[Recorded by Electronic Apparatus]
Tuesday, April 30, 1996
.9003 
[English]
The Chairman: Order, please.
Good morning, everyone, and a special welcome to a good friend and our colleague, the Minister of Health. We're hoping you'll have the briefest of opening statements to give us lots of time for questions and answers.
Hon. David Dingwall (Minister of Health): Thank you, Mr. Chairman. With me today is the Deputy Minister of Health Canada, Madam Jean.
[Translation]
I am pleased to appear before your committee to discuss my Department's Main Estimates.
Canadians want to know that the Minister of Health will take whatever action is necessary to ensure that Canada's medicare system remains strong and capable of providing for their needs, regardless of where they live or what their income may be. In conversations and in letters, Canadians tell me again and again that medicare enriches their lives. It embodies what is good about Canada, and what they want to see preserved for themselves and their children.
.0905
[English]
Mr. Chairman, in my capacity as Minister of Health it would be my desire to continue to ensure universal access to health care by upholding the Canada Health Act. As I said previously,Mr. Chairman, I don't mind debating the principles of the Canada Health Act, but those principles are just not negotiable. The reason they are not negotiable is that Canadians have said over and over again that they support the principles of the Canada Health Act. The federal government clearly has a responsibility here to articulate, to advocate, and I believe to act on behalf of all Canadians.
Canadians expect my department to be in the forefront of current medical knowledge about emerging infectious diseases. They want to know that my officials and I will work closely with our provincial and territorial counterparts to implement national disease control strategies, which we have done in the past and will do in the future.
It should be noted, Mr. Chairman, that in more than 600 health facilities across Canada, status Indians and registered Inuit rely on the community health services provided by my department. At-risk groups such as children, women and seniors depend on my department's employees, working closely with their provincial and territorial counterparts, to address their specific needs through targeted programs.
[Translation]
Finally, Canadians want to know that my Department is working not only with provinces and territories but with non-government medical and health groups at the regional and community levels to combat diseases such as AIDS, breast cancer, heart disease and tuberculosis.
Given these considerations, one of my priorities as Minister of Health is to preserve and enhance medicare.
[English]
Mr. Chairman, let's not confuse affordability and funding issues. On the revenue side we've committed ourselves in the throne speech and the budget to providing a stable and ongoing cash contribution to health through the Canada health and social transfer.
The March budget delivered on the government's promise to provide provinces with a secure, stable and ongoing cash portion of the Canada health and social transfer to help fund medicare. That is a significant accomplishment in a time of tight fiscal constraint. By guaranteeing that the cash component of the CHST will never fall below $11 billion, we are ensuring that the principles of the Canada Health Act can and will be enforced throughout the country. Stabilizing the CHST cash sends a clear signal that the federal government is absolutely committed to the five principles of the Canada Health Act.
Mr. Chairman, when I say we must make medicare more affordable, I am talking about the expenditure side of the equation. Our health system is straining under the weight of heavy cost, and in many ways it is no longer suited to today's realities. For example, we know that home care is often more effective and more supportive for many patients, yet we lack the infrastructure to move toward this more appropriate and effective form of care. Our challenge, Mr. Chairman, is to find ways to reduce costs to the system while being innovative and progressive in providing care.
I intend to work in partnership with provincial and territorial governments and with the rest of the health community to preserve and enhance medicare and to make it more affordable. If we do the job well, I think it will have profound implications for improving the quality and affordability of health care in Canada.
Mr. Chairman, with your concurrence I'd like to table my speech, which would be read into the record as if I had spoken it, so that we could move to questions right away.
The Chairman: Thank you very much, Minister.
Paul.
Mr. Szabo (Mississauga South): Minister, welcome, and thank you for your comments.
The government continues to assure Canadians that the five principles of the Canada Health Act - universality, portability, comprehensiveness, publicly administered and accessibility - will continue to be defended. I wonder if you could comment on the state of the adherence of the provinces to protecting or participating in protecting those principles.
.0910
As the second area of questioning, would you please comment to the committee on the vision or strategy of Health Canada as it relates to its efforts being split between prevention and cure? The history of our health care system has been a preponderance to the curative or remedial, something like 75%; only 25% has gone to the preventative approaches.
From the funding in areas such as HIV-AIDS and the tobacco strategy - and, hopefully, health warning labels on alcoholic beverages - we have had some indications that prevention will form a major part of Health Canada's visionary strategy and for the long term for Canada's health system.
