) points out that jobs will create the kind of environment we need to guarantee high quality health care in this province, which is a given because we are way ahead of all the others, anyway, but guarantee high levels of service in the health care field, education field, social services field for many years to come.
It is the ability which brings it right back to our own government. Our ability to create and foster an economic climate which generates jobs galore is our best guarantee not only of health care and social services but also the ability for government to keep on balancing those budgets, which is the best guarantee I know of for the kinds of things that everybody in this Chamber and everywhere in this country really want to see for our country. We see ourselves as a very, very successful country in a competitive world, and we see ourselves continuing that way for many years to come.
You know, Sir Wilfrid Laurier did say that the 20th Century belongs to Canada, and, you know, up until a few years ago I thought that he was just a little ahead because it probably will not be till the 21st Century. Then the Filmon team entered on the scene, and I could see that at least in this part of the country Sir Wilfrid Laurier was right.
I do not quote Liberals that often, but there is one of them that had a vision. You know, I think the reason that he that vision was his minister of the interior was from Brandon. That is important. Sir Clifford Sifton was Sir Wilfrid's minister of the interior. He was the first Attorney General from Brandon, by the way, from Manitoba. I was the second one which is kind of nice. I take a lot of pride in that. In any event, Sir Wilfrid said that and he was not that far off.
Because is it not interesting, and now I speak seriously, that in two years out of the last three, the United Nations has said that Canada is the best country in the world. That was a survey based on the amenities, based on the social services that countries can provide to their people, and two years out of three Canada came in No. 1, and the other year it was Japan. So it is not that wrong for us to compare ourselves to Japan in lots of things. Faced with these kinds of realities that we live in a very, very fine country, which takes its place in the world basically second to none, what is all the rhetoric about, you know, about who is responsible for this and that and the other thing? Well, that rhetoric helps to keep us the best country in the world. I feel that. I believe that. We ought to be very proud of this country and be very vigilant about keeping it the best country in the world.
So we hear from members in the New Democratic Party perhaps--we all have our sort of different reasons and we all have some same reasons too. One of the same reasons we keep talking about, preserving the best of what we have is because we really mean it. I believe the honourable member for Inkster (Mr. Lamoureux) and I believe the other honourable members as long as they believe me too, because my colleagues and I work hard to preserve the best. While we are preserving the best, let us get rid of that which is not working properly and replace it with that which does and also keep our eyes on the importance of the determinants of health, the health promotion side of things.
You see, medicare and what the honourable member for Crescentwood (Mr. Sale) was asking me about, we were basically talking about medicare all the time. While medicare is important, as Prime Minister Chretien said, it is there to keep us from getting into those catastrophic things. That was what it was designed for. Then he went on, of course, to say that a lot of things do not have to be covered. Well, we like covering a lot of things in our health care system in Manitoba and it is on that point that we may get into debate with the Prime Minister. Of course, he is trying to keep our expectations from rising too high and maybe he should because he is not going to be able to send us as much money as they used to send.
* (1640)
I want the member for Inkster to know I understand that. I am really only going to pick a little bit at the federal budget. I am not going to condemn it. I think, in general direction, whomever was in office this year in Ottawa did not have much choice. This is the general direction it had to go.
I will be critical on the so-called little areas even though they are not so little when you think about it in human terms. When I see Minister Marleau, see her correspondence to me the day after the budget saying that you know, the nutrition program is going to be cut and the program for moms, prenatal programs, are going to be cut and in comparative terms the numbers were not big compared to the whole budget, but still big enough to have an impact, I thought, well, they did not do a lot of work to prepare for that budget. They just sort of hit the bottom lines and said let us look after our bottom lines and let somebody else worry about the details. I thought that was the thing I wanted to criticize in the federal budget. It is not a fatal flaw in terms of the total direction of the budget.
I sense sometimes New Democrats would say, no, we could have gone back to the other method. Very often it is, have a fair tax policy and everything will be okay. In other words, find all those billions of rich people in this country and billions of large corporations and just gouge them and everything will be fine. I do not think it is quite that easy. No one has yet convinced me that it is. Until somebody does, I will remain working with my colleagues on this side of the house to show Manitobans that we have our priorities well placed. I will just gently nudge the honourable member for Inkster to implore his federal colleagues next year when they do their budget--have a little more attention to detail.
Mr. Lamoureux: Mr. Chairperson, I believe, actually you and I now both heard not only the Minister of Health, but the Premier (Mr. Filmon) offer advice, political advice to me. I always appreciate receiving advice and that advice was, of course, whatever the federal government does, go and oppose it and oppose it in the best way that you can. You have nothing to benefit by saying anything positive about the national government. I appreciate and I thank them for their advice. I do not think it will have, with all seriousness, any significant impact on me. I am already aware of the benefits and the negatives of what the federal government might or might not necessarily do, but I am also aware that, at times, government and the New Democrats do tend to exaggerate what is going on.
