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37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Monday, February 10, 2003

1535

The Vice-Chair (Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.))

Ms. Yolande Thibeault (Saint-Lambert, Lib.)

The Vice-Chair (Mr. Stan Dromisky)

Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance)

The Vice-Chair (Mr. Stan Dromisky)

Ms. Yolande Thibeault

The Vice-Chair (Mr. Stan Dromisky)

Ms. Judy Darcy (President, Canadian Union of Public Employees)

1540

The Vice-Chair (Mr. Stan Dromisky)

Ms. Judy Darcy

The Vice-Chair (Mr. Stan Dromisky)

Ms. Judy Darcy

The Vice-Chair (Mr. Stan Dromisky)

Ms. Maude Barlow (Chairperson, Council of Canadians)

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations)

The Vice-Chair (Mr. Stan Dromisky)

Ms. Elaine Johnston

The Vice-Chair (Mr. Stan Dromisky)

Ms. Elaine Johnston

The Vice-Chair (Mr. Stan Dromisky)

Ms. Maude Barlow

1545

The Vice-Chair (Mr. Stan Dromisky)

Ms. Kathleen Connors (Chairperson, Canadian Health Coalition)

Mr. Michael McBane (National Co-ordinator, Canadian Health Coalition)

1550

The Vice-Chair (Mr. Stan Dromisky)

Ms. Judy Darcy

1555

1600

The Vice-Chair (Mr. Stan Dromisky)

Ms. Barb Byers (Executive Vice-President, Canadian Labour Congress)

1605

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

1610

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Elaine Johnston

Mr. Rob Merrifield

Ms. Kathleen Connors

1615

Mr. Rob Merrifield

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

1620

Mr. Claude Généreux (National Secretary Treasurer, Canadian Union of Public Employees)

Mr. Réal Ménard

Mr. Claude Généreux

Mr. Réal Ménard

Claude Généreux

The Vice-Chair (Mr. Stan Dromisky)

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.)

1625

Ms. Judy Darcy

Mr. Jeannot Castonguay

Mr. Michael McBane

Mr. Jeannot Castonguay

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson (Burnaby—Douglas, NDP)

1630

Mr. Réal Ménard

Mr. Svend Robinson

Ms. Kathleen Connors

Mr. Michael McBane

Mr. Svend Robinson

Mr. Anil Naidoo (Campaigner, Council of Canadians)

1635

Mr. Svend Robinson

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson

The Vice-Chair (Mr. Stan Dromisky)

Ms. Yolande Thibeault

Mr. Michael McBane

Ms. Maude Barlow

Ms. Judy Darcy

Ms. Yolande Thibeault

Mr. Michael McBane

Ms. Judy Darcy

1640

Ms. Yolande Thibeault

Ms. Judy Darcy

Ms. Yolande Thibeault

The Vice-Chair (Mr. Stan Dromisky)

Mrs. Carol Skelton

Ms. Kathleen Connors

1645

Mrs. Carol Skelton

Ms. Kathleen Connors

Mrs. Carol Skelton

The Vice-Chair (Mr. Stan Dromisky)

Mr. Réal Ménard

Mr. Claude Généreux

1650

Mr. Réal Ménard

Mr. Claude Généreux

The Vice-Chair (Mr. Stan Dromisky)

Ms. Carolyn Bennett (St. Paul's, Lib.)

Mr. Michael McBane

Ms. Carolyn Bennett

Mr. Michael McBane

1655

Ms. Carolyn Bennett

Ms. Elaine Johnston

Ms. Maude Barlow

1700

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson

Ms. Judy Darcy

Mr. Michael McBane

1705

The Vice-Chair (Mr. Stan Dromisky)

Ms. Hélène Scherrer (Louis-Hébert, Lib.)

Ms. Elaine Johnston

Ms. Barb Byers

1710

Ms. Kathleen Connors

The Vice-Chair (Mr. Stan Dromisky)

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance)

Mr. Michael McBane

1715

Mr. Claude Généreux

Ms. Barb Byers

Ms. Elaine Johnston

Ms. Barb Byers

1720

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson

The Vice-Chair (Mr. Stan Dromisky)

Mr. Svend Robinson

The Vice-Chair (Mr. Stan Dromisky)

Ms. Carolyn Bennett

Ms. Barb Byers

Ms. Carolyn Bennett

Ms. Judy Darcy

The Vice-Chair (Mr. Stan Dromisky)

CANADA

Standing Committee on Health

NUMBER 019

2nd SESSION

37th PARLIAMENT

EVIDENCE

Monday, February 10, 2003

[Recorded by Electronic Apparatus]

¹ (1535)

[English]

The Vice-Chair (Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.)): I'd like to call the meeting to order.

Before we proceed, I'd like to thank all the representatives from the five different organizations for appearing, and not only for that purpose but for taking such an active, participatory kind of role in our democratic society.

Democracy, as you know, is a relative thing. It all pertains to the amount of participation by each and every individual within our society. Thank goodness we have people who represent organizations like yours, who are doing their job in helping this country develop policy and to find the right course for years to come. Thank you very much for appearing.

We will follow an order. First of all, we have two motions for the Standing Committee on Health received from Carol Skelton. Do you all have copies of the motions—the first motion? Yes.

[Translation]

Ms. Yolande Thibeault (Saint-Lambert, Lib.): Mr. Chairman, I move that the motion be tabled.

[English]

The Vice-Chair (Mr. Stan Dromisky): Very good. The motion is to be tabled for a future meeting.

Mrs. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance): Why, may I ask?

The Vice-Chair (Mr. Stan Dromisky): There's no debate on a motion of that nature.

All in favour of the first motion being tabled to a future meeting please signify.

A witness: Can we vote?

The Vice-Chair (Mr. Stan Dromisky): I wish you could, because we have a heavy agenda today.

(Motion agreed to)

The Vice-Chair (Mr. Stan Dromisky): The second motion by Carol Skelton is that this committee immediately convene hearings into the special health needs of northern and remote communities, especially those needs related to their unique funding requirements.

[Translation]

Ms. Yolande Thibeault: Mr. Chairman, I move that this motion be tabled as well.

[English]

The Vice-Chair (Mr. Stan Dromisky): Thank you. All in favour, please signify.

(Motion agreed to)

The Vice-Chair (Mr. Stan Dromisky): We will continue by following the list you have before you.

We'll ask for a representative from the Canadian Union of Public Employees to make their presentation.

Ms. Judy Darcy (President, Canadian Union of Public Employees): We've actually switched the order around a little bit, and I'm going to ask Maude Barlow to start, if that's okay.

¹ (1540)

The Vice-Chair (Mr. Stan Dromisky): All right. Let me know what the order is.

Judy Darcy, you're number two?

Let me just get this order.

Ms. Judy Darcy: Maude Barlow will say a couple of words and introduce Elaine Johnston from the Assembly of First Nations. Then we'll go back to Maude Barlow. Then we'll go to Mike McBane from the Canadian Health Coalition, then to me, and then to Barb Byers, Canadian Labour of Congress.

The Vice-Chair (Mr. Stan Dromisky): I probably will forget that, so you make sure I follow that course.

Ms. Judy Darcy: Anything you want us to do, we're happy to take right over.

The Vice-Chair (Mr. Stan Dromisky): All right, please proceed. Each organization has five minutes. After all the presentations are made, there'll be questions and answers.

So let's start.

Ms. Maude Barlow (Chairperson, Council of Canadians): Thank you very much.

I'm Maude Barlow from the Council of Canadians. We're the representatives of the people who put on the people's summit on health care this past weekend, which was wonderful. We've chosen to start with Elaine Johnston from the Assembly of First Nations as a sign of our support for the first nations and their concerns about the first ministers' meeting.

Elaine.

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations): Thank you.

I want to first of all acknowledge that we are on the traditional territory of the Algonquins, and I'd like to thank you, honourable members, for listening to my presentation.

To my colleagues, thank you for the honour of presenting first.

I'm Ojibway Potawatomi from Serpent River First Nation. I'm a registered nurse by profession and the director of health at the Assembly of First Nations.

I've worked in various environments--hospital, community--on air and water. I'm also a recipient of the health care system as a result of a serious fall last November.

I'm here to tell you that the Royal Commission on Aboriginal Peoples report of 1996, volume 3 on health and healing, echoed some of the recommendations from the Romanow report.

We are disappointed that the AFN was not invited to participate in the first ministers' conference. This would have been an opportunity for mutual respect and the recognition of the immense responsibility of various governments to the plight of aboriginal peoples in this country.

Our health status is considered third world, and the status quo is no longer acceptable.

We were prepared to table how we could be full participants in looking for positive solutions for positive health outcomes, and we were prepared to do that.

We were intrigued by the recommendations put forward by the Roy Romanow report for a framework agreement. Now that the unsigned accord mentions the Health Council of Canada, we would urge governments to involve first nations.

The northern parts of the provinces have the same concerns that Nunavut, the Yukon, and the territories have. A flight from Fort Severn in northern Ontario takes about three to four hours, depending on the destination. The closest hospital for specialty services is in Thunder Bay or Winnipeg.

In 2001 the average expenditure per Canadian was $2,405. For aboriginal peoples it was $3,307 for hospital care, medical care, prevention, and other health services the provinces provide. Why are the numbers higher? Poverty leads to poorer health and higher costs. The cost of health service delivery to remote areas is higher.

For the First Nations and Inuit Health Branch, it spends approximately $1.3 billion, with the majority of its funding in community health programs and the remainder in non-insured health benefits and about 2% in hospitals.

Without us being at the first ministers' conference we have many concerns and questions, and again, decisions are being made for us. The corporatization of health care also concerns us greatly, as our access to health services is already problematic.

We support the recognition of health care as a fundamental human right. I would urge the Standing Committee on Health to hear from members of our chiefs' committee on health.