Mr. Dingwall: Thank you, colleague, for two important substantive questions.
With regard to the Canada Health Act, we do have the five principles, and I have to say, from my individual discussions with provincial ministers of health and reading of statements from first ministers, that there is wide acceptance of the five principles of the Canada Health Act.
Most, if not all, of the polling data is quite clear in terms of the overwhelming majority of Canadians, in every province, every region, and every territory, who subscribe to the five principles of the Canada Health Act.
As I've said to my provincial counterparts, if we're trying to enhance medicare in this country, then we cannot keep our feet stuck in the cement. We have to be creative and open-minded as it relates to the Canada Health Act.
Let me give you an example. It doesn't make much sense to me that we would provide medication for a person who is hospitalized under the CHA but we wouldn't provide any financial assistance for medication if the person is at home and getting the same medication. Something is wrong, and I think what is wrong there is that it has to be modernized. When I say ``modernized'', I don't mean that we lower the standards. I think that we come into the 21st century knowing some of the realities that are out there, trying to deal with those kinds of issues.
Provincial governments have been very supportive, at least in my initial discussions, in terms of modernizing the Canada Health Act in that regard. What does that really mean? It really means that the Government of Canada has to listen and to try to understand some of the things they are attempting to do, all at the same time upholding the principles that we believe to be important. That will take some discussions; it will take some negotiations; it will take some representations on their part and clarifications, if you will, on our part. I'm reasonably confident on that.
In terms of upholding those principles, I think everybody knows the way in which we can do that. We've done it in the past; we are doing it; and, if necessary, we'll do it in the future.
In terms of Health Canada and its role, we have two objectives. One is on the medicare side - for the sake of argument, let's say that's the cure, if you will - and the other side is population health. If we are to move forward in a positive way, population health has to be weighted equally with medicare.
The health determinants impact substantially on the whole issue of medicare in this country, and we, as a department, are working very closely with provincial and territorial governments and national, regional, and provincial organizations in terms of some of the things we might be able to do. I think that's the way in which we can go.
.0915
Not only must there be some moneys allotted in that regard, which there is, but there also has to be a well-thought-out program, a clear objective in mind and an action plan in order to pursue that. It means managing resources somewhat differently.
Coming back to the first point in terms of the CHA, my counterparts provincially, the minister in New Brunswick, the minister in Nova Scotia, the minister in Saskatchewan, and more recently the minister in Ontario, have agreed that the modernization of the Canada Health Act is important, important so that we know what the realities are today and can make the necessary changes in order to accomplish our particular objective.
The Chairman: Antoine.
[Translation]
Mr. Dubé (Lévis): I am sorry, Minister, to have missed the beginning of your statement. However, I made up for it by reading your notes in French.
[English]
Mr. Dingwall: It was a great speech: standing ovations.
[Translation]
Mr. Dubé: I do not dare to be this enthusiastic. I am sorry to disappoint you.
On page 2 of your notes, you say:
By guaranteeing that the cash component of CHST will never fall below $11 billion, we are ensuring that the principles of the Canada Health Act can and will be enforced throughout the country.
Having seated on the Standing Committee on Human Resources Development, I understand very well the principle of the Canada Health and Social Transfer; that is, funds which should have gone to health care, social services and post-secondary education have been cut.
Looking at last year's budget, I see that health care stood at $8,553,690,000, and you talk about $11 billion. However, it says in the budget that health care will be reduced by 5.2%. I am trying to understand.
[English]
Mr. Dingwall: I want to thank the member for his question.
In terms of the CHST, the Canada health and social transfer, which was announced in last year's budget - the details were provided in this particular budget - the Government of Canada has reacted in terms of its fiscal difficulties, but equally importantly, in terms of the demands that had been made upon the national government as it relates to the consistency of funding coming from the national government for the purposes of social programs, health care is one, and one of the major ones.
In that regard, when I met with ministers of health shortly after my appointment, they indicated to me that they needed two things. They needed, one, a cash floor in terms of the social programs, and two, some consistency. The Government of Canada was to go well beyond that. Not only did we give them consistency - $25.1 billion for the three programs - but we also provided in that a cash floor of $11 billion.
