1984-01-20

STATEMENTS PURSUANT TO S.O. 21


Mr. Gordon Taylor (Bow River):: Mr. Speaker, this Liberal Government of Canada is the most adept in the world at setting up smokescreens to hide the real facts from the people. Let us take, for example, the Department of National Revenue. Members of the Progressive Conservative Party have set out case after case which should be corrected, quota after quota which should be eliminated, and principle after principle which should be changed. What does the Government do? Does it examine each, and deal with it? Oh, no, that would be too simple. It hires Woods Gordon to conduct a study of the administration. Instead of spending the relatively few dollars to be fair to taxpayers, the Minister soaks taxpayers again with another bill of a few thousand dollars to pay Woods Gordon.
Why does the Government not pay back the thousand dollars it lost, misplaced, or stole from the new Canadian at Cochrane? Why does it not fire the public servants responsible for three reassessments of the same file, each with a different result? Why is the Minister not replaced, when he told the House that there were no quotas and it has been proven that there were and are?
The Government protects the Minister when it should be protecting taxpayers who have been harassed and abused. The Minister and the Prime Minister (Mr. Trudeau) have been advised of the National Revenue official who screamed and yelled at a sick lady who had asked for an audit and, in tears, offered post-dated cheques. However, the Department froze her bank account, driving the company into bankruptcy. Will this official receive an increase in pay? He should be fired on the spot.
What the country needs is an election and a Progressive Conservative Government under the Leader of the Progressive Conservative Party (Mr. Mulroney), who will evaporate the smokescreens and clean up the mess the Liberals are hiding behind in their camouflage.



Mr. Dave Nickerson (Western Arctic):: Mr. Speaker, Revenue Canada has struck a new low in its dealings with taxpayers across the country. The Department is using delays in the mail over the Christmas period to levy penalties against taxpayers, when the real culprit is Canada Post.
A-l Bookkeeping of Yellowknife reports that although employer payroll remittances had been mailed into Winnipeg on behalf of clients on or before December 15, 1983, as is its usual custom, at least three client firms have been assessed late payment penalties of some 10 per cent of the amount due, presumably because Canada Post either failed to deliver the mail on time or postmark it on the day of receipt. This is grossly unfair, both to the clients who get stuck with the bill and to the bookkeeping firm which feels that its reputation has been unnecessarily damaged through no fault of its own.
Why cannot Revenue Canada use a little common sense in its dealings with the public? Why does it use every little technicality in the law to squeeze and penalize honest taxpayers? Why is the Minister so complacent about the seedy, money-grubbing tactics of his Department, or is it that he was responsible for their use in the first place?


EXTERNAL AFFAIRS
Mr. Stanley Hudecki (Parliamentary Secretary to Minister of National Defence):: Mr. Speaker, Mr. David Patterson, the Ontario Director of the United Steelworkers of America, representing 75,000 Ontario members of the steelworkers union, was denied admission to the United States on January 16 on the basis of having been arrested in Canada on two occasions for assault. The first assault conviction occurred some years ago, in 1970, after a saloon altercation, and the second arose from participation in a picket line incident in 1981.
The United States refuses admission to anyone convicted of serious crimes such as murder, rape, robbery, or certain degrees of assault. Mr. Patterson was prevented by an individual United States immigration officer's interpretation on that day of the term "assault" from going to Pittsburgh for a meeting at the international headquarters of the Steelworkers of America, even though Mr. Patterson had been allowed

January 20, 1984
into the United States many times before by other immigration officers who had a more flexible interpretation of the term "assault".
The union leader has an opportunity for review by a United States immigration judge in Buffalo. Following this, there is no other avenue of appeal to the ruling. I strongly urge the Department of External Affairs to make representations to the United States to review Mr. Patterson's case on a priority basis so that he may be allowed to attend future meetings of his union in Pittsburgh. It would also improve similar situations if the United States could instruct its immigration officers to interpret the immigration rules on a more consistent basis.


Mr. Speaker:: I regret to interrupt the Hon. Member, but his allotted time has expired.


UNEMPLOYMENT INSURANCE
Mr. Ted Miller (Nanaimo-Alberni):: Mr. Speaker, on January 9 the Unemployment Insurance Commission Board of Referees declared that regulations setting special rules of eligibility for fishermen are unconstitutional. Whereas other workers are required to work 10 weeks to be eligible to apply for benefits, fishermen often have to work up to 15 weeks before qualifying. In the case before the Board of Referees, the applicant had worked 9 weeks at a shore job and 5 weeks fishing, for a total of 14 weeks, but was still ineligible.
This is not the first time such problems have arisen over the discriminatory nature of UI regulations for fishermen. Last year the Supreme Court told the Government that it had no right to impose such discriminatory legislation. This was not good enough for the Government, however, and it brought down legislation which reaffirmed its authority to discriminate against fishermen. Now the whole process has been thrown into question again, but the Government still will not accept that it is doing anything wrong. It is appealing the decision of the Board of Referees.
The NDP and many fishermen's groups have been warning the Government for years that such discriminatory practices will not be tolerated in this country, and that it is necessary to take a whole new approach to this issue. How many more court challenges, legal decisions, and fishermen's lobbies will be required before the Government accepts fishermen in the same way as everybody else? When will the Unemployment Insurance Act be amended to bring fairness to Canada's fishermen?


NATIONAL REVENUE
Mr. Arnold Malone (Crowfoot):: Mr. Speaker, the Minister of National Revenue (Mr. Bussieres) has made a decision to review the methods by which he fills the King's purse. I want to plead in the strongest way I can that he recommend criteria that will be fair and predictable both for the citizens and the Government in the use of third party demands on a citizen's account.
It is wrong to use a third party demand when guilt is only \ presumed but not established. I recognize the Government may have more difficulty in collecting tax if it has to follow the full legal process of establishing proof of tax debt. Nevertheless, the fundamental presumption of law that the vast majority of Canadians take as their first right is that they are innocent until proven guilty. Those who believe they are innocent, and have the intention of establishing that through the processes that are available to them, are in effect condemned as guilty when the message ripples through a small community that Revenue Canada has frozen their accounts. Their credit rating crumbles, the capacity to pay their bills has been smothered, and their self-esteem has been destroyed.
We live in a society where the rights of the individual are expected to be paramount. A democratic government is one where the government is the servant of the people and, therefore, we must always start from the fundamental presumption that no punitive measures can be taken until guilt has been established. Revenue Canada can also cause the effects of guilt without trial by simply calling for reassessment after reassessment after reassessment of a citizen's tax. Even though the citizen may be innocent of a tax debt-


Mr. Speaker:: Order. I regret to interrupt the Hon. Member, but his time has expired.



Hon. Roch La Salle (Joliette):: Thank you Mr. Speaker. I have been somewhat hesitant to raise this question which affects us all, and I am referring to the attitude of employees of the Department of National Revenue. For three weeks the Minister has been claiming there is no quota system. Then he admitted that certain claims concerning specific sector were true.
Today, this morning, a Montreal daily newspaper announced that a former employee of Revenue Canada claims that Quebecers are also affected by the quota system on tax recovery. Considering the fact that this former employee stated that he had agreed to show the newspaper his references
January 20, 1984

and is even prepared to sign an affidavit attesting that his statements are true, I am prepared to ask the Minister responsible today to make a commitment to have the appropriate House Committee make a complete study in order to shed some light on the statements of this former employee and on other comments made by my colleagues, considering the fact that the Minister still refuses to admit that a system was established.
Mr. Speaker, either the Minister is unaware of what is going on in his Department, which bespeaks incredible incompetence and irresponsibility on his part, or he has not told this House the whole truth, which is unacceptable.


Mr. Speaker:: I am sorry to interrupt the Hon. Member but his time has expired.


CANADIAN BROADCASTING CORPORATION
Mr. Jim Fulton (Skeena):: Mr. Speaker, in view of the fact that CBC lost its bid to carry the Super Bowl on Sunday to Global Television, and in view of the fact that large areas of Canada will now be without coverage of the game, I call on all Hon. Members of this House to rally together and terminate the Minister of Communications (Mr. Fox) and his consort, Pierre Juneau.
In my constituency, which is roughly the size of France, the CBC and the CRTC denied my appeal to allow the CBC affiliate to carry the game. However, in New Brunswick, CHSJ Television, a CBC affiliate, has been given the right to carry the Super Bowl. The reasons are that cable penetration in New Brunswick is only 20 per cent, and is 60 per cent in northwestern British Columbia, the national average. Newfoundland has the same cable penetration as New Brunswick, but it does not get the game on CBC.
On behalf of the several million Canadians who intended to watch Super Bowl at home, and now in many cases will be forced to fly, drive, or bus hundreds of miles to where they can watch cable, let it be known that Doug Small, Global, and Labatt's offered the Super Bowl broadcast for my constituency to CBC for free, and that was not good enough.
 * *


AGRICULTURE
Mr. Gus Mitges (Grey-Simcoe):: Mr. Speaker, the integrity of the federal meat inspection system in Canada has never been higher, and we can proudly boast that it is one of the best in the world.
Oral Questions
Like many other organizations, necessary adjustments have to be made from time to time for the betterment and the improvement of any system. Our federal meat inspection system is no exception to this.
The Department has been reorganized to make better use of the inspectors' time without any reduction whatsoever in their duties, namely, to make sure our meats are wholesome and free from any diseases. Therefore, I find that adverse statements made by individuals in authority, who obviously have very little or no knowledge of the inspection system, and who should know better, have been reported, saying that our inspection services would suffer because of the changes made. I believe that such individuals should be publicly censored because of the false impressions and uneasiness left with the general public by their remarks, as well as for downgrading our excellent inspection service which, as I mentioned earlier, is one of the best in the world.



ORAL QUESTION PERIOD


Hon. Perrin Beatty (Wellington-Dufferin-Simcoe):: Mr. Speaker, the Minister of National Revenue will know that last night CBC television carried a report in which a taxpayer said that he feared his conversation with an official from the Department of National Revenue had been taped. Can the Minister give the House the assurance that any such taping would be contrary to departmental policy, and that taxpayers can talk to officials of the Department without fear of having their conversations taped?


Hon. Pierre Bussieres (Minister of National Revenue):: Mr. Speaker, I want to give that assurance to the member, the House, and all taxpayers of the country. First, it is contrary to the law and, indeed, we in the Department want to follow all of the laws of the land. 1 want to assure the member that we have never used such practices.


THIRD PARTY DEMAND FORMS-USE OF SOCIAL INSURANCE NUMBERS
Henry Perrin Beatty: Mr. Speaker, I wish to ask the Minister about another aspect of taxpayers' privacy. It is something about which I wrote to him some weeks ago, but have yet to have a response from the Minister.
I wrote to the Minister with regard to third party demand forms which, as he knows, contain an individual's social insurance number and the amount of money he is alleged to owe to the Government. These demands are sent out even before an

January 20, 1984
Oral Questions
individual has had a chance to prove or disprove his innocence. These are sent out to numerous people who could owe him money.
In order to safeguard the privacy of ordinary taxpayers, will the Minister order that third party demand forms be changed, in particular to remove the individual's social insurance number from those forms and also, if possible, to remove the amount of money that he is alleged to owe the Government?


Pierre Bussières: Mr. Speaker, there are two aspects to the Hon. Member's question. First, there is the use of third party demands. I might remind the Hon. Member and his colleague who commented earlier, and other Hon. Members, that third party demands are not made arbitrarily, and that the Act is quite precise where it says that when a Notice of Assessment has been issued, the Minister is responsible for collecting taxes. The Act goes even further and provides explicitly that even if the taxpayer sent the Department a notice of objection, he is responsible for paying the amount he was assessed. That is clear, and it is in the Act. It is therefore the Minister's duty and responsibility to observe the Act.
The second aspect of the Hon. Member's question concerns the use of social insurance numbers. I am sure the Hon. Member will understand that the number is used on the form to simplify contacts with the databank where the taxpayer's account is kept, so that if, for instance, instalments were paid between the time the third party demand was made and the time it was carried out, the information on the balance of the taxpayer's debit account is as accurate as possible and the demand does not exceed the amount owed.
Although removing the social insurance number could increase the time factor and affect the accuracy of the amount due, I am prepared to consider this point for the sake of the principle of protecting individual privacy.


REQUEST FOR STATISTICS ON USE OF THIRD PARTY DEMANDS
Henry Perrin Beatty: Mr. Speaker, as the Minister knows, gratuitously releasing an individual's social insurance number to third parties is a clear invasion of his privacy. There is no reason in the world why the Department could not use another file number when dealing with outside individuals.
I have a third question with regard to third party demands. Yesterday in answer to a question from the Hon. Member for Crowfoot, the Minister conceded that the number of third party demands issued has been increasing very dramatically. I called his Department and asked for figures on third party demands, and was told that his Department in Ottawa does not have those figures. Why does it not have them, Mr. Speaker? Will the Minister undertake to collect those figures and release them to the House of Commons?
[ Translation]


Pierre Bussières: Mr. Speaker, I had a chance to examine the prepared written reply, and I am aware of the verbal reply referred to by the Hon.
Member, which he received from my officials.

One point is, Mr. Speaker, that the figures may include a third party demand for one of the Department's accounts receivable to a number of third parties who owe money to the taxpayer, so that the unrefined figures may not be accurate. The absolute figures do not necessarily give an accurate picture of the exact number of individuals involved. I shall enquire about the procedures and the time involved, in order to clarify the situation, and I shall be happy to pass the information on to the Hon. Member.


Mr. Speaker:: The Hon. Member for Joliette.


Roch La Salle: Mr. Speaker, my question is directed to the Minister of National Revenue, who for weeks has insisted on rejecting the concept of setting quotas on tax recovery. Mr. Speaker, I recognize the need to collect taxes in Canada, and that is where the Government has erred. I believe the Minister has no right to take stringent measures in order to correct his past mistakes.
My question is as follows: In the circumstances, the Minister has already admitted that a quota system existed in Ontario. A senior official of the Department of National Revenue has admitted and stated today that the system also exists in Quebec.
In the circumstances and in the interests of Canadians, we have asked the Minister to shed some light on the attitudes of his officials. I would therefore ask the Minister, in the interests of proper administration of his Department and the Government's credibility, to give the House the assurance today that he will order the appropriate Committee of the House to consider this matter, to enable these officials, if they have erred as he may claim, to tell us the facts, and thus all Canadians would know whether the Minister has been acting in good faith in this matter. I believe Canadians need to know, and they will through this Committee, and before April 30, please!


Pierre Bussières: Mr. Speaker, I am pleased that the Hon. Member should ask this question, because I must admit I was rather surprised at the statement made by a former official of the Department of National Revenue.
However, I may remind the Hon. Member that first of all, the person in question was very careful to remain anonymous. I would therefore invite that person, as I already invited another individual who said that quotas had been set for an
January 20, 1984

auditor to collect a certain amount of taxes, to discuss the matter openly with departmental officials.
Second, I think we should understand what it means to set quotas for a person, and it is to tell someone that when he does his assessment, he must find 'x' amount of money.
I think the Hon. Member will agree that this is not a practical idea. The Hon. Member will also understand that the Department cannot afford to waste the auditors time, that some kind of evaluation of the taxpayer is involved, or else the Department is aware of some non-compliance with the Act, and we can also do a performance appraisal to ensure that the auditor is doing his work properly.
A third point that surprised me in this person's statement was where he said that even when a taxpayer's account was crystal clear and everything was all right, they would nitpick. Well, if that was his attitude, it is certainly against the basic ethics of the conduct expected of him as an auditor with the Department of National Revenue. Mr. Speaker, 1 want to repeat, as confirmed by the National President of Representatives of Employees of the Taxation Division of the Department of National Revenue, that it is not our policy to set quotas for auditors, that it is not the Department's policy to do so, nor is it departmental practice.


REQUEST FOR ENLIGHTENMENT ON CERTAIN ASSERTIONS
Roch La Salle: Mr. Speaker, I know perfectly well the Minister has been telling us for three weeks that it was not the Department's policy, but the Minister will have to admit today that the practice did exist in his Department. That much is clear. If a former official dared to make that kind of statement, it means that it did exist, and he admits he still has enough friends at Revenue Canada to be able to claim that the practice still exists at the present time. Therefore, Mr. Speaker, the Minister has just proved that he is not aware of what is going on in his own Department, and that is a serious matter.
That is why, in the interests of Canadians, and the Minister will understand-


Mr. Lalonde:: Ask your question!


Roch La Salle: The Minister of Finance has some comments to make, for once. This does not concern him, Mr. Speaker, so 1 am directing my question to the Minister responsible. Why is he hesitant about calling a meeting of the appropriate Committee to shed some light on this matter, in the interests of Canadians, and if what the Minister has been saying for three weeks is true, we will be glad to know, once and for all. However, the Minister does have a responsibility to clarify this matter for the Canadian public in order to reassure Canadians with respect to his attitudes and practices. Once again, Mr. Speaker, I will doubt the Minister's sincerity if he turns down my request this morning.
Oral Questions


Pierre Bussières: Mr. Speaker, I think the Hon. Member has been in the House long enough to realize a Minister has no authority to call a meeting of a committee. It is up to the committees to determine and to decide what their business will be. That is my first point.
My second point, Mr. Speaker, is that the Hon. Member is relying on an anonymous authority who is referring to a situation that existed in the fifties, and the article contains elements that cast considerable doubt on its credibility. As for me, Mr. Speaker, I take my references from reliable officials who have taken an oath of office and have responsibilities as Deputy Minister, Assistant Deputy Minister, District Office Director and as professionals, and, as I said before, who have taken an oath of office, and these people have given me the positive assurance that they put the Department's policy into practice.
My third point, Mr. Speaker, is that a study is underway, and I am sure it will not have to consider this problem because in the isolated cases where there may have been such occurrences, that is no longer the case.


ATOMIC ENERGY CONTROL BOARD
Mr. Doug Anguish (The Battlefords-Meadow Lake):: Mr. Speaker, my question is directed to the Minister of the Environment. I am a little disappointed, I must say. I phoned the office of the Minister of Energy, Mines and Resources this morning and he said he would be present in the House to answer questions which have come up over the last five days, but he does not appear to be here. Now that the Minister of the Environment has had ample time to reflect on the questions we have asked, after five consecutive days of questioning, can the Minister tell this House if the operators of the Key Lake mine filed a spill contingency plan prior to the Government issuing them the licence to operate?


Hon.   Chas. L. Caccia@Minister of the Environment: Mr. Speaker, I am happy to respond to the Hon. Member's question on this matter. I was informed this morning that the Key Lake Mining Company met all the requirements of the Atomic Energy Control Board with respect to its mining operations, including the one of submitting information on spill control, before receiving the licence.


REQUEST THAT LICENSING REQUIREMENT DOCUMENTS BE TABLED
Douglas Keith Anguish: Mr. Speaker, I appreciate the Minister finally providing us with an answer to this very serious concern. Will the Minister, or those

January 20, 1984
Oral Questions
responsible within the federal Government, table the documents which outline the requirements that uranium mines and mills must meet to receive an operating licence, and in particular the documents relating to the Key Lake Mine?


Hon.   Chas. L. Caccia@Minister of the Environment: Mr. Speaker, I do object to the Hon. Member creating the false impression he has been asking this question for several days. He raised this question for the first time in this House this morning.


Some Hon. Members:: Oh, oh!


Mr. Caccia:: It was his colleague yesterday who raised this question for the first time. He rose in his seat this morning asking this question, and he got the answer today.
As to the tabling of documents, Mr. Speaker, relating to agencies under the jurisdiction of another Minister, I have to refer the Hon. Member's question to the Minister.


Douglas Keith Anguish: This is not the first time I have raised this in the House, Mr. Speaker. If the Minister will check Hansard, he will find it has been raised on other occasions.


SURFACE LEASE AGREEMENT PROVISIONS
Douglas Keith Anguish: Mr. Speaker, there was a requirement under the surface lease agreement with the mining company to file a spill contingency plan prior to the opening of the mine. That particular plan was never filed with the Saskatchewan Government, which in turn should have passed it on to the responsible federal officials. Is the Minister now telling us that that spill contingency plan was filed by the Key Lake Mining Corporation?


Hon.   Chas. L. Caccia@Minister of the Environment: Mr. Speaker, the terminology "contingency spill plan" is used by the Saskatchewan Government. I therefore urge the Hon. Member to raise the question with the Government of his province.


AIR TRANSPORT
Mr. Pat Nowlan (Annapolis Valley-Hants):: Mr. Speaker, my question is directed to the Minister of Transport. Can he explain to this House why on December 22, 1983, in a considered written judgment, he rejected an appeal from Soun-dair Corporation for a commercial air licence, the appeal arising from a November 3 decision of the Air Transport Committee of the CTC, yet on the same day, December 22, he recommended to Cabinet that the licence be awarded to Soundair, as it was that day, through Order in Council
PC-1983-4193? Can the Minister explain this amazing flip-flop?


Hon. Lloyd Axworthy (Minister of Transport):: Mr. Speaker, it is not an amazing flipflop. It was an attempt to ensure continuation of an important service to a number of out of the way, small rural communities in western Canada. I would not expect the Hon. Member to have much care or consideration for such matters, but the fact is the service supplied by Aero Trades had been discontinued as a result of their bankruptcy. Negotiations were going on with Soundair to take over the operation of those routes. The CTC had not yet ruled on the matter of a permanent transfer. The appeal could not be judged on legal grounds, but it was certainly within the authority of the Minister to recommend, through Order in Council, that there be a temporary continuation of those licences so those communities could continue to have the air service they need, particularly over the winter period when they would not have any other transportation available to them.