Thank you, merci, and I look forward to a continued dialogue with you.

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, Elaine. You held up a report that you have there. Would you table a copy with the clerk so that we can all have a copy of it?

Ms. Elaine Johnston: I certainly will.

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Ms. Elaine Johnston: I'll hand it over now to Maude Barlow.

The Vice-Chair (Mr. Stan Dromisky): Maude.

Ms. Maude Barlow: Thank you very much. On behalf of the Council of Canadians, I want to express our concern about the first ministers' meeting that took place last week. It's important to say, I think, that all of our groups collectively represent millions of Canadians, so we're here on behalf of a lot of members, all of us together.

We felt the Romanow commission was very clear in its presentation to the federal government, and that people who presented to the Romanow commission were very clear in their position—and the polls are very clear—that Canadians don't want for-profit health care in our country; that we're in fact worried that we're losing medicare by a death of a thousand cuts. However, we're very disappointed that at the first ministers' meeting last week there was no discussion of for-profit health care, no mechanism put in place to either monitor it or control it in any kind of way. Rather than seeing an expansion of the public health care system, we're actually seeing quite a bit more money going into a system that's going to promote private health care.

We're also very concerned in all our organizations that under the rules of current trade agreements like NAFTA and the national treatment provisions of NAFTA, the health care exemption is only good as long as we're delivering health care entirely in a public and not-for-profit way, and that as we move more into a commercial, for-profit system, national treatment provisions of NAFTA currently say we now have to start allowing American corporations that come into Canada not only to set up a commercial presence but also to demand equal funding to what is given to domestic health care institutions in our country.

We're also very concerned about the expansion of health care under the General Agreement on Trade in Services and the Free Trade Area of the Americas, which are services agreements—or at least the FTAA has a new services agreement, and the GATS is a services agreement. We've already put health insurance on the GATS table, and we're deeply concerned that this was not addressed in the first ministers' meeting.

We're also concerned that there was no discussion of and no agreement come to around the reason why there's such a high price of prescription drugs in our country, which is the patent monopoly rights given to the transnational drug corporations. There's money being put into catastrophic prescription drug care, but that's public money paying for and covering up the huge profits that are made by these transnational corporations.

So we're concerned about what was not in the accord and are wanting very much for these issues to be raised when ministers come together again to hash out the details of this accord. Of course, we're very worried that the health council will have no accountability if it's not able to deal with these issues, if it's going after symptoms and not the problem.

I'll just finally say that we are collectively deeply concerned that by not dealing with these key issues, the first ministers' meeting deepened the democracy deficit in Canada and highlighted the growing gap between the political elite of this country and the vast majority of Canadians who really don't want for-profit health care.

Thank you.

¹ (1545)

The Vice-Chair (Mr. Stan Dromisky): Who follows? Michael McBane?

Ms. Kathleen Connors (Chairperson, Canadian Health Coalition): My name is Kathleen Connors. I'm the chairperson of the Canadian Health Coalition and I come to that position through my role as president of the Canadian Federation of Nurses Unions. Mike McBane will do the brief intervention, but I think it's important that the committee know that today in this room I'm proud to have representatives of nurses from Prince Edward Island through to British Columbia. We stand in solidarity with the other members sitting at this table around the issue of health care, because it's where we live and work.

The perspective that maybe won't be addressed but deserves attention is the whole issue of social determinants of health. Those issues cannot be ignored for the sake of health care provision. Hopefully you'll want to talk about that issue as well, because housing and poverty and food safety and peace are all issues that are indirectly impacting on health of the Canadian population.

But Mike is going to speak to a more specific issue, and I will let him do so now.

Mr. Michael McBane (National Co-ordinator, Canadian Health Coalition): Thanks, Kathleen.

I want to provide a couple of examples of why ownership in health care matters, because we have the government, including the Minister of Health, saying that as long as it's publicly funded, who cares who owns your health care facilities. We have the Alliance Party telling Canadians, delivery doesn't matter as long as you have this quality health care. So we need to look at the facts.

Canadians were baffled that we were prepared to spend this much money and we had no restrictions on it going to for-profit and investor-owned health care. I think one of the reasons is the agreement between the Government of Alberta and the Canadian government in 1996, which states in one of two principles amongst twelve that they must “ensure a strong role for the private sector in health care, both within and outside the publicly funded system”. The other principle in this secret memorandum is that they will introduce “measures to expand the opportunities for the private sector to deliver services within the single-payer envelope”.

Perhaps this explains the silence in the agreement about restricting for-profit delivery.

The second piece of evidence I want to point to is in the annual report to Parliament on the Canada Health Act. I photocopied this for members.

C'est disponible en anglais et français.

Do members have a copy of this excerpt?

You will see that on the question of how much money is spent in for-profit facilities...I gave you the one for the province of Ontario; it's true for all provinces in the report. What is the answer? That the minister table before you, before Parliament, before Canadians, representatives...“not available”. For every single category, every single province, “not available”. That's a failure to perform legislative duty. If it's not available, if we don't know how much profit taking there is and where this money is going, there should be no money going there.

The third issue I want to raise around why ownership matters is that there are higher death rates in for-profit hospitals. This has been established by a team of Canadian medical researchers and published in the Canadian Medical Association Journal. This is irrefutable evidence about why it matters.

The Alliance health critic will relate to the fourth piece of evidence, having worked on regional health authorities in Alberta. The example comes from the Calgary Regional Health Authority, where several members of the regional health authority are running and owning for-profit health care facilities, for-profit hospitals, for-profit clinics. They are run by doctors who have senior leadership positions in the health authority. Do you know what that's called? Conflict of interest. That's why it should matter who's delivering the care.

The fourth example I want to give very briefly is from Ontario. The contractor who won the bid on the proposal to build a private hospital in Ottawa was a major contributor to the election campaign of the Ontario minister and the Ontario premier. Some people would call that influence peddling.

The next example is also from Ontario. I have a letter available, which I haven't been able to distribute because it's not translated yet, from an Alberta company that owns almost all the laboratory service clinics in Ontario . This company sent letters to eastern Ontario, to Rockland, to Cumberland, to a number of local communities. They said that unless these communities gave them a 25% profit they would close their X-ray clinics, and if they wanted to keep them open, to have their municipality give them the subsidy. They subsequently closed these clinics throughout eastern Ontario in communities that had no public transportation.

The Ontario government calls this an innovative approach to health care. I call it extortion. If you look in the dictionary, that's what they're doing.

So for any elected official to get up in the House of Commons and tell the people of Canada that ownership doesn't matter, I think of Suzuki's line, they're either stupid or they're lying.

I'll end there. We don't have a lot of time, but I want to say that on the health care accord there will never be enough money if you allow the corporate scams that are currently in place and that the privatizing premiers have in store for this public financing. Thank you.

¹ (1550)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, Michael.

Next.

Ms. Judy Darcy: I'm Judy Darcy, national president of the Canadian Union of Public Employees, which is Canada's largest union, with 527,000 members, including 180,000 health care workers, several of whom are here today. We're in town for the people's summit. With me also is Claude Généreux, our national secretary treasurer, who is the former president of CUPE's social affairs federation in Quebec, health care workers, and an activist in the Coalition solidarité santé. If there are any questions concerning how all of what we're saying today relates to Quebec, he would also be very happy to speak to that question.

When I was there the night of the first ministers' meeting and we were all frantically reading the document together with the media, the first thing that struck us was that there were three critical words that were in there and three critical words that were missing. I believe on page 2 of the document, when it talked about the new innovative programs that this accord encompassed, it said “at their discretion”, referring to the province's role in determining what all this was going to look like and how it was going to be delivered. Three fundamental words that were not there were the words “not for profit”. To us that's extremely worrisome, because we have seen, as a result of major cuts from the federal government over the last decade, as well as because of the ideological bent of several provinces in this country, privatization growing like wildfire across the country. There is nothing, absolutely nothing, in that agreement—accord, deal, arrangement, whatever you want to call it—that is going to stem the tide towards further privatization. In fact, we believe it is going to grow even more quickly as a result.

Already across the country, almost every week there is a new “P3” hospital announced—“public-private partnerships”. They are spreading like wildfire, and the rhetoric that surrounds them says it doesn't really matter who owns the hospital; what matters is the care services that are delivered--that this debate is really all about bricks and mortar. Well, the fact is that most of these public-private partnerships, which are 25-, 30-, 40-, even 60-year long-term lease arrangements, are about building, owning, operating, maintaining, etc.,—as well as financing—by the private sector.

They're called experiments. They're called pilot projects. But the fact of the matter is there is already considerable evidence that exists in Canada and internationally to show that the P3 model of health care does hurt the quality of care.

There was a detailed study done by Lewis Auerbach, who is the former director of audit operations for the Auditor General. We have copies of this for all of you. We also have a copy of technical briefing papers prepared by our union for the Romanow commission on the issue of public-private partnerships.

But the bottom line with public-private partnerships, with the experience in the U.K., is that because there are higher costs for borrowing for the private sector than the public sector, because you have to build in profit margins, because of huge overruns in construction costs—and on and on—the costs are higher. Those costs have to be taken from direct care, and on average with PFI or “private finance initiative” hospitals in the U.K., known as P3s in Canada, staff and bed costs, service costs—direct-delivery staff and beds—were cut by 25% to 30%. And yet several provincial governments—Alberta, Ontario, British Columbia, and New Brunswick is musing about it—say this is the wave of the future, and the agreement that was made last week doesn't do a thing to stop it.

It has to be stopped. The federal government needs to act. It is also said by several of these same provincial governments that what matters, strictly, is public funding, not public delivery. In particular it's said that it's only what are called “core services” that matter, not support services. The word “hotel services” is used, or “hospitality services”, or “auxiliary services”, to describe the work many of our members do, that work being in dietary services, in laundry, in cleaning, in housekeeping.