Even in the lengthy answer that the Minister of Health gave, he made reference, well, maybe we get legal opinion as to why and if they can and what we can do about getting them to take on more of the responsibility, to get them to put in more billions and billions of dollars, Mr. Chairperson.
Again, I would like to see the numbers. I do not necessarily believe the Minister of Health is right on, when he says billions and billions of dollars that have been taken out. I would ask, in particular for the province of Manitoba, he has made the commitment in terms of getting back to me with respect to some form of a graph over the last 10, 15 years, of the EPF on Health.
So I will ask him specifically, on the line of Health, under Others--it is 2.(h), if you like, total revenue of $4.869 million, what that line is there for, along with, under the Canada Assistance Plan, there is Health at $14.611 million, and the actual amount of the Health transfer payments, just for the last three years through EPF.
Mr. McCrae: Mr. Chairperson, we try to be very responsive over here. We came sort of prepared to discuss the Estimates of Expenditures, as opposed to Estimates of Revenue, but that is alright. We do not have it at our fingertips, but I think that we can get what the honourable member is asking for. My only concern is, he is probably going to disagree with the numbers when we get them anyway.
I remember being on the platform with the former member for Crescentwood, Avis Gray, and we had a disagreement about what the federal budget was going to mean in terms of revenue for the next three years. For the life of me, I could not figure out her numbers, and for the life of her, she could not figure out mine, and yet we were both right, according to us. You know how that goes.
Mr. Chairperson, just as soon as the honourable member clarifies that, I would be recommending a five-minute recess.
Mr. Lamoureux: Mr. Chairperson, the reason why I am interested in those specific numbers is because we are talking about the federal government's commitment to health care. Just in reading and perusing this--and what caused me to peruse it was the member for Crescentwood's (Mr. Sale) concentration on this very important issue.
When I look at the actual numbers of Health, from the $4.6 million to $4.8 million, there is an increase there. Under the Canada Assistance Plan, under Health, again, there is an increase from $12.9 million to $14.6 million. There is a couple of million dollars in terms of additional dollars going into Health, and then under the EPF funding there is a reduction from $420 million to the province to $416 million. There is $4 million difference. There is just under $2 million coming into Health from two other lines and there seems to be $4 million that has been cut out from the EPF.
This is the first time that I have gone through the Health Estimates; I could be missing something here, and that is the reason why I am asking the Minister of Health. Out of the Health EPF, what percentage of that $4 million reduction is actually from Health. We could take the five-minute recess and come back.
Mr. Chairperson: Is it the will of the committee to take a five-minute recess? It is agreed.
The committee will recess for five minutes.
The House recessed at 4:47 p.m.
________
After Recess
The House resumed at 4:56 p.m.
Mr. Chairperson: I call the committee to order.
Mr. McCrae: Mr. Chairperson, just before our little break the honourable member for Inkster was asking for some information, and I am advised that we can make that information available to the honourable member for next day.
Mr. Lamoureux: I will leave that line of questioning until I actually get the information, and, of course, because there is no hidden agenda that I am looking for, what I am interested in is in fact to compare what I see at least on paper approximately $1.9 million increase in two other lines of health care transfers compared to the $4 million decrease through the EPF funding.
I wanted to move on to--actually I would like to be able to continue what I started last time we sat as a committee, but prior to doing that, I want to pick up on an issue that I brought up today, actually during Question Period, because I think it has a lot to do with committees that are out there. The Minister of Health was very kind in providing a list of all the different committees that the Minister of Health has commissioned or ongoing. Some of them, of course, are past committees. I take it they have stopped. One of those committees deals with the need to try to recruit more medical doctors, in particular to go out into rural Manitoba.
What caused me to raise the question, it was brought to my attention, actually one of my assistants was reading through the newspaper and found an interesting story with respect to doctors who were being recruited potentially to go out and work in rural Manitoba, and there was a conditional register.
If I can I will quote right from the paper: The conditional register would exempt South African doctors from a requirement of two years of internship, but not other immigrant doctors. The two-year rule would also be applied to the latter retroactively, even against doctors who have been working in their field for years. That rule alone eliminates 60 of the 76 unemployed immigrant and refugee doctors in the province.
When that particular article was brought to my attention, I thought it might be a good question to ask the minister. He indicated during Question Period that he does not believe that there is anything that would establish a two-tier system in terms of immigrant doctors possibly practising medicine in the province. I was glad to hear that, but I am wondering if the minister can give us the government's position on immigrant doctors that do come to Canada and how we might be able to take care of two problems in one by trying to resolve these two issues hand in hand. It seems that there are doctors who potentially have the qualifications if they were given the opportunity possibly to write the exam or something of this nature.
* (1700)
Mr. McCrae: I am happy the honourable member feels reassured with respect to the issue of any bias. I am told and assured there is no bias for any reasons other than reasons relating to appropriate training and standards by which we can measure the ability for a doctor to carry out his or her practice.