TRANSPORTATION OF GOLD BARS
John Patrick (Pat) Nowlan: Mr. Speaker, I am amazed at that answer because the Minister covered most of those points in a written decision he gave on December 22 before the Order in Council went before Cabinet. The Minister talked about the fact that the service was continuing through a bankruptcy and through the trustee, Clarkson Gordon, in his written judgment.
Was the Minister aware, when he so suddenly reversed himself on the same day, that without the contract for the commercial air licence, Soundair would have been unable to obtain a contract on January 4 of this year for the transportation of Brinks gold bars, previously held by Millardair?


Lloyd Axworthy: Mr. Speaker, I am constantly amazed at the inability of the Hon. Member to deal with some simple and obvious requirements to continue proper government service in the air transport area, but I am quite prepared to help him with his education. The fact of the matter is that the operation of the contract for Soundair to maintain those lines is continuing. It would not have continued unless the temporary licensing had been approved.
If the Hon. Member is suggesting that he and his colleagues would have preferred that we simply let the licence lapse, the service be discontinued and those communities to be without service, then I think we are now beginning to discover what kind of air policy the Conservative Party is going to promote in the future.
January 20, 1984


COPYRIGHT
Hon. David Crombie (Rosedale):: Mr. Speaker, my question is for the Minister of Justice who, I am sure, is aware that a few weeks ago there was a very serious violation of the Canadian copyright law when well over 2,500 American editions of Canadian books were dumped on the Canadian market. As 1 am sure he is also aware, that has caused very serious concern among Canadian authors and, if that sort of action is allowed to continue, it could place the Canadian book publishing industry in great jeopardy. Both I and they would like to know what action the Minister's Government intends to take in order to deal with the situation?


Hon. Mark MacGuigan (Minister of Justice):: Mr. Speaker, that matter has not come to my attention. Indeed, I would not be the responsible minister. It would be, I suppose, the Minister of Consumer and Corporate Affairs. My hon. friend might wish to redirect his question.


PLEA FROM WRITERS' UNION OF CANADA
David Edward Crombie: Mr. Speaker, I beg to differ. It was actually brought to the Minister's attention. He may not have caught up with his mail, but on January 9, 1984, there was a letter from the Writers' Union of Canada to the Minister asking him to prosecute under Schedule C of the 1978 legislation. That was a commitment made by the Government at that time to the Canadian book publishing industry. If the Minister has not dealt with the matter, perhaps he would like to have someone in Cabinet deal with it if he will not.


Pierre Bussières: Mr. Speaker, if the Hon. Member will allow me, Revenue Canada is responsible for the administration of the Customs Tariff, which contains provisions designed to prevent entry into Canada of counterfeit editions of books copyrighted in Canada, or copyrighted in England and so recognized in Canada.
When a counterfeit edition of a book enters Canada and is marketed throughout the country because it has not been seized by customs officials, we immediately advise the owner-distributor to withdraw those editions. In the specific case mentioned by the Hon. Member, if I remember the question correctly, it has to do with an edition of a book by Pierre Berton. In that case, a company we knew had those books in stock and we asked them to withdraw them from the market. We found out that a number of copies had not been withdrawn, so we referred the whole case to the Royal Canadian Mounted Police.
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Oral Questions


ADMINISTRATION OF JUSTICE
Mr. Speaker:: The Hon. Member for Ottawa-Vanier (Mr. Gauthier).


Mr. Jean-Robert Gauthier (Ottawa-Vanier):: Mr. Speaker, my question is directed to the Minister of Justice. Yesterday, in the Court of Appeal of Ontario, the Crown attorney stated that the Canadian Constitution does not go as far as granting the right to manage or control the educational institutions of the official language minority.
Again according to Mr. Brad Smith, the Crown attorney, the linguistic minorities will have to bring their case before the courts ad nauseam each and every time their constitutional rights are breached. Considering that the Canadian Parliament, by adopting the Charter of Rights and Freedoms, and pursuant to Section 23, gave every Canadian as an individual the right to have his children educated in the language of the minority in educational institutions of that minority and, in addition, considering that when someone is given-


Mr. Speaker:: I regret to interrupt the Hon. Member, but the matter is now sub judice, and the Hon. Member seems to be seeking a legal interpretation.


Jean-Robert Gauthier: Mr. Speaker, my question does not relate to a case before the courts. What I want to know from the Minister is this: yesterday in Toronto, did the Crown attorney faithfully reflect the current policy of the federal Government on the interpretation of Section 23? That is what I want to know, it has nothing to do with the law.


Mark R. MacGuigan: Mr. Speaker, I cannot comment on the case before the court. However, I can say that the wording of the Constitution may be ambiguous, or rather, as we see it, overly flexible. I can only agree with the suggestion of the Hon. Member, and anyone given a right must also have the means to exercise that right. However, the real question is what is a fair means of exercising that right, and that is the question on which the court will rule.


SPECIAL RECOVERY CAPITAL PROJECTS PROGRAM
Mr. Lome Nystrom (Yorkton-Melville):: Mr. Speaker, my question is for the Minister of Finance. Under the Special Recovery Capital Projects Program which the Minister has talked so much about, the Canadian Government, through the Department of Supply and Services, is purchasing two ships

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Oral Questions
for our Canadian Coast Guard. As I understand the purpose of the Special Recovery Capital Program it is to create jobs here in Canada. Why was the contract for the eight engines for these two ships, which are valued at some $4 million, given to a Swedish firm, when those kinds of engines are produced by the Bombardier Company? Two hundred and seventy jobs would result if those engines were produced in Canada. Is this the type of thing he had in mind when he announced this special program a few months ago?


Marc Lalonde: Mr. Speaker, the Special Recovery Project indeed provided for the building of a number of ships in Canada, and these ships are being built in Canada by Canadian shipyards. As far as the equipment for those ships is concerned, that obviously would have to be awarded on the basis of competitive tenders. With respect to the specific question that the Hon. Member raises, I would refer him to the Minister of Supply and Services who is in charge of the administration of the Department of Supply and Services. I am sure he will explain to the Hon. Member why, in this particular case, the engines are coming from Sweden. They are probably coming in at a much lower price than those produced by Canadian firms. The specifics would have to come from the responsible Minister.


SUPPLY AND SERVICES
Lorne Edmund Nystrom: I have a supplementary, Mr. Speaker. Because of a decision of the Canadian government, hundreds of Bombardier employees will probably be laid off next summer. Did the Minister or the Government add to the cost of the contract given to the Swedish company the additional costs incurred because of items such as unemployment insurance and welfare benefits in Canada? Did the Minister take into consideration such items, which are very important?


Marc Lalonde: Again, the Minister of Supply and Services will be happy to provide all the information required by the Hon. Member, but I remind him that the Canadian Government has also helped the Bombardier company to get important contracts, for the subway service in New York for instance, that it has received a lot of assistance from the Canadian Government to get contracts in Mexico, and that we also help Bombardier to get orders in other countries. Recently, there were discussions with the Chinese Government to get contracts for this firm. As far as the specific example mentioned by the Hon. Member, the Government of Canada is already doing a lot for this Canadian business, which has been very successful in its sales abroad. It would be very difficult to suggest that we can sell abroad, but that foreign companies cannot sell in Canada.
If we want Canada to be successful, we shall have to be competitive internationally, and Canada cannot close its doors
while asking every other country to open its markets to Canadian goods. If we really want to succeed in this country, we shall have to be competitive. This is our policy, namely to become more productive and more competitive, and we cannot succeed in the present context if we close our doors to foreigners who want to sell to us while asking them to open their own doors to Canadian products. This is the policy of the Government.


FARM CREDIT CORPORATION
Mr. Murray Cardiff (Huron-Bruce):: Mr. Speaker, my question is for the Minister of Agriculture. During the administration of the present Government many food producers across Canada were forced to borrow money from the Farm Credit Corporation at high rates of 16.75 per cent. Some of those farmers were successful in getting an interest rebate on those loans. Today that program has expired. Has the Minister put any programs forward to continue that program, and also to include the other rates from the Farm Credit Corporation which were given in that period of time?


Hon. E. F. Whelan (Minister of Agriculture):: Mr. Speaker, I am sure the Hon. Member is well aware that when they borrowed that money at 16.75 per cent they would have been lucky to get it from the private sector at 21 or 22 per cent interest. It seemed to be a good thing. We recognize, as he does, at the present time that that probably should be changed. We are reviewing that.
I had a meeting with the Chairman of the Farm Credit Corporation this morning to dot the i's and cross the t's on some of our submissions to make sure that we have what we want in that. There are nearly 8,000 farmers in that category. We have worked out a program that we think will be acceptable, in a fashion that will cost hardly any money and enable us to lower the interest to the going rate of interest for the Farm Credit Corporation at the present time.


TIMING OF ANNOUNCEMENT OF NEW PROGRAM
Murray Cardiff: Mr. Speaker, there are many farmers who will be unable to plant their crops this Spring unless that is implemented almost immediately to enable them to make their plans for this year. When could we expect to have that announcement made? Would it be in time for the Spring planting?


Eugene Whelan: Mr. Speaker,
I am sure that the Hon. Member knows as well as I do that a lot of them will be able to plant their crops because of the tremendous amount of money that we are giving them on stabilization. A lot of his constituents are being paid a subsidization of $275 a tonne for white beans. A lot of his constituents will also be subsidized for apples. About $12 million will
January 20, 1984

go into Ontario. This announcement will be made to enable those who are not growing white beans or some of the other crops, to plant.


WESTERN GRAIN TRANSPORTATION ACT
Mr. Bert Hargrave (Medicine Hat):: Mr. Speaker, my question is for the Minister of Transport. It is in regard to the application of the new freight rates for grain handling and so on. Agricultural products such as alfalfa, and more specifically meal, pellets and cubes, were to be eligible for the new rates. Is the Minister aware of the fact that both railways are now charging the full commercial rates for shipments of containers of the products of agriculture from western Canada to Vancouver for direct shipment overseas to Japan? Will he indicate what he might do about that?


Lloyd Axworthy: Mr. Speaker, I would like to express my appreciation to the Member for Medicine Hat for having drawn the problem to my attention earlier. We have begun to look into it. There is no question that the inclusion of alfalfa pellets was part of the rate structure and they are eligible for the new rate under the Western Grain Transportation Act. The initial response I get from the railways is that the containerization does create an ambiguity in the application of those regulations. I have instructed our officials to meet with the railways to clear up that ambiguity so that we will not have any further confusion in that area. I hope that we will be able to clear up the matter for the producers in the Hon. Member's area in the beginning of next week.


RAILWAYS' INTERPRETATION OF ACT'S PROVISIONS
Herbert Thomas (Bert) Hargrave: Mr. Speaker, my supplementary question is directed to the same Minister, on the same subject. I appreciate the nature of his comment. In light of Article 50 in the new legislation and the authority of the Canadian Transport Commission with respect to that, is the Minister aware that both railways are assuming that, in order to qualify for that new rate, agricultural products have to be shipped by boxcars or hopper cars, in other words, excluding containers? I would appreciate whether that could be investigated in the whole question as well.


Lloyd Axworthy: Mr. Speaker, I think the Hon. Member brings up a very useful and important point. We will use that as a reference as part of our discussions with the railways. I think it does point out the necessity to implement quickly the practical parts of the legislation, which are the establishment of the office of the Grain Administrator and the Senior Grain Transportation
Oral Questions
Committee so that many of these issues can be worked out through that particular mechanism. I hope to be in a position within the matter of a week or ten days to move forward on those very important developments. But I do thank the Hon. Member for bringing these matters to my attention. As I said, we will have them cleared up by next week.


FISHERIES
James Ross Fulton: Mr. Speaker, my question is for the Minister of Fisheries and Oceans. He knows that yesterday Alcan applied to proceed with its Kemano II Project. This will take, as the Minister knows, in total 88 per cent of the water out of the Nechako river system. I am sure the Minister is also aware that British Columbia has either already flooded, or has under reserve flooding, an area roughly the size of Prince Edward Island. Since the Minister's own Department and the International Pacific Salmon Fisheries Commission have expressed alarm and deep concern over the Alcan proposal, would the Minister tell members of this House, British Columbia sports fishermen, native food fishermen and commercial fishermen, what use his fleet restructuring plan, his buy-back plan, and everything else are, if he is going to allow an unnecessary hydroelectric project to proceed in British Columbia?


Hon. Pierre De Bane (Minister of Fisheries and Oceans):: Mr. Speaker, I would like to reassure the Hon. Member that no decision has been made about this project, and one will not be made until hearings scheduled by the Utilities Commission have been held. As you know, the Department issued and made public on January 5 several scenarios about this project, and as far as my Department is concerned we are going to wait until a full hearing has been held.


James Ross Fulton: Mr. Speaker, I am sure the Minister is aware that the proposed B.C. Utilities Commission hearings are nothing more than a kangaroo court, rubber-stamp process. There is no funding for intervenors. There is no cross-examination, and there are no subpoena powers. I would invite the Minister of Fisheries and Oceans to speak to the former Minister of Fisheries and Oceans in terms of the trouble that Minister got the Amax Corporation into by not having-


Mr. Speaker:: Order, please. Would the Hon. Member please ask his question?


REQUEST FOR PUBLIC INQUIRY
James Ross Fulton: Mr. Speaker, my supplementary question is for the Minister of Fisheries and Oceans. Will he and his Government show some backbone on a project that will affect the Fraser river and the Skeena river system, and have a full public inquiry process that will allow experts on

January 20, 1984
Oral Questions
both sides, not just Alcan's side, to put forward their views on this project?


Pierre De Bané: Mr. Speaker, I would like to remind the Hon. Member that the British Columbia Utilities Commission is legislatively based.


James Ross Fulton: Wrong.


Pierre De Bané: If the Hon. Member wants to call it a kangaroo court or a fraud, this is the opinion of the Hon. Member, but the Commission allows all regulatory agencies and the public to come forward with their own views. After that full hearing has been held, then the Department will issue its own opinion. I think the Hon. Member is certainly accusing a regulatory agency which exists according to the law of British Columbia, of bad faith. I am not ready to make that kind of irresponsible statement. On the other hand, the Department of Fisheries and Oceans will not renege on its own legislative responsibilities.


AIR TRANSPORT
Hon. James A. McGrath (St. John's East):: Mr. Speaker, I have a question for the Hon. Minister of Transport. I attempted to ask this question yesterday. When was the Minister advised of the decision of Eastern Provincial Airways to move its headquarters and maintenance operations from Gander to Halifax, a loss of 300 jobs to Gander, and a substantial loss to the economy of eastern Newfoundland? As a principal employer in the town of Gander, what steps has the Minister taken in conjunction with his colleagues, the Minister of National Defence and the Minister of Employment and Immigration, to offset this economic blow to the town of Gander and to eastern Newfoundland?


Lloyd Axworthy: Mr. Speaker, as I recall, the notification was received within about a 24-hour period prior to the public announcement of the move from Gander. We did not have much notice if that is the intent of the Hon. Member's question.
As far as looking at alternative measures that could be taken is concerned, I have had discusisons with the Member of Parliament for that area, with the Minister of Mines, the Minister from Newfoundland, as well as with my two other colleagues. We would obviously like to try to provide some assistance to fill the loss of jobs. I understand there are still some negotiations going on in Newfoundland itself. I certainly agree with the sentiment that it is a very tragic blow to the Gander community. To the extent that we can provide alternative support, I am sure this Government will attempt to do so.


EMPLOYMENT
James Aloysius McGrath: Mr. Speaker, my supplementary question is for the Minister of International Trade. It has to do with the economy of Newfoundland where there is 20 per cent unemployment. On January 15, 1984, the Minister announced U.S. $143 million assistance for a paper-mill in Malaysia. The Minister knows that the Bowater paper-mill in Cornerbrook, Newfoundland, will be closing in April unless a buyer can be found.


Mr. Speaker:: The Hon. Member's question is not a supplement to his first question.


An Hon. Member:: It has to do with jobs.


James Aloysius McGrath: With respect, Mr. Speaker, my question has to do with employment in Newfoundland and it is clearly supplementary.
The Bowater mill will close down because of the loss of markets in Europe as a result of Scandinavian competition. If the Minister can find U.S. $143 million to support a papermill in Malaysia, what steps is he taking to stop or to prevent the closing down of the Bowater mill in Cornerbrook, which will mean a loss of 1,300 jobs and the destruction of the economy of the west coast of Newfoundland?


Hon. Gerald Regan (Minister for International Trade):: Mr. Speaker, I want to thank the popular, genial, able Member for St. John's East for his question.


Mr. Lawrence:: You left out incisive.


Gerald Augustine Regan: He is the scion of a very distinguished Newfoundland family, and he has contributed greatly to the deliberations of the House of Commons during his years here.


Some Hon. Members:: Oh, oh!


Mr. Nielsen:: Where are your idiot cards?


Some Hon. Members:: Oh, oh!


Gerald Augustine Regan: The Hon. Members are rather noisy because they are obviously against the Hon. Member. They do not like him to be praised.


Some Hon. Members:: Oh, oh!


Gerald Augustine Regan: I want to say that I thank him for expressing his concern about the situation in Cornerbrook, and tell him that I share that concern in relation to the future of the Cornerbrook mill.
I hope the Hon. Member is aware that the Newfoundland Government has been in contact with some interests. There is the possibility of getting them to participate in a solution for that important plant. The Government of Canada, through the appropriate agencies, will certainly be interested in entertain-
January 20, 1984

ing any opportunity to be of assistance in finding a permanent solution to that troubled situation.


Some Hon. Members:: What about Malaysia?


Gerald Augustine Regan: I want to say to the Hon. Member that he deals with a totally different subject when he talks about the sale of Canadian goods and services overseas.


Mr. Mazankowski:: Order.


Gerald Augustine Regan: The sale to Malaysia about which he is talking results in 4,000 man years of employment in this country. It results in the sale of goods and services. That is the business we are in. Indeed, if the Hon. Member wants to say that we should not sell the machinery for a plant of the type that exists in this country, I would say to him that would be putting his head very firmly in the sand, because there were five other countries in competition for that contract that would have been happy to have it. The result of Canada winning the contract means that the jobs come to Canada. Let us help our industries, but let us not stop selling our goods and services overseas.


Some Hon. Members:: Hear, hear!


Mr. Speaker:: The Hon. Member for St. Catharines.


Mr. Joe Reid (St. Catharines):: Mr. Speaker, my question is for the Minister of the Environment but he has just stepped behind the curtains. If he would take his place, 1 would pose my question.


An Hon. Member:: He has gone.


Joseph Lloyd Reid: I will reserve my question then, Mr. Speaker.


CANADA-UNITED STATES SECTORAL FREE TRADE NEGOTIATIONS
Mr. David Kilgour (Edmonton-Strathcona):: Mr. Speaker, my question is for the Minister of International Trade. Will the Minister tell us with respect to the Canada-U.S. sectoral free trade negotiations whether agreement has been reached between the two Governments on three fronts, namely, farm machinery in all its aspects, software and data processing, and speciality steel? Will the Minister also tell the House what the status is of red meat, petrochemicals, and surface transportation?


Mr. Speaker:: May I suggest to the Hon. Member one question at a time.
Hon. Gerald Regan (Minister of State (International
Trade)): Mr. Speaker, I think my answer to the Hon. Member might be rather general, or it might take a considerable period of time. But I want to thank him for the question because I am
Oral Questions
glad to see that keen interest on the part of the Hon. Member in an area of negotiations between our two countries which can be of great meaning to the Canadian economy and to the creation of additional jobs in this country.
Negotiations with the Americans on the subjects which the Hon. Member mentioned are underway at the same time as the exploration of the feasibility in each sector is being undertaken by officials of the Governments of the two countries. We are hopeful that progress will continue to be made, but it cannot be achieved overnight.


WESTERN GRAIN TRANSPORTATION ACT
Donald Frank Mazankowski: Mr. Speaker, my question is directed to the Minister of Transport. As he knows, under the Western Grain Transportation Act the Government has a duty and obligation to appoint a Grain Transportation Agency Administrator. Has a decision been made on who will be receiving that appointment? When will the announcement be made? Perhaps the Minister could also indicate whether there is any truth to the rumour floating around that the present Chairman of CNR is in line for the job?


Lloyd Axworthy: Mr. Speaker, we would have to extend Question Period by double its time if I were to enunciate all the various rumours, speculations, requests and submissions respecting the Grain Administrator.
In answer to the Hon. Member's question, a decision has not been made on that particular position. I hope to be in a position to make a recommendation to Cabinet some time in the next week or ten days on that. However, I am still engaged in very active consultations with a wide variety of sources. Certainly I would be glad to have further representations from the Hon. Member for Vegreville.


LIST OF CANDIDATES
Donald Frank Mazankowski: Mr. Speaker, I have a short supplementary question for the same Minister. Could he indicate whether the current Chairman of CNR is on the short list of candidates for that job?


Lloyd Axworthy: Mr. Speaker, if my memory is correct, a number of members of that very distinguished western family have been appointed to very senior positions as grain administrators in the past. Who knows what will happen in the future?


Some Hon. Members:: Hear, hear!

January 20, 1984
Petition


PETITIONS
Mr. Speaker:: I have the honour to inform the House that the petition presented by the Hon. Member for Vaudreuil (Mr. Herbert), by filing with the Clerk of the House on Thursday, January 19, 1984, meets the requirements of the Standing Orders as to form.
The petition presented by the Hon. Member for Grey-Simcoe (Mr. Mitges) on Thursday, January 19, 1984, does not meet the requirements of the Standing Orders as to form.



ROUTINE PROCEEDINGS


Mr. Charles Turner (London East):: Mr. Speaker, I have the honour to present the fourth report of the Striking Committee in both official languages.
[Editor's Note: For above report, see today's Votes and Proceedings.]