I want to also leave with you some major studies: a literature review on the relationship between cleaning and hospital-acquired infections, and also a major study, Do Comparisons between Hospital Support Workers and Hospitality Workers Make Sense? In both cases the evidence will very clearly show—and we're happy to provide you more detailed information on it—that it matters a whole lot to the quality of care whether operating rooms are sterile. It matters a whole lot that the people delivering laundry know that operating room linens need to be separated from hospital room linens, from uniforms and so on, and that there are very specific things that need to be checked for. They need to be cleaned in a certain way. There's a lot of study that has been done and a lot of evidence on this issue, and contracting this work out to the lowest bidder does not make sense from the point of view of safety and quality of care. It certainly doesn't make sense to create a low-wage economy by doing decently paid women, hospital workers, out of jobs and replacing them with contingent, casual, part-time workers.

¹ (1555)

We also know that with further privatization and delisting by provincial governments, the issue of health insurance and health benefits is appearing on bargaining tables across the country. In the United States the overwhelming majority of labour disputes and strikes happen over the issue of health insurance. That trend is growing across this country and will become even more marked if privatization is not tackled.

Fundamentally, what we want to say to you is that the first ministers failed Canadians. They failed Canadians because what they argued about once again was jurisdiction, and what they argued about was money. While money is absolutely, critically important, the issues of accountability and being not for profit were what was fundamental about Romanow. Those issues should have been what was fundamental about what the first ministers agreed on, yet they didn't do that.

Going back to what you said about democracy at the outset, sir, our members, together with other people who took part in the people's summit, don't believe that the Government of Canada or the provincial first ministers have really listened to Canadians. You're going to see the beginnings of even greater mobilization by the people across this country, including health care workers, as we're determined that we're going to have a health care system that really does do the job for Canadians, and that means a public, not-for-profit health care system.

º (1600)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, Judy.

I think we have one more speaker.

Ms. Barb Byers (Executive Vice-President, Canadian Labour Congress): Good afternoon. My name is Barbara Byers, and I'm an executive vice-president for the Canadian Labour Congress. We represent 2.5 million members across Canada and their families.

I'm a recent transplant to Ottawa. I come from the province of Saskatchewan, the province that gave this great gift to Canada, which is medicare. I was 11 during the doctors' strike, so you can do your math from there. Suffice it to say that although my family was not involved in politics in a partisan sense, very clearly we understood what medicare meant to our family and to the families in our neighbourhood.

I believe that the people who came together in the 1960s, first of all in my province and then across Canada, had great vision and had great courage in terms of what needed to be done. They were prepared as well to take some risks for the health of the citizens of the country.

I don't believe this has been recreated in 2003. The federal government had the opportunity last week to truly secure the future of medicare. It had the money, it had the support of the vast majority of the Canadian people, and it had the strength of being the national government. Unfortunately for Canadians, the federal government lacked the political will to show the kind of leadership required for greatness, the greatness we experienced in the 1960s. As a result, we believe, as you've heard this afternoon, the integrity and the viability of medicare has been left at risk.

As has been pointed out, we had a people's summit. When people first came, and there were over 400 people from coast to coast to coast--I think it's fair to say that a number of us were somewhat demoralized by the events of the week, that the first ministers' meeting had not turned out the way we had hoped, namely that it hadn't endorsed the Romanow report as we had hoped it would. Tommy Douglas, who liked to quote Robbie Burns, would have said something like, “We laid ourselves down to bleed a while, then rose to fight again”.

You opened your remarks talking about democracy and participation by individuals. Well, I want to tell you that after about 24 hours of feeling sad, the participants at the conference decided this wasn't going to get us very far and that we might as well get angry and take action. I think you're going to see and experience lots of democracy across the country.

Our summit participants decided to rededicate themselves to that democracy, to rededicate themselves to medicare, and to rededicate themselves and their organizations to a full range of actions at the federal level, at the provincial level, at the municipal level, and with employers. Quite clearly, we are going to take action with employers to make them clearly understand the economic advantage they have because we have the kind of medicare system we do. You will see events as they unfold. They are still under discussion, but there is commitment from the national, provincial, and local organizations to work together to achieve the things we think need to be done.

We have rededicated ourselves as well to action in support of aboriginal health and the health of excluded groups. We have rededicated ourselves to health accountability and to transparency, and that means taking on the for-profit health providers and very clearly showing what their profits are, what their benefits are, and how that doesn't benefit people who need health care.

We have rededicated ourselves to health reform and to a national home care program. If you couldn't get as far as what even Roy recommended on the home care and drug plan--yes, we know there is talk, but there are no details--then quite frankly we'll go back to the position where we need far more than what was there, even in the Romanow report.

We know that with drug plans there has to be, again, the political will to take on the patent drug makers and to make sure, as has been pointed out, that people get the medication they need at prices they can afford, and we've rededicated ourselves as well to primary health care.

As Maude has said, we've rededicated ourselves to fighting trade deals that are undermining our health care system in this country and around the world, and we've rededicated ourselves to democracy and to community action.

Roy Romanow heard this from Canadians time and time again. We believe his report reflected the sentiment that came from Canadians about the things they wanted, and we want to assure the people in this room, the parties you represent, and the provincial politicians across this country that they are going to be hearing from Canadians in the coming days, weeks, and months.

Thank you.

º (1605)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, Barbara.

Now we will continue with our pattern of questions and answers. We normally start with the loyal opposition. Who is going to be first?

Rob, you go right ahead. You have ten minutes. What does that really mean? If he has a very long preamble that runs for six minutes, or seven minutes, or eight minutes, that means that you, anybody on that panel, only have two minutes to respond, or three minutes or four minutes.

So please, members of the committee, keep your preambles as short as possible. It's more important for me to hear the kinds of responses that these people have to present than to listen to your preamble. All right. Go right ahead.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): There's the deal. I'll keep my questions short if we can keep the answers short, and we can probably get through as many questions as we possibly can. That's what you're saying, right?

Let's start with the leaders of the territories. Elaine, I'm impressed that you're here. I'm really quite interested and intrigued by the response they had to the accord last week because they're at least the ones who got up from the table, recognized it was a bad deal for them, and refused to go along with it in any way.

I certainly appreciate your comments as far as recognizing the difference in the territories and the uniqueness of providing health care to your peoples there. I'm wondering what kind of a dollar figure they had in mind. You must have an idea in the back of your mind as to what would be the appropriate number of dollars the premiers from the territories would have agreed to. Where are we at with it? Is it just that it's not recognized, or is there an actual dollar figure that you have in mind?

Ms. Elaine Johnston: I could tell you that for the First Nations and Inuit Health Branch, they already spend $1.3 billion, but what's happening--

Mr. Rob Merrifield: Excuse me, what was that?

Ms. Elaine Johnston: The First Nations and Inuit Health Branch, which covers the first nations and Inuit, have $1.3 billion. They estimate that they're going to have a $150 million deficit this year, $285 million for the next fiscal year, and $350 million for the following year.

What they've also been doing is taking some of the moneys that have been targeted for children in the Speech from the Throne to cover off the deficit.

The problem I see here is that unless we get sustainable funding, we're in the same situation as the provinces, if I can put it that way, in regard to sustainable funding, a base amount. Then we can start to help reform the system.

What we've been tasked with, even before Roy Romanow was commissioned to do his report and before Kirby, is health renewal. The problem Health Canada has been working with has been the whole sustainability exercise. It has been “rob Peter to pay Paul”, so to speak. That has been our challenge.

I know there has been $1.3 billion mentioned in the accord. There has been a lot of confusion about what exactly that means, because it says “aboriginal people”. We don't know whether that's sustainability money or whether that's targeted for programs. So there are a lot of unanswered questions in that regard to the $1.3 billion.

If I were to give you a dollar amount, I would say that we would probably need to look at sustainability money to take care of the deficits that are already there, and we need to look at health reform.

Mr. Rob Merrifield: How much for that?

Ms. Elaine Johnston: I would say $750 million. Then we need to look at health reform moneys, because there were moneys that were targeted for the provinces for health reform.

It's interesting that in the accord it says aboriginal people will be taken care of in the health reform fund, but if you read further on in the accord, it says those moneys are targeted to the provinces. So I'm not exactly sure how that was going to happen.

Mr. Rob Merrifield: There was a lot of fuzziness in the numbers. Just give me your number for the reforms.

Ms. Elaine Johnston: For the reforms we were looking at roughly, I believe, close to $1.5 billion on top of taking care of the sustainability.

º (1610)

Mr. Rob Merrifield: So $1.5 billion. That's just for the territories.

Ms. Elaine Johnston: No, that's just for the first nations and Inuit.

Mr. Rob Merrifield: I see, first nations.

Ms. Elaine Johnston: As far as the territories are concerned, I can't speak for them as far as what they were looking for. When I raise the issue that the northern parts of the provinces have the same issues as the territorial governments in the Yukon and Nunavut, it's because I worked in northwestern Ontario. In Fort Severn, which is the farthest community in northern Ontario, as I say, they have the same problems of flights. They travel to Sioux Lookout to go to hospital. Then from there, for the high specialty services, they have to fly to Thunder Bay or Winnipeg.

Mr. Rob Merrifield: Yes, and we were quite surprised that they left the table and the recognition of the things you just said was not there. But we're not going to solve it here, and hopefully we will be able to address that, or the Prime Minister will address that, in upcoming meetings.

I want to get my head around where we're at with drugs with the panel here. We understand that a catastrophic drug plan that came out of the accord dealt with the difference in health delivery now because the cost of some of the drug treatments, let's say, and therapies are becoming very catastrophic and are going to increase as we move forward. I don't think anyone has a bit of a problem with that, other than that some provinces are providing that now, and some are limited, depending upon which province. However, 10% or 13% of Canadians have no drug plan at all. That was not addressed by Romanow. It was not addressed in the accord.