The honourable member singled out one country, South Africa. There are other Commonwealth countries that have similar levels of academic achievement required before graduation from medical school. The thing with graduates of foreign medical institutions that are not the Commonwealth ones is that they have not got the same standards that are required in Canada and, I think, U.S.A., U.K., Ireland, New Zealand, Australia, South Africa. That is the problem. It is not any inherent bias against somebody who does not happen to come from those countries. It is the difference in academic standards followed in the other countries.
Technically, as far as the college is concerned, their concern is that a) that a physician meets the requirements set by Canada, and then they have their own requirements, the college, does. Countries whose medical school programs do not meet the same standards, people who attend those medical schools may have more difficulty meeting the requirements for service to the residents of Manitoba. That is what we are talking about; it is an academic issue and nothing else. Any suggestion that there might be some other kind of bias involved, I would want to follow up and make sure that was not the case.
For example, it was suggested to me that it is not fair that some people cannot rewrite a test. Well, I wanted to follow that up a little bit because in the mind of the person making the allegation, that policy reflected some kind of an inappropriate bias on the part of the college. I wanted to satisfy myself that if such a bias existed, that it was terminated, stopped, and if there was no such bias, that that be made clear too. Now I understand the College of Physicians and Surgeons is willing to have a look at that policy. So that is good, in my view.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Two bottom lines: one is let us get some medical service to underserviced areas and secondly, let us make sure that the practitioners meet appropriate requirements so that we do not have a two-tier, i.e., one kind of expertise required in some parts of Manitoba and a different kind or an inferior kind somewhere else. That is all it is.
I understand that immigrants coming to Canada are told before they come to Canada, and it is a Canada-wide policy, that there are no assurances given that they would receive licences to practise medicine in whatever their destination in Canada. I can understand how it would make somebody feel to think that we cannot find a doctor for community A and yet there is a doctor working at a minimum wage in Winnipeg somewhere. The point is, is that doctor able to meet the requirements of our College of Physicians and Surgeons? It is a made-in-Manitoba college. They have their made-in-Manitoba way of deciding who should be registered to practise medicine and who should not, and what standards are required to be met in order for someone to get on the register.
Still and all, we want to make opportunities available to the extent that we reasonably can, keeping in mind the balance that we must strike. Once someone is licensed to get a conditional licence, we are extending from one year to five the opportunity to practise and bring the skills up, and meanwhile the community can benefit as well. That one-year term was seen to work against the long-term location of physicians in some regions, and the five-year one is felt to provide a better level of stability for Manitoba communities.
Mr. Lamoureux: Mr. Chairperson, I want to continue to have more dialogue with respect to this particular committee. The actual name of the committee, is it the Physician Resource Committee? What is the actual title? I am just trying to find it in the document that the minister provided.
Mr. McCrae: Mr. Chairperson, a year ago the government of Manitoba entered into an agreement with the Manitoba Medical Association. As part of that agreement, it was decided that there would be a Medical Services Council. That Medical Services Council is there to make recommendations to the government as to how is the best way to spend the $250 million that is there for the medical services--[interjection] Down to $242.5 million, how best to spend that to get the right results, as we were discussing earlier about needs and outcomes and so on. How best to spend physicians' fees to achieve maximum benefit for the population? That council was set up with representation from the medical association, from the government, from the College of Physicians and Surgeons. I think the Centre for Health Policy and Evaluation is represented there. The medical school is represented, and the medical students, I think, have representation there as well. Not on that one? It is on the other one? Right, not on that one, the students are not on the Medical Services Council. And community representation as well on the Medical Services Council.
Also part of the agreement with the MMA was that a subcommittee of the Medical Services Council would be struck to address the very important issue of physician resources throughout Manitoba. It was recognized by the signatories to the agreement, which is quite historic really, because it is the first time we have had a peaceful working relationship with the physicians in, I am told, 20 years in Manitoba, so that is very significant. A subcommittee of the Medical Services Council is the Physician Resource Committee. The Physician Resource Committee is charged with the responsibility to see that we have doctors in all those regions of Manitoba where they are needed and also the issue of the specialty requirements is addressed. On that committee we have representation from the public, three representatives, plus that is the one where we have the medical graduates or Medical Students Association, the MMA, the government, the Manitoba centre, the college. Carolyn Park, our provincial nursing adviser is on that committee, too, and representatives of the public.
* (1710)
The Physician Resource Committee, late last year or early this year, put out an interim report. It is their job to make sure they have produced a final report by the end of this year. That report, it is our expectation, will have contained within it the longer-term plan for physician resources. We do not want to be faced on a frequent basis with some new crisis in some other Manitoba community where their doctor has passed away or their doctor has left to go to the United States or somewhere else, or their doctor is on holidays. We want to make sure that we have a locum tenens program that will be there for the longer term so that we will not have an issue of crisis proportions every time a position decides to leave a community.
We would like to know there is something that can be done every time that happens, because the honourable member has to recognize that you look at the city of Winnipeg and remove one family practitioner from Winnipeg--[interjection] Well, it is not as serious a matter, obviously, as it would be in a community like Leaf Rapids where you would have a serious problem. If you have two or three physicians working in a community and one of them leaves, you have just either doubled or greatly increased the amount of work that has to be done by the remaining physicians. The longer you allow that to go on the sooner burnout is going to set in, and you are going to have very unhappy physicians and burned out physicians and maybe physicians who want to leave.