PETITION
Mr. Lome Greenaway (Cariboo-Chilcotin):: Mr. Speaker, it is my pleasure to present a petition signed by 183 citizens of the Cariboo-Chilcotin riding in British Columbia who support the policy guidelines of the Registered Nurses Association of British Columbia concerning Bill C-3, to establish the Canada Health Act.
The purpose of this petition is to support the Canada Health Act in its commitment to a primary health care system as the basis of a medical services plan, but also to draw attention to the need for a more comprehensive health service than the Bill presently outlines and for more provincial control than Bill C-3 presently entails.
The petitioners hope that in your examination of the petition, Mr. Speaker, you will find it in order and will refer it to the appropriate committee at the earliest possible time.


QUESTIONS ON THE ORDER PAPER
[Stage Direction]
(Questions answered orally are indicated by an asterisk.)
Mr. John Evans (Parliamentary Secretary to President of the Privy Council):: Mr. Speaker, the following questions will be answered today: 126 and 257.


Mr. Stewart: Is there a Work Adjustment Training program (WAT) and, if so, since its inception (a) how many people have been accepted into the program (b) at what total cost for each fiscal year?


Hon. John Roberts (Minister of Employment and Immigration):: There has been a			Work	Adjustment Training Program	
since 1973-74.					
1973-74	(a)	49	(b)	not available <	re-1974-75	294	not available J	integrated with1975-76	865	not available j	other programs1976-77	1,094	not available '	1977-78	1,513	$1,259,673	1978-79	1,537	$1,652,658	1979-80	1,126	$1,233,554	1980-81	1,131	$ 805,124	1981-82	1,080	$1,423,693	1982-83	1,159	$1,532,582	Total	9,848	$7,907,284


Mr. Scott (Victoria-Haliburton): 1.	Were any school teachers sent government information packages in mid-October and, if so (a) how many (b) what was the mailing cost?
2.	Was Southern Direct Marketing Services paid for dispatching this material and, if so, in what amount?
3.	Who authorized the expenditure of funds for producing and mailing these boxes?


Mark R. MacGuigan: 1. (a) Teachers as such were not sent information packages. Material was sent in mid-October to a total of 8,025 Senior Administrative Executives, which included: ministers and deputy ministers of education; directors of education, teacher training, curriculum and instruction; superintendents and assistant superintendents; district supervisors and assistant district supervisors; subject consultants; master teachers; co-ordinators; and to 15,716 school principals.
(b) The exact mailing cost was $60,050.34.
2.	Southam Direct Marketing Services was paid $2,301.70.
3.	The Canadian Unity Information Office authorized the expenditures.


John Leslie Evans: Mr. Speaker, I ask that the remaining questions be allowed to stand.


Mr. Speaker:: The questions enumerated by the Parliamentary Secretary have been answered. Shall the remaining questions be allowed to stand?


Some Hon. Members:: Agreed.
January 20, 1984



GOVERNMENT ORDERS


[Stage Direction]
The House resumed from Tuesday, January 17, consideration of the motion of Miss Begin that Bill C-3, an Act relating to cash contributions by Canada in respect of insured health services provided under provincial health care insurance plans and amounts payable by Canada in respect of extended health care services, and to amend and repeal certain Acts in consequence thereof, be read the second time and referred to the Standing Committee on Health, Welfare and Social Affairs.
Stanley Hudecki: Mr. Speaker, at the outset I would like to congratulate the Minister of National Health and Welfare (Miss Begin) on her aggressive and dynamic commitment to the five principles of medicare and to providing health care services at a reasonable fee for the average Canadian. No one can question her sincerity and dedication toward making high quality health care available for all Canadians regardless of age, sex and the region in which they live.
In this debate on the Canada Health Act I would like to put into perspective the role of the medical profession in the health care of the nation, its successes and its frustrations. My initial comments are directed to Members of the House and, to a lesser degree, to the media for much unwarranted criticism of the medical profession. As a member of the Royal College of Physicians and Surgeons and one who has practised surgery for 30 years, I resent the derogatory and cynical insinuations made by some individuals who are very much uninformed about the complexities of medical practice and kindle public distrust and anxiety by accusing physicians of such practices as performing unnecessary surgery, ordering excessive or unnecessary stays in hospital and desiring excessive compensatory rewards.
Certainly in every profession there are bad apples that give the profession a negative image, but that is no reason or excuse for the continuing harassment of the medical profession as a whole. The violators of ethical medical practice are few. The vast majority of physicians are sensitive, responsible Canadians who are among our most respected and hard-working people.
There is no other profession in the country that is exposed to the constant stress of responsible decision making hour by hour, day by day, year by year. There is no other profession in which its decisions are often linked with potentially horrendous consequences in terms of life or death, partial or complete physical and/or mental impairment; where decisions must be made on the spot without the benefit of other opinions, committee input, briefing by experts or academics; and where someone seems to be constantly watching over one's shoulder, threatening legal action if the expectations of the patient are not fulfilled. The medical profession, by virtue of its ethics, is
Canada Health Act
at the beck and call of every member of the public at all hours of the day, by any citizen who presents health problems either real or imagined.
The tensions to which medical men and women are exposed are difficult to quantify but may be perceived by the higher than average rate of suicide among M.D.s, by the numbers of the profession who tend to seek solace in drugs and alcohol, and by the many family breakdowns resulting from unavoidable neglect by a medical parent in the performance of his or her duties as a doctor. Yet in the past ten years this same group of medical personnel has provided Canadians with the benefits of ever-escalating refinements in technical advances, as evidenced by our diminishing infant mortality rate and the increasing longevity of Canadians.
The general public has shown its respect for the medical profession by voting it in a recent Gallup poll as being the most credible and trustworthy of professions. I should also add that in that assessment politicians and journalists ranked near the bottom of the list. My plea to Hon. Members of Parliament is to temper any anti-doctor rhetoric by recognizing the significant contribution which those people are making to the quality of life and health of all Canadians.
Also I have been disturbed by the lack of precise statistical information and hard data about the medical system on contentious issues which have created debate and confrontation. Many statements leading to controversy are anecdotal impressions and generalizations. I am referring to the accountability of the provinces for the expenditure of federal funds which have been transferred to provincial governments and which should be spent on health care.
I have found it difficult to find an accurate statement of the annual deficits of hospitals, of the number of bed closures, on the length of waiting lists in hospitals in various parts of the country. A great deal of research is necessary, including studies of Canada's changing demographics, in order to provide health care administrators and politicians with factual information on which they can accurately assess funding and planning priorities in allotting health resources.
The federal Government contributes funds to the provinces for health care through cash and tax transfers. However, there is great difficulty in precisely accounting for the government funds which are expended for health care in each province. There should and must be greater accountability for these funds.
What, then, is the status of the health system in Canada? What are the needs for the future? Many people are on hospital waiting lists. The Canadian Medical Association has given a figure of 150,000 nationwide, but what is the source of that information? It seems to be based more on conjecture than precise information.
My own investigation in the City of Hamilton indicated that for the past four or five years there has been constant pressure for hospital beds, but as a result of a computer monitoring of bed availability in all Hamilton city hospitals, there is no real

January 20, 1984
Canada Health Act
problem of bed shortages for emergency cases. For elective surgery, there are a few days of waiting. For non-urgent cases, the average wait is between 30 and 45 days. These figures are approximations, not precise calculations.
Again in the Hamilton area, there are periodic hospital bed closures amounting to 130 beds. These closures are carried out each summer and during the Christmas holidays, but are restored for the rest of the year. The reason given for the temporary closures is a budgetary one. For a variety of reasons, there is greater delay in the assigning of beds to patients for the cardiac ward. The delay is not only due to a shortage of beds as such, but due to an inadequate number of intensive care beds and provisions for diagnostic studies.
As far as the funding of hospitals in Hamilton is concerned, the Province of Ontario had no difficulty in covering operating deficits for our hospitals until approximately three years ago. Since that time many hospitals have been left to their own devices to fully meet their costs.
The lack of capital funding for new medical equipment, renovation and replacement of buildings has been a serious problem. In Ontario, permission to retain surpluses and to use discretionary funds such as those derived from gift shops and local fund-raising campaigns has slightly improved the situation, yet because capital funding is inadequate in all hospital departments, budget restraints are therefore enforced. The situation which I have outlined is that in one area, Hamilton, an urban setting where there is a university teaching program involving community hospitals. These observations can in no way give an adequate overview of the needs of the community style of hospitals in small towns or in different areas of the country, such as the Maritimes or Yukon Territory.
In assessing the needs of our medical system, it must be remembered that there is no single program of medicare in Canada. Instead, there are ten variants. Each province has its regional problems and its own remedies for adequate delivery of medical care.
The health care system in Canada is regarded as one of the finest in the world. This is not an exaggeration. A great deal of credit goes to the administrative skills of both senior levels of government, but the ultimate credit must be given to the health professionals.
The responsibility of providing care in the past 10 to 15 years has become extremely complex and demanding. The reason for this has been an explosion of medical knowledge involving the application of all forms of technical advances in equipment and procedures. This eruption of knowledge and information has necessitated a growth in the need for specialists in medicine in order to apply the new techniques with skill and understanding.
In addition to the traditional expert nursing care, this has led to a generation of new health care technicians; the paramedic, the respiratory technician, nursing aides, otologists, speech therapists, social service workers and so forth. Each specialty and sub-specialty has its own supportive team of technicians. This had led to better medical care, but it has also led to
increased wage costs and increased costs for new medical equipment.
Also, as a result there has been some confusion among the Canadian public as to the role of the different members of the health care team. Many patients do not know the extent of training of many of the health workers and do not appreciate their skills and their limitations. They are uncertain how to interpret the variety of opinions which they have received, some of which appear to be contradictory. Many patients are not prepared to take the assessment of the nursing practitioner, the psychologist and the physiotherapist alone, and this has led to some frustration with our health care delivery system.
Why has there been resistance of some in the medical profession to medicare? The doctor, in whatever field he is practising, has always linked his services to the individual. His traditional contract was solely between the individual and himself. In that way, he was free to make an assessment of the patient's problem and employ his skills as his judgment indicated. The patient, in turn, selected him on the basis of previous medical consultations or the recommendation of a satisfied patient. More recently, however, a third player- government-has entered into the picture and interfered with this traditional one-to-one relationship.
Since government has the power of the purse, there is growing fear that the doctors' autonomy is being eroded and that there exists a potential for stifling his or her freedom to practice according to his or her conscience. Many doctors in Canada look upon this as their principal complaint. They resent any interference with what is deemed to be their right to decide on his or her own fee. However, I should stress that by far the great majority of doctors are practising within the fee schedules agreed to by their profession and the individual provincial governments and they are satisfied with the system, especially as the medicare program has facilitated the collection of fees owed to them and has led to the upgrading of many hospitals.
Some fear has been expressed that a time may come when a physician could be guided by rules and regulations imposed on him or her by the state if all doctors must be opted into government programs and that doctors could be forced to fulfil the financial requirements of the state rather than meet the specific needs of the patient. For example, a rule could be imposed that there would be no kidney transplants for people over 60 years of age because such transplants are not cost-beneficial.
This is an exaggeration, of course, but there have been examples in this century where some states have issued horrendous dictates to medical practitioners. This is one argument, though, which has been advanced in favour of allowing physicians to opt out of medicare. This may be a valid argument in favour of allowing opting out as a safety measure for physicians, but it is not an argument which can be advanced in favour of extra billing.
The very fact that only 2 per cent of doctors' incomes comes from extra billing, while 98 per cent comes from medicare, is lost on many citizens. However, a problem still exists both for
January 20, 1984

patients who do not want to be extra-billed and for many doctors who feel threatened by imposed fee schedules. Indeed, some doctors feel that they have a fundamental right to decide on the fee for service to a patient and that a case could be made for this right based on the Charter of Rights and Freedoms.
The current health care system can be improved considerably from the point of view of the medical profession. To increase the acceptance of our medicare system, doctors should be able to opt out of medicare along the Ontario model, but without extra billing privileges. Allowing doctors to opt out of medicare and yet collect their fees from medicare would let doctors retain their independence in principle and not become civil servants.
Paying all physicians at uniform rates as at present is leading to mediocrity in Canada's medical care. The pay scheme now in existence encourages equal pay for unequal training and experience. Seniority does not count for increased compensation. Currently, operative and medical procedures are paid according to the procedure itself, unrelated to the duration of the procedure or to the physical state of the patient. The system has failed to recognize talented, well-trained, experienced doctors.
However, all of these factors are beyond the jurisdictional scope of the federal Government because the doctors' fee schedules are set by the individual provinces. Because of the jurisdictional separation, the proposed Canada Health Act cannot provide a solution to the fee schedule of the medical profession or a solution as to how that fee schedule should be arrived at.
Doctors are entitled to adequate compensation but as yet no one has defined what is adequate. If merit, experience, and expertise are ultimately to be taken into consideration in arriving at appropriate compensation to doctors, then it is up to the provincial medical associations to draw up a fee schedule and for doctors to then lobby the provincial governments, not the federal Government, to accept that fee schedule.
If physicians, particularly in some specialties, are asked to discontinue extra billing, then a system of fees taking into account the doctors' experience, degree of training, type of community they live in and the complexity of the medical procedure performed must be negotiated with the provinces. This negotiation of fees is referred to indirectly in Clause 12(c) of the new Canada Health Act, but the details of the compensation to be paid to physicians is, as I have mentioned, a matter that must be resolved between the provincial governments and the doctors. A better consultative mechanism between the doctors and each province is needed if doctors are to be satisfactorily compensated and thereby encouraged to stay within the medicare system and eliminate extra billing. Perhaps an amendment should be considered for inclusion in Clause 12(c) of the proposed Act to make it a requirement that a consensus be reached by the provinces with doctors
Canada Health Act
before fee schedules or other changes to the medicare system are arranged.
Canadians as a whole are pleased with medicare. Though the existence of waiting lists to visit a doctor or to enter a hospital is a concern, by and large Canadians are willing to wait for treatment as long as our medicare system provides good medical care on an implied "free" basis. However, many people are displeased with the so-called assembly line or cursory treatment given by some physicians. Such treatment relates more to the personality and to the philosophy of the individual physician rather than to the efficiency of the system. It is unlikely that such physicians would change their practice under another fee structure.
The bed shortage in Canada is aggravated by many situations, such as pressure from patients and their families to remain in hospitals, by an inadequate number of nursing beds and requirements in some provinces that patients must be admitted for certain tests. Utilizing the complete facilities of a hospital for only five out of the seven days in a week is another factor. Yet there is an erroneous public perception, fuelled by the media and some politicians, that the blame for unnecessary hospital admissions should be placed on the doctors.
Canadians are dissatisfied and worried about the incidence of extra billing by doctors. This is especially so in emergency situations. There is a practice now in vogue in using a number of consultants, particularly in cases of trauma but in other emergency cases as well, without consulting the family. Such billing can amount to formidable sums that cannot be handled by low and middle income families.
The needs of hospital care services should be assessed scientifically and projected for the future in order to control costs. The time has come when people expect to have diagnosis made by sophisticated technical devices, such as the costly "Cat" scanners, rather than by exploratory operations.
The assessment of the pros and cons and the costs of various medical procedures and equipment should be presented to the public and a decision should then be made as to whether or not Canadians are prepared to pay increased taxes to meet our hospital care needs. Better use of nursing home care, community health clinics and health promotion programs can keep the hospital population reduced and costs diminished.
Such a change in emphasis must be brought about by the provinces and not the federal Government, as they are responsible for the delivery of the health care system in Canada. Physicians should also be made aware of the prevailing economy and be realistic in their expectations during periods of fluctuations in the economy. In other words, there is a great deal which can yet be done in Canada to improve the efficiency and cost effectiveness of our health care system within the current level of spending.
The increasing number of medical graduates is a luxury which the country may not be able to afford in the future. In 1975 there was one doctor for every 890 people in Canada. In 1981 there was one doctor for every 563 people. Each new doctor in a community increases the costs to the medical

January 20, 1984
Canada Health Act
system, according to different economists, anywhere from $250,00 to $500,000 per year. In addition, their distribution to cover the needs of the country has not yet been solved.
The general public has indicated that they are in favour of having the financial burden of health care carried by general taxation and by premiums rather than by user fees or extra billing by the medical profession. This is the principle of having the population as a whole assume the cost of our medical needs. But there is still a question as to how much individual Canadians are prepared to pay through taxes for health care.
One of the five principles of medicare is accessibility. However, there are anomalies in Canada's size and make-up which in effect tend to result in a violation of the accessibility principle of medicare in the less populated and remote regions of our vast country. There is a tendency for geographic distribution of hospitals and physicians in the highly populated southern section of the country. This problem of accessibility to the highest quality of medical care in the more remote and less populated areas of Canada is one which both the federal and provincial governments should review.
In speaking of accessibility, the term "reasonable and affordable accessibility" should preface that vital principle of medicare.
I see that you are signalling, Mr. Speaker, and I will stop at this point.


Mr. Skelly:: Mr. Speaker, I would like to address a question to the Hon. Member. It concerns an area which he covered quickly and suggested that it was an area for provincial concern alone. It basically is the position put forward by the Canadian Nurses Association. I believe that all of my colleagues here from British Columbia have been lobbied by the Registered Nurses Association of British Columbia.
There are four points which they have put forward that would reduce the cost of health care and probably provide more effective health care to Canadians generally. The first one is that nurse practitioners and nurses be given the opportunity to provide first access point and that it not be exclusively the right of physicians. Second, the health care legislation should put greater emphasis on prevention and education, or health promotion, as a mechanism for saving. The third point they brought forward is that community health clinics be developed in which health care professionals would work on a community basis. Of course, they have a proven track record in many areas of the country. The fourth point is that there be more emphasis and support federally for community-based health services, such as home care for the chronically ill.
I suggest that the Canadian Nurses Association has put forward one of the most sound responses and suggestions for improving health care in Canada as a basis for the Canada Health Act. Why has the Government and specifically members who are as influential as the previous speaker not come forward in outright support but preferred basically to cop out by saying that this is strictly a provincial responsibility? Why
is the federal Government not providing direct funding as an incentive to allow this kind of thing to happen?


Stanley Hudecki: Mr. Speaker, all the suggestions which the nurses are making are important and constructive. There is no question that the federal Government has supported in principle the use of nurse practitioners. Indeed, there are some programs that I know of which have been funded with the helf of the Department of National Health and Welfare at various university centres.
There is a great deal of merit to what the Hon. Member says. At this point, however, we have not really sold the concept of a nurse practitioner to the public as a whole. I am sure the Hon. Member, when seeking medical attention, would want a good diagnosis as quickly as possible, one which would take into consideration his total well-being and state of health. He would be the very first one to complain that he should have been assessed and treated by someone who is very conscientious, intelligent and dedicated and not someone who really does not have the full experience or background to make the kind of diagnosis he would want.
If we were able properly to sell to the Canadian public the very fine service that nurse practitioners can give and if the program were such that nurse practitioners would work with the appropriate clinical and medical background, I think it would be an ideal way of reducing costs and giving good service. I do not think that society has accepted that concept as much as the Hon. Member and the nurses feel at the present time.
His other question referred to advertising various preventive methods of controlling health and that is a major undertaking. I think that one of the best examples of this is the program showing the defects and problems caused by smoking, although that still has not eliminated the problem. The number of cigarettes smoked each year is increasing, so the effectiveness of that program can be questioned. You can only go so far with the educational techniques and methods we have, because it is the individual's will to accept consultation and advice that counts in the long run.


Mr. Breau:: he believe physicians are using this as a psychological outlet in the bargaining process in the long term rather than as an effective means of raising income?


Stanley Hudecki: Mr. Speaker, physicians are individuals and it would be difficult for me to generalize. Undoubtedly some feel the pay is inadequate for the service, training, background and responsibility they have. Some are just anxious to increase their particular income. A good number of them will argue that this is gross discrimination but that is a minority group. As a minority group doctors are it is forced to accept the fees set by the Government and do not have the individual freedoms that are accorded to other members of society.
Then again, there are others who use it simply as a safety valve in order not to be suddenly found to be under the complete control of government; in other words, to be state controlled physicians, knowing from history what that could lead to in controlling the type of treatment you and I would receive from them.
1 really cannot put my finger on any one attitude but I think it is a combination of the three or four that I have mentioned.


Mr. Cosgrove:: Mr. Speaker, I have a short question. I listened attentively to the Hon. Member make his presentation and because of his reputation in his profession and in his community I want to pose these questions.
I have observed that the Canadian Medical Association has, I believe, sponsored yet another committee to canvass the opinions of Canadians on the subject of the health system in Canada. I would be interested in the Hon. Member's opinion of the fair-mindedness of any recommendations that would come from a committee which has obviously been directed by the Medical Association.
The Hon. Member concluded his remarks rather rapidly, Mr. Speaker. I wonder if he wanted to summarize or would wish to conclude in some form on this comment?


The Acting Speaker (Mr. Herbert):: The Hon. Member for Hamilton West (Mr. Hudecki) has 30 seconds.


Stanley Hudecki: Mr. Speaker, I think I will just comment on the task force that has been organized by the Canadian Medical Association. I can assure you it is a very objective task force that has been brought together. The only name that comes to mind is that of the former Lieutenant-Governor of Ontario, Pauline McGibbon. I think the committee will go into some detail in examining the costs and defects in the system and will come up with recommendations.
To show you how fair I think it will be, some members of the Canadian Medical Association are concerned that much of the information that may come out of this committee may contradict some of the statements they are making. 1 think it is a very objective committee and we should look to it for advice, support and guidance.


The Acting Speaker (Mr. Herbert):: That is the end of the 10-minute period allowed for questions and comments.
Canada Health Act


Mr. Epp:: Mr. Speaker, I have a point of order and I should like your advice. I draw to the attention of the House that there is no Minister in the House and Government business is being debated. I wonder if that is in keeping with their position.


The Acting Speaker (Mr. Herbert):: That may be desirable but I do not think it is obligatory.