Your concern, to me, or what you expressed in your panel, was that we have to get cheaper drugs, and that means challenging patent law--I imagine that's where your heads were at with that--and we have to try to get easier access to drugs so that they become open for everybody.

One of the things that disturbs me about that--and I made this presentation to Mr. Romanow--is in Canada we have an alarming number of deaths because of the misuse not of illicit drugs but prescription medication. I hope you would champion that cause as much as the others so that the people who are dying because of prescription medication would also be addressed. There are two sides of the coin here that we absolutely have to get hold of when we have 30% of our seniors addicted to prescription medication and 20% of our general population.

Actually, Kathleen mentioned that we have to look more broadly than just crisis management in health care. I want your perspective on that. It wasn't mentioned here in your presentation, but have you thought of the other side of that coin?

Ms. Kathleen Connors: Rob, in response, I would suggest that you might want to take a look at the brief that the Canadian Health Coalition presented to Mr. Romanow, because in fact the brief does address many of the issues with respect to prescribing practices. To date, it's physicians who prescribe most of the pharmaceuticals in this country, with a limited prescribing practice for some nurse practitioners. So there is the issue of prescribing practices, and even the drug detailing that happens around why physicians are hoodwinked quite often into prescribing newly patented, more expensive drugs when a non-patented older drug has the same therapeutic effect. There is reference around that and around the education of people about the medications they take; around practitioners; about interrelationships in the medication protocols you have, because one drug may cause a side effect and impact on how another drug will interface with how you will come out in the treatment.

The issues of the use of drugs, patent protection, of looking at reference-based pricing, and an examination by the Canadian governments, federally and provincially, of drug programs that are available in Australia and New Zealand need to be considered, because there are countries that have wrapped their heads, much more successfully than this country has, around how to be cost effective in the provision of pharmaceutical products to the people. The other piece is having the political courage, such as Brazil and India have had in the world, in saying no to the extensive 20-year patent protection, under obligations of trade, that Maude raised.

There are many issues. The Canadian Health Coalition and certainly CUPE, the Canadian Labour Congress, CNFU, in our presentations raised many of these issues, and we have provided--

º (1615)

Mr. Rob Merrifield: My time is limited and I don't know how much I have left.

The Vice-Chair (Mr. Stan Dromisky): You have one minute.

Mr. Rob Merrifield: I'll just leave it at that. I think we made the point that there are two sides to it. I hope that when you go out and challenge better access to drugs and cheaper drugs, you'll also challenge the abuse of drugs that is presently taking place, because it's two-sided. If we open it up and we don't touch the other, we will cause a tremendous number of problems even more acute than what we have right now with regard to the abuse of prescription medication. So I hear what you're saying, and all I'm doing is challenging you with that.

I suggest you're all saying you agree with Romanow and you're championing his report. There have been a number of reports. In fact, this government has spent $243 million just studying health care in the last decade, so we don't really need more reports. Nonetheless, this is a very important report. Kirby had a report as well, and others.

If we--

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Now we will jump over to Mr. Ménard.

Mr. Rob Merrifield: They weren't going to answer it anyway.

The Vice-Chair (Mr. Stan Dromisky): No, but you were making a statement. You weren't asking a question.

Mr. Rob Merrifield: I was about to ask one.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Personally, I believe very strongly in the importance of a public, universal system. I believe that in my own province—and I never refer to Quebec as a province, but I am doing so to facilitate people's understanding of the situation—very interesting initiatives have been introduced. Over the next few months, I would like to focus particularly on the issue of drug prices.

Wednesday, I will be presenting a motion to my colleagues. The issue is not easy for members from Quebec, given the whole quarrel surrounding the brand name drug industry. However, I do not share the view that reviewing this is incompatible with a calling into question of intellectual property considerations.

As you know, Canada is a member of the WTO. It has signed the agreement on TRIPs. I do not think we should deal with this issue by saying that we will question the 20-year period; this would be futile. However, there are some issues that should be considered.

We could review the role of the Patented Medicine Prices Review Board; I would like to know what you think about this. Are we comparing ourselves to the right countries? Some say that we should be comparing ourselves to Australia. You also mentioned the example of New Zealand. Something could be done along these lines.

In my opinion, the crock of the problem is that Health Canada is not doing its job. It is not right that research authorizations are being given and that drugs that do not have any new therapeutic values are being authorized for sale. That is the problem.

Did you know that this year, for the fifth time in Canada, the cost of drugs is higher than the total remuneration paid to all doctors? In my opinion, Health Canada is partly responsible for this situation. I can understand that an investment in research of $700 million cannot be recovered in two years. However, I expect that the drugs approved by Health Canada and subsequently marketed should be new drugs. However, the studies that I have been reading for two years on this suggest that this is not the case.

We need to work in a collegial manner. I therefore hope that this committee would study the issue of drug prices as a whole. We cannot do so by calling into question intellectual property considerations, because there are two concepts known as the law and international conventions. Moreover, this idea would never be accepted in Quebec.

However, if there are original, innovative ways of making drugs less costly and more accessible than they are at the moment, I think we could work together on this.

Finally, and I will close with this—I understand that you support the Romanow Report. However, the Bloc Québécois would never support a report that gives more power to the central government in an area that does not come under its jurisdiction. We are always very aware of these considerations. As far as I am concerned, I fully agree that there should be a drug insurance program in English Canada. As you know, Quebec has had such a program since 1996. It has been around for some time.

Those are the points I wanted to make. Do you think that any of these ideas could lead to an intelligent debate on drug prices?

º (1620)

Mr. Claude Généreux (National Secretary Treasurer, Canadian Union of Public Employees): There are a number of parts to your question, and we do not have much time.

Mr. Réal Ménard: But the chair is very generous.

Voices: Oh, oh!

Mr. Claude Généreux (National Secretary Treasurer, Canadian Union of Public Employees): I will nevertheless try to answer them, to go straight to the point.

We did mention in our presentations that there were a number of different programs within Canada. Of course, you mentioned that the Quebec government established such a program, which is not perfect, but it does have a program in place. You also said that we could not touch on intellectual property, that this would not be accepted in Quebec. I would say with all due respect that we disagree on this.

Mr. Réal Ménard: Why?

Mr. Claude Généreux: We have to deal with this issue in the same way as Mr. Lewis, acting on behalf of the United Nations, is trying to make some major breakthroughs in Africa, not only in South Africa, but throughout the entire continent. We have to deal with it as China has done: by requiring negotiations among the various patent holding companies which therefore hold both the intellectual and commercial property of these drugs, which were patented, of course, in accordance with existing conventions.

Mr. Réal Ménard: China has not signed TRIPs.

Claude Généreux: What I meant was that in both China and Africa it is possible to discuss things if there is a political and social will to deal with problems. As far as intellectual property goes, it is true that huge costs are involved. If the financial problem is excessive, it is not because of individual drug use, as was suggested earlier by the honourable member who spoke before you. We are not dope addicts in Canada. We are not using too many drugs.

There is a problem with prescriptions. Ordinary citizens do not prescribe drugs to themselves. We need to educate doctors and drug companies. I'm trying to answer quickly, but your questions contain so many sub-questions. It is possible to call into question the current intellectual property regime. I'm not talking about renouncing it, but about reviewing it, and correcting it to make it less costly. Yes, we agree that some drugs are marketed without having proven their worth clinically and therapeutically. In addition to being expensive, this practice also has a harmful effect on health. Moreover, many American and Canadian studies on this show that this has even resulted in some deaths.

The New England Journal of Medecine recently published quite a comprehensive study of this issue. It would be advisable to tame this consortium of companies, in the same way that we tame wild animals. These are actually wild animals that are not in cages, that have not been tamed at all. There must be a desire on the part of the government to legislate and regulate the drug system more specifically and better than it is at the moment. In Quebec, there is of course a drug plan, but there is also a great deal of room for improvement there as well.

[English]

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, Claude.

There are other people who would like to respond to some of the areas of concern that Réal has introduced.

We're going to stick diligently to the schedule for the first round, and then on the second round we will be much more flexible than in the first round. In all fairness to all members of the committee, we must stick to the first round, as stated in our regulations.

So we will now jump to a Liberal. Is there someone from the Liberal side who would like to raise a question?

Dr. Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you, Mr. Chairman.

We know that many of the details about the arrangements still have to be worked out. One possibility that was mentioned was to target certain amounts specifically to front-line care, home care and catastrophic drug coverage. Of course, there were some objections to that, but apparently there was agreement in the end. I think this is a step in the right direction, and I would like your opinion on that.

When we take steps in this direction, do you think there should be Canada-wide rules, or should we respect the various provincial jurisdictions and have equivalent programs? We've heard two views on this. Some say that the program should be the same for all Canadians. Of course, when we talk to the provinces they say that we must respect provincial jurisdiction, that there could be equivalent programs. What do you think about that, after your weekend activities? I imagine that you must have talked about these concerns and aspects of the question. I would like you to tell our committee what you think and what conclusions you reached at your meetings.

º (1625)

[English]

Ms. Judy Darcy: If I could just deal with the home care part, other people may want to speak to other parts of it.

Roy Romanow recommended that there should be a national, public, not-for-profit home care program and that the Canada Health Act should be amended to include it. The arrangement, agreement, accord, deal--whatever you want to call it--says the home care program will be at the provinces' discretion.

We believe it should be a more comprehensive home care program and not deal strictly with palliative care and post-acute-care release, which is almost exclusively what it deals with. Other support services allow seniors to stay in their homes much longer and be independent. It's better for their quality of life and their mental health, and it costs the system less than having them go into long-term care.

So there are many things that are missing in the definition of what will be funded, but the fundamental problem is that it should be a public, not-for-profit home care program. If it's not, we've already seen that there are enormous problems.