We do not want that, and that is why we had the foresight a year ago to agree with the MMA that this was something that needed to be addressed. Thank goodness we did, because if we did not, I would suggest, we would be in a lot worse shape today than we already are in, and that is not to say we are in perfect shape today. We have pressures in some communities that absolutely must be addressed on a priority basis.
Mr. Lamoureux: Mr. Chairperson, you know, I can recall our former critic before Avis Gray, Dr. Cheema, who often made reference to immigrant doctors who come to Canada and the lack of recognition for credentials, if you like. So the rural Manitoban shortage of doctors has been an issue over the last number of years. It is not something that has come about now.
In listening to the minister, I understand then that the committee that is established would be a subcommittee of a committee that was established by the MMA. Now, I am wondering, you know, what would the--I should not necessarily say the criteria, but why would the government not, knowing that this has been an issue now for a number of years, have established a committee to deal with this particular problem years ago? Or, you know, playing devil's advocate if I may, if they feel that it is an issue, why did they not charge MMA to look into it years ago? Why are we dealing with that particular issue today as opposed to, you know, six--it was in all likelihood about six years ago when it was actually first brought to my attention.
Mr. McCrae: Well, Mr. Chairperson, with all due respect, the problem goes back much longer than the six years when the honourable member first became aware of it. I became more acutely aware of it in recent years too, but it has been an ongoing problem for provinces in Canada for--I would not even want to hazard a guess how many years it has been. It has been a lot more than six that doctors have congregated in the larger communities.
This Physician Resource Committee was not something established by the MMA, as the honourable member said. It was established with the MMA as part of an agreement with the government. It is not a new concept to try to do something about this problem. We have the Standing Committee on Medical Manpower that has been in existence for a number of years, and I do not know how many committees before that. It is not a new problem.
It is a particularly sticky one, and no one wants to say they have all the answers. Some people say, well, force the doctors to go to rural Manitoba. Well, do we force architects to go to rural Manitoba? Do we force MLAs to go to rural Manitoba? The trouble is, with forcing people, you tend to make them wonder if you are not infringing on their rights just a little bit.
The old question about, the carrot or the stick, comes into it. I have tried really hard, and either way I see it, depending where you stand, whatever measure you bring forward can be viewed either way. So, I say, well, we are trying to offer a carrot. Somebody else says, no, you are trying to drive us out. You are trying to drive us out into the country where we do not want to be. So, I find, and other governments, and other ministers have found, this to be a sticky problem for many, many years. Only by working in co-operation with the MMA will we hope for some success, I suggest, on a consistent basis.
Over the years, I do not know how many things have been tried. One initiative might work well in a particular circumstance, but it might not work in a different community on another day, and in different circumstances. It is like you almost have to have a tailor-made system, to tailor make an initiative each time a problem crops up. That is what has been missing, I suggest. I think communities have tried with inducements of one kind, or incentives of one kind or another, housing arrangements, various sorts of incentives. They work for some; they do not work for others.
To say we are just beginning to look at that is not correct. I suggest for many years various governments and ministers have grappled with this, and I continue with this issue. I think that we are beginning to work our way to a point where the players are going to be more willing to work together. We are just determined that we will not accept a model of medical health delivery that only gets delivered out of the big centres. Not good enough for Manitobans, in my view, so we are finding ways what with conditional registers, pools for locum tenens, and all these different things. I say all these different things because one idea will not solve the problems in every corner, every region. It seems like everywhere you go, they have a little bit of a different kind of a problem, so a simple, easy to understand solution does not work everywhere.
Mr. Lamoureux: Yes, that is why we want to be able to provide a number of different potential solutions that are out there.
In the article it makes reference that there are 60 people, at least a minimum of 60, that are excluded from this. Now, again, I do not want to say that this is a fact, because I do not have the background in order to substantiate that it is a fact that there are 60 people that are prepared and would be doctors if given the opportunity, but I have not heard anything to counter that.
I have heard over the years that there are a significant number of individuals in the province that do have the ability or would like to be given the opportunity to demonstrate that they have the ability to become a doctor and would jump at the opportunity to be able to go and service a rural community, and I think that is a viable option, and this is an option that has been there for a number of years.
Another option, and I believe I made reference to it in question period, was the idea of the enticement for individuals, in particular, not exclusively, but in particular, individuals that live in rural Manitoba that are entertaining the thought of going into medical school, and that is to possibly offer to pay substantially, if not possibly even wholly, the cost of putting them through that facility in return for a commitment in terms of time in that rural community.
The Minister of Health makes reference to, well, you want to provide a carrot as opposed to booting them out of the city, if I can put it that way, and I concur. And the biggest carrot of them all, no doubt, is the rural way of life. If we can provide other carrots, then let us do that. I do not think that we would be breaking ground in Canada by saying, look, we are going to put you through medical school; in return you are going to serve as a medical doctor for five years up in Flin Flon. And one might say, well, the Charter says, it is the right of mobility, I should be able to move and do whatever it is that I want. Well, you can always provide the buy-out, some form of a buy-out clause.