Mr. Tom McMillan (Hillsborough):: Mr. Speaker, that is particularly desirable when I am on my feet making a speech.
I am pleased to participate in the debate on Bill C-3, the Canada Health Act. If I may be permitted a personal reference, my interest in the subject stems largely from a strong family connection with the health care profession. My late father was a surgeon; an uncle, his brother, is a urologist in Charlottetown; my eldest brother is a cardiologist in the same city; a brother-in-law is the public health officer in New Brunswick; a sister is a hospital dietician, and another sister is an instructor of nursing associated with a large hospital in Peterborough, Ontario. But I cannot stand the sight of blood, Mr. Speaker, which explains why I am a politician and not a doctor!
My own views do not merely reflect the interests of the health care professionals. I have made up my own mind on the question before us. I think the Progressive Conservative caucus as a whole has done its homework under the outstanding leadership of the official spokesman for this Party in the field of health, the Hon. Member for Provencher (Mr. Epp). Other members of caucus have done a lot of work in the area as well. Among them is the Hon. Member for Rosedale (Mr. Crombie) who, as Minister of National Health and Welfare in the Clark Government, laid the groundwork for a major review of health under the direction of Mr. Justice Emmett Hall.
I am proud that the new Leader of this Party was so quick to express his support for medicare following his election to that post in June. Indeed, support for medicare was one of his major policies in the Central Nova by-election.
Given the Party's long-standing commitment to medicare, extending back to the Progressive Conservative leadership convention and policy conference in 1956, one can only express puzzlement at the Government's and the media's surprise that Progressive Conservative Members of Parliament would support the Canada Health Act.
While recognizing that the Bill is far from perfect, how could we not vote for, or at least support in principle, legislation of this kind, given our history of commitment to the bases of medicare? After all, it was the Diefenbaker Government which enacted the Hospital Insurance and Diagnostic Services Act in the late 1950s. That legislation, which extended access to hospital coverage on a prepaid basis to all Canadians, was a precursor to medicare and is now to be superseded by the legislation being debated today.

January 20, 1984
Canada Health Act
The same Diefenbaker Government established the Royal Commission on Health Services headed by Mr. Justice Emmett Hall, reflecting the intent of the government of the day to launch a national medical insurance plan. When the succeeding Liberal Government in 1966 sponsored the Medical Care Act based on Mr. Justice Hall's report, every single Progressive Conservative Member of Parliament without exception, to my knowledge, voted for it. Our Party's support for the principles of medicare-universality, accessibility, portability, comprehensiveness, and public non-profit administration-has not flagged since that time. Why, then, I ask you, Sir, should anyone be surprised by the position which the Party is taking on Bill C-3?
This Bill seeks to do several things. Essentially it details the conditions under which federal payments will be made to the provinces for insured health services. Basic to those conditions is the Government's opposition to extra billing and user charges by doctors and hospitals. The Bill authorizes the federal Government to reduce payments to a province by the amount of extra billing or user fees it charges.
As far as my own Province of Prince Edward Island is concerned and the Atlantic region as a whole, this facet of the Bill has little direct relevance, if any, which is an irony because extra billing has been at the heart of the medicare controversy. There is very little extra billing in the Province of Prince Edwaid Island. To the extent that it exists, island doctors are allowed to extra-bill while remaining in medicare. They simply bill the patients directly, then arrange for them to be reimbursed by the plan for the amount covered by medicare. If the charge is no more for a given service than the amount covered by medicare, the doctor can bill the plan directly and the patient never has to pay a single cent out of his or her pocket. In the event the charge for the medical service does exceed the amount covered by the plan, there are flexible arrangements for the payment of the balance.
In practice, Mr. Speaker, few doctors in Prince Edward Island extra-bill. Extra billing tends to be restricted to rare cases where patients request special services beyond normal medical requirements; or even less often, where the fee covered by medicare for a particular service is patently out of whack with its widely accepted value. In fact, each year the total amount of extra billing by the Island's 120 practising doctors is less than $500,000. This is a small sum relative to the $118 million contributed to health care by the federal Government, by the province and by the private sector together. Moreover, Islanders are not charged premiums for medicare, and user fees are not levied at local hospitals. In most of the rest of Atlantic Canada, the level of opting out and extra billing is about the same as that on the Island. In all of Canada, in fact, the amount of extra billing last year was only $100 million, which is a paltry sum in the context of the total national health care bill of $30 billion.
Yet, the Minister of National Health and Welfare (Miss Begin), in an effort to latch on to an issue which would shore up the sagging fortunes of the Liberal Party, has talked about
little else for well over a year now. She has treated the issue as though it were not just the most important health question in the country, but the only one. In the process, the real problems which plague the health care system have remained neglected. In truth, Mr. Speaker, the Government's Health Care Act is virtually irrelevant to the conditions of Prince Edward Island and Atlantic Canada as a whole, and I venture to say it is irrelevant to the concerns of most Canadians.


Herb Breau: How can you say that?


Thomas Michael McMillan: It utterly fails to address our most important problem-and this includes the Province of New Brunswick-which is not one of how funds are raised but rather whether funds are available at all for certain types of health care. In Prince Edward Island, for example, and in New Brunswick, Nova Scotia and Newfoundland, a limited tax base prevents the province from offering a range of medical services which are taken for granted elsewhere-


Herb Breau: Nonsense.


Thomas Michael McMillan: -or from covering under medicare certain types of services which are offered. The plan does not insure- and I direct this to those who say this is nonsense and 1 advise them to check the facts-the plan does not insure such fields as podiatry, optometry and chiropractic-I am talking about my own province in this case-nor are drugs covered, even for senior citizens, as is the case in some other provinces.
The funding problems of Prince Edward Island are compounded by the fact that it has the highest proportion of senior citizens in the entire country. Twelve per cent of the population is over 65 years of age as compared to only 9.5 per cent nationally. At present the age group over 65 years accounts for approximately 42 per cent of all those who use hospital services in Canada. Statistics Canada has documented that, if current hospital capacity and utilization rates remain unchanged, Canadians over 65 will require 71 per cent of all hospital beds by the turn of the century, and every hospital bed in the country by the year 2021. This situation, given current trends, will likely continue to be even more critical on Prince Edward Island than in the country as a whole.
Despite those facts, Mr. Speaker, the Health Care Act before us for debate today remains silent on issues, concerns and problems of that kind. At a meeting with the Health Minister of P.E.I., Albert Fogarty, the federal Minister refused to commit herself to addressing the province's specific concerns. Mr. Fogarty himself has promised to seek support from his counterparts throughout the region so as to convince Ottawa to act. For my own part, I have begun to discuss the matter with Members of Parliament from the Atlantic region in both major parties in an effort to broaden support for Mr. Fogarty's initiatives.
One possibility which is well worth pursuing, and which was alluded to a few moments ago by a representative of the New Democratic Party, is increased utilization of nursing and other non-physician personnel to provide high quality, cost-effective services to all members of the population, especially the aged.
January 20, 1984

Access to the skills and abilities of such personnel is limited in the existing system, geared as it is to traditional physician-based care.
Similarly, more needs to be done to deliver health care services outside the conventional hospital setting. Hospital care constitutes about half of Canada's total health care costs and nearly two-thirds of all government spending on health. Current arrangements encourage some doctors and patients-not all of them but enough to be of concern-to over utilize hospital facilities. Controlling hospital expenditures, therefore, will require incentives to employ non-hospital facilities, including community health centres and home care, where possible.
The author of a superb study published in 1972, Dr. John Hastings, then of the University of Toronto, and 1 believe he may still be there, once said that it would cost less to care for some patients in a first-class hotel than in a hospital without any sacrifice in the quality of service. In P.E.I. about 10 per cent to 20 per cent of acute care hospital beds are tied up by convalescents when these people could just as easily be cared for out of hospital in facilities more appropriate for that purpose and cheaper to service.
Clearly savings can be achieved in all kinds of ways that could free up money for health care objectives. A major emphasis on preventive medicine would serve the same end. At present the system is biased in favour of curing illness rather than preventing it. The priority, Sir, is exactly the opposite of what it should be.
In the final analysis, cost-saving measures must be based on a genuine commitment by government to health care. That truth applies to the federal Government as much as it does to the provinces. While attacking the provinces for the way they are funding their share of health care in Canada, the Minister's own Government has actually been reducing its relative contribution to the system. The Minister engages in statistical sleight-of-hand to prove otherwise. But when preventive and extended health care programs are included in the calculations, the federal Government's contribution to the national health care system is now down to 40 per cent, compared to just under 50 per cent when Established Programs Financing was launched in 1977.


Herb Breau: Check your facts.


Thomas Michael McMillan: The Hon. Member for Gloucester (Mr. Breau) spoke about federal-provincial sharing of health costs in his speech in the House on Tuesday. He, above all other Members, should be aware of the federal Government's role in the erosion of program conditions. He headed the all-Party parliamentary committee which unanimously warned the federal Government that if it persisted in its plans to remove the revenue guarantee component for funding of health and postsecondary education, the erosion of program conditions like universality and accessibility would follow.


Herb Breau: You have not read the report.
Canada Health Act


Thomas Michael McMillan: Yes, I read the report from cover to cover. The Government ignored those warnings and the erosion followed. The Minister of National Health and Welfare and her colleagues have only themselves to blame for the very situation they are scrambling to rectify now.


Arthur Jacob (Jake) Epp: MacEachen said it himself.


Herb Breau: If you read the report-


The Acting Speaker (Mr. Herbert):: Order, please. Would you please address your remarks to the Chair.


Thomas Michael McMillan: Mr. Speaker, if the federal Government is now to legislate against user fees, as I think it should because they do deter some people from getting the health care they badly need, that Government has an obligation to assist provinces to make compensating cost savings in the delivery of health care. Otherwise the Government's action against user fees will penalize the very people it is intended to serve, namely the public, by robbing the system of badly needed funds.
Sir, to the extent that the Atlantic provinces now charge user fees, and that is a limited extent, our region will be hardest hit if they are abolished. 1 say that because the provincial governments in the Atlantic region, including New Brunswick, are least able to replace the lost funds from alternative sources. As things stand, the region is able to ensure only 75 per cent of the services available in other parts of Canada.
These problems cannot be resolved in a spirit of discord and distrust between the federal Government and the provinces on the one hand, and between the federal Government and the medical profession on the other. Yet, not since the birth of medicare has there been as much acrimony as there is now. It is as though the Minister of National Health and Welfare had deliberately set out to create an atmosphere where it would be more difficult to resolve the controversy. Certainly she has injected into the debate, Mr. Speaker, a degree of partisanship without precedent under previous Ministers of National Health and Welfare.


Herb Breau: What are you doing?


Thomas Michael McMillan: One should not question her genuine commitment to health or medicare, and I do not. In fact, I pay tribute to her. But neither can one doubt her meanness in dealing with the provinces and doctors alike. By poisoning the atmosphere for progress on the real problems plaguing the health care system-funding, regional disparities, overutilization of acute care facilities and neglect of alternative approaches like extended care and preventive medicine-she has done a tremendous disservice to those whose cause she purports to champion.
In conclusion, Mr. Speaker, in my view, and not because of partisanship but because of my appreciation of the harm she has done, the Prime Minister (Mr. Trudeau) would be wise to replace the Minister of Health and Welfare at the earliest

January 20, 1984
Canada Health Act
possible moment with an individual more strongly committed to co-operative federalism and to basic principles of harmonious government-private sector relations. Then everyone concerned, among them people in this House, could get on with the task at hand of making medicare work for Canadians in every region of the country.


Raymond John Skelly: Mr. Speaker, I have two questions for the Hon. Member. In the Edmonton Journal of December 15, the past president of the Alberta Medical Association, speaking of the federal Tories accepting medicare, said that they can see that they would be dead ducks if they went against medicare. Instead, the federal Tories will do something to defuse this politically touchy election issue and have promised that when they get in power they will fix it up and make it right for us.
If that is the bargain between the doctors of this country and the Conservative Party, I think it is unfortunate that the previous speaker, and particularly the Conservative Party health critic, did not lay out the mechanism of how they are going to make it right for the doctors.


Arthur Jacob (Jake) Epp: Yes, I did.


Raymond John Skelly: This seems to have been confirmed by other members of the Conservative caucus from Alberta who are quite free in their comments on what they will do when they are in power. There is a great deal of fear about the permissiveness of that legislation. Perhaps the previous speaker can tell us what the formula will be for making it right for the doctors.
Secondly, he mentioned the proposals of the Canadian Nurses' Association. I refer to the four basic proposals in which that organization is looking for a substantial improvement in health care in Canada through prevention, home care programs and substantial reduction in costs. I am interested in why the Conservative Party health care critic is not mentioning in public their willingness to fund those programs. If the Hon. Member's Party should form the Government, why are they not prepared to stand up here in the House and say they will directly fund those kinds of programs?


Thomas Michael McMillan: Mr. Speaker, I have about 90 seconds to answer two questions. As to whether we have given any commitment to the medical profession or the provinces, let me simply say that we have given a commitment, and I confirm it here, not only to them but to Canadians as a whole, that we will approach health care in an atmosphere of harmony, not discord. We are not going to use doctors or provinces or even patients in the way the NDP and the Liberals have done for their own narrowly defined political advantage. We are interested in reforming medicare and preserving it, not in using it as a rallying cry around which to shore up the sagging fortunes of the socialists and the Government Party.
On the second point, the question is almost as though the Hon. Member who posed it had not listened to a single word uttered in long and thoughtful speeches by my P.C. colleagues the Hon. Member for Provencher, the Hon. Member for Rose-dale, the Hon. Member for Oxford (Mr. Halliday) and the
Hon. Member for Calgary Centre (Mr. Andre), all of them dealing in detail with the specific question he raised.


The Acting Speaker (Mr. Herbert):: Order please.
It being one o'clock, I do now leave the chair until two o'clock this afternoon.
At 1 p.m. the House took recess.


[Stage Direction]
AFTER RECESS

The House resumed at 2 p.m.
The Acting Speaker (Mr. Herbert):: Following the remarks of the last speaker there remain six minutes for comments.


Mr. Dionne (Northumberland-Miramichi):: Mr. Speaker, this is the first opportunity I have had in the House to offer my congratulations on your appointment as Deputy Chairman of Committees of the Whole House. From the time I have been here I can say that you have been one of the most assiduous attenders of the House. It is obvious that you have a good knowledge and feel of the House. I know you will do a good job in your position.


Some Hon. Members:: Hear, hear!


Maurice Adrian Dionne: Mr. Speaker, I got up before the lunch hour adjournment in order to put a question to the previous speaker, the Hon. Member for Hillsborough (Mr. McMillan). Since he did not have the courage to come back to defend the equivocal position he took-


Mr. Thacker:: I rise on a point of order, Mr. Speaker. I do not mean any unkindess to my friend from Northumberland-Miramichi, but as I recall the rules there is nothing in them that say that in the absence of the person who held the floor there can be questions and comments. I would seek your ruling on that. It seems to me, with the previous speaker unavoidably being able to be here, that ends his part of the day and we move on to the next speaker.


The Acting Speaker (Mr. Herbert):: That is not a point of order.
The Hon. Member for Northumberland-Miramichi (Mr. Dionne).


Maurice Adrian Dionne: Mr. Speaker, I started to say that I had a question for the Hon. Member for Hillsborough. Since he did not come back to the House he obviously over ate, or something else happened of that nature. I will make a brief comment on his remarks.


Blaine Allen Thacker: Mr. Speaker, I rise on a point of order. Again my friend, the Hon. Member for Northumberland-Miramichi,
January 20, 1984

should not be making comments vis-a-vis the eating habits of my colleague from Hillsborough, just as we do not comment on members' drinking habits or other habits of a personal nature.


The Acting Speaker (Mr. Herbert):: Again, that is not a point of order. I would ask the Hon. Member for Northumberland-Miramichi to confine his comments to his speech.


Maurice Adrian Dionne: That is precisely what 1 was trying to do, Mr. Speaker, when I was interrupted twice by the Hon. Member for Lethbridge-Foothills (Mr. Thacker). In any event, I thought the Minister of National Health and Welfare (Miss Begin) had done the Tory Party a favour, as well as the people of Canada, when she brought in this Bill. She finally smoked the Tories out and made them, as a Party, take a position on medicare.
The Hon. Member for Hillsborough did a rather beautiful job today, if I can describe it that way, in fuzzing his position. 1 wanted to know, having listened very carefully to his speech, if one could get him to extricate himself from that picket of the fence he was straddling, what his position was on extra billing. Since he is not here to answer the question and having listened to his speech, I can only conclude from his remarks and from the way he associated himself so closely with those elements of the medical profession who extra-bill that he is in favour of extra billing.


Blaine Allen Thacker: Mr. Speaker, I rise on another point of order. My colleague from Northumberland-Mirtamichi knows very well that he cannot draw opinions from the comments of other people. He can give his own statements but he cannot make erroneous and false statements as to what an Hon. Member said.


The Acting Speaker (Mr. Herbert):: I am sorry, that is not a point of order. This is debate. I would ask the Hon. Member for Northumberland-Miramichi to wrap up his remarks.


Maurice Adrian Dionne: Mr. Speaker, 1 would have finished by now had 1 not been interrupted again. It is obvious the Hon. Member for Hillsborough is in favour of extra billing-


Blaine Allen Thacker: That is not right.


Maurice Adrian Dionne: That leads me to ask the Tory Party, and the official critic can answer, with your permission, Mr. Speaker, what is its position on extra billing? Are the Tories in favour of it or are they not?


Arthur Jacob (Jake) Epp: 1 would like to comment, Mr. Speaker, and I want to say to the Hon. Member for Northumberland-Miramichi (Mr. Dionne) that while he has a lot of experience, his learning needs a lot of filling in yet, obviously. He is not listening very well.
1 point out to the Hon. Member that the official position of the Conservative Party is supporting the principles of this Bill. If the Hon. Member has read the Bill, the one brought in by
Canada Health Act
his own Minister, he will find out there are penalties attached for extra billing and user fees. I have said on behalf of our Party, our Leader has said so, and every member of our caucus has supported fully, that we do not favour extra billing.
Having said that, there is another point I think that has to be made. I would like the Hon. Member to listen. The Canada Health Act leaves unstated and unresolved some of the very deep issues affecting the Canadian medical system. That is what the Hon. Member for Hillsborough (Mr. McMillan) was raising. He was doing so from the point that when we look at aspects the Minister has in her bill, it is legitimate also to look at other aspects, a point made in my speech as well. If you talk to any health care professional you will find that health care professionals are not opposed to medicare. What they are deeply concerned about is the demographic reality that we will face as Canadians. They are concerned about defensive medicine, technology and its impact on costs, preventive health care and the better use of health care professionals; and, most of all, that the medical system can only survive and be enhanced if there is co-operation between the federal Government and the provinces and health care professionals.
I know the Hon. Member reasonably well. I think he is a fair-minded enough man even though his comments today would not really indicate that. Health care professionals feel very strongly that the Minister was trying to pick a political fight. That fight has been defused. The Hon. Member knows and I notice that a lot of Liberal back-benchers are gritting their teeth because that issue has been defused. Now what we are interested in is not only the Bill but other issues. I would like to know from the Hon. Member how he stands on those five or six issues that I reiterated and which the Hon. Member for Hillsborough embellished in his speech.


The Acting Speaker (Mr. Herbert):: Order, please. The period for comments has expired.


Mr. Gary F. McCauley (Moncton):: Mr. Speaker, I have been sitting here on my ample back bench since May, 1979. Since February, 1980, I have watched in profound amazement the antics of the Official Opposition. I have watched its members destroy the credibility of Parliament. I have watched them ridiculously ringing bells.


Mr. Forrestall:: Is this your maiden speech?


Gary Francis McCauley: I have watched them deliberately and unjustifiably hamper the passage of good legislation.


Blaine Allen Thacker: Is he really a member? I have never seen him before.


Gary Francis McCauley: I have watched them jump out like little children from behind curtains to vote against legislation designed to assist many Canadians. I have watched them perform like clowns doing serious damage to the image of other parliamentarians who are working hard for their constituents with honesty and integrity. The entire nation watched the internal convulsions of the Official Opposition Party as it wrestled with the problem of how to please everyone with its

January 20, 1984
Canada Health Act
position on the Western Grain Transportation Act. The solution of the Official Opposition was to do nothing for three more years.


Arthur Jacob (Jake) Epp: We would have all been better for it.


Gary Francis McCauley: That is really taking a stand. At least the New Democratic Party had the intestinal fortitude to stick with its original position. As NDP Members saw it, it was a position of principle.


Blaine Allen Thacker: Why didn't you stick to your original position?