There has been a patchwork of programs in some communities in Ontario over a number of years, and some have worked better than others. But with the model the Ontario government has introduced and has insisted on, you have a competitive bidding model for home care in the province. It's coordinated through what are called CCACs, continuing care access centres, and they're clearly directed by provincial government policy to regularly flip contracts and go to the lowest-cost bidders. That generally means profit delivery, but it doesn't mean better quality care.

There are experiences that have been well-documented and publicized. In Windsor, Ontario, for instance, the Victorian Order of Nurses for years provided high-quality home care to residents there, to seniors. Then because the contract had to be flipped, because someone said they could do it at a lower cost, people who had been providing care to senior citizens for years were yanked because another agency could do it cheaper--not better. It's not better for those seniors, and it's not cheaper in the long run either. That's what a for-profit model leads to.

It means growing privatization in the health care system because people are being released from hospital sicker and quicker. More people therefore have demand for home care, so you're seeing growing privatization in the system. It matters if it's public or for profit.

[Translation]

Mr. Jeannot Castonguay: I do understand that point very well. That is the second time you have mentioned that today.

When we talk to the provinces, they tell us not to worry, to send them the money and they will manage health care. What I really want to know is whether you think we should have the same program in every province.

In the case of home care, for example, should the program be the same in all the provinces, or is there room for each province having its own, equivalent program? That is part of the debate, after all. We cannot close our eyes and tell the provinces to get lost. There's a jurisdictional issue that must be respected, in my opinion. What conclusion did you come to on that?

[English]

Mr. Michael McBane: If I could just intervene on that issue, I think Canadians are sick and tired of the issue of jurisdiction stepping in the way of access to care that's right now being denied. The Constitution of our great country, Canada, says there's a federal spending power. That is constitutional, and you don't use the federal spending power unless you're establishing a national standard.

So please, governments in other provinces that claim it's a jurisdictional intrusion to establish national standards with federal spending are actually not correct. The federal spending power is constitutional, and you don't use it if you don't have national standards as your objective. Clearly, our organizations want national standards in home care. We need national standards in long-term care. We need national standards in all aspects.

That doesn't mean you're dictating to a province how to deliver, but all provinces, including Quebec, share the same values, the same principles, and they're sick and tired of the Quebec government playing jurisdictional games as well. Civil society likes the values of Romanow and the notion of national standards. That's what Canadians want.

So let's get on, work together at all levels, and not play football over jurisdiction.

[Translation]

Mr. Jeannot Castonguay: So, if I understand correctly...

[English]

The Vice-Chair (Mr. Stan Dromisky): Keep it for later.

All right, we will now go to the NDP and Svend Robinson.

Mr. Svend Robinson (Burnaby—Douglas, NDP): Thanks very much, Mr. Chair.

It's my first meeting as the new health critic and I'm delighted to be here at the committee. I have a very steep learning curve, and I look forward to participating as a member of the committee.

º (1630)

[Translation]

I would like to welcome all our witnesses. I apologize for not being here for your presentations, but I had a meeting with the Minister of Justice on the issue of hate propaganda, and it had been scheduled for a long time. I was very pleased to hear my friend Mr. Ménard suggest that we should perhaps study the issue of access to drugs. Quite frankly, however, I very much disagree when he says that we cannot touch the intellectual property regime and the regulations. My colleague on the Standing Committee on Industry, Science and Technology suggested that we study the regulations, and it was the Bloc Québécois that opposed that. So it does not surprise me that they receive a lot of funding from the major pharmaceutical companies in Quebec.

Mr. Réal Ménard: But you get funding from the banks, Mr. Robinson.

[English]

Mr. Svend Robinson: Pas au niveau fédéral.

My question is for one of the witnesses who focused particularly on the issue of private, for-profit care.

One of the concerns I think many of us have is that we still aren't able to get access to the information to know just to what extent this is already a reality, to what extent this is already weakening the public, not-for-profit health care system.

I wonder if the witnesses could talk a bit about some of the existing difficulties, compounded by the fact that the accord, the arrangement, or whatever we want to call it, is totally silent with respect to this issue. It's failed on accountability totally, unless I maybe missed something in the agreement. I didn't see anything in there at all about access to information, about Canadians having the right to know where that money is going and how much is going to the private, for-profit sector.

We heard today in the House of Commons, in response to my question to the Prime Minister, that we're respecting the five principles of the Canada Health Act, so what have we to complain about?

How do you respond to that, and specifically, how do you respond to the concern about access to information about private, for-profit money?

Ms. Kathleen Connors: Really quickly, looking at the indicators that are appended to the agreement, accord, whatever it is, there is nothing that requires the provinces to report what those public dollars are being spent on. That could easily have been inserted. That's one thing that wasn't there. It's one thing this group is going to insist the indicators include.

Mike made earlier reference to the lack of availability on the requirements of the annual report on the Canada Health Act. There is a legislative responsibility for that information to be provided, so we're calling on the federal government to exercise that legislative authority to provide that information, to demand that kind of accounting be made available, so we're making decisions based on evidence, on knowledge, on what gives us the best bang for our buck.

Mr. Michael McBane: To follow up on Kathleen's point, when you sign a contract as a public health authority with a private, investor-owned corporation, those contracts are secret, so you don't know how much money's changing hands. Those books are not open. Canadians want accountability and transparency. The last place you're going to get it is if you sign a contract with a private corporation. They're not obliged by law to open their books.

So we don't know what's happening in these private contracts in Alberta. We don't know about these private MRI clinics, what the deals are with the doctors. It's all secret. We're losing control over the medical standards and we're also losing public accountability. There's no auditing with these private, investor-owned facilities. It opens us up to incredible corporate fraud.

Mr. Svend Robinson: I had one other question, if--

Mr. Anil Naidoo (Campaigner, Council of Canadians): Thank you, Chair, and thank you for the question, honourable member.

I'm with the Council of Canadians. I just want to add to comments by our fellow panellists here in that there is a veil of secrecy around corporate information, as we've all seen. That runs into the drug industry as well, certainly. There is no true peer review of drugs. That's what's getting us in a lot of trouble around the whole issue of the effectiveness of new drugs.

I think with P3 hospitals, as Mike brought up, it's another issue. I think we're setting ourselves up for Enron-style funny accounting to influence our health care industry. We saw it with King's Health Centre in Toronto a few years back. I think the amount of evidence is legion on the side that we need true transparency, and that means public accountability. That's not in this accord.

º (1635)

Mr. Svend Robinson: I just had one other question, Mr. Chairman, if I might.

The Vice-Chair (Mr. Stan Dromisky): Sorry, but opposition parties get only five minutes. Only the “royal” opposition gets 10 minutes.

Some hon. members: Oh, oh!

Mr. Svend Robinson: On a point of order, Mr. Chairman, I appreciate that I am new to the committee, but I've sat on many parliamentary committees, and this is the first committee I've ever sat on in 24 years in which there's been a different length of time for one member as opposed to other members.

The Vice-Chair (Mr. Stan Dromisky): Diversity is an enrichment of life.

Mr. Svend Robinson: Has this been adopted as a formal motion by the committee, this difference of time? There should be equality of access to witnesses.

The Vice-Chair (Mr. Stan Dromisky): We could discuss this at a further point, but I think we have established a pattern here, and we're following the pattern, all right? It has been in practice for quite some time, so we will continue now.

Madame Thibeault, you have five minutes.

[Translation]

Ms. Yolande Thibeault: Thank you, Mr. Chairman. Good afternoon, ladies and gentlemen.

I would like to pick up on something you mentioned in passing in your presentation, Mr. McBane. You spoke about a study that apparently showed that the mortality rate is higher in private institutions than in public institutions. Does the study say why this would be the case?

Mr. Michael McBane: Yes, there are a number of reasons, but one basic one, very clearly, is that these hospitals are staffed by fewer health care professionals, so patients do not receive adequate care.

[English]

The fundamental reason for the higher mortality rate in for-profit hospitals in the United States is that the investors are cutting back on the budget that pays for high-cost labour, which is doctors, nurses, and other technicians. It's been documented that the for-profit hospitals have inadequate staffing, which jeopardizes people's lives.

Ms. Maude Barlow: It should be added that this wasn't just a study; it was a meta-analysis of all the studies done on the difference in the death rate in for-profit versus not-for-profit hospitals. It's more than just one study; it's an actual, scientifically grounded meta-analysis.

Ms. Judy Darcy: We can certainly provide you with copies of it.

[Translation]

Ms. Yolande Thibeault: Yes, that is what I wanted—the title of the study, so that we can read it ourselves.

So what you are saying, Mr. McBane, is that there is less staff in private clinics than in public facilities. That is what you are saying.

[English]

Mr. Michael McBane: Yes. The study is available on our website at medicare.ca. The lead doctor is P.J. Devereaux.

Another reason for higher mortality rates, besides the cutting back on staff, is that in dialysis in for-profit clinics they don't change the filters as often and they don't transfer patients for transplant quickly enough because they make more money treating dialysis than they do putting people in for transplants. This is also a documented cause of higher mortality in not just for-profit hospitals but for-profit clinics. Both these studies are on our website.

Ms. Judy Darcy: Just further on that same issue, I spoke earlier about the connection between the cuts in cleaning and infection control staff and mortality rates. There are also studies available on that, where in the United States they've seen a 25% cut in hospital housekeeping, cleaning, and infection control staff with higher rates of death as a direct result. This is especially true with superbugs and all those things we read about all the time in the media, bugs that are immune to a whole lot of drugs that are on the market. We've seen a rapid increase in those, and when you don't have the people to take care of cleaning and infection control, the rate of infection goes up and the number of deaths also goes up.

º (1640)

[Translation]

Ms. Yolande Thibeault: Are you saying that this phenomenon has not yet happened in Canada?