* (1720)
You know, when I was in the Forces you could actually go through the colleges, the Forces colleges, and if in fact you decided after receiving your degree that you wanted to opt out of the Forces, in order to do that you had to pay back, and I think again, this is another option that is there for the government to be considering.
If the government believed that this was an issue in which it merited a higher priority, the type of priority in which we see, whether it is through Question Period or discussion or debate within the Chamber, because the minister indicates that he wants to have the doctors in rural Manitoba, I am a bit confused in the sense of why it is then that I am not able to begin, well, you know, here are the options that you point out. We have looked into them and here are the problems to those options, and it is just something that is not feasible. If, in fact, you indicated that is the case, then I would be more resolved to try to come up with some other solution.
The other day, I was talking to the Leader of the Liberal Party, and he mentioned that he met with some of these individuals that would like to be able to practise medicine. Their concern was again, give me the opportunity to prove my ability. I think this is what sort of action government should be doing, is looking at how it can resolve the rural issue of the doctor shortage or what some are terming is more of the crisis that could potentially develop in particular in northern Manitoba, and trying to get answers in a much faster fashion because we have the civil servants and the professionals to be able to make the decision. We can quite easily, I would think, find out if, in fact, some of these individuals say they have the ability, we should be able to demonstrate whether or not they have the ability.
I think that is, at least in part, possibly the short-term answer, and ultimately I would like to think that the long term might be in that latter option that I made reference to, in terms of trying to get young people from rural Manitoba to come into medical school and go back into the rural communities. One of the ways you can do that is through some form of a tuition enhancement.
I would ask the Minister of Health (Mr. McCrae), when would he foresee--he has made reference that we are going to get a final report in November. Does he believe that it would be premature for the government to take some form of action prior to that? Is there not something that we can do to try to alleviate some of the concerns that are there today by taking quicker action? That could be quite simply because we do not know, or at least I do not know, and the minister could likely find out, just how often that particular subcommittee is meeting. Is it possible for them maybe to have the extra meeting or two that might be necessary--I do not know because I do not know how much preliminary work has been done--to be able to draw this issue to a quicker conclusion.
Mr. McCrae: The honourable member's question really brings out the same sort of frustration that I have felt in dealing with these physician resource issues. I will certainly see to it that the honourable member's comments are shared with the members of the Physician Resource Committee. I would like them to read first-hand what the honourable member has said, because sometimes those ideas do seem to sound like they are just straight common sense that you can attract people into a profession by making those kinds of deals.
It seems to me that contractually speaking that is not something that is a rights issue. If you do not want to do it, then do not do it, but there are some who might want to engage in that sort of a program where you get some assistance with your costs and in return you deliver a service.
My mind is not closed, by any stretch. I have heard many, many different ideas about how we might proceed. Sometimes they do not really survive the scrutiny of the light of day, but sometimes they do and they end up, in one way or another, looking very much like a recommendation that comes forward.
I see a lot of important health issues, but I do not see any more important than the issue of physician resources. I have made it very clear to the Department of Health and everybody I am able to influence that this is a top priority for me. I have made it clear to the Manitoba Medical Association that physician resources are a top priority for me.
I do say, though, that Manitobans, wherever they live, are entitled to be served by people whose credentials have been tested and found to be appropriate for the delivery of service. To me, it is not good enough to say, well, you are from rural Manitoba so we can send you a physician who does not meet the requirements of the College of Physicians and Surgeons. To me, that is not good enough. It reflects the wrong kind of attitude about rural Manitoba as far as I am concerned.
* (1730)
I do not think that is what the honourable member was trying to get across. I say you have to be really careful with these professional-type issues. We are dealing with people's health care and sometimes in emergency situations you want to make sure you have physicians who are appropriately trained and up to speed on what their colleagues are doing in Manitoba and from every recognized medical school.
I believe that the Medical Services Council has an extremely important job and so does the Physician Resource Committee. We simply want them to do their job because it is important to the way we deliver health care. That is why we have the Manitoba Centre for Health Policy and Evaluation involved in so many of our medical care, our health care issues. They will address the issues of needs and outcomes.
There are times, I have to say, that there may be those who think that we can measure our health by the number of doctors we have. That argument is about as good as the argument that we can give an accurate measure of poverty or lack of poverty by the number of people on social assistance. Those kinds of arguments are really somewhat flawed.
We have to, with the help of the Manitoba Centre for Health Policy and Evaluation, make a determination about population groupings and what is the right amount and the right mix of professional caregivers in a particular region to deliver a certain group of core services that is felt by the health planners to be the right group of services to be delivering in a particular area. Then you have to have your provincial programs that operate province-wide or operate only at the Health Sciences Centre or St. Boniface Hospital to serve the whole of the province, then you have your regional centres and so on. These are the issues these committees grapple with.