In my discussions I think three years was the requested timeframe. We gave them five years. We made it consistent for five years. We gave them an escalating clause for the last three years. So in actual fact, the cash component and the tax transfers will be something in excess of $25.1 billion for the last three years of the five-year cycle.
A portion of that money will be administered, if you will, by the provinces in terms of what they see fit in their respective jurisdictions. We believe, and they believe.... At least, they haven't voiced to me - I had a ministerial conference just last week - that the amount of moneys under the CHST is inadequate in terms of meeting their needs, particularly health, social services and post-secondary education.
.0920
[Translation]
Mr. Dubé: We have seen that some provinces, such as B.C., have had trouble with these five principles as stated by the government. Where are we standing now in terms of the non-enforcement of these principles by some provinces?
Has everything been cleared up or will the federal government withhold from some provinces funds that should normally have been given to them?
[English]
Mr. Dingwall: Again, an important substantive question.
We are withholding funds from the Province of Alberta for what we believe to be a serious breach of the Canada Health Act. But this is an ongoing type of examination. These decisions are not reached unilaterally, as some people would like you to believe. That's a bunch of bunk. The fact is that the Government of Canada works fairly closely with the provincial governments where allegations of breach of the Canada Health Act come into play. You don't just get an allegation on a Friday and then on Monday you come with a particular figure to announce that allegation. You have numerous discussions. There's an exchange of written information with the province. It's their approximation of the amount of dollars by which they may be in breach of the Canada Health Act.
There are some provinces that are not living up to crossing all the t's and dotting all the i's. I don't think it's serious at this point. But where those issues arise we have discussions, we give them notice of our intent, and then we try to resolve those issues without going to the media. Normally we're pretty successful, because Canadians by and large support the principles and support the enforcement of those principles.
But I guess the real issue in the province of Alberta was in terms of its breaching the Canada Health Act.
The Chairman: Grant.
Mr. Hill (Macleod): Thanks for being here, Mr. Minister.
You mentioned that Alberta is being penalized under the provisions for semi-private clinics. You omitted to mention that Nova Scotia is also being penalized - Newfoundland, Manitoba.
In the last round I had with the previous minister, I asked why Ontario and Quebec were being omitted from these penalties. I've brought semi-private clinics in both those provinces to the attention of the public and no penalties are being levied. To be specific, the Morgentaler clinic, which is close to the House of Commons here, charges facility fees to those out-of-province women who visit it. The Magee neuro-muscular trauma clinic charges facility fees. The International Prostate Centre charges facility fees. The IVF clinic for test-tube babies in Ontario charges facility fees.
It's a great difficulty for me to understand why there is a somewhat selective vision. Those facility fees in Ontario may be somewhat hidden, but could you explain to me why those clinics are not being shut down?
Mr. Dingwall: First of all, Mr. Hill, it is not a selective vision. The fact of the matter is that as my deputy here indicates, many of these issues, some of which I have just heard for the first time - and I thank you for bringing them to my attention - are under discussion with the respective provinces. You are correct that Manitoba is in serious breach of the Canada Health Act, by $6,000. Newfoundland is even more serious: it's $8,000. For Nova Scotia I don't have the figure in front of me, but there are other provinces that are in breach and we are withholding those moneys as well.
.0925
I don't want you to be confused about the process that takes place leading to the conclusion in terms of earmarking the amount of money, whether it's $6,000 or $600,000. It's quite a long process. As I said, you don't just get an allegation on a Friday and then do an assessment on a Monday. You have an exchange of information. You have meetings amongst different officials. You have clarification of different positions -
Mr. Hill: That wasn't really my concern about the process. My question was really that there seems to be -
Mr. Dingwall: Mr. Chairman, if I may, the hon. member in the preamble to his question makes a false assertion. He makes that false assertion because he doesn't understand the process. I think it's important for members to understand that we have an important process here related to enforcing the principles of the Canada Health Act.
Mr. Hill: As I said, and I've tried to be very specific, the issue is that we've had two years of these fines, there has been ongoing consultation, and in my view there are many clinics being missed in other parts of the country. That is the point to which I believe we have not had an answer.
Mr. Dingwall: We'll look at that.
Mr. Hill: That was the answer I got last year, that it is being looked at. I believe that is really not an acceptable answer.