[English]

Ms. Judy Darcy: I'm saying that the major studies on it have been done in the United States because that's where you see a predominance of for-profit hospitals and that's where we're in a position to make a comparison. It's also where we've already seen a significant cut in the staff who are responsible for things like infection control. The results are already there. We're saying we shouldn't be experimenting, because there's evidence. We don't need the proof. The proof will be in lives, and let's not go there.

[Translation]

Ms. Yolande Thibeault: Thank you very much. I am very interested in reading the study referred to by Mr. McBane. Thank you.

[English]

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Now we will start our next cycle, and I believe, Madam Skelton, you have a question.

Mrs. Carol Skelton: Thank you very much.

I come from Saskatchewan and I'm very proud of it. When the doctor strike was on, my aunt was expecting twins, so I can remember it very well.

I too have great concern about our nurses and our staff at our hospitals, and I know at home we're having problems getting nurses and other quality people. Our nurses are played out, they're tired, and they're having a hard time. Have there not been any studies done on what's happening? Why wasn't this discussed in the accord, about health care professionals and health care workers? Do you have any ways to help us look at that whole situation?

Ms. Kathleen Connors: I'd be very pleased to tell you about that from a nursing perspective. In 2001 to 2002 there was a year-long study done by the Canadian Nursing Advisory Committee. It consisted of representations from federal and provincial governments, employers, nurses' unions, nursing education centres, and nursing executives. As a result of that year-long study, there was the “Final Report of the Canadian Nursing Advisory Committee”, an extensive report with some 51 recommendations dealing with issues related to the retention and recruitment of new nurses.

Now, when the federal, provincial, and territorial health ministers met, there were some words spoken but no reference to that report. We were very, very disappointed as health care providers that in the most recent accord there was no reference to implementing the recommendations of the CNAC report.

And it's more than nurses; it's the physicians, it's the technicians, and it's the technologists. It's having adequate numbers of prepared people to do the dietary, the laundry, and the maintenance that needs to be done. This is an area of delivery of care that involves people's lives. It's incumbent on us to have the best and the brightest practitioners.

In addition to the advisory committee report, there are actually some Health Canada-HRDC joint labour sector studies happening for physicians and for nurses, the latter involving registered nurses, licensed practical nurses, and registered psychiatric nurses. There is a sector study looking at, I believe, technicians and technologists. There are a number looking at the health care centre, so there is work being done.

The fact that there's no reference being made to this work in spite of the ideas that have been put forward to address this and that there's no targeted funding or strings attached, that is a dire concern.

The accord talks about primary health care reform. How are we going to have true primary health care reform so that you have a multidisciplinary team of providers providing care if you don't have sufficient numbers of practitioners there? You still need to have those people working in the hospitals, because we cannot eliminate the hospitals of this country.

º (1645)

Mrs. Carol Skelton: Why do you think it wasn't included?

Ms. Kathleen Connors: We have looked at things such as using employment insurance dollars, where there's a huge surplus. The Canadian Labour Congress has actually proposed a pilot project for health care, where EI dollars could be used to assist individuals to get the educational preparation to become health care providers. That seems to be going nowhere. Why wasn't that idea picked up? There are recommendations to help keep nurses and other providers in the system by, for example, adopting what is happening in New Brunswick. In the collective agreement it has been negotiated that nurses who are approaching their retirement can work part-time and the employer and the nurse will make full-time pension contributions. Rather than lose that nurse entirely to the system, they're going to be kept, and their pension will accrue so that they will have sufficient income to be able to retire with dignity. Why are those measures not being adopted? It's lack of political will and commitment to the people who work in the system, I would suggest.

Mrs. Carol Skelton: Thank you.

Do I have more time?

The Vice-Chair (Mr. Stan Dromisky): In the next round.

We'll jump over to Réal.

[Translation]

Mr. Réal Ménard: I am going to have to leave at 5 p.m., because I have to make a speech in the House.

In all due respect, Mr. McBane, I would say to you that the National Assembly passed a resolution and we will never accept national standards on health care. We completely agree with the accountability. As you know, there are various accountability mechanisms in place in the National Assembly.

I want to come back to the discussion about the pharmaceutical industry. I would like to issue a warning. This debate must take place, and I am prepared to take part in it on behalf of the Bloc. I will distance myself with respect to Mr. Robinson's comment about political contributions. One thing is sure: this is not a cowboy movie. We do not have the bad guys from the drug industry up against the consumers. People need drugs, we have to reach an accommodation between the two. There are original ways of going about this debate, but this is not a cowboy movie. We have to be careful, because we lose credibility when we seek to polarize the debate in such way that we can no longer see the nuances that must be considered. I am sure that is not your intention. The NDP, which is at 8 p. 100 in the polls, is adopting a centralist approach, and we want nothing to do with that. We want to be involved in innovative ways of talking about issues, and I am sure that each of you can make a valuable contribution in this regard.

When we look at the role of the Patented Medicine Prices Review Board, the role of Health Canada and the expertise of the various professional federations, it is clear that such a debate is possible. However, it is not true that we will be able to completely disregard the treaties or existing legislation on intellectual property. That simply is not true. The case of South Africa is different. Our country may be a member of the WTO without having signed the TRIPs agreement, but once a country does sign this agreement, it has a number of obligations. It is not accurate to say that we can disregard that.

Mr. Claude Généreux: That is a very interesting subject, but I will not talk about it because we are short of time.

Mr. Réal Ménard: We will go out for a meal together.

Mr. Claude Généreux: We do not deny that intellectual property considerations exist. Just to be clear, I will give you the People's Summit views on the relations between Quebec and the rest of Canada. The People's Summit represents all of the people of Canada, including those of Quebec.

At the summit, there is a very broad representation of Quebeckers. There were organizations representing volunteers from the health care and social services network, organizations representing all sorts of not-for-profit groups, organizations representing the recipients of various health care and social services, representatives of those who deliver health care and social services and all the major unions.

The coalition speaks as one voice. We say that there is room for Quebec to express its aspirations differently and to manage them differently. However, there is no doubt that historically and even in the present context, the people of Quebec have the same aspirations as the people of Canada. They want a publicly run health care system. They want not only money, but also a publicly-controlled system. We want to be very clear on this: the coalition does not deny this right to Quebec.

However, I would say in a non-partisan way that if the Quebec government wants to establish its jurisdiction, it must also exercise it. In this regard, the coalition would like to suggest respectively to the Quebec government that if Quebec wants to exercise this jurisdiction, it must enshrine it in a Quebec statute similar to the Canadian act. The act would have to be broadened and modernized so that it would include not only the existing medicare system, but also the long-term care system we spoke about earlier. Such a system could be established.

That is not at all in contradiction with our vision, but this jurisdiction must be carried out. Two weeks ago, a Polara poll showed that Quebeckers wanted the public health care system to be maintained and reinvigorated.

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Mr. Réal Ménard: But we agree that we are not talking about national standards.

Mr. Claude Généreux: When we talk about aspirations, we are talking about standards. Are they the same thing? No. We are talking about equivalencies, which is not the same thing. We are not talking about things that are exactly identical, but about things that are equivalent. The system must be similar and transferable. If I am ill today in Ottawa I must be able to use my Quebec health care card to receive care here in Ottawa, Ontario, free of charge. There have to be similar standards, that can be measured and are equivalent. The summit has no objection to the Quebec government exercising its jurisdiction, but it must do exactly that. To date, there have been statements of principle, but there is no Quebec law that is in any way similar to the Canadian Act, which enshrines financial support, but also the delivery of public services—a public good for the benefit of the entire population.

[English]

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Dr. Bennett.

Ms. Carolyn Bennett (St. Paul's, Lib.): I have a couple of very specific questions on the idea of drugs and privatization. I wonder why generic drug handlers are not viewed as private companies and why we are happy not to look at their books. I have a sneaking suspicion that they're making lots of money. Last week we were pretty upset when we realized the issue around pork and beef insulin.

I've heard that up to 90% of drugs with expired patents have never been genericized. It's better to work on the patent for a potential blockbuster than it is to actually genericize a boutique drug for a small condition.

In terms of these next steps, if sunlight is indeed the greatest disinfectant, how can we begin to make sure that with all of the public dollars we're spending on health care that go to private companies, we get to see what's happening in those companies. I don't care if it's a private home care provider or a.... One of the conditions of making a deal with government is that your books have to be open so that we can actually see where the profits are. I understand that some of the generic companies sell the drugs for a lot less in the States than they do up here because there's competition down there. I'm always interested in why some have black hats and some have white hats. I think for profit means for profit and that we should actually figure out what's happening with our public dollars.

Do you have any numbers on any of this?

Mr. Michael McBane: Dr. Bennett, we agree that all companies should be treated the same. They have a for-profit obligation to their shareholders, and it's not to serve the public health interest.

Ms. Carolyn Bennett: But they don't have any shareholders; they're private companies. They don't actually have to have an annual report.

Mr. Michael McBane: When we argue for the availability of generic products, nobody is arguing there should be special arrangements with generic companies in terms of evading transparency, or allowing them to be irresponsible in pricing or shortcut safety and make unsafe drugs available.

The issue on the generics is that they should be more available and purchased in a bulk fashion. A lot of medications have generic equivalents. According to the government's Patent Medicine Prices Review Board, up to, I believe, 92% of new medications have no therapeutic advancement--zero. Therefore, you should be using more generics because you're getting no value for higher prices from the brand-name companies.

There are people who have the facts on this, like Dr. Arnold Relman, who recently wrote an article in The American Prospect, December 2002. There are good and bad people in this story. The brand-name companies are not innovating. There are practically no new chemical entities in the pipeline, according to the experts, and the people who are innovating are doing it on the backs of public research dollars. And what do they get for all this? A 30% return on investment. That is plunder.