As part of the Manitoba Medical Association agreement with the government, there is a cap on the number of physicians practising in Manitoba. There is concern there is no cap on the number of physicians who can practice in the city of Winnipeg, because that is what has grown over the years to levels that are not sustainable anymore in terms of the successful operation of a health system.
If we have a surplus of physicians in Winnipeg, surplus to our needs, and we have a shortage in rural Manitoba and northern Manitoba, it follows fairly naturally what should happen. But do you drive the doctors out? That does not seem to be a very smart thing to do because if we did that, I would daresay the honourable member and others on that side of the House would be the first on their feet saying you are driving the doctors out. They would not just be driven out of Winnipeg, they might voluntarily just go right beyond the province of Manitoba, and then we would feel that we were creating a problem for ourselves. So the honourable member can understand the nature of the problem we have.
I have been to many, many communities in rural and northern Manitoba, and I can join the chorus of those who talk about the high level of the quality of life in those communities, and those who live in those communities are even better able to do that. But something happens at some point in the life of a physician that says well, Winnipeg or Brandon or somewhere like that is the place to be to practice medicine. So I think the medical school is trying to address issues like that by establishing in curriculums and so on the whole concept of health as opposed strictly to health care, primary health.
You know, doctors traditionally learned their skills in a hospital setting, so a lot of doctors think, well you have to have a hospital nearby or I cannot practice medicine properly. Somewhere in there is something that needs to be addressed, because we do not have hospitals on every corner in our province; we have people, though, who need the services of medical people.
I want to be part of an effort that would make a rural or a remote practice an attractive proposition for a young doctor or any doctor. How do we make it an attractive proposition? The honourable member's suggestions and many others are the kinds that our committees look at to make an assessment about what is realistic, what can really work and actually achieve the ends that we want to achieve. So as I said before, I will be making sure the honourable member's suggestion is made known to the Physician Resource Committee.
Mr. Lamoureux: Mr. Chairperson, it would be interesting, as I indicated at the onset of the discussions on the Estimates, that this being my first time through health care, interesting in the sense that when we go through this process again next year, to see what sort of a response we would get from the minister and from the committee with respect to this particular issue.
Wanting to move on and continuing along the same thought of the committees that are out there, in the documents that the minister provided us, it makes reference to the 110 both current and past committees that have been established through the department, of which 74 of them are actually current.
Of the ones that are current, what number or which ones would be ongoing committees? They might be charged with a particular responsibility at some point in time, but of the 74, are those always around to act in some sort of an advisory capacity to the Minister of Health?
Mr. McCrae: Mr. Chairperson, the list of committees that the honourable members have before them are basically the so-called reform committees. They exclude committees that have always been around or always will be around, such as the Health Board and those types of committees.
I cannot be numerically specific today, to say that six of them are finished their work forever and will never meet again, or 18 are ongoing committees, and 26 are, you know, committees actually to implement, or whatever. I cannot give that sort of detailed information today.
Much has been made of the fact that there are a number of reform committees though. Maybe it would be helpful to deal with that issue, because it strikes me as somewhat a difficult issue to deal with when on the one hand, they tell you you should not have committees, and on the other hand, they tell you you have too many. So what is the right thing to do?
Right from the time of the production and release of the reform document called Quality Health for Manitobans: The Action Plan about this time in 1992, that is three years ago now, right from that time and including to this, the whole process has involved input from thousands of Manitobans. I am told some 15,000 Manitobans have been involved in the reform of our health care system.
* (1740)
So then people create these images of back-room secret groups making decisions and tinkering with the health care system. I think that is really an incorrect characterization of what it is that is going on. Either you consult with Manitobans, or you work from an ivory tower approach. I do not think the Liberals have ever suggested that the methodology here or the approach was particularly wrong. I am not laying this at the doorstep of anybody right now. I am just trying to explain what it is that we have been going through as a province.
We looked in 1992, I guess for the first time or maybe shortly before that, at health and said, well, what is it about health? What is the future of our health care system, and what is the significance of health, as opposed to health care, or not as opposed to, but as part of this discussion. We were told by those experts out there that we are not going to be able to sustain the kind of growth that we have been seeing in the acute care sector of health if we do not get a handle on what it is that is making people sick in the first place, or if we do not get a handle on a better way to look at health, or if we do not get a handle on the whole issue of outcomes.
For years, we were able, because of the things we talked about earlier in this discussion today, i.e., the ability to find money--when pressures were exerted on the health system, what did we do? Well, we just built another hospital, or we added a ward to one that already existed, or we added this or we added that, with never a thought to what are we getting for all these dollars.
It was always felt that politicians were just supposed to respond. When somebody raised an issue, well, you threw some money at it, and then it would go away--and they did. They went away until the time came when we could not proceed that way any more.
You know, every time you build a hundred beds or you build a new building, you also have to pay people to run that building, every year, year after year. The combination of all these costs were just getting too much for governments everywhere.