You mentioned that the cash floor of $11 billion will be reached in the year 1999. There is a significant reduction in funding to the provinces in the meantime. I remember very clearly during the election campaign a strong, strong commitment to health care. The cash drop is $4.3 billion over two years. I don't really see that as something to be delighted about. Could you comment, please?
Mr. Dingwall: First of all, Mr. Hill, one could be very argumentative and aggressive in this particular committee and shoot back some pretty devastating figures in terms of where your party stands on the whole issue of health care and social programs. But let's be candid, since we're amongst our colleagues.
The Government of Canada, upon assuming office in October of 1993, had a fiscal situation that was, to say the least, very, very serious. All departments of the Government of Canada, including Health Canada, from Public Works to Human Resources Development to Industry Canada, etc., embarked upon what we called a vertical assessment of program review in terms of where we could make various cuts to meet our budgetary targets.
Minister Martin, to his credit, gave notice to provincial governments across this country about transfer payments and the way they would be funded both for the short term and the long term. There was no surprise whatsoever - none whatsoever. First ministers indicated to the Prime Minister that if there were going to be cutbacks, if transfer payments were going to be cut, surely they as provincial governments must have due notice; they must have some consistency in terms of what that financial framework would be. Minister Martin gave due notice in previous budgets. We embarked upon a very healthy, if you will, consultation process with the provinces.
In this particular budget we were able to fix that side of the ledger, in my view, by providing the necessary revenues from the Government of Canada in excess of, over a five-year period, $25.1 billion annually. That's composed of a cash floor and a transfer. To date, in meeting with the ministers of health both privately and publicly, I don't recall any of them objecting to that amount of money. They understand the environment of our fiscal situation and they know that what we have given as a national government has been fairly generous in view of the economic circumstances.
I think we have quite categorically lived up to our commitments to providing the necessary funding for social programs, and in particular health care, in this country.
Mr. Hill: I'll have one more if I may, Mr. Chairman.
The Chairman: We'll get one more the second time around.
John.
.0930
Mr. Murphy (Annapolis Valley - Hants): Welcome, Minister, and welcome, Deputy Minister.
As you know, Paul Szabo, my colleague here, has a private member's bill before one of our subcommittees right now concerning the labelling of alcoholic beverages. We're beginning to hear from a number of witnesses. Particularly, coming up is the brewing industry.
I was wondering what your position on this bill is. Do you think labelling is an effective way to reduce the number of people who are drinking in an irresponsible way? I'd like to hear your comments.
Mr. Dingwall: Firstly, in terms of the abuse of alcohol in this country, I am very concerned about it, for personal and other reasons. A large part of my family, my father and indeed two uncles, had abuse of alcohol shorten their lives considerably.
I've said to Paul privately, and I think I've said publicly, that I can support the principle of the bill. But as the Minister of Health I also have to ask the second question: is this the most effective way? So far, I think the evidence doesn't come out very positively in terms of this being the most effective way of curbing abuse in the consumption of alcohol. The principle is one that we have to applaud, but, in view of the information we have, I don't think it's the most effective way.
It's costly. It would be very costly to Health Canada, I think in excess of $10 million. I don't know what it would cost the industry.
I think there is a way by which we can take the principle and find other means to get that message through, whether it's demands upon the industry themselves in terms of changing some of their marketing practices and/or the way in which they inform the consumer about the possible effects.
I must say, though, that I have been very impressed by the Canadian Brewers Association over the years. It didn't start in my tenure, but well in advance of that. I think the responsible drinking portfolio that they have put forward has been fairly effective throughout the country, and I would like to see some more work done on how we could realize the principle that my colleague has so correctly raised for us.
Mr. Volpe (Eglinton - Lawrence): Mr. Minister, welcome.
You used the word ``modernize'' three times during your presentation and in your answers this morning. I think that reflects your counterpart in Ontario, Health Minister Jim Wilson, who also is quoted in the press as saying that he thinks the Canada health system must be modernized.
In reading the outlook document from the department, I think that's reiterated, repeated on several occasions, and I'd like to give one quote as a preamble to my question. It says that health issues ``are increasing in complexity and sometimes in frequency of occurrence due to Canada's shifting demographics, and the impacts of globalization and new technologies''.
In your presentation and in your answers to some questions, Mr. Minister, you made specific reference, as well as allusions, to a creative tension between a commitment to preserving the principles of the Canada Health Act and the desire and the need to engage in this modernization. I wonder if it is possible to walk that fine line and to make that creative tension productive while you're upholding the principles and not negotiating them, which I think is something else you have said, even in the House.