º (1655)

Ms. Carolyn Bennett: But is not the biggest problem in drug costs in this country the fact that physicians are prescribing the most expensive anti-hypertensive instead of a mild diuretic, or giving macrolides for strep throat? In terms of spiraling drug costs, there's a lot we need to do in terms of prescribing.

I guess that's why I had hoped that if we could move into some sort of actual health council, we could start to really have a look at what public administration would mean, what it would look like. We could actually see where the drugs were going, how many people are on uppers and downers at the same time, how many people we're killing doing this stuff.

My real thing is that if we only look at evergreening or the things that have been raised, we aren't going to get to this big problem of what could be treated without a drug, what is a better way of treating certain conditions.

Ms. Elaine Johnston: Can I respond?

The federal government provides non-insured health benefits to first nations and Inuit. It's interesting you should say that the doctors provide the most expensive drug. But Health Canada doesn't allow the most expensive drugs and goes to the generic drugs. It's not necessarily whether it's most effective, it's what's going to cost us the most. When you talk about efficiencies, that's what they're looking at. That's our concern, what is the best drug for the client from the point of view of safety and in regard to their health condition.

You have two dichotomies here. When you're talking about accountability mechanisms, when you talk about the health council and the accord, my concern is what kind of accountability this health council is going to have. If you look at the wording in the accord, it doesn't really have any meat, it doesn't have any substance. There needs to be more in the health council to look at the whole accountability issue you're raising.

Ms. Maude Barlow: I don't think anyone on this side of the room would disagree that profit is profit and all the books need to be open. I'd make two points, though. First, that doesn't negate our argument that we have to do away with the power of these patent drug transnationals, because they are holding on. You know all the ways they have. They're allowed to keep the generics in court for two years while their drugs go stale, even if they know they're going to lose because their 20-year patent is up. They can spend all the money they want on lawyers because it's worth it for them. That's holding the Canadian people ransom.

I'm sorry that our Bloc friend is not here, but I just want to go back to this notion that we can't open up the TRIPS, the trade-related intellectual property agreement of the trade agreements. That is one of the most divisive issues coming up at the World Trade Organization meeting in Cancun, Mexico, this fall.

All of the African countries, increasingly most of the Latin American countries, and a number of Asian countries are asking that the TRIPS agreement be reopened to deal with this 20-year patent right. It's not just for the AIDS drugs and so on to be able to...in catastrophic situations, but actually to break the back of it.

I just got back from Brazil. There is a new prime minister or president there who isn't going to willingly go into a TRIPS agreement in the free trade area of the Americas. We would very much like to see Canada playing a different kind of role than always taking the most extreme pro-drug company, pro-American position at these trade negotiations.

So on the notion that those can never be opened up, I'd just like to put it on the record that that's not true; there's a lot of push to renegotiate the TRIPS agreement.

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The Vice-Chair (Mr. Stan Dromisky): Thank you.

Svend Robinson.

Mr. Svend Robinson: Thanks very much, Mr. Chair.

On the pharmaceutical drug issue, I'm very glad that Maude Barlow made the point about the TRIPS agreement. I was in Doha, as she was, and she'll recall that this was an item of huge controversy and real concern. Frankly, it was shameful that some of the poorest countries had to beg and plead with the wealthy countries just to have the principle that public health should come ahead of corporate profits in pharmaceuticals. I mean it was just unbelievable.

This is a subject for bigger debate, but for the life of me I don't understand why the summit and progressive folks in the country aren't even moving beyond this notion that we have to kind of reopen TRIPS, and so on. If ever there was a sector in which the public sector should be actively involved, it's pharmaceuticals.

We have to start looking very seriously at the role for the public sector and ask some of the finest scientists and others in this field to come together to work on the creation of a publicly owned pharmaceutical company that is not based on how much money we can make globally.

I think it's long overdue, when you look at the obscene levels of profits of the multinational pharmaceutical companies; when you look at the amount of money they spend on marketing; when you look at the amount of money they waste on drugs that have marginal, if any impact; when you look at the fact that the multinationals refuse to in many cases fund research for drugs that only help poor people. The sleeping sickness in Africa was the classic example of that.

I just want to respectfully suggest that the groups represented here today go a bit further and say, look, this is a sector in which the people of Canada have a right to have ownership and take profit from.

But in terms of my question, because we only have five minutes, I wonder if you could just elaborate on the issue of diagnostic services. This is an area in which, once again, the private, for-profit sector is just waiting to move into, and in many cases is already there.

Romanow clearly recommended that there should be an amendment, as I understand it, to the Canada Health Act to include diagnostic services within the framework of the Canada Health Act so there could be enforcement, at least theoretically, although with this government we don't see enough enforcement under the existing provisions.

Could one of the witnesses just comment on the importance of actually broadening the scope of the Canada Health Act to include diagnostic services?

Ms. Judy Darcy: It is the single biggest travesty of that agreement by the first ministers that it threw out the fundamental tenet of Romanow's report that not-for-profit delivery was the way to go. He didn't say it for ideological reasons. We all know Mr. Romanow. We know he's a very pragmatic man. He insisted that all of his findings be based on evidence. He said over and over again that the issue of public versus private delivery was fundamentally important. But all the first ministers talked about was public funding; they didn't deal with the issue of public delivery.

When he said public delivery, that meant that these new programs--the expansion of our home care program that would modernize it, diagnostic services, a national home care program, a national pharmacare program, even the limited catastrophic drugs--should be part of the Canada Health Act. That meant they would be covered by the principles of the Canada Health Act so they would be public, not for-profit.

The Globe and Mail was absolutely right. On the morning of the first ministers' conference they ran a headline that said “Not-for-Profit is Off the Table”. There has been a conspiracy of silence amongst the first ministers and the media in this country on that issue. Nobody is talking about it. We raised our voices loud and clear at the first ministers' meeting and to the media afterwards, and barely a word was spoken of that issue. That's where they failed Canadians.

Canadians are absolutely clear on it. We did some polling in CUPE that was released about two weeks ago, just before the premiers' meeting. It showed that 95% of Canadians said there needed to be far better accounting for how health care dollars were spent; 92% said government should have to account for every penny of federal and provincial health care dollars; and 77% of Canadians said that not a penny should go for profit. That has been ignored by all of the first ministers in those statements.

Mr. Michael McBane: If I could just make a comment about the diagnostic sector, we know that the Ontario government has plans to open up 25 private CAT scan, CT, and MRI clinics. The problem is they are going to go around and take the radiologists out of the public hospitals to work in those private clinics. After two and a half years their profit will be $1 million per clinic.

There's an Alberta entrepreneur going around recruiting doctors out of our public system. He's been told by the Ontario health minister, “Don't worry, I have the contracts in my back pocket for you”. Now they're gloating that the feds are giving them the green light.

This is going to sabotage public health care with our money. So we cannot accept federal politicians saying this doesn't matter, because that is going to cannibalize the public MRI system and public diagnosis. Romanow said if you take public money and put it in the private sector instead of the public sector, you will cannibalize Canada's public health care system. That's what Ontario plans to do.

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The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Mrs. Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you, Mr. Chairman.

I would like to raise a different subject from what we have been talking about so far.

At the first ministers conference, I mainly heard premiers asking for money to meet their existing needs for equipment and human resources. I did not hear the premiers talk about things like the profile of Canadians, Canadian youth and prevention. Statistics show that at the moment young Canadians are very obese and sedentary and have all sorts of problems. I would of like to have heard the premiers say that they were investing a lot in prevention. It is well known that prevention is a very important way of reducing health care costs.

There were more investments in prevention in one area, but I did not hear much talk about investment in nutrition and physical education programs. I would like to know the summit's stand on these issues. How do we go about encouraging prevention? At the moment, we are talking about disease, not health. I think that if we do not invest substantially in prevention, we are going to miss the boat for the future. Our current needs will be growing steadily. If we do not establish a prevention program now, and if people like you do not stand up and say that we must invest now in prevention for our young people, we will miss our opportunity, and we will never manage to reduce or control health care costs.

[English]

Ms. Elaine Johnston: I can say it was a discussion, number one, that health promotion and prevention was lacking in the determinants of health. It's very critical with regard to trying to reform the health care system.

I know that the Assembly of First Nations, when we presented to Roy Romanow, talked about a wellness model. He only put two recommendations in his report, which talked about partnerships and a framework agreement. He didn't really talk about what we had presented with regard to a wellness model, which talks about health promotion and prevention, as you mentioned.

My concern with what has come out of the accord is that it is focused on these key areas, which is really not health reform. It's more talking about money and investing in certain targeted programs--or areas. I don't even want to call them programs. I know this was a discussion because we did have the Canadian Public Health Association there at the forum this weekend. The concern is that there is no focus on promotion and prevention, and how do we get that? The premiers did talk about money and they talked about specific areas, so that is a concern, very much so, and we feel that this certainly needs to be addressed.

Ms. Barb Byers: I want to add to that as well.

I think the summit this weekend definitely took on those issues that Elaine has mentioned, but also issues around poverty, around clean water, around homelessness.

One of the things we probably could have discussed more was the question of health and safety because it's a preventative program. If you're dealing with preventing injuries at work, that's dealing with the system as well. The amount of money that's spent on workers' compensation.... Again, here's a system where, guess what, the workers' comp systems across this country are the biggest users of the for-profit systems. They're paying to make sure their people can jump the queue. It might seem contradictory for a labour leader to say that we don't think workers should go to the front of the queue, but we don't because we think there should be a queue that is there for everybody, and there should be, again, equal access to quality care. Workers' comp systems are in fact, again, undermining that, so they're all combined.