Gary Francis McCauley: The people of Atlantic Canada watched the Leader of the Opposition (Mr. Mulroney) attack the National Energy Program which has been of so much benefit to the people of Newfoundland and Nova Scotia. The list of obstructionist tactics by the Official Opposition goes on and on. It was opposition for the sake of opposition; destructive opposition for the sake of opposition.
Finally and amazingly, the Official Opposition is now in full support of this Bill. Why? Because even the Official Opposition, wonder of wonders, knows that it cannot play games with the health of Canadians. The Canadian people will not stand for it. They will not tolerate children rushing from behind curtains, vis-a-vis this Bill. Canadians will not tolerate bells ringing when it comes to this Bill. This Bill ensures that all Canadians will receive proper health care. The vast majority of Canadians support it fully. A poll which I conducted in my own riding indicated that 84 per cent of the people who responded were in favour of a publicly funded system of health care in Canada. 1 believe that opinion is typical of Canadians throughout this land.
I noted with great interest an editorial which appeared Tuesday in a certain right-wing Toronto newspaper chastising the Opposition Leader for his support of the Canada Health Act. Apparently the right-wing legions out there are incensed, many of whom are members of the Conservative Party. We have all read the polls conducted by the Tories of their convention delegates which indicate that 82 per cent felt that funding for medicare could be reduced or kept at current levels. It seems to me the Tories have a problem. This view of Tory delegates contradicts what the Leader of the Opposition stated publicly and what the Hon. Member for Provencher (Mr. Epp) stated in the Chamber last Monday. Whom are we to believe? What is the real position over there? I suggest that the sacred trust about which the Opposition Leader speaks with regard to medicare is little more than a friendship of convenience, to be trotted before the Canadian public only when Tory backs are up against the wall.
[DOT] (M20)
Given the recent potential for further erosion of medicare in Canada, it was urgent that steps be taken to protect medicare. The Government of Canada has a social responsibility to ensure that no one in the nation wants for medical care. This is not a gift to be disposed of by whim but a social right of every
citizen. Health care in Canada today is not better just because we have more and better doctors, just because we have more hospitals or are committing more public funds than ever to this essential service. Canadians receive better health care today because humane social policies, Liberal policies, formed the foundation of medicare.
The Canada Health Act renews a commitment made to Canadians that freedom of access, equality and administrative efficiency would be the hallmarks of publicly financed health services. I would like to speak about freedom of access for a moment. If access to quality health care was not a right, who would be the first to suffer? It would be the poor and the elderly. Who would wish to see a two-tiered system in Canada where one's state of health would be determined by one's financial resources? Poor and rich alike should have equal access to medical care when they are sick.
Federal-provincial financing of medical services has resulted in administrative efficiency as well. Today we have a substantially greater number of physicians and hospital facilities, and a more equitable distribution of both than would have resulted in a health system dominated by private insurance. Having one plan reduces administrative costs, eases the fears of the ill and simplifies the delivery of health services. Voices from the right call for privatization of the Canadian health system, and these same voices attack the Canada Health Act because it proposes Financial penalties for those provinces which allow user fees and extra billing.
We have heard the arguments-user fees deter frivolous use of medical services and extra billing provides an infusion of cash into the national health sytem. I, for one, am tired of listening to those arguments. There is no evidence to support the claim that hospital services are being abused. We know from the report of the Hall Commission that hospital user fees deter the sick, the poor and the elderly from obtaining medical treatment. However, is that what we want? I think not.
Recently the New Brunswick Minister of Health gave a ringing endorsement of user fees by stating that visits to outpatient departments have fallen by 16 per cent since the imposition of user fees in that province. Also the Health Minister announced that the revenue from these fees for the first year should approach some $3.4 million. It is true that people may have been deterred-the poor and the old-but the claims of savings are very suspect. The Government of New Brunswick is operating under a fiscal illusion. Money is saved only if alternate care is not sought. We must then look at the costs of seeking that alternate care or, of greater importance, the costs of forgoing care. In this case lack of treatment could cause serious illness. Indeed this is false economy. Further I remind the Government of New Brunswick that its calculations are based upon a partial study; this its brave estimate of perceived savings presents a shaky argument for regressive fees.
For Canadians the cost of extra billing in 1983 was $72 million. This is unacceptable. Canadians should not have to pay again for a service they have already paid for. The arguments for extra billing are as fallacious as those for user
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fees. Without a doubt extra billing discourages office visits, but this is not something to cheer about. Doctors claim they extra-bill because they do not receive adequate compensation for their services. If this is so, why do not all doctors extrabill? The vast majority of doctors have chosen to accept the provincial benefit schedule and do not extra-bill for any of their services. As well, extra billing is more common in provinces where the incomes of doctors are generally higher. There is no evidence that higher pay schedules for doctors deter extra billing. For instance, in Alberta a large fee schedule increase of 15.5 per cent in 1979 had little, if any, impact on the level of extra billing.
Both extra billing and user fees are said to put extra funds into our health care system. This is nonsense. Physicians pocket the dollars from extra billing and, as I have pointed out, user fees are not an effective cost remedy. In fact both these deterrent charges are in reality a public health hazard.
I want to touch briefly on the myth of underfunding. No respected independent health economist in Canada feels that our health care system is underfunded. Earlier this week I heard the Hon. Member for Oxford (Mr. Halliday) talk about the "dearth of funds in the health care system". Also I heard his suggestion that both user fees and extra billing are benign responses to underfunding of the system. This type of misinformation adds little to the debate.
I agree with the view of the New Democratic Party health critic that we should look to the future of medicare. I personally envision a health care system based less on large institutions and more on community health centres, home visitation programs and programs of preventive medicine, all of which would complement our large hospital complexes. He spoke mainly of increased funding-and that is typical of that Party-to reform the health system when in fact the modes of delivery of which he spoke are considerably less expensive than traditional delivery systems. Expanded funding alone will not preserve the principles of medicare. A reaffirmation of the federal commitment to medicare, as this Bill surely is, will show our political will is unshakeable. The principles of medicare can be ensured only by a moral decision to do so. The foundation must be strengthened before reform can proceed.
Similarly, I find the views of the Conservative health critic, the Hon. Member for Provencher, that provinces cannot afford to get into alternate care schemes because they are now strapped for funding, to be a misleading argument. I use as an example my Province of New Brunswick where an extramural system of hospital services was begun two years ago. The goals of the program were to reduce demand on hospitals and nursing homes, reduce demand on high-cost, high-tech equipment, reduce home visitations by doctors and expand the roles of nurses, occupational therapists, physiotherapists and dieticians, to name a few. These services allow hospitals to discharge patients early, thereby freeing acute care beds. The terminally ill are often cared for at home in a more comfortable, supportive and familiar environment. The results of the program are admirable. Presently the patient cost per day in
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this program is $22, compared with $220 per day in hospitals and $50 per day in nursing homes.


Dave Nickerson: Mr. Speaker, I rise on a point of order. I feel obliged to bring to your attention the fact that the Hon. gentleman is reading his speech. I can see distinctly from this angle that he is reading word for word what he is saying. This is prohibited by the rules. However, we might be lenient with him. Although he has been here since 1979, it would appear to be his maiden speech. I have never heard him speak in this House before.


Gary Francis McCauley: Mr. Speaker, I suggest to my colleague from across the way that he has an eyesight problem. Perhaps he should see an ophthalmologist, one that has not opted out. I am referring to notes, as anyone with good eyesight can see.
I would simply like to say that services provided by extramural programs, for example, can reduce the cost of health care in any province. If we can do it in New Brunswick, which is not one of the wealthier provinces in this country, it can be done anywhere. So much for the argument of the Tory health critic that provinces cannot afford alternate systems of health care.
I applaud the efforts of the Canadian Nurses Association in pushing for a greater role in health delivery. Study after study has demonstrated that nurses offer a cost-effective alternative to today's high-priced hospital and physician-based system.
In conclusion, the answer to our alleged health problems is not to ration health care, but to rationalize the delivery of that care. We should not indiscriminately increase funding without first discerning where the money is going and, second, whether an appreciable improvement in the quality of health care will result. Bill C-3 could be termed a counter-offensive against those who wish to destroy the Canadian institution of medicare. The threats to medicare are real, the defence is necessary and must be continued. The medicare bill epitomizes what the Liberal Government stands for. It stands for meeting the needs of all Canadians, not just the vested interests of a few.


The Acting Speaker (Mr. Herbert):: There are ten minutes for questions and comments.


Blaine Allen Thacker: Mr. Speaker, it is a privilege to rise today and address some comments to Bill C-3. There have been some fine speeches on it. The Liberals have again shown that they are prepared to say anything, do anything, be anything in order to be elected. Once again we have caught them out to lunch. They thought they had a great issue with medicare. They thought because they heard the odd so-called right-wing Conservative, often not even a member of the Party, making comments that they had a real issue.
The Liberals failed to realize that John Diefenbaker brought in the original Hospital and Diagnostic Services Act. It was John Diefenbaker and this Party's Bill that set out the five conditions which they laud and parade around the country. It
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has a long history. 1 do not know why they will not admit it. It is amazing how long these myths and tales go on.
What we are talking about is $5 billion cash that is raised through this Parliament from all Canadians and then transferred to the provinces for the purposes of health care. We are talking about what are reasonable conditions that Parliament and the elected members should expect in order to be accountable for that $5 billion. We all agree that under the medicare system, which covers both doctor and hospital services, the five conditions are reasonable. We all agree that reasonable reporting and information should come from the provinces. Therefore, we do not have an issue on the points that the Minister has been trying to make.
It is important for Canadians to remember that we are dealing with the cost of doctors and their services, which is about 15 per cent of the overall total cost of health care. We are also dealing with the other 85 per cent which covers hospital costs and the operating and capital costs for the system. It is to that area that we need to direct our attention, particularly for the future.
My first major point is that medicare is universally agreed to. No one disputes the value of it. When we get sick and are not able to work, all we want to concentrate on is getting better. We are prepared to pre-pay, whether by premiums or general taxation, hospital costs. That is a reasonable request.
In terms of social policy, I do not see that as being socialism. My attack against the Liberal Government and the NDP is the way they have socialized the economic creation of wealth. History has taught us for many centuries that it is the individual and the flexibility that individuals give to corporations as well as their entrepreneurial spirit that creates wealth rather than the state trying to do that. That is why we are Progressive Conservatives. In terms of economics, we are Conservatives because we know the individual can do better than Canadair, Petro-Canada or de Havilland. In terms of social policy, there are all sorts of things we can do collectively; for example, our educational system from which we all benefit.
I, along with other Hon. Members, have studied this issue very carefully. I have listened to and talked with many doctors. I have read the views of the provincial governments. I am convinced that the Minister of National Health and Welfare (Miss Begin) deserves some genuine and fair criticism for the manner in which she has handled this whole issue over the last two or three years. She has tried to politicize this issue for the benefit of the Liberal Party. That will punish them, as the polls show. People are on to that.
The Liberal Party has been elected too many times by bringing forward issues that appeal to a certain sector and is prepared to write off whole sections of the country. That is not acceptable. People do punish political Parties. In 1968 the Liberal Party had 27 western members. It does not have any in the west now. It is not because there is anything wrong with the Constitution or with the people of the west. It is the deliberate policies which they brought forward.


Herb Breau: Is that why you do not have any members from Quebec?


Blaine Allen Thacker: Exactly, and this Party will get its act together, as it is now doing, and will start to get members from Quebec.
The Minister of National Health and Welfare and the federal Government missed a golden opportunity to grasp this whole question of health care and leave medicare stronger for our children and grandchildren. By their fights with the provinces in other areas, whether it was on the first proposal of the Constitution or on the National Energy Program, they have set up a climate of distrust. When people want all of us to work together and handle the medicare problem, it cannot be done. This is because the relationship between the provincial and federal Governments has been too badly injured.
The majority of doctors want medicare to work, but they feel alienated when they deal with the provincial governments which so often unilaterally take a position and set a fee schedule. When they turn to the federal Government and listen to the speeches from the NDP and Liberal members, they find that they are attacked in their personal and medical qualities. It is simply unacceptable for us in public life to be going after a very critical and important part of the medical profession in particular and the whole area of health care.
I personally believe that we should be listening, understanding and accepting that broad central opinion of the medical profession and that we should listen to them, because their true position is much different from what the NDP members are saying in their vicious personal attack on doctors. Having served on a hospital board, I happen to believe that doctors are absolutely critical to the successful operation of the whole system. I am also convinced that the average Canadian holds their doctor in high esteem and for very good reasons.
While they still have the highest average income-which is another reason why the doctors must understand the perceptions of others-they are still the hardest working people in this country. A 65 to 70-hour work week is still typical. I think the NDP have particular difficulty understanding the position of a professional person, especially doctors. They are never away from their practice. Their mind is never away from the concerns of a particular patient who is critically ill in hospital. That is one of the obligations of being a professional and the vast majority of doctors meet those obligations well.
When they say to me that they believe, particularly in the long run, that the system is underfunded, I believe that they are right. They are saying that if we continue with this closed, inflexible system that we have now, we cannot fund it over the long run. As our population becomes older, unless there is more flexibility and creativity in the system, it simply will not operate. The system will come tumbling down and we will have left our children and grandchildren in a much worse position than we are in. That is what the doctors are saying when they say that the system is underfunded.
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I saw some statistics on the comparison of high technology equipment between Montana, which is one of the poorest states in the U.S., and my own Province of Alberta, which is one of the richest provinces in this country. The amount of high-tech equipment in Montana is unbelievable. It far exceeds what exists in Alberta. When one asks why we do not have that amount of equipment, the reason is that a system has been put in place which is inflexible and we have a federal Government that is unilaterally trying to dictate so many things rather than negotiating with the provinces. For instance, it does not recognize Alberta's unique situation and try to work something out, or work something out with New Brunswick, for example. We must have co-operation. Surely that is the lesson we must learn. Politicians should not try to politicize the issue as the Minister initially did. If she has learned nothing else out of this, I hope she has learned that.
Eighty-five per cent of the overall health care costs go to the hospital system, both in the operating costs of the hospital to cover nurses, nurses-aides and the equipment they use, as well as the capital equipment in the hospitals. This includes the "cat" scanners that we so desperately need and the high technology equipment we need to keep babies and senior citizens alive.
I believe the doctors when they say that the current system and the tensions have caused many medical people, in certain specialties particularly, to emigrate to the United States. I suggest it is mostly cardiac surgeons and ophthalmologists who leave. Those doctors leave not only for the money; it is also a matter of equipment and a matter of attitude. They leave because they do not believe that the existing inflexible system will offer any reasonable solution in the near future.
To my mind the exodus of doctors is serious. In 1981 a total of 1,050, if you include interns, resident physicians and civilian physicians, left the country. In 1982 some 1,196 medical people left. That is a serious drain of high professional skills.
The doctors in my home city of Lethbridge, who serve some 120,000 people in all, tell me that it is certain categories of specialists who are going. Under the medical fee schedule, for an operation for which they will receive some $500, or even $900 if they extra-bill another $400, for that same operation Montana pays $3,000. While money is partly the reason they leave, I believe doctors when they tell me another reason they leave is their attitude, that they do not see any hope here.
The United States will not disappear. We must have a system which will allow doctors to stay here and feel comfortable here. It is true that certain steps can be taken in the Province of Quebec in terms of permitting them to opt out and imposing a system where neither the doctor nor the patient can collect the medicare fee. However, this cannot be done in the rest of the country because many of the doctors in Quebec are trapped, in a sense, because they want to work within their own language and culture. The doctors in the rest of the country are not so confined and they will leave. The people who will suffer will be our daughters, sons and grandchildren.
I believe doctors when they say that this rapidly aging population will totally inundate the system. I believe them when they say that we need to have more long-term care. As
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they point out, often some 30 per cent of the acute hospital beds are filled with long-term patients. If those people could be moved into long-term units, it would free 30 per cent of the beds which would then allow people to be moved through the acute hospital system more quickly and eliminate the long line-ups which worry the doctors so much. People will not be dying in their homes because they cannot get into hospital.
The system is underfunded because it has been so inflexible. The long-term auxiliary hospitals and the chronic care hospitals, which cost approximately $40 or $50 per day per bed compared with the $350 a day in the acute hospital system, cannot be put into place. Surely if more money were put into that it would be an investment that would pay off for all of us.
There is no doubt that the doctors themselves can and indeed must do more. They also have an extreme group among them which says that this issue is a question of freedom and individual rights. While we all have those rights, the vast majority of doctors are prepared to work within the system, but what they must do with respect to the extra fees is to get the medical profession together and reorganize their own schedule. The doctors do not seem to object to certain specialists extra-billing, so they must believe that the service is worth the extra money. In that case, they should be changing their own schedule and offering a higher amount of money for that particular service.
The doctors can do a lot more for themselves and I hope they will undertake to do so. I realize that it is a complicated process to change that schedule but there are in existence relative values for surgical and medical procedures. Their present fee schedules do not reflect those relative values and the medical profession could get that under control.
They must sit down and simply negotiate a better process with the provincial governments. As a result of this process I hope that the provincial governments will be more flexible with their doctors. One of the reasons the doctors will not give up this privilege or right, as they say, of extra billing is that they do not trust politicians. They have good reason not to trust politicians because politicians at the provincial level have frequently taken unilateral action and simply imposed fee schedules. This does not give the doctors reason to believe that their case has even been heard, let alone sympathetically heard and rejected. It is one thing to have negotiations and lose those negotiations. We do not mind that. When something is just imposed on you and you have not been listened to, that is quite a different thing.
I want to deal now with the points raised by the Hon. Member for Gloucester (Mr. Breau) who served as chairman of a task force on fiscal federalism. Once again he gave the classic Liberal excuse for the cutback in transfers to the provinces. However, he cannot get away from the basic fact that as a result of the 1982 legislation, $5.6 billion less will be transferred to the provinces. He will claim it was the revenue guarantee. With great respect, he will recall that in 1971 when tax reform was brought in, the provinces were concerned that

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Canada Health Act the new tax structure, where they increased their rates and the federal Government reduced its rate, would not give them the same revenue. In 1971, the federal Government offered to give them the revenue guarantee so that they would not get less money under the new tax system. That is what happened and it continued through 1972, 1973 and 1974.
In 1977 the federal Government wanted to get into bloc funding and in order to do that it had to cancel the earlier process. That had not been done so it would have been obliged to carry on with the old payments for a couple of years more. In the event, it simply offered to give the provinces the extra money if they would agree to the deal at that particular time. The provinces agreed and the money continued to be paid.
From that point the whole concept of revenue guarantee was finished; it had been lost as a result of a negotiation. For the Liberal Government to tell the provinces in 1982 that it was going to cut funds back by $5.7 billion over the next five years because of the revenue guarantee, and not because of health care, is not a sound argument, Mr. Speaker. The revenue guarantee had been negotiated away.
I also want to deal with the comments made by the Hon. Member for Winnipeg-Birds Hill (Mr. Blaikie). He made what is perhaps the most personal and vicious attack on the medical profession that I have heard in many years when he sat as a member of the fiscal task force and afterwards. If he really wanted state medicine he should be prepared to say that the doctors will work 37.5 hours per week, that we will have to provide all their medical clinics and all their nurses and so on. We know that would cost billions and billions of dollars, so we really do not have any choice but to carry on with fee for service. For him to claim that he wants state medicine when he knows it cannot be funded is irresponsible and does not make a contribution to the system. It just attacks a critical and important part of the system.


Raymond John Skelly: Mr. Speaker, I should like to pursue some of the statements made by the Hon. Member for Lethbridge-Footh-ills (Mr. Thacker). Part of his theme was developed by the previous speakers for the Liberal Party, the Hon. Member for Hamilton West (Mr. Hudecki) and the Hon. Member for Moncton (Mr. McCauley).
He talked about the program that the Canadian Nurses Association has put in place which is a long way from state medicine. It probably offers one of the most sound approaches to revamping the health care system that anyone in the House has heard. The Hon. Member for Hamilton West said that it was cost effective and a good idea but that the public would not accept it. I believe that is nonsense. The Hon. Member for Moncton said it was cost effective and a good idea but that he was not prepared to do anything about it since the legislation totally eliminated it.
I should like to ask the Hon. Member for Lethbridge-Foothills why his Party has not given clear support to this concept put forward by the Canadian Nurses Association to develop and change the delivery system of health care in the country so that it would complement what physicians and other health
care agencies are doing. The health critic for the Progressive Conservatives has not made any statement about what that Party would do if it came into power. It is fine for individuals in that caucus to say that this is a good idea, but what are they going to do about it? If it is a good idea and it is cost effective, are they just going to do as the Liberals and say it is a good idea but they will do nothing about it? Is that their intention?


Blaine Allen Thacker: Mr. Speaker, that will be one of several alternatives. When the next election is over and we come back with 190 seats, there will be a whole new mood in the country. We will sit down and work on all of these matters. There is no doubt that there are some alternate possibilities. If we could get the people together, that particular proposition might be very attractive. Doctors would then be truly doctoring, which is what they want to do; nurses would be truly nursing and preventive health care would be getting on with the job. We need to move on about six different fronts and that is the commitment of this Party. We will move on all of the broad bases to maintain that principle of medicare so that when a person gets sick they can be made well. We will see that we have the doctors and specialists and nurses and hospitals and the CAT scanners and all the high technology equipment that is necessary. If the existing system continues, eventually it will tumble down around our ears-perhaps not next year but within a decade or 15 years. We have to move on this and that is the commitment of this Party.


Herb Breau: Mr. Speaker, in his speech the Hon. Member talked about the $5.7 billion saving that the former Minister of Finance spoke of. He knows as well as I do that not one provincial government and not one provincial official in all the provincial capitals that the task force on fiscal arrangements visited-and he was at every one of them-admitted that any of the funds were being allocated to either health care or post-secondary education. How can he say that any of that $5.7 billion has been eliminated from health care programs or post-secondary education when not one provincial government claimed that it should be counted? He knows that in the meeting at Victoria in August, 1981, the premiers deliberately put it outside Programs Financing in the tables that they published.
Would he not agree when Parliament included the local taxes from municipal services that the increase in equalization revenues to the provinces that received them, for the current five years or the next five years, will be beyond what those provinces lost with the revenue guarantee?


Blaine Allen Thacker: Mr. Speaker, on the last point the Hon. Member is absolutely correct. As a result of the recommendations of the task force and with the negotiated settlement, the equalization will give more to some of the provinces with less fiscal strength. That will more than cover the make-up but it does not cover the other provinces.
Why use a false argument to get out of changing this? Why does the Government not just say that it has less money so will transfer less money because it needs it for national purposes? Why does it not act honestly? The provinces would probably
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agree to that, rather than have the gimmick of cancelling the revenue guarantee that had been lost five years ago.