First, is it possible to preserve, allow the debate, but not negotiate? If so, give this committee an indication of how that can be done.
.0935
Mr. Dingwall: A lot of Canadians are spooked when you say you want to modernize the Canada Health Act. They think you want to do away with doctors, want to do away with hospitals in this country, and want to erode the system of medicare in this country. Well, that's certainly not my intention, and I have to take at face value the words and the commitments of my provincial colleagues, whether they be in Alberta, Ontario or New Brunswick.
It just seems to me that as we move from institutionalized care, en masse, to community clinics, to home care - which I have some concerns about and would be prepared to share with the committee - we have to modernize the act. I'm sure there are many deficiencies in the system that could be overhauled, if you will, or changed without interfering with the principles whatsoever, providing more meaningful health care delivery in this country.
One of the examples I gave earlier was medication. The other example is the whole way in which doctors are paid in this country. All provincial governments are looking at that very fact.
I don't think we should put our heads in the sand and say, oh, well, someone might give an interpretation that it might breach this or it might breach that. I think we should be open-minded. I think we should be creative. I think we should sit down with our provincial governments to find out what are the best ways in which to deliver the product from both a medicare and population health side.
Quite frankly, when we talked about the blood system last week we talked about several other issues. The provinces are, in very many instances, very much on side in terms of proceeding in that way.
I also want to say for public record that all too often those of us in the ivory towers like to take shots at the provincial governments, but many of them have gone to great lengths to try to modernize their health care systems in their respective provinces. Yes, there have been closures of different facilities. Yes, there have been mergers of different institutions. But I don't think it would be fair for us to say the quality of care has decreased. I think this has all been done with an intent to enhance the quality of care in the respective provinces. I have no qualms about entering that kind of debate and that kind of discussion with the provinces.
On the other side of the ledger, if there are some out there who want to use this as a vehicle to knock the federal government out of the debate, to lessen the standards, I don't think I would be on side for that kind of debate. But if it's to modernize, improve and enhance, I think there is a lot of goodwill there, and we could move on some of those issues.
The Chairman: Folks, we have about 20 minutes left. The minister has another commitment at 10 a.m. I'd like to have, in this order, Andy, Antoine and Grant.
Mr. Scott (Fredericton - York - Sunbury): Thank you very much, Mr. Chair.
On the question of modernization - you mentioned, for instance, the delivery system - I welcome the announcement in the budget of the delivery services research fund. I think it's long overdue. It also positions the federal government in terms of its role as we engage the country in that debate. I know the provinces are struggling. The question specifically is one of elaboration on where the federal government fits in that.
Second, as we move toward a preventative approach - and I think the two are complementary - what is the federal government's role, not necessarily on the substantial matters - on, say, tobacco, secession or whatever national strategies may be in place - but in terms of coordinating the various provincial efforts in terms of dealing with this, a large national issue whether it's delivered provincially or not?
.0940
Finally, just as a matter of clarification, has there ever been a commitment in the past to a floor on the cash component of the transfers from the federal government? I think we all understand that from the beginning, essentially as the tax point revenues have increased the cash component has decreased. Ultimately, as the tax portion got to the point where it reached the ceiling.... Presumably until such time as a government makes a commitment that there would be a cashflow, that cash component would disappear. Has there ever been such a commitment before?
Mr. Dingwall: Thank you, colleague.
About the cash floor, to my knowledge from the study of federal-provincial relations, particularly under EPF and the block funding, which was the proposal presented many years ago, the answer is no, there has never been a commitment to a cash floor. In point of fact, under the existing system, before the budget you would have had the tax points increasing substantially and the cash component decreasing substantially. What we've done is we've been able to provide the cash floor with the tax transfer and the growth, of course, will come in the tax transfer.
So the answer to that question is no, that's never been a part of it.
About provinces and health population and health promotion, we want to move in a fairly strategic and comprehensive way on that side of the ledger. We don't want to overlap, don't want to duplicate. We want to make sure we have the best delivery of the particular program. Many times that's not government. It can be a third party. It can be municipal. It can be an agency. It can be a national agency, a non-profit organization, an NGO, which is then in a position, with federal and provincial funding, to attract other types of funding in order to address the particular issue they feel very strongly about.