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Ms. Kathleen Connors: As I said while we were having a meeting earlier today, on the issue of social determinants of health and the issue of health care spending, governments have a choice. You spend it on the front end and keep people well and healthy and without requiring hospitals or physicians or nursing or technicians' services, or you spend it on the system. So in regard to spending on homes, adequate housing, clean water, a peaceful environment, all those things, money spent there will save the acute care system millions and billions of dollars. Then we would have the money so that we could keep seniors in their homes with the provision of home care, which includes somebody maybe going and getting some groceries, shovelling the walk, and providing the supportive services so that these people don't have to be institutionalized. We just have to get the politicians to get the issues right and put the priorities where they need to be.

The Vice-Chair (Mr. Stan Dromisky): Mr. Lunney.

Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Thank you, Mr. Chairman.

I want to expand the dialogue maybe a little further than where it's been, although we've touched on some of the issues I want to raise. The issue is genuine health care reform. I want to make sure Canadians get true value for their health care dollars.

As I think Kathleen mentioned earlier, in terms of the effectiveness or cost-effectiveness of pharmaceuticals, perhaps there are other models that we might look at for delivering value to Canadians in that regard.

Shouldn't Canadians have access to all, and perhaps the best, options? On this front, there's great concern that much of our health care delivery system has developed without demands to demonstrate either effectiveness or cost-effectiveness. A lot of procedures that are done today have had very dismal results, and we've had some great disappointments.

Someone else here mentioned the secrecy regarding drugs, for example, and effectiveness, and because of proprietary information and patenting and so on, the issue of peer review. There have been great disappointments, such as, for example, hormone replacement therapy, which was recommended for years. Women bought into that. Lots of dollars were spent on it with actually very poor outcomes, in fact the reverse of what they might have been expecting. And anti-arrhythmia drugs, for example, have just been turfed out for basically not doing what they're supposed to.

What if there are other ways of doing procedures that might be more effective? What about wellness and prevention? What measures might be taken in that area? What if vitamins and nutrients might be more cost-effective than medications for many conditions? What about, for example, intravenous chelation therapy, which has a potential to save millions and millions of dollars for people with heart conditions? What about chiropractic treatment of low back pain? Mr. Romanow touched briefly on that, but had no room for discussing it.

If we're talking about primary care reform, what about practitioners in, for example, chiropractic, who specialize in treating neuro-muscular skeletal disorders? If we stick to just low back pain, the health care economists suggest it could save up to $2 billion a year by simply redirecting how the care is delivered.

There's a shortage of manpower. But what if there are other professionals who have been shut out of the current system who actually could deliver very effective care if they were given a chance? How does this fit in with a primary health care debate?

I throw that out for consideration. It's a little different direction than where we've been. I wonder if panel members would have something to contribute to that dialogue.

Mr. Michael McBane: I think you've asked some really good questions, and there was another question about why not more focus on prevention. I would suggest that one of the reasons is that in our society the economic values are running roughshod over other social objectives. There's a perverse economic incentive at work where the drug industries, the food industries, and the chemical industries are making a lot of money off disease management. There's no money in health promotion.

If your objective is to make money, you're not going to concentrate on preventing people from getting sick in the first place. That's why I'm concerned. For example, the Minister of Health has just announced there's going to be a wellness summit in the next month or so. I predict she will have the food industry and the drug industry there, whose job is to sell products that are making our children sick in terms of the additives in the food, etc.

We have to get our priorities right. Are we interested in people's health or are we interested in selling chemicals? The corporate powers behind these products are what's blocking a lot more effective treatments, a lot safer treatments, and a lot more holistic medicine.

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Mr. Claude Généreux: Mr. McBane, we don't have a problem. Quite the opposite. We'd welcome, for example, the acknowledgment of midwives and their integration as part of the overall system. It's not a problem, but it doesn't mean the door is open-ended.

You alluded to effectiveness, and we had a chance to compare what was going on with eye surgery, cataract surgery, between Edmonton and Calgary, for example, in Alberta. It was way more effective and efficient when it was publicly delivered in terms of the waiting time for beneficiaries. And the actual net outcome was way better when it was performed in Edmonton, where it was public, rather than in Calgary, where it was private. So we have traces there to see what works better. In this case, it was very clearly public.

Again, it's not a problem to look at these things, and the summit, the coalition, certainly doesn't have a problem with possibly chiropractors for some very specific acts, and midwives, as I have mentioned, and others. We didn't want to go there because of time constraints. But if we can continue the discussion, of course we'd like to say there's more to that.

Ms. Barb Byers: Elaine has a comment, and then I have a brief comment as well.

Ms. Elaine Johnston: I mentioned earlier that the first nations were involved in health reform before Romanow and Kirby were announced.

They said to us, tell us how to do business better. We always found there were stumbling blocks in front of us, and I think with this accord we're finding the same thing. We knew it before. It's that money keeps becoming the issue. What stalled us with regard to our health reform discussions was, how much money does the First Nations and Inuit Health Branch need to sustain the programs they already have? The provinces are having that same discussion.

The question we have is, how do you get back to real health reform discussions? For the first nations that has always been the issue. We don't have enough health care workers. That's the reality. For many years we've had community health representatives because we couldn't get nurses. We don't have enough physicians. How do we take care of that? You've asked a question we've been asking ourselves for many years. The problem is that we're always in crisis mode with regard to trying to respond to the problems. How do we get back to talking about real health reform? I think you're asking a very important question. We've been asking that as well.

Ms. Barb Byers: I want to give the people here an example of a real preventative program, which actually worked. Unfortunately, it isn't around any more because the profit motive took over. It's something we haven't talked about here. That is the dental plan for children. Ms. Skelton will remember this. In Saskatchewan we had a dental plan that was offered through the private system, with dental nurses going into schools, and parents had the option of their children seeing the dental nurses there. From the age of five to sixteen the kids were covered under that plan. From sixteen to eighteen they could go to private dentists, and the plan would cover their care there. We had the plan from about the early seventies to the early eighties.

The private dentists lobbied the Devine government to get rid of the children's dental plan, because not only were they missing out on working on kids' teeth during the ages of five to sixteen, but when the children then went into the private system, their teeth were in good shape, and you can't make money on kids who don't have cavities and other needs. That's the reality.

There was a huge outcry when that program was done away with by the Devine government. As Michael has said, it was purely economics and not about the prevention that was needed. It was a huge hit to farm families, because the parents, who didn't have to worry about that before, ended up having to leave their farms and go get their kids at school and take them off to the dentist and so on. It was very difficult.

But it was a real prevention program. I had forgotten about this until Carolyn raised the whole issue of dental health earlier today. It's the reality that we have very good prevention programs when we look for them, and they can do the job for us. But we can't let the economics take over.

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The Vice-Chair (Mr. Stan Dromisky): Mr. Robinson.

Mr. Svend Robinson: As a new member of the committee, I want to get clarification with regard to the rules for a notice of motion. I want to give notice of a motion I intend to move at the earliest possible opportunity, which is that this committee urge the government to support the creation of a northern health fund as called for by the three territorial premiers, to be funded at the level requested by the premiers. I think it was Mr. Merrifield who asked earlier what that might be. It's between approximately $60 million and $70 million. It's peanuts in the overall scheme. It's 0.5% of the promised new federal dollars in the first ministers health accord. I want to give notice of this motion now. I'm not sure at what point I can actually move it. Would it be 48 hours?

The Vice-Chair (Mr. Stan Dromisky): Yes. We need 48 hours' notice.

Mr. Svend Robinson: Fine. I've given notice of the motion. I'll give it to the clerk.

The Vice-Chair (Mr. Stan Dromisky): Okay.

Are there any questions from the Liberal side? Do you have a short one?

Ms. Carolyn Bennett: Sure. No, it's huge and really long.

Say we could get to a federal-provincial situation where there were national standards and a health council and where people came together collaboratively and the feds showed up with their problems with regard to aboriginals, the military, corrections, and veterans. How would you actually see enforcement? The Canada Health Act has been pretty difficult to enforce, because nobody really wants to take money away from a poor province for flunking. Are we really going to claw back provinces in the future?

Ms. Barb Byers: We have to. For any other law in the country, would you say, well, do we really want to enforce that law?

Ms. Carolyn Bennett: Obviously, we need sticks and carrots. I do think we have to keep the stick, or threaten them and hope we never have to use it. I think what I hear you saying is that if you don't use it too often, people think you'll never use it.

Is there a way we could move to a reward system, where provinces that had new ways of doing things got extra money, for having a dental program, a way of measuring outcomes, or waiting lists, etc.? At a conference once a year--this has always been my big fantasy--we could bring best practices together at the time of the first ministers' meeting, and people could be celebrated if they were doing good stuff.

Ms. Judy Darcy: Well, certainly, if the federal government believed we should have a national public home care program, they could have said to Manitoba, which has had a public, not-for-profit home care program in place for a number of years, that they wanted to give specific support to encourage this. They could encourage models or pilot projects, absolutely. But they also have to penalize the provinces that are breaking the law.

It's outrageous in this country that one province after another after another has set up more private hospitals, more private clinics, more delisting of services, and the federal government has sat on their butts and done nothing. The attitude has been “Hear no evil, see no evil, speak no evil”. They just sit and do nothing. It's like fiddling while Rome burns.

The federal government has its fiscal authority--

The Vice-Chair (Mr. Stan Dromisky): The meeting has come to an end.

Now, before we dismiss our guests, I would like to say to the members of the committee that we meet on Wednesday from 3:30 p.m. to 5 p.m. to deal with Bill C-260. Then from 5 p.m. to 5:30 p.m., we hope we will be successful in determining, without any hassle, what our agenda will be for the next year or two or three. All right? So please be here.

Now, witnesses, thank you very much. Believe it or not, you will have had an impact on these people here. You have go-getters on this committee, and I think all of them are very, very sensitive to the issues you have presented. Thank you very much for coming.

The meeting is adjourned to the call of the chair.