Stanley Hudecki: Mr. Speaker, I should like to ask the Hon. Member for Lethbridge-Foothills if he has any information about how the funds allocated to the provinces have been disbursed for health care. I think this is one of the basic bits of information that is not available. If that accounting had been accurate and if the provinces had set out how that money was spent, then we would be in a better position to judge whether or not the funding was adequate. We constantly hear the accusation of underfunding. I wonder if the Hon. Member could give me any statistics on how many doctors are now leaving for the United States? There was a peak and now there is a considerable diminution, not only because doctors do not wish to leave but because conditions are more strict in the United States.
Finally, has the Hon. Member had any experience with nurse practitioners? We heard about this from the Hon. Member for Comox-Powell River (Mr. Skelly). Again, people who have had no experience with nursing practitioners talk so glibly about them. We in Hamilton have had experience with them. We realize their worth and their abilities. The public has not yet accepted them but at the moment they are of the greatest value working in teams in clinics. Hopefully, with more education and more understanding of what they are able to do, this might be changed. However, from practical experience I know that people who want to be examined and treated want to be treated by the people who have a total knowledge and understanding of the problems of disease in human beings.


Blaine Allen Thacker: Mr. Speaker, Mr. Justice Emmett Hall looked into the whole question of whether the federal transfers of money to the provinces were spent on that. He found that the money was all spent. For example, 1 believe in Alberta, to take a rich province, there is a spending of $2.4 billion on health care programs. The federal transfers are a mere $400 million. So that it is impossible to say that the $400 million was not spent on health care. However, it is true that if you cut that $400 million down to $200 million, the province has that much less income and something has to be cut somewhere. You can say, "We are going to cut you by $200 million but we want you to delete it from your highway system". It just does not work that way because they have overall global budgets. Mr. Justice Emmett Hall found very conclusively on the latter point.
With respect to doctors, I have the exact up to date figures, Mr. Speaker. In 1980 a total of 1,232 medical people left. These included interns, resident physicians and the civilian physicians. These are technical terms with which I am sure my friend is familiar. In 1981 the total dropped to 1,050 for those three categories. However, in 1982 it bounced up again and the figure was 1,196. I do not know that we have the statistics for 1983. That is a lot of medical personnel, and it is not that it is just general practitioners who are leaving, it is top notch surgeons, top notch ophthalmologists and so on. Therefore,
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there are procedures which we cannot take in this country now, Mr. Speaker. We must send our people down to the United States. That is the dangerous part of this problem. If we could sit down and work this out, if everyone would be fair and committed to medicare and health care, we would not have these problems.


Mr. David Weatherhead (Scarborough West):: Mr. Speaker,
I am very pleased this afternoon to participate in the second reading stage of Bill C-3, the Canada Health Act. I have been very interested in this general field for a great number of years. When I first ran for Parliament back in 1968, an issue in that campaign was whether the recently passed new Medical Care Act would actually be proclaimed and, of course, it was proclaimed by the Liberal Government later that year.
I was also one of the seven Members of Parliament from all three Parties who took part in the fiscal arrangements task force under the chairmanship of the Hon. Member for Gloucester (Mr. Breau) which held hearings all around Canada in 1981 on the then status of medicare and some other matters which were jointly funded by the federal and provincial governments. In addition, for the last year I have been the Chairman of the Standing Committee of the House of Commons on Health, Welfare and Social Affairs and I hope to be re-elected as its Chairman when the Committee is reorganized within the next few days. This Bill, of course, will come before our standing Committee for further study once the second reading stage is completed.
I hope, Mr. Speaker, that all Hon. Members will work toward the strengthening of medicare, which is one of Canada's greatest social policy achievements and, for the people of Canada, the single most popular Government program. Over the years, the principles of medicare have become an important fibre of our social system. Access to good health care is not just a privilege enjoyed by those who can afford it. It is the right of everyone in Canada. Although few Canadians alone can afford to pay the real costs of health care, as a society working together we can afford to do so. We do not tax the sick. We share the burden and prepay our health insurance to buy peace of mind.
The medicare program is based on the principle that necessary hospital and medical services be accessible to all residents of Canada regardless of their financial circumstances. Thus, medicare means to the elderly, who have contributed so much to Canada, that they will be cared for. It means that the ordinary citizen will not be ruined by unexpected and sometimes staggering medical bills and that children will not have to suffer because their parents are unable to pay. Canadians know that universal medicare is more than an ideal. It is a practical and efficient program, and one which is worth preserving.
All sectors involved benefit from medicare. The patient is freed from the extra burden of health spending when the trauma of illness alone weighs so heavily. Physicians are assured of payment for their services while retaining professional freedom, and hospitals have more financial security and can better serve all Canadians. What has become evident,

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however, is that through the practices of extra billing by physicians and the charging of user fees by hospitals, the principles of medicare are being undermined.
Concern about the phenomena of opting out and extra billing, about user fees and the level of services provided in our hospitals, is high. The Minister of National Health and Welfare (Miss Begin) spoke in the House on this subject just last Monday. The doubling of extra charges from $50 million since 1978 to over $100 million in December, 1983, which she illustrated, draws attention to the fact that extra billing is a growing problem. Extra billing imposes a financial barrier to access to health care. Studies show, as we all know, that the poor, the elderly and those with large families are deterred by user charges and extra billing. User charges and extra billing undermine the basic principle that the cost of medically necessary health care should be borne by society so that people are not financially penalized for being sick.
Both the Breau task force and the report of Mr. Justice Emmett Hall underline the threat to medicare which these practices pose. In his report in 1980, Mr. Justice Hall stated the following at page 27:
If extra billing is permitted as a right and practised by physicians in their sole discretion, it will, over the years, destroy the program, creating in that downward path the two-tier system incompatible with the societal level which Canadians have attained.
In the Breau task force report, the following statement of our committee can be found on page 110, and I quote:
The task force believes that doctors are a critical part of the health delivery system and should be well paid for their professional work and fully compensated for the expenses of their practices.
However, the task force feels that the legitimate interests of doctors must give way to the broad public perception that uncontrolled billing of patients beyond the levels of professional medical insurance plan schedules, will ultimately destroy Medicare.
Some supporters of the practice of charging user fees argue that abuses of the health care system are reduced by this method. This has been proven untrue. Our Committee and the Breau task force report stated at page 108, and I quote:
A number of studies have suggested that the application of effective user charges leads to an immediate reduction in the utilization of services by patients, that the impact selectively affects more adversely the economically disadvantaged, and that there is no evidence that it contributes to a reduction in "abuse" of the rights to services.
Abuse of the system is in fact somewhat of a red herring, Mr. Speaker, as it is the physician who ultimately decides who will be admitted to the hospital and who will not. Hopefully, only those in medical need are in fact being admitted now by physicians. Halting the growing erosion of the basic principles of medicare is a raison d'etre for the tabling of Bill C-3, and the Act will be effective in this. Discussion of issues relating to the health expenditures will, of course, surface in this debate, and the issue of underfunding has already arisen. However, I believe the facts are clear in this regard. Prior to 1977, the federal contributions we made were made on a cost-sharing basis, that is, approximately 50 per cent of provincial expenditures on hospital and medical care. The federal Government and most of the provinces felt that this was too inflexible and did not provide incentives for improving efficiency in provincial programs. The change from cost sharing to bloc funding was a mutual effort strongly supported by many provinces and seen as a step forward for all concerned. Since 1977, federal transfers for health care have been greater than they would have been if the old cost sharing had continued. In those six years the provinces have received a total of $3.2 billion more than they would have received under the former program. Federal contributions to the Provinces under Established Programs Financing for medicare over the past three years has been as follows: In 1981-82 fiscal year, $7.7 billion, an increase of 12 per cent from the previous year; in 1982-83, $8.7 billion, an increase of 12 per cent; and in 1983-84, the current fiscal year, $9.5 billion, an increase of 10 per cent. Increases such as these during the tight fiscal period we recently went through are symbolic of the commitment to health care that this Government holds. The health areas of the Established Programs Financing were one of the few exceptions to this Government's six and five restraint program.
Over the past decade, Mr. Speaker, health spending in Canada has fluctuated between 7 per cent and 8 per cent of our GNP. In 1982, it reached $30.1 billion or 8.4 per cent of the GNP allocated to the health sector. In that respect Canada is currently about average among OECD countries. It is significant to note that the Canadian health care system generates services of equivalent quality at lower unit costs, while also providing universal prepaid coverage and reasonable accessibility to basic health care for all residents. Thus the level of spending should be lower here than in the U.S. where, for example, high malpractice insurance, business costs to physicians and pricing practices all inflate the cost of service to U.S. citizens.
As a Government we are proud of the continuing success of medicare, but it is our intention to build in even more guarantees with the tabling of Bill C-3. The fundamental objective of this new Act is simply to preserve the basic principles of medicare. The existing Acts which define the principles and conditions underlying hospital and medical insurance are the Hospital Insurance and Diagnostic Services Act, and the Medical Care Act, which are 25 and 17 years old respectively. Recent developments have served to highlight how generally and vaguely some of the principles were defined, and there is a wide consensus that there should be a new Act.
Bill C-3 sets out the program criteria and conditions of payment for the cash portion of federal contributions to the provinces for insured health services, and payments to the provinces for extended health care services. The insured health services covered by this legislation are all necessary hospital services, physician services and surgical-dental services performed in a hospital. The extended health care services covered by this legislation are nursing home intermediate care, adult residential care, home care and ambulatory health care.
The criteria a provincial health program must meet to be eligible for the full cash portion of the contribution are based on the long-standing principles which have served as the
January 20, 1984

backbone of Canadian medicare since its inception. However, the criteria have been adapted to answer the problems facing medicare today. As everyone in this House knows, the criteria are as follows.
Public administration: the program must be administered by a public authority accountable to the provincial Government. Comprehensiveness: the program must cover all necessary hospital and medical services, and surgical-dental services rendered in hospitals. Universality: One hundred per cent of residents of a province must be entitled to insured health services. Portability: the waiting period for new residents must not exceed three months; insured health services must be made available to Canadians temporarily out of their own province, at no extra charge to patients; payment for services out of province must be paid by the home province at host province rates, and payment for services out of country are to be at the home province rate. Accessibility: reasonable access to insured health services is not to be precluded or impeded, either directly or indirectly, by charges or other mechanisms. Reasonable compensation must be made to physicians and dentists providing insured health services. Adequate payments must be made to hospitals in respect of insured heath service. The conditions of payment that the provinces must meet to be eligible for the full cash portion of the federal contribution and payment also include the provision of reasonable information on the operation of the program to be supplied by the provinces to the Minister of National Health and Welfare. Federal contributions to the programs are to be given appropriate visibility.
In addition to these conditions, the Act also states that extra billing and user charges must not be permitted except as outlined in the regulations attached to this Act. Where a provincial plan fails to satisfy any one of the program's criteria, or the province fails to comply with either of the two conditions of payment, the Act provides that cash portion of the federal contribution or payment may be reduced. This is discretionary and must be preceded by consultation with the province. Where a province fails to comply with the condition of payment relating to extra billing and user charges, the Act provides for a non-discretionary reduction of the cash portion of the federal contribution by the amount charged to extra billing or user charges. For the first three years after proclamation, however, funds withheld from provinces because of extra billing or user charges will be held in the public accounts of Canada and shall be paid to the province if the practice of extra billing or user charges is eliminated during those three years.
Medicare, Mr. Speaker, is one of the great social achievements for Canadians, and this Act will solidify and clarify its basic principles to ensure that every Canadian, no matter the age or income level, will have the absolute right to necessary physician and hospital care.


Raymond John Skelly: Mr. Speaker, I do not think this issue has been fairly dealt with by either the Government or the Official Opposition. I know the Hon. Member is aware of the position put forward by the Canadian Nurses' Association which paid
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attention to the fact that the federal Government delivered some of the funds he has talked about to a revamping of the way in which health care is delivered. There is, for example, the more effective use of health care professionals such as nurse practitioners, as mentioned by the Hon. Member for Hamilton West. Then there is health prevention, health education, and community health care clinics where professionals work as teams in delivering health care in the community. There are community-based health services to the chronically ill and elderly. However, the particular legislation before us today deals with none of that, and it is not likely it will be opened again for many years to come. Other speakers, both from your Party and from the Official Opposition, say that this is an effective method of delivering health care and is cost effective. Yet neither the Liberals nor the Conservatives are prepared to stand up and say that the Bill is deficient in that aspect, that it does not apply real funding so as to provide an incentive for that kind of programming.
Could you explain what your position is going to be when the Bill is before the House?


The Acting Speaker (Mr. Corbin):: Order. I must remind Hon. Members that they should put their questions to the Chair.


David Bennington Weatherhead: Mr. Speaker, I thank the Hon. Member for his question. All of us in the House who follow this issue think that there is a lot more that can be done to the health care system in regard to improvements and modernization. Some of these matters have been referred to by the Canadian Nurses Association and others. Our Standing Committee on Health, Welfare and Social Affairs will be hearing the Canadian Association of Nurses and will have a chance to examine closely what they are saying and question them on that. The Committee will decide whether it can be done in this particular Bill, or some other Bills, or whether it is now being done through the health promotion branch of the Department. All of us who are interested in the issue will try to find some way to implement at least some of the things that the nurses are suggesting.


Raymond John Skelly: Mr. Speaker, the previous speaker knows that there is not an adequate budget in the health promotion area to fund this on that scale. He knows that the Canadian Nurses Association has been to see the Minister and that almost every Member of Parliament has had an adequate chance to look at this. The Bill in reality is deficient. This is probably one of the most cost effective situations for us to pursue. It is also an effective way of delivering health care. Why is the previous speaker on behalf of the Liberal Party not prepared to acknowledge that this Bill is deficient? Why is he not prepared, as an individual Member of Parliament and collectively with other Members of Parliament, to approach the Minister and the Government to have this position changed in the legislation that is before us?

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David Bennington Weatherhead: Mr. Speaker, as I said, the nurses will be coming before us along with the other main interest groups within the next few weeks. I and the other members of the Committee will listen carefully at that time and extensively question the Canadian Nurses Association and other groups. I think that, prima facie, they have a lot of good ideas. After we listen to them, the Committee can then decide what it might do about it.


The Acting Speaker (Mr. Corbin):: Debate. The Hon. Member for Cowichan-Malahat-The Islands (Mr. Manly).


Mr. Jim Manly (Cowichan-Malahat-The Islands):: Mr. Speaker, I appreciate the opportunity to take part in this important debate which touches upon one of the most fundamental questions affecting Canadians. It touches on one of the most fundamental questions, but it does not begin adequately to deal with Canada's health care needs. When my colleague, the Hon. Member for Winnipeg-Birds Hill (Mr. Blaikie), spoke on this Bill at its introduction, he identified two major areas of concern for our Party. He said that he had very serious questions as to whether Bill C-3 had an adequate mechanism to do what it intends to do, that is, to prevent user fees and extra billing. We are very concerned that user fees and extra billing are only the symptoms of the disease and are not the underlying disease affecting medicare. I would like to deal with both of those areas of concern very briefly.
The New Democratic Party has consistently opposed user fees and extra billing. For four years we have heard the Hon. Member for Winnipeg-Birds Hill asking the Minister what she was going to do about this billing practice. In this sense the Bill is at least three and one half years late. The Hall report of September 1980 indicated that this practice should be stopped. We can fairly say that without the persistent efforts of the Hon. Member for Winnipeg-Birds Hill and other members of our Party no action would have been taken on this matter at all. The Tories were very silent on this entire question of extra billing and user fees until the Bill was practically introduced.
Our Party has very serious questions as to whether or not the dollar for dollar penalties will in fact deter provinces from imposing user fees or allowing extra billing. People who support these practices claim that the Act is a useful deterent against the frivolous use of medical facilities or of doctors' time. No doubt there are a certain number of hypochondriacs in our society who do take up, in an inappropriate way, a great deal of medical attention. Perhaps this indicates that we need to think of a different system which can meet some of the needs of so-called hypochondriacs. They do have needs. Nobody in their right health, body and mind, is going to spend time sitting in a doctor's waiting room, at least no doctor's waiting room that I have ever seen. People who spend time unnecessarily on medical appointments have concerns that need to be addressed, which our present medical system does not do. If user fees and extra billing deter these people from using up doctors' time, even more than that they will deter poor and needy people from using medical facilities and from going to a doctor at a time when they need medical help.
It is important to remember that although user fees and extra billing may deter poor people from using these facilities, user fees and extra billing pay only a fraction of the total cost of medical care. This creates a very serious problem which the House should think about for a moment.
I would like to use a rather far out example which might put this in perspective. Imagine a province that had approximately one million adults in which the government decided that it would be a good idea to give every adult a new $1,000 TV set. This became the program. Then a new government came in and decided that somehow it was immoral to give people something for nothing. It decided that because the TV set program was very popular it did not want to do away with it entirely but it would impose a $100 cost for these $1,000 TV sets. Theoretically, with a million people that would mean that they would save $100 million. In fact, Mr. Speaker, that is not the case at all. Some people would not be able to afford the $100. For the poor people who could not afford to pay the $100 for the $1,000 TV set, the Government would save not $100, but $900. When poor people are excluded from the use of medicare facilities that are paid for out of public funds, Mr. Speaker, they are not getting their fair share. This is one of the basic concerns that we have. Theoretically, a province could suffer the dollar for dollar penalties that are imposed by Bill C-3 but could still come out ahead of the game because there would be a decreased use of facilities by people who could not afford to pay those user fees.
In our Party we are concerned about medicare premiums. Last year in British Columbia premiums accounted for some $315 million. The Minister herself spoke about medicare premiums and pointed out how unfair and inefficient they were. Our Party and I would like to know what this Bill and the regulations attached to this Bill do with respect to medicare premiums. What relationship is there between the 100 per cent universality requirement of the Bill and the payment of premiums? Who defines what constitutes 100 per cent coverage? There are a lot of questions about that and I suspect that the Government does not really have adequate answers. We are concerned that the disincentives, the dollar for dollar penalty, will not really meet the objectives that the Government has set for it. On top of that, there are absolutely no incentives for positive action. There are no incentives for provinces which have never allowed extra billing or provinces which have never collected premiums or imposed user fees or for provinces that act expeditiously to do away with them. We believe that perhaps you can catch more flies with honey than with vinegar and some positive incentives might help.
Our second major area of concern is that dealing with user fees and extra billing really deals with the symptoms. The proposed Canada Health Act leaves us locked into a very expensive health care model. It offers no financial help to make that model run. I would like to use my own Province of British Columbia as an example. I do so noting that I am in no way an apologist for the present British Columbia Government. That Government has very badly mismanaged the
January 20, 1984

economy. In a mean-spirited way it has introduced cutbacks in education and social service. In a very shortsighted way that Government has cut back vital programs in forestry and so on. But in health care British Columbians, on top of provincial mismanagement, have to carry the burden of federal underfunding.
Last week when I was in my riding I met with a wide variety of health care workers, doctors, nurses, hospital administrators, board members, orderlies and cleaning staff. They showed a great deal of concern about what was going to happen to the medical situation in British Columbia. They told me that floors in some hospitals had been shut down. I heard of one long-term care situation. Fortunately, it was not within my riding. On night shift one nurse and one aide were responsible for 75 patients, some of whom were incontinent and some who needed a lot of help and care, others had difficulty eating. The aides did not have time to feed them normal food and so all the food was put through the blender. This is the ghetto to which we have relegated some of these people. Acute care beds are being used for chronic care patients because the cost of maintaining chronic care is lower than that for acute care patients. Elective surgery is postponed and postponed again. In an increasing number of cases it is postponed until surgery becomes critical. Doctors in British Columbia got a fair amount of publicity last year when they postponed part of a very handsome salary increase. At the same time hospital employees had a new contract which leaves them far behind the current rate of inflation. Even though the Government boasts about how low it has brought inflation, the new contract leaves these workers far behind.
When I talked to people on hospital boards they estimated that 6 per cent to 10 per cent of revenue came from user fees. They had absolutely no confidence that the Socred Government would make up any increased deficit. They said there was no more fat in the system. There had already been cut-backs and any further cut-backs in financing would mean an increasing deterioration in patient care. This is the situation facing medical care in British Columbia. I submit to you, Mr. Speaker, and through you to the Government on behalf of the people of British Columbia, that all of this federal-provincial squabbling about who is going to pay the next dollar is obscene. While that is happening, our medical care system is being eroded. The federal Government does not provide adequate funding for the present model, and it gives absolutely no incentive to develop other new and more cost efficient models.
There has been a fair amount of reference to the Canadian Nurses Association's submission about the increased use of nurses. I would like to refer to page 73 of the Hall report. It mentions a number of pilot studies that have been made about the use of nurses. One of these studies done by the Victorian Order of Nurses had a nurse attached to a team of five family physisians. Let me quote:
This study showed that, generally, patients preferred the nurse for many health care services and this preference increased with the amount of care given; that length of hospital stays also could be shortened, particularly for surgical procedures and for psychiatric disorders, because discharge planning and follow-
Canada Health Act
up care were available; and that hospital admissions of terminally-ill and dying patients could be reduced when the family wished it.
It is not, as the Hon. Member for Hamilton West (Mr. Hudecki) suggest, that there are no studies and we do not know how patients respond. Patients have responded very positively. There can be a greater use of nurses precisely in such areas as health promotion and sickness prevention, as well as at the other end of the health care spectrum in terms of functional support of people who have chronic illnesses. We do not provide support for those until they have been allowed to degenerate into some kind of situation where acute care is once again warranted. They are then returned to an acute care situation. When that situation improves slightly, they are put out again with no kind of ongoing support. This is the area when nurses can be a great deal of help. This will be cost effective and it is something the Bill should be addressing.
In addition to expanding the possibilities for health care by professionals, I believe we need a more holistic approach to health than the present medicare system recognizes. There is a law of diminishing returns in the use of medical expertise and equipment. Perhaps the Indian people of Canada can be a good example here. Not all health problems can be solved by having more doctors and bigger and better equipped hospitals. For example, in the West Coast community of Bella Bella, a Doctor George Darby went there as a medical missionary at the beginning of this century. When he retired in the 1950s some of the Indian people in Bella Bella said to him, "Before you came, our babies all died. Now they all live". That is very moving testimony. But then something terrible happened. In the late 1960s and 1970s there was a rash of suicides among young people in Bella Bella. This situation was not limited to Bella Bella; it was a phenomenon which took place in many Indian communities across Canada. Some of the very lives which Doctor Darby had saved as babies, some of the most sensitive and talented, committed suicide. Others died in boating accidents and some became victims of the city. No matter how modern the hospital at Bella Bella or how many doctors and how well trained they might be, they cannot meet this kind of problem. Mr. Justice Tom Berger put his finger on this problem when he quoted from a Health and Welfare document in his report on Indian and Inuit health consultation. Let me quote:
It has become apparent that government's efforts to improve the health of Indian people are no longer having the desired effect. Our standard medical tools do not seem to address the problems of high hospitalization rates, violence, anti-social behaviour, suicide-all indices of an accelerating crisis of health and social breakdown. We always thought that, as health professionals, we knew what Indians needed with respect to health care, and in areas where we concentrated our attention, such as communicable diseases and maternal and child health, we began to see improvements in health status.
In other areas they were completely helpless. The conclusion which Mr. Justice Berger and our own Indian Self-Government Committee reached is that Indian people have to have control over their own lives and communities.
I would like to share with the House a story about an Indian family which was summarized by Richard Cleroux in an