There is no better example than to look in our neighbouring province of Saskatchewan, where over the years they built a capacity of hospitals, rural especially, that was clearly beyond their requirements and when the time came for Saskatchewan to deal with the issues, there was the closure or changing of the rural admission of 52 rural hospitals.
I would never say that to be critical of Saskatchewan, except that some say they overbuilt in the first place. Well, maybe they did. The fact is, people got affected when 52 hospitals were closed or changed significantly. It created a labour issue. I do not know if it created a health issue. I think it created a labour issue though.
Similarly, in other jurisdictions, including Manitoba, where bed closures happened in 1992-93 at our big hospitals here in Winnipeg, labour was affected, staff were affected by that. It created a fair amount of discomfiture, culminating in a $700,000 ad campaign in the recent election, to which the nurses' union contributed a very large amount of money.
Or you can look to Ontario where their version of health reform was to close 10,000 hospital beds. Reading Michael Decter's book, he has it pegged at 8,000. There have been some things happen since that book was published and I understand it is up to 10,000 beds.
Look at Montreal, the recent announcement by the Minister of Health there, the closure of seven urban hospitals in the city of Montreal, 10,000 jobs involved.
What we have done in Manitoba, even though we were accused of doing otherwise, was to build alternate systems of care. I cannot remember offhand how many hospital beds were closed, but about an equivalent number of personal care home beds have been opened since that time. That provides a fair amount of employment, and in addition, under our capital program we have another number of hundreds of personal care home beds coming on stream. The spending on the home care program has doubled in the last seven years. In the last five years alone, 750 more people are working for the Home Care program than previously. So what you are seeing is a shift. As you do all these things, as you look at lab services, a very important part of diagnostic treatments, imaging, things like CAT scans and MRIs and X-rays and those sorts of things, we have committees to help us make policy.
Obstetrics, as the honourable member was asking about that before, we have people who work in the field, specialists and others who are involved in the delivery of those services working together to advise government. We are accused of having committees. Well, is someone suggesting that a minister, all by himself, or a group of ministers sitting around a cabinet table ought to play God? I hope not too many are suggesting that because it has been done that way and the pain is deeper than we have to put up with in the province of Manitoba.
I think of New Brunswick where they have a significant number of faith-based institutions, hospitals and personal care and that sort of thing. The government there, because it had a requirement to take dollars out of the health system, passed legislation. Never mind the way we are doing it over two or three years and consulting everybody all over the province to figure out how best to regionalize our health system, they have done it already. So in that sense they are ahead of us, but how many people have been hurt or upset by that approach? How many faith-based institutions feel that their missions and goals have been totally ignored? Well, ask them. I am telling you that by entering into a Memorandum of Understanding with faith-based institutions here in Manitoba, we can protect their goals and their missions in the future and make health care reform happen in an effective way.
Similarly, in Saskatchewan, they have had a pretty vibrant rural life in Saskatchewan over the years. I guess that is what led to the creation of some 300 hospital districts--
An Honourable Member: Three hundred? No, it is 30 now, right? It was 300.
Mr. McCrae: No, there were 400 boards and now there are 30.
How did that happen? Relatively overnight in the ivory towers of the Legislature in Regina. They had to achieve the same kinds of things we have to achieve.
We do not believe we can just run away from our responsibility and just allow ourselves to spend the life out of our health system or to suffocate, choke, our health system to death by spending it into oblivion. So it is a question of how you do it in the various places.
Alberta, taking a much more aggressive approach than we are when it comes to cuts and being criticized pretty widely outside Alberta, although inside Alberta there seems to be an understanding of what is trying to be achieved there. I know that nothing is ever unanimous, but I know enough people in Alberta to know that the people I speak with are cautiously approving what is going on there in Alberta, even though I do not think we need to do it that way in Manitoba, nor do I want to. Polling results there tend to show that it is felt that they are on the right track, but I do not know that that is transferable to Manitoba either.
* (1750)
So just in case, we have sought and, I think, achieved made-in-Manitoba solutions where we have faith-based institutions that require some kind of understanding from government. I think those organizations could see what was happening elsewhere and were pleased to enter into arrangements with our government.
I know the honourable member for Inkster (Mr. Lamoureux) is not being critical about this, but these committees--it is quite a job, keeping track of who they all are and what they are all doing. I recognize that, but there is no effort here to do anything but to try to build a consensus and to try to have a ground-up sort of approach to better methods of delivering health care services and, in so many of them, you have got representatives who understand the issues of outcomes and what we are trying to achieve. In every one of them, I would hope, I think, expect that the needs of the patient or the client are the needs that we are all working towards achieving.
Sometimes, even in a time of transition, there are those who would want to go to bat for the vested interests. Well, it is the vested interests that built our health system, and so we owe them a lot, but the vested interests also built some things into the health system that are not good too. They might be good for the vested interests but not good for the patient, and those are areas where it gets tougher, health reform. It gets much tougher, and you need a fair amount of wisdom and all of that, which I do not have enough of, but I keep working on it, Mr. Chairperson, and I hope that by getting some advice from people who have some wisdom that we can find our way through this process and achieve a health system that we can promise will be there for the next generations of Manitobans.