In the past we have worked very closely with NGOs. As we now speak, we're working very closely with our provincial counterparts on a variety of different programs. I've given instructions to my officials that I don't want overlap and duplication, and they have got that message. I've been there only three months, so we'll have to wait to see how that plays out.
The Chairman: Antoine.
[Translation]
Mr. Dubé: I will ask you a question, but I do not expect an answer this morning because it might be a bit long.
Given the fact that the CHST has been implemented since April 1, I would be very interested, on behalf of the Official Opposition, to get more details about the enforcement of these five principles. There must surely be some ground rules.
I will leave this subject because we could talk about it for hours. In the newspaper this morning I read something which I feel very strongly about. In the United States, President Clinton is talking a lot about a fierce fight against the effects of drug consumption. In the U.S., health costs related to drugs have been estimated at $47 billion.
I know that last year there was a bill, which is pending actually, dealing with all the various issues related to drugs. This bill will come back to us when the Senate has finished its review. So we will talk about it in due course.
You did not mention it in your notes, unless I read too fast. Do you have any program or strategy that could be harmonized with the American one and that could, at least on the prevention and information side, inform young people about consequences of drug consumption on them and their health? This would imply additional costs for all Canadians.
.0945
[English]
Mr. Dingwall: With regard to the CHST and some of the details, we'll be happy to provide that information to you and to your researcher.
Secondly, on the issue of drugs, I think there are two components of drugs, particularly as you talk about utilization. One is illicit drugs and the other is the consumption of medication in this country.
With regard to illicit drugs, we do a variety of different programs with different groups in different provinces on substance abuse, on how we can curtail some of those activities, trying to change behavioural patterns if you will, working closely with provincial governments and, as I said, non-profit organizations in trying to move on that issue.
It is also a major role for the RCMP and the Solicitor General, with issues in terms of enforcement in trying to ascertain exactly where the flow of drugs is coming from and thereby stopping it.
Another part of the issue, which is of grave concern to me, is that of drugs in Canada, not only in terms of pricing but also from a utilization perspective. I don't wish to belabour this, but it is important to say that drug costs are one of the biggest drivers of cost in the medicare system in this country. That's not a statement made by the Minister of Health; that's a statement that is made by provincial ministers of health, who have asked for my support and my help in trying to lessen that cost in the system.
One way is through price - and you've got generic versus brand-name - but also there is the utilization of drugs. I don't prescribe drugs. You don't prescribe drugs. Drugs are prescribed by physicians in this country, and we have to work with the Canadian Medical Association and the respective provinces in trying to address some of those very substantial issues.
I'm told that in some jurisdictions the increase in utilization of prescription drugs is up by about 15%. You can imagine what the costs of that are and, if that utilization is taking place, what impact that has on various special-interest groups, whether they be seniors or youth or aboriginals. So we are very concerned.
We discussed that last week with ministers of health, and we're going to be exchanging information on price, on utilization, on marketing practices, and on the rounding up of drugs that are found to be no longer needed by the consumer.
So we're going to be embarking on those four types of items, and hopefully we'll be able to come up with some suggestions on what we can do to ease the cost and to ease the utilization.
[Translation]
Mr. Dubé: Do we have an assessment of related health costs? I am interested specifically in illicit drugs. Has their been a Canadian assessment of health costs such as the one that was released this morning for the U.S.?
[English]
Mr. Dingwall: I don't have the figure before me, but we'll certainly get it for you.
The costs vary. It's an approximation. I wouldn't put the mortgage on it, but it's quite substantial in terms of what it means to our health care system.
When you're talking with the RCMP, they shed some very detailed information on the cost to society, generally speaking, of the consumption of illicit drugs and what it does to our society in a variety of sectors.
We'll try to provide that information to you.
Mr. Hill: The minister mentioned that he would like to compare party positions on medicare, as though I would come out very poorly in that comparison, so let me just make a statement for this committee for the record.
The Reform Party, by looking at wasteful spending in other areas, is able under our Canada health and social transfer to reduce health care by $1.5 billion over three years. I note very carefully - and I want this recorded publicly - that the Liberal government has reduced it under Canada health and social transfer spending by $4.3 billion over two years. So that comparison might well be one for the minister to be careful about when he mentions that it might not look good for Reform.