January 20, 1984
Canada Health Act
article in the January 12 edition of The Globe and Mail. Birdie and Joyce Cantin and their three daughters lived in the Wabigoon Reserve in northwestern Ontario. They had a modest home with reasonable furniture. She had a job and he picked up part-time work. About a year ago the three daughters began developing a series of illness-the flu, an ear infection, an eye infection, impetigo, skin rashes, blabber infections, chest infections and abdominal pains. The local health nurse investigated and discovered that the sewage system had backed up inside the house. There was raw sewage in the crawl space. The entire house and all their goods had been contaminated. The house was condemned and the band council was told to find a new house for the Cantin family. Of course the band council could not do that because, like all band councils across Canada, it had no more housing money; in fact it was $80,000 in the hole.
Last December the Cantin family moved to Winnipeg. From being an independent family on the Wabigoon Reserve, it became a welfare family in Winnipeg. Because they are now living off the reserve, it seems that the federal Department of Indian Affairs and Northern Development has very little concern about them. They have no work and they are demoralized.
I would like to read the last paragraph of Richard Cleroux's article. It says:
Joyce no longer has her job. Birdie is having trouble finding work. He's unskilled, has no credentials and has never worked in the city. They live off welfare. They get $148 a week. They moved into a City of Winnipeg public housing unit on the outskirts of the city. The rent is only $195 a month. They pay it out of their welfare money.
There's not much to do where they are. Joyce goes to bingoes a lot. And Birdie sits at home minding the girls. The girls love the city. They are at school. They watch television and draw beautiful pictures of skyscrapers and can hardly wait to get into the pinball arcades.
I talked with the mother on the telephone this week. She fears the family is headed for skid row. This is one health problem with which we are not dealing. There are other similar health problems. We in the NDP are concerned about environment health. It is something on which we would like to see the Government take action. For example, there is the situation in Key Lake arising out of the use of wood preservatives by woodworkers in British Columbia.
I see that my time has expired, Mr. Speaker. In conclusion,
I say that we are concerned about the mechanisms for dealing with user fees and extra billing. They are not adequate. Bill C-3 falls short of what the health care system needs, to be up to date in the 1980s.


Stanley Hudecki: Mr. Speaker, I would like to ask the Hon. Member a question. Was the Hon. Member differentiating between nurse practitioners and nurses? Certainly his comments about nurses are not denied by anyone in the medical field. They are traditional support for doctors. They work in operating rooms and they provide at home care. They make rounds with various organizations such as the Victorian Order of Nurses and the St. Elizabeth Order of Nurses. It has never been and will not be disputed that they are an integral part of medicine.
When one talks about nurse practitioners, one has to take a different approach. It is a good, sound approach. It is something new that is being developed. At the moment it works best in clinics. The Hon. Member talked about what he has read. I can tell him what is happening in areas such as Hamilton where the program has been given a good trial. Working in clinics, nurse practitioners carry a great deal of the burden of the work of doctors. They work with them. However, when the Hon. Member talks about nurse practitioners being initial medical care providers, it must be noted that this is a new field which is being developed. It has great merits, but it has to be sold to the public. In due course it will find a rightful place in the Canadian health care system.
Did the Hon. Member draw that distinction or have that distinction in mind when he made comments concerning the contributions of nurses to the medical health care system?


James Douglas Manly: Mr. Speaker, 1 thank the Hon. Member for Hamilton West for his question. I frankly admit that I am not well versed in the distinction, but I would like to refer to page 73 of the Hall report which referred to the Beaverton project that included nurse practitioners. I would like to read the following summary contained in the report of the Hall Commission:
In the "Beaverton Project", another Canadian demonstration project, the practice setting extended over an area of approximately 85 square miles with a large proportion of the population (26 per cent) over 65 years of age. One objective of the project was to demonstrate that a qualified nurse practitioner could operate as co-practitioner taking primary responsibility for significant office load, thus allowing the physician to devote more time to the management of complex medical problems of his patients.
It referred to the practitioner working within the office and continued:
With a high level of independent decision-making the nurse fulfilled the functions of providing primary health care, of intervention in episodic incidents or occurrences, of monitoring chronic care, and of promoting and maintaining health. The investigation concluded that home visiting by the nurse practitioner decreased the need for hospital or other institutional care; she also was able to identify early health problems which had they been left unattended might have led to more serious health problems and eventually to more health care costs.
The Beaverton project referred to practitioners operating in an office-clinic setting and home visits and suggested that both cases were helpful.


Mr. Kristiansen:: Mr. Speaker, I appreciated the comments of the Hon. Member for Cowichan-Malahat-The Islands on the matter of providing a more full role for the nursing profession within the medicare system.
I believe that in his concluding remarks he touched on a slightly different topic. He wanted to address more fully some of the problems relating to occupational health, particularly with regard to the problems faced by people in the plywood industry in British Columbia and elsewhere. Would he expand on those remarks? In my constituency of Kootenay West there are many people who are vitally interested and would appreciate his comments.

January 20, 1984


James Douglas Manly: Mr. Speaker, I appreciate that question because 1 did not have time to expand on it. A study was conducted of woodworkers in Port Alberni two years ago. These workers had infrequent or frequent and daily exposure to polychloro-phenols used in wood preservatives on the West Coast. The study found that there was a high incident of respiratory problems, nervous disorders, skin ailments and cancer.
In the last few weeks I was pleased to see that a $15,000 grant was made by the Department of National Health and Welfare for a further study of the problem as it relates to mortality from cancer. It is my belief-and certainly it is on record by the International Woodworkers of America-that the use of such preservatives should be banned until they can be proven safe. If there is a study going on right now about the relationship between the use of these products and cancer, and if other studies have indicated a high correlation in the complaints, there should certainly be a moratorium imposed on the products until they have been declared safe.
In connection with the whole question of health and safety, I urge Hon. Members to look at the last issue of Goodwin's Magazine which contains a very graphic story of death from asbestos. One part of it is about a worker in Whitby, Ontario employed by the Johns-Manville Corporation. That company showed a completely callous disregard not only for his health while he was working there, but also for his needs when he became sick. It is incumbent upon the Government now to bring in revisions to Part IV of the Canada Labour Code dealing with occupational health and safety. Three Ministers in this House have dealt with the question and we still have not seen the revisions. They are important to every Canadian worker and his family.


Joseph Lloyd Reid: Mr. Speaker, I am happy to have this opportunity to speak for a few moments on Bill C-3, the alleged new Canada Health Act. It does not bring very much that is new and futuristic. It could be more properly styled simply a Canadian contribution to the provinces for insured services.
I was rather surprised to hear the Hon. Member for Moncton (Mr. McCauley) say that only 80 per cent of his constituents replied to a questionnaire stating that they favoured a publicly-funded medicare program. One could hardly find a person on the street who does not favour a publicly-funded medicare program, a program so essential to the well-being of Canadians.
In introducing this Bill, the Minister said that she was proud of our medicare program, meaning our existing medicare program. She said it was one of the best, if not the best, universal, top quality prepaid health care system in the world.
This Party, the Progressive Conservative Party, has made a substantial commitment over the years to health care which makes it possible for today's Minister to make such a statement. Indeed, Mr. T. C. Douglas said of a fellow colleague from Saskatchewan, "If it had not been for the co-operative negotiations of the Right Hon. J. G. Diefenbaker with the
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provinces, Canada may not have achieved medicare as we know it today". He was one of the more objective, constructive NDP-CCF members.
I emphasize the co-operative negotiations that led to the implementation of the Hospital and Diagnostic Services Act, so different from the approach and single-mindedness of the several Liberal Governments as they were confronted with the problems and issues in the evolution of medicare.
The present Minister has learned her heavy-handed and confrontational approach well. In 1969 when the Province of Ontario was coerced into the national plan, the then Minister of National Health and Welfare, the Hon. Member for Hamilton East (Mr. Munro), said: "Comply or you will fail to qualify for federal contributions". Where have we heard those words before? That was at a time when the national plan was practically funded by Ontario taxpayers.
It was stated then, as it is still being stated, that the federal position is not one of a medicare plan per se. It is simply a financial proposal under which the federal government will meet a portion of the cost borne by the provinces. The provinces are responsible for the introduction, implementation, administration and operation of the medicare plan. Let us come back to the best health plan in the world. If there is any argument at all, it is based on the cost of the system, the cost of the plan and how it should be met.
Provincial Treasuries are strapped. Instead of the co-operative negotiations of John Diefenbaker with the provinces, we have a Minister of Finance (Mr. Lalonde) and a Minister of National Health and Welfare (Miss Begin) holding back on the established transfers to the provinces, transfers of funds to which they are entitled. They are reluctantly handed over as though they were alms for the poor.
The Minister of Finance said: "It is significant that federal aid to the provinces is increasing at a time when federal resources are under considerable strain". I wonder how much they know about the problems of the provincial Treasuries. Is this the kind of rhetoric that builds trust and confidence between levels of government regarding a program such as medicare, which has the support of practically all Canadians of all political stripes, without regard to economic conditions or circumstances? The answer to supporting and enhancing medicare lies in co-operative negotiation between the provinces and the federal government, the means by which we used to resolve federal and provincial problems in days gone by. Against that, this Government's approach has been an "us" against "them" approach.
The Minister says: "I will talk. I am prepared to negotiate, but I won't compromise. Don't tell me about the complex problems of medicare". This is more than simply regrettable. It is an outright abdication of the federal Government's responsibilities to medicare. I would like to take a moment to illustrate that fact.
For many reasons the public has come to regard the medicare debate as one revolving around extra billing, user fees- goodness knows, we have heard a lot about that in this

January 20, 1984
Constitution Act, 1867
debate-and health insurance premiums to a lesser extent. Each is said to be bad. These are simply symptoms of a problem which goes much deeper. Extra billing and user fees are, for the most part, functions of underfunding. If anyone here does not know and believe that there is underfunding in the delivery of medicare service today, they are not acquainted with the position of the medicare world.
Canadians want and expect the best care system available. To provide that system requires large sums of money and close co-operation between all levels of government. We need some consensus as to the base level of medicare, what is desirable and what is affordable. What can Canadians afford to pay?
Mr. Speaker, I wonder if I might call it four o'clock?


Mr. Deputy Speaker:: Questions or comments? Is the House ready for the question?


Some Hon. Members:: Question.


Mr. Deputy Speaker:: Is it the pleasure of the House to adopt the motion?


Some Hon. Members:: Agreed.


Mr. Deputy Speaker:: I declare the motion carried.


[Stage Direction]
Motion agreed to, Bill read the second time and referred to the Standing Committee on Health, Welfare and Social Affairs.
Mr. Deputy Speaker:: It being four o'clock, the House will now proceed to consideration of Private Members' Business as listed on today's Order Paper.


PRIVATE MEMBERS' BUSINESS-PUBLIC BILLS   BRITISH NORTH AMERICA ACT, 1867 REQUEST TO CHANGE BOUNDARIES OF NATIONAL CAPITAL
Mr. Deputy Speaker:: Shall all Orders and items preceding No. 102 be allowed to stand?


Some Hon. Members:: Stand.


Mr. Deputy Speaker:: Stand by unanimous consent.
On the Order:
December 15, 1983-Second reading and reference to the Standing Committee on Justice and Legal Affairs of Bill C-206, An Act to amend the British North America Act, 1867 (national capital of Canada).


Mr. Gaston Isabelle (Hull) moved: that Bill C-206, an Act to Amend the British North America Act, 1867 (national capital of Canada) be read the second time and referred to the Standing Committee on Justice and Legal Affairs.
He said: Mr. Speaker, on a point of order. Yesterday afternoon I spoke to the Parliamentary House Leaders, who gave me their consent, and that is why today, I wish to seek the unanimous consent of the House to withdraw Bill C-206, an Act to Amend the British North America, 1867, which stands in my name on the Order Paper and Notices, and to substitute therefore a new Bill C-206, an Act to Amend the Constitution Act of 1867.
According to the Law Clerk and Parliamentary Counsel, the Bill should have been presented in the form of an amendment to the Constitution Act of 1867, and my colleagues may rest assured that the only difference between the two bills lies in the title and all references to the British North America Act. I therefore seek the unanimous consent of the House in this matter.


J. Michael Forrestall: Mr. Speaker, it is quite true, the distinguished Member has had conversations with us and we are quite prepared to give that unanimous consent.


Lyle Stuart Kristiansen: Mr. Speaker, the consent is forthcoming from the New Democratic Party as well.


Mr. Deputy Speaker:: Does the Hon. Member have the unanimous consent of the House to move the motion?


Some Hon. Members:: Agreed.


Mr. Deputy Speaker:: Shall Bill C-206 be withdrawn by unanimous consent?


Some Hon. Members:: Agreed.
Bill withdrawn.


CONSTITUTION ACT, 1867 REQUEST TO CHANGE BOUNDARIES OF NATIONAL CAPITAL
[Stage Direction]
Mr. Gaston Isabelle (Hull), seconded by Mr. Turner, moved that Bill C-206, an Act to Amend the Constitution Act of 1867 (national capital of Canada) be read the second time and referred to the Standing Committee on Justice and Legal Affairs.
January 20, 1984
[Stage Direction]
He said: Mr. Speaker, the purpose of this Bill, which is very straightforward, is to amend Section 16 of the Constitution Act of 1867, which reads as follows:
Until the Queen otherwise directs, the Seat of Government of Canada shall be Ottawa.
As I said at the beginning, the national capital area would be designated as the national capital of Canada. There are various reasons for this, Mr. Speaker, because if we refer to the history of the national capital area, we see that since the small village of Bytown was selected by the Queen in 1858, it was then ridiculed and called a forest centre and and a logging capital, the City of Ottawa as such has constantly developed.
The reason why I am asking for that amendment is that since the time of Sir Wilfrid Laurier, Sir Robert Borden and even the Right Hon. Mackenzie King, we have always wanted to make of the capital of Canada a national symbol, the seat of our national languages or, if you prefer, the beating heart of our nation.
Up to now, I think that we have always thought of the capital of Canada as a city in Ontario. I have nothing against Ontario or Ottawa, but throughout the years, we have asked the Federal Government to contribute to the beautification of the region and we have been saying that it should not be restricted to the city of Ottawa. Parliament has continued to expand the region on the Quebec side, in the Outaouais region, and we are now saying that the National Capital Region is a product of Canadian federalism and reflects many of the familiar political, social, linguistic and cultural differences and ambiguities of Canadian society. It is typical of Canada.
Mr. Speaker, the people who come to visit the Canadian capital simply visit an Ontario city, and I remember quite clearly that the former mayor Lorry Greenberg did not want Ottawa to share the honor of being the capital city with any other municipality in the National Capital Region. Now that Ottawa is bigger and that an Act passed in 1956 designates the neighbouring municipalities both in Ontario and in Quebec as part of the National Capital Region, I do not see why this region could not become officially the capital of Canada. Of course, this would take nothing away from Ottawa, which would keep its title of capital city, but at least, it would not be alone and would be part of the national capital, and the same would be true for Nepean, Gloucester, Vanier, Aylmer, Gatineau and Hull, because I am sure that such a capital would be a much more appropriate symbol than the city of Ottawa. Indeed, at a constitutional conference held in February 1969 in Toronto, it was even agreed that the cities of Ottawa and Hull and the surrounding areas constituted the National Capital Region.
If the cities so designated constitute a region known as the Canadian capital, I do not see why they should not be called the Capital of Canada. I can think of many politicians-I am
Constitution Act, 1867
not blaming them; they are quite justified-the Ontario Premier, for instance who, every time he comes to Ottawa, he always says how happy he is to be in the capital of Canada, Ottawa, Ontario, and he places much more emphasis on the fact that Ottawa is in Ontario than on the fact that it is the national capital. I am sure that there has been a lot of progress since 1896. Sir Wilfrid Laurier wanted to make Ottawa the Washington of the North. The Hon. Robert Borden also wanted to do the same when he created the Ottawa Improvement Commission, because the municipality did not have the facilities required to maintain the Canadian capital properly. I am sure that, with this change, the capital of Canada could reflect the various ethnic groups as well as the biculturalism and bilingualism that our capital should represent as the heart of the whole country.
I am sure that my colleagues who live in this region can appreciate these remarks more readily than many others who come to Ottawa for a few days or a few years. They do not share the same enthusiasm as the residents of the National Capital Region for whom the National Capital is the birthplace of the nation, so to speak, and it should represent everything Canada has to offer. It is a microcosm, a sort of mirror, a reflection of Canada.
That is the purpose of the message I wanted to convey, because although the region includes many municipalities, it can be said that the federal Government has never been quite at home in Ottawa, in the sense that it has always been subject to the laws of Ontario and the by-laws of the municipalities, and it has to spend money if it wants to improve the environment.
From 1947 to 1967, I think it spent $111 million to buy land, not to build but only to upgrade the Capital of Canada. If I may put it this way, it was the only way it could control the land over which it had no jurisdiction. By purchasing land through the National Capital Commission, the federal Government gained direct control over that land. It stands to reason that, had the National Capital Commission been unable to buy land, chances are the Parliament Buildings would not be where they are now. Because the federal Government, through its agencies, has no authority when it comes to building height regulations, and I am sure that if the federal Government had not acted as I said earlier in my remarks, that is built up a land bank to restrict construction, we would hardly be able to see the Parliament Buildings. As I keep saying, not only is the Capital the seat of Government, but it is also the soul and the fount of strength of the nation.
Mr. Speaker, those are the reasons why the National Capital Region should become the Capital of Canada. If it were, the municipalities which are part and parcel of the National Capital Region would be a lot less reluctant to co-operate than they have been for a number of years.
We have created various organizations on both sides of the river, they have multiplied and so overloaded the administra-
[Stage Direction]
January 20, 1984
Constitution Act, 1867
tion that we now have the most overgoverned and indeed the most overtaxed region of Canada.
Whenever we have asked for the co-operation of the various regional governments, it has always been hard to get. This is why over the years I have always advocated a federal district, in order that the federal Government be at home here. But this is not for tomorrow, because we know what came out of the so-called co-operation between the various levels of government, both local and provincial.
I feel therefore, the time has come for something to be done along those lines. For sure, this will not bring in the slightest change in the current administrative structures; if anything, it will give some sense of pride to the people of the National Capital area who do not happen to live in the City of Ottawa proper, either side of the river and I am sure that once this is done, it will be much easier to set milestones along the road to whatever we should have had for years, even since 1857, that is a federal district. If I refer to a federal district it is because I think Queen Victoria, when she decided to designate Ottawa as the capital of Canada, Bytown as it was then called, may not have taken a good look at our geography, since as we know, in earlier times Canada's capital had changed places-Kingston, Montreal, Quebec, Toronto-before settling for Ottawa under Order-in-Council, by authority of the Queen, between Upper and Lower Canada. For this reason, a neutral area should have been selected, comprising a part of Lower Canada and a part of Upper Canada, to be the seat of the Government. Indeed, Section 16 of the Constitution does not refer to the Capital of Canada, but rather to the Seat of the Government of Canada. A seat can be moved, it can be expanded, it can be amended any way one likes. For that reason, I feel that the willingness of the House of Commons to amend Section 16 of the Constitution would enhance the pride of Canadians and provide a much larger dimension, a better image of what Canada actually is, because if there is one place in Canada that is ideally suited for a National Capital, it is the Ottawa-Hull area.
To those who suggest that an extraordinary process is required for amending Section 16, I say all that is needed is an Order-in-Council, simply adding Hull and the surrounding municipalities on both sides of the river, so that Canada's National Capital truly reflects the daily life of every Canadian. Because certainly visitors, whether they come from British Columbia or from New Brunswick or Prince Edward Island, are not particularly enthralled when coming to Ottawa to visit just another Ontario City.
Let there be no misunderstanding: I am not suggesting that we should get rid of Ottawa as such, but that we should make Ottawa part of the national capital region just as all the other municipalities which are now part of the national capital region. And I am sure that members of the House are aware of this major problem of a capital for a young country such as Canada, for we have had a flag for some twenty years and we
have a practically new, at least freshly patriated Constitution. In my opinion, what really matters now is to endow ourselves with a capital which clearly reflects the wills, aspirations and modus vivendi of all Canadians. It should occupy a neutral ground, outside the territory of any individual province, and I just cannot understand how a province such as Ontario can logically have two capitals. If there is disunity, if the West feels alienated, it may be because we have no meeting point where we could all get together and feel at home as Canadians. People from Western Canada think that they are away visiting Eastern Canada when they come to this Ontario city, and those from Eastern Canada think they have gone West when they are in the same Ontario city. Therefore, to dispel any doubt and give Canada a new image or impetus, in line with the novelties we have known over the past few years, including the flag, I think it is a matter of individual self-esteem and national pride to have a capital which reflects the character of all Canadians from coast to coast. Thank you, Mr. Speaker. [English]
Mr. Paul Dick (Lanark-Renfrew-Carleton):: Mr. Speaker, I want to commend the Hon. Member for Hull (Mr. Isabelle) for bringing his proposal forward once again and I should like to make a few comments on it. It seems to me to be a practical idea and I have nothing against it. I must admit that many years before I came to this place, in the Parliament of Canada of 1965 and 1966, as I recollect, there was a small committee of Canadians set up who referred to themselves as the Riel Committee. It wanted Ottawa and the surrounding area to be taken out of the Province of Ontario and the Hull and Gatineau area taken out of the Province of Quebec, and something like an eleventh province set up, a truly different area apart from Quebec or Ontario which would be the capital territory as they have in Washington, D.C. or in Canberra, Australia. Quite frankly, I see a lot of merit in that idea. I rather like it, even though part of my constituency would fall into that new area and part of it would fall outside.
I feel there is a lot to commend that idea. I have not thought in great detail about this. I am sure there would be many complications and problems which would have to be worked out. However, I do know that in other parts of Canada, people really do not like to write to Ottawa, Ontario, when they are writing to the capital of the country. People out west do not think the capital should be Ottawa, Ontario. It should be Ottawa, Canada. Perhaps it should be called "Ottawa, Outaouais", something other than Ottawa, Ontario. I do not believe these people like writing to a Department of the Government in Hull, Quebec. I believe they would like to write to Ottawa, Canada. This is a feeling I know people out west have, as well as some people in the east.
Why not create a jurisdiction, taking away a small portion of land from the Province of Quebec and from the Province of Ontario, and creating a truly independent capital region? Not, however, a region as they have had in Washington, D.C., where the voters are not allowed to have anything to say. In
January 20, 1984