We have an Advisory Committee on Mental Health Reform, referred to the other day, it is on the organizational chart on page 9 of the Supplementary Information, those dotted line ones that the honourable member for Kildonan (Mr. Chomiak) referred to. The Advisory Committee on Mental Health Reform is an advisory committee. The chair is Dr. William Bebchuk.
I am going to go through these names because I think it is important that it be understood that the people who are named on these committees are named on them for a reason, and the reason is they know more about certain things in mental health than I do. I do not think it is right for us to proceed in the way that some think we should, and that is to just not have committees. I think you need to have them.
There is Dr. Jeff Ivey; Sister Jean Ell; Ms. Pearl Soltys; Steve Todd; Dr. John Arnett; Dr. Garey Mazowita; Ms. Veryl Tipliski; Mr. Bill Martin--I think everybody around here knows who Mr. Bill Martin is--Dr. Gary Altman; Ms Darlene Dreilich; Bill Ashdown; Jerry Marek; Catherine Medernach; Katherine Davis; Maureen Koblun; Ed Driedger; Jim Mair.
Even an advisory committee has subcommittees because Jim Mair is a chair of one of the subcommittees. Gail Friesen is the chair of another one. Judith Dedrick-Williams is the chair of another one. Lorraine Compton is a chair of a subcommittee. Linda Lehmann, Linda Earl, Myles Haverluck, and Del Epp are all chairs of various mental health subcommittees and what is wrong with that, you know, that is my question.
Maureen Lennon-Borger, Sue Hicks and Dr. John Biberdorf are all members of the Advisory Committee on Mental Health Reform.
There are a couple of other ones that are in dotted boxes on page 9, the Appeal Panel for Home Care. On the Appeal Panel for Home Care, the chair is Dr. Peter Connelly. He is the chair but he is the past president of the Manitoba Medical Association, and he is a staff physician at Deer Lodge and medical director of Holy Family Nursing Home.
Claudette Labossiere is a licensed practical nurse in the Home Care program.
Paul Murphy is involved in--I think the member for Concordia might recognize this person's name--services to people disadvantaged by disabilities. He is the president of the Thalidomide Victims Association of Canada.
Ed Paterson is the past president of Fred Douglas Lodge and past executive director of United Way for fourteen years.
Sandra Ringaert is a registered nurse with a bachelor of nursing degree. She has got 25 years of community health nursing experience with the VON.
Elizabeth Semkiw is an advocate for people disadvantaged by disabilities. She is employed with the Council of Canadians with Disabilities, and she is also a client of the self-managed Home Care program.
Those are the people we have dealing with appeals from people who are dissatisfied with the arrangements they are getting from our Home Care program. I think that is an excellent group of people and they do extremely important work for us, for all of us. They have made life much better for clients of the Home Care program.
Another one is the Advisory Committee to the Continuing Care Program. The chairperson is Paula Keirstead. She is a community activist and she has a Bachelor of Social Work. Cindy Brown is a consumer of the Home Care program. Myrna Fichett, is a registered nurse with a certificate in Gerontology. She is the director of care at Red River Valley Lodge. Elaine Prefontaine is a retired registered nurse. Joyce Rose is a former member of the Manitoba Council on Aging. She is involved with Support Services to Seniors. Dr. Elizabeth Watson is the departmental head of Geriatric Medicine at Seven Oaks General Hospital. Again, people are offering their assistance to advise us on the effective operation of our Continuing Care Program.
Very quickly, I will run through the Minister's Advisory Committee on AIDS, which is also another one on page 9 in the dotted box. Bill Gardner is the chair, Dr. Erma Chapman, Dr. Carl Landrie, Dr. Richard Stanwick, Dr. Linda Poffenroth, Laura Donatelli, Brian Peel, Myra Laramee, Albert McLeod, the Reverend Fred Olds, Brenda Elliott. I used to do a fair amount of work with Brenda Elliott when I was Justice minister, too. Margaret Fast is an ad hoc member, as is Pat Matusko, Joyce MacMartin, and the assistant from my office, Kathleen Hachey is also attached to that particular committee.
Sorry to be so long with that answer, but I wanted to talk a little bit about the committees in dotted lines because the questions were raised.
Mr. Lamoureux: Mr. Chairperson, one cannot necessarily condemn government if they see fit that there is a need to establish committees on the condition that the committees they are establishing are there for all the right reasons. The primary reason, of course, is to ensure, as we have alluded to on many different occasions, that the patient's interest is first and foremost and kept as the first priority, and also, that there is some sort of report or that we are getting something from the committee in which the government is prepared to take action on.
On the health reform committees that were established, there were 36 that are no longer functional, if I can use the word "functional." Can the minister indicate whether he has received final reports from those 36 committees?
The Acting Chairperson (Mr. Radcliffe): The hour being six o'clock, I am leaving the Chair and will return at 8 p.m.