.0950
On the blood issue, there has been a huge controversy over the Krever commission. Many commentators in Canada feel the Krever commission has been muzzled by legal actions. I have heard over and over again - and it usually doesn't come from the minister himself but from his colleague the Minister of Justice - that this just a relatively narrow legal interpretation and the Krever commission will make a report soon. I vigorously disagree with that. I believe what is happening is going to shut the Krever commission down.
I also hear, and hear regularly, that Canada has as good a blood supply as any country in the world. By objective measures, I don't agree with that. I would like to look specifically at Belgium and what happened in Belgium during the same period as the Krever commission.
In Belgium there was immediate screening of high-risk donors. When testing became available in the international marketplace, it was immediately adopted. Canada did neither of those things.
In Belgium their old blood supplies, which were not heat treated, were destroyed immediately. They were not left on the marketplace. Canada did not do that.
In Belgium there was an immediate switch to cryo-precipitate from fractionated blood products. Canada did not do that.
The end result was in Belgium 6.5% of their hemophiliacs were affected with HIV. Canada ended up with 44% of our hemophiliacs infected.
If we don't get away from this con job that our blood supply is the best in the world, we will never fix it.
I want two things from the minister. I want a specific from him on whether or not he will do everything humanly in his power, as the Minister of Health, to be sure the Krever commission makes its report - a full, complete, and independent report - and I want him to do whatever he can to make sure this blood supply is as good as we can get it.
Mr. Dingwall: Mr. Chairman, just so I can get to the substantive part of his second question, and so the committee will know, since he raised the figures in terms of his party, I think it should be said the leader of the third party said in September 1993 the Reform Party supported user fees and deductibles and would eliminate universality. He also said, in October 1993, the Reform Party is opposed to private health care and user fees.
The member for Macleod, however, said in the House on October 17, 1995, that medicare is bad for everyone. Then on November 23 he came back to say medicare is important to all Canadians.
The member for Macleod I think wants Canadians to look at his party as the defender of social programs. But on March 5 of this year, Mr. Chairman, his leader, the leader of the third party, of the Reform Party, was asked point-blank whether he supported his health critic or not. The response of the leader of the Reform Party, his leader, was no. He said Reform would cut the deficit by cutting transfers. This was March 5, 1996.
Now, on the blood issue I want to make it clear, because this is an important issue, and I think even Dr. Hill, because he's raised the subject, believes it to be an important issue, that the Minister of Justice has a fiduciary obligation as the Minister of Justice to make certain individuals who could in fact be cited in the commission do have the opportunity to present themselves for the purposes of giving evidence and giving testimony on their side of the issue. That is a fundamental tenet of Canadian law. It is something the Minister of Justice must adhere to. He cannot shirk that responsibility.
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What would happen if he didn't do that? I suspect that if the report of the Krever commission came forward and that was known, we would be tied up in legal niceties for many months thereafter. I don't think that's what you want, I don't think that's what the Canadian people want, and that's certainly not what I want.
In terms of the Krever commission, I don't want to personalize this because it's not right to personalize it, but it was my party in opposition that trounced Benoit Bouchard, as the Minister of Health...to call for an inquiry. I as the opposition House leader of my party was the one who made the demand on behalf of my party to call for the Krever inquiry. I don't think there's anybody in the House of Commons who is more anxious and more concerned than I am to have the final report of Justice Krever on the Canadian blood system. I want it sooner as opposed to later, and I'm hoping it's going to come sooner as opposed to later.
In terms of the safety of our system - and I don't want to play on words here - I believe and the provincial governments believe that we do have a safe blood system here in Canada. But I think there's an obligation on all of us, I as the national Minister of Health and the provincial ministers of health, to make sure it is the safest in the world. That's why we came together last week, put our partisanship aside and went into the issue. We've directed our officials to come back with ways in which we can address some of the issues of governance so that the kinds of things that have happened in the past will never happen again.
But I am very much - and I hope this responds to your question - committed to getting the Krever report. I'm very much committed to trying to make our system the safest in the world, and I'm working to that end. I want to work with my provincial counterparts and we're going to put that agenda ahead very forcefully.
The Chairman: Thank you very much. Our time is up. On behalf of the committee, I want to thank the minister
[Translation]
and also our friend, Mrs. Jean. Thank you for your help, Madam.
[English]
We're going to recess for about two minutes to make the transition to in camera.
[Proceedings continue in camera]