fact, they did not even have a vote. They could not even elect a municipal council until a few years ago. I do not want it to be a dictatorship. I would like it to have proper municipal voting patterns, perhaps a provincial legislative body, and it would have the federal Parliament. The federal Parliament, then, thought the National Capital Commission and the National Capital Region, would be able to assist the new legislative body of a provincial nature in carrying out projects to beautify and enhance the capital of Canada for all Canadians.
I have not thought through all of those ideas and I am sure there are many people who would counter them with other suggestions. Perhaps the question would be, would the Province of Quebec willingly give up Hull, and perhaps Gatineau, Gatineau Park and Aylmer, and allow it to fall into a new jurisdiction? And would Ontario willingly give up Ottawa, Kanata and some of the rural areas to a new jurisdiction? There may be some people who would say that there is no way those provinces would give up that territory. One would immediately ask why they would not, and it might be because they want the power, the jurisdiction, legislation and tax base of those people who live in those areas.
Perhaps it would be appropriate to consider this, and 1 suggest that if a meaningful discussion was started, the federal Government, in order to set up this new jurisdiction, might offer, in payment to the Provinces of Quebec and Ontario, a proportionate amount of their provincial debts considering the number of people who would be taken out of the two provinces compared to the rest of the population, which would add up to a few hundreds of millions of dollars. That might be attractive to them. And those provincial debts should naturally fall to the new jurisdiction backed by the federal Government, because the provincial debt reflects the number of people-in the province, and if some of the people are taken away with the land, then I feel the new jurisdiction should assume some of the responsibility, because those provinces have incurred that debt by building highways, transmission lines, and so on.
Those are some of the ideas I have, and I feel that the suggestion I might be making here goes beyond what the Hon. Member for Hull (Mr. Isabelle) has suggested in his Bill. On the other hand, I feel quite confident that perhaps he would have liked to go as far as I have in my suggestion but thought that going part way would be the best way to start the ball rolling. It seems odd, if one looks back in history, that it was as far back as 1899 that the Government of the time first set up the Ottawa Improvement Commission to beautify and to enhance the capital of Canada, or the seat of Government, as it might be more appropriately called. The Government of the day wanted to make the capital something special for the people. As time progressed, the name was changed and the new Government, around 1926-27, brought in a new group called the Federal District Commission. Of course, it was in 1958 that a new piece of legislation came along and the National Capital Region was prescribed in that legislation. It was legislation introduced by the Government of the Right Hon. John Diefenbaker. So this is certainly not a completely
Constitution Act, 1867
new idea. It is not a partisan idea and I feel it is being discussed here today in a nonpartisan way.
It seems that we have never gone beyond the stage of discussion or beyond the stage of implementing half steps and half measures. Section 16 says that the seat of Government will be Ottawa. We have moved to the point where the National Capital Region encompasses a large portion of the Province of Ontario, including Fitzroy Harbour, Pakenham, Almonte and places like Orleans on the east, so it is not just the City of Ottawa anymore. The National Capital Region stretches farther than that. It also encompasses the other side of the river in the Province of Quebec, which I feel is only appropriate as it takes in a more proper balance of the two cultural groups which I suppose founded this country in the sense of a country called Canada being formed. They were the instigating partners. I believe that a new jurisdiction should cover those areas and those cultural groups, including the civil law in what is presently the Quebec portion and the common law in the Ontario portion. They could both be encompassed in a new jurisdiction or province or capital region, whatever the name might be.
I would like to believe it might even go farther. The Hon. Member for Hull, in introducing the Bill, may have been more wise than I. He has taken that intermediate step in suggesting that we would deal with the whole area as being the seat of Government and the capital of Canada. I have one problem as to whether it should be Ottawa-Hull. I would prefer that the name "Ottawa" be retained as it is a historical name, a Canadian name, it is named after Indians, whereas "Hull", quite frankly, was adopted from the name of a city on the east coast of England. Perhaps that name does not have the same sort of Canadian content that a name adopted from the name of original native people in this country would have.
It might be more appropriate for the Bill to not be read at this time and perhaps the subject matter referred to a committee. It would seem to me that that might be a way of giving it an opportunity to be taken up by a committee and looked at in all of its dimensions.
I am not sure if that suggestion commends itself to the Hon. Member who has introduced this Bill, or to other Hon. Members who might want to speak on it, at least for a short period of time. I do not want to take up too much time, but I believe there is much merit in this idea. I think it would help to reflect the duality of this country. As I say, I have a certain reservation about the name "Ottawa-Hull", but those are technicalities which people can work around in one way or another. I would like to see an independent jurisdiction set up which could work out the problems directly with the federal Government rather than having two provinces quarreling over jurisdiction and where the buildings would be.
I think it should be pointed out that this area has changed much. When Canada became a reality we had three buildings here on Parliament Hill, the Centre Block, the East Block and the West Block. Those buildings housed all Members of

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Constitution Act, 1867
Parliament, all Senators and all civil servants in this country. Now we have Tunney's Pasture and Confederation Heights and a proliferation of government buildings throughout the Ottawa area. In the last 10 or 12 years we have seen a proliferation of buildings on the other side of the Ottawa River in what is presently the City of Hull, to reflect the capital on both sides of the river. In essence I think most people, whether they liked it at the time or not, accepted then and accept now that the capital of Canada is on both sides of the Ottawa River. Indeed, the federal Government pours in considerable money to beautify not just Ottawa but the National Capital Region which takes in portions of both provinces. I would certainly favour this matter going to committee to be considered even beyond the scope of the Bill, but if necessary I would even support the Bill.


Lyle Stuart Kristiansen: Mr. Speaker, I am pleased to rise and support whatever action is necessary in order that the Bill may become a reality in some shape or form. Many of the visitors who come here from as far as British Columbia-and I know many have come from my own constituency as well as others-regard the National Capital Region, not just the City of Ottawa or the City of Hull, as the capital. They look around and see the work done, particularly by the National Capital Commission, and they have the feeling that the region is the capital and the whole area represents the country. What they have seen they feel to be one, and they also feel it to be quite good.
As one who was a resident of this area back in the early 1960s for a couple of years, I know that the improvements which have been made, largely through the NCC, have given to all of us who have come to know this area or to visit it, a feeling of some pride. No matter how distant we may be in our own homes from what is regarded as the political centre of the country, we do have some pride in it and feel as though there has been a good job done. I would also say, perhaps a little tongue in cheek, that even though the nation's capital may not always be in the mainstream, by following this suggestion at least we will put the mainstream in the national capital. That may not be a bad idea as well.
In listening to the remarks of the Hon. Member who just spoke, I find myself a little concerned, as desirable as though it may be, about attempting to remove areas from either the Province of Ontario or the Province of Quebec. It seems to me that it is perhaps typically Canadian to have a capital in which jurisdictional squabbles are ever present. We sometimes tend to be isolated enough without asking for even more departures from the norm.
In listening to the remarks of the Hon. Member for Hull (Mr. Isabelle), I note that he expressed, perhaps not misgivings, but some thoughts as to the fact that many Canadians may not regard this as the centre of the country. That is not unique in the Canadian experience. In my own Province of British Columbia the capital was selected in a colony separate from the major part of the mainland and so we had to cross the water in order to get to our provincial capital. That was entirely within the Canadian experience.
As an aside, Mr. Speaker, may I say that I, along with many other Members of the House on Tuesday evening, attended the gala performance at the National Arts Centre in honour of the visit of the Premier of China. No one could have mistaken that performance as being anything else but Canadian. Perhaps I felt more distinctively Canadian then than I had felt for some time, if not ever. The fact we can put together that kind of performance on relatively short notice, the fact that, as has been alluded to previously, we have in recent years adopted a number of symbols, a new national anthem, a national flag, a constitution, a charter, about which many people across the country feel pride and which they consider to be not only an instrument but as a symbol of nationhood and a coming of age, makes it entirely appropriate that we should find some way of expressing the duality of our major founding cultures and the uniqueness of those things which make us Canadian. We should recognize that taking a segment from both sides of the river and calling it the capital seems good and proper and is welcome.
I would just say again that whatever course the Hon. Member for Hull may choose to take on this Bill, he has our general support. We hope that in the not too distant future his intent will become a reality. We welcome the proposal.


Mr. Chuck Cook (North Vancouver-Burnaby):: Mr. Speaker, I have looked at and considered this Bill very carefully. It says:
It is hereby declared that the national capital of Canada and the seat of the federal government of Canada shall consist of the city of Ottawa, in the Province of Ontario, and of the city of Hull, in the Province of Quebec, and also of such surrounding area as prescribed from time to time by the Parliament of Canada.
That is the essence of this particular Bill. The explanatory note says:
The capital of a country should not simply be considered its seat of government but should symbolize its authority and unity, and should project to the world the repository of the nation's soul.
In other words, this amendment to the Constitution will authorize Parliament to legislate so as to include in the National Capital all areas now included in the National Capital Region.
It may surprise the Hon. Member who proposed this Bill, but I find he has a great poverty of thought. I am opposing this Bill on the grounds that it does not go nearly far enough. He is proposing to include the whole area and yet to leave it out. He is proposing a Bill that does not accomplish what should be accomplished. Had his Bill been properly framed, I would be the first Member in the House to support it fully.
We all know the difference in taxation between the Province of Quebec and the Province of Ontario. We all know there are many immense Government buildings in the City of Hull, and that city should certainly be part of the capital of Canada. No doubt about that. I can certainly agree with that, but the Bill does not go far enough. I suggest to the Hon. Member that he did not frame his Bill in the proper way. The national capital should have become the national capital including Hull and the surrounding area and including Ottawa and the surrounding area. That is the real capital of this country. He should have proposed that this Government make representation to the Government of Ontario and the Government of Quebec
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that they give up this territory in order that a national capital area be designated, an area with its own laws and taxation on the same basis on which the District of Columbia in Washington, D.C. operates. On that basis I could approve this Bill.
There is no question at all that Hull is part of the national capital. But it is improper to have taxation in Quebec which causes Quebeckers to buy their gasoline in Ontario. It is improper that English Canadians cannot live across the river in the Gatineau Hills because of the difficulties involved with school taxes and proper schools for their children. It is improper that Ottawa and Hull are not totally bilingual, as I suggest a national capital of this kind should be.
This Bill is improper. It should not be passed. It should be tossed back and the Government should be required to go much further in that respect. We do need a national capital region.
As anyone wandering the streets of Ottawa knows, we have the RCMP, the Ontario Provincial Police, the City of Ottawa Police, the City of Hull Police and the Quebec Police. Frankly, I find that offensive. One policeman is bad enough, but five policemen from different jurisdictions, all operating within basically the same area, is offensive. The City of Ottawa and the City of Hull should be part of this Bill. There should be an amalgamation to make it truly the national capital. That we do not have. This Bill is not going to help it at all. Taxation within the National Capital Region should be equalized so that the person who owns a house in Hull pays the same taxes as does a person in Ottawa. Regardless of which side of the river a person buys his gasoline, the cost should be identical. If he buys a meal in a restaurant, his taxes should be the same. In other words, there should be a jurisdiction for the national capital, an area which is truly the national capital, as opposed to what we now have. The beautification that has taken place on the Ottawa side of the river should be extended fully to the Hull side of the river. We would no longer have the jurisdictional disputes in which an Ottawa painter paints half of the bridge and a Quebec painter has to paint the other half. Those kinds of disputes do not lead to national unity. Those kinds of problems which we are faced with are ridiculous. In a sovereign nation, a country of this size which means so much to all of us, it is time we ended the solitude which exists between Ottawa and Hull.
The Member nods at me. He agrees with me. Then why did he not go that far? Why do we have this simple Mickey Bill which, if passed, would only mean that we would perpetuate mistakes that have been made in the past? Let us put this country together by taking Hull and Ottawa and making them into what could be a great national capital and district. If we did that, it would certainly solve the problem in this Bill of not including Hull. I am not prepared to go part of the way. I want to go all the way. I want to do something for this country which would make for unity in the country rather than the two solitudes that exist on either side of the river. This Bill does not really contribute to that, in my view. It is too simple.
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Perhaps it is a step, but it is an inadequate step. If only that step were taken, the real issue involved in the situation would not be addressed.
Queen's Park, Quebec City and the Members of this House of Commons could solve this problem and give us a national capital which could be the finest in the world. They could give us a unity in this particular area within the confines of the ghetto that Ottawa is now and the ghetto that Hull is now by putting them together and having one civic government for the whole area and one police force for the whole National Capital Region. I think possibly that could be done. I think we could get an agreement out of two provincial Governments which have a tendency to fight with each other. We could get an agreement with a constitutional amendment which could set up such a region. All we would have to do would be to offer lower taxes to the whole area so as to have the full support of the citizenry. As a matter of fact, I suspect the people of Ottawa would welcome this. No one likes to be charged with Quebec taxes when he lives in Ontario. No one in Quebec likes to work in Ottawa and realize that his taxation is substantially lower than that of somebody who lives on the other side of the river. No one likes the idea that, depending on what education and school he wants for his children, there is a substantial difference in where his residence is.
Because of those factors I feel the Bill is inadequate. It does not go nearly far enough. It does not really deal with the problem which is a unit of disunity in the country.
I said that I thought the Hon. Member displayed poverty of thought. Perhaps that is a little strong. I would say that his intentions were excellent and noble. However, as I mentioned initially, he just did not think through to what the real implications should be, what could happen in this country and what a contribution the proper Bill could make to the total unity of this country.
If we had a capital region we might name the city Sir John A. MacDonald. I suspect there might be some difficulty with that. However, I am sure that we could find a name and dispense with Hull, Quebec and Ottawa, Ontario. We could have a name that truly reflects the national will, the will of the nation as a whole, and that truly means something to Canadians. It is their capital.
We see busloads of schoolchildren arriving here from now until the end of June. All Members have visitors who come and who are awed by the Parliament buildings. The Parliament buildings happen to be on the Ottawa side. Should the people of Quebec not be able to feel exactly the same pride in these buildings? That territory belongs to all of Canada. It is not part of Ontario, and Hull is not part of Quebec; it is part of the national capital. That is the answer to the situation rather than a Mickey Mouse Bill which simply includes Hull to a certain extent. I do not care what you call it. How it is policed can be worked out. The administrative functions, I am sure, can be amicably agreed to by everyone over a period of time. Taxation within the region would be taxation within the region and it would no longer matter on which side of the river you lived.

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I would personally be delighted. I think the Gatineau is among the most beautiful country in all of North America. I cannot live there. I cannot afford to. It simply is not possible as opposed to living on this side of the river. To me that is very wrong. My children are grown up. But I know many people with children who would sooner live on the other side of the river but cannot. I was talking to a new Member from British Columbia who won a by-election last August and one of the things I told him and warned him about was attempting to live on the other side of the river in the Hull area. I pointed out to him some of the things I have pointed out to you, Mr. Speaker, about taxation, about the differences in hours, about the differences in food costs, about differences in the wine, beer and liquor stores and the costs involved on both sides of the river. Much as he wanted to bring his French to the point where he would be absolutely and totally bilingual, he had to take a very good look at the situation before he realized there were penalties involved for him, that there were demerits, and that living over there would not work for him. Reluctantly, he lives in Ottawa. Frankly, that is a sad situation. It is unfair, and that is not a contribution to national unity. The Hon. Member for Hull (Mr. Isabelle) had a good idea, but he did not carry it far enough. I am not prepared to vote for such a simple Bill when so much more is needed. This country should take a very good look at the situation. Darn it, it is our national capital. It should be the National Capital Region. It should be a separate jurisdiction from what goes on in Queen's Park, Toronto or what goes on in Quebec City. The national capital should reflect the whole of the country.
In my view, the City of Ottawa and the City of Hull should both be part of the national capital for the very purposes of national unity. The Premier of British Columbia should have as much to say about what takes place in the National Capital Region as the Premier of Ontario does now or the Premier of Quebec. The Premier of Nova Scotia should have some words that he can express about what his feelings are on the National Capital Region, just as all Canadians should have something to say about it, whether they are French, English, Swedish, German, or what have you. If we want a truly national capital and if we want a truly National Capital Region, then this Bill is not the answer. We should have a much stronger, more vigorous Bill that will set up this area as the national capital of this country in the proper sense, in the same sense as the American genius who arrived at the concept of the City of Washington, D. C. and the District of Columbia, which is not subject to any of the individual states surrounding it. I do not think that is really such a far out idea. I do not think there would be much against that idea throughout the country. It would certainly equalize taxation on both sides of the river. It would mean the guy with the shoe store in Hull and the guy with the shoe store on the Sparks Street Mall would know they are being treated absolutely equally. In some of the areas there is great difficulty now, and I mention gasoline again. It is not difficult to see by going back and forth across the river, that gas prices are considerably higher in one area than in another
because of taxation. All one has to do is look at the provincial income taxes to realize there is an impediment on one side. That does not necessarily mean it is all bad in Quebec either. Quebec has some things that I would like to see here. It would mean that everyone living in the National Capital Region would be treated on exactly the same basis.
There is a great inequality now. Things will not change under a Mickey Mouse Bill like this. Things will only happen if we can get agreement that we can get a separate jurisdiction and if this particular area becomes, in the truest sense of the word, a real national capital. That is what I would like to see. That is the kind of Bill that I would be prepared to vote for, not this one. I say that with great respect, Sir. I understand the Hon. Member's motives are good and I understand his attempt to correct something that is wrong right now, but why not go after the bundle? Why not collect the full bundle and eliminate all of the pressures, eliminate to whatever extent it still exists-and it does to a considerable extent-the two solitudes on both sides of the river? Put them together. Certainly Hull is part of the national capital. No one can deny that. All you have to do is look at the thousands of civil servants crossing the bridges every morning, both ways, Put them into one jurisdiction. I do not believe the House of Commons should control that jurisdiction. You can certainly have a municipality with a municipal government that has representatives elected equally from all parts of Hull and from all parts of Ottawa. It would make a major contribution to national unity. I think also it might give those of us from the far outposts of this country a slightly better feeling about the national capital, knowing it was a separate jurisdiction that was not part of Ontario, that was not part of Quebec. By golly, let us have a district of one kind or another that belonged to all Canadians from whatever part of the country they may have come.


Blaine Allen Thacker: Mr. Speaker, on a personal basis I want to thank the good doctor, the Hon. Member for Hull (Mr. Isabelle), for bringing this Bill forward. As I have studied the background of this Bill, he has singlehandedly taken this idea, developed it and nurtured it. He has sent out householders to people, and I gather now there is a substantial majority of people within Hull itself who are in favour of a National Capital Region. That is a real tribute to the Hon. Member. The former Member for Peace River, Mr. Ged Baldwin, worked for 15 years on freedom of information before that idea seeped through to all other Members of the House. I am sure each time the Hon. Member for Hull brings this Bill forward, there will be additional Members standing and saying they are in favour of it personally. I want to do that today, representing as I do a riding from southern Alberta where there is an enormous feeling of distance and isolation from Ottawa as part of Ontario and the capital. What we need is, as the Hon. Member for North Vancouver-Burnaby (Mr. Cook) said, a national capital with which we can all truly identify, that is not associated with the provincial politics and conflicts that arise and the great baggage that history brings to each of the Provinces vis-a-vis each other.
January 20, 1984

I wonder, though, if the Hon. Member has given any thought to whether at this time, were the Bill to be referred to a committee, were an official committee of the House to deal with it, it would not revive somehow the battle between the federal Government and the provincial Government of Quebec? While some of us might say that that does not matter because the PQ separatist Government should be slapped around, I wonder whether at this time when many people in Quebec are feeling ill at ease as a result of being left out of the constitutional settlement this would make the situation worse.
I would say to the Hon. Member that if he were prepared to convene a like minded group of Members of Parliament who
Constitution Act, 1867
would like to do some work on their own on an unofficial basis, I would be more than happy to join with him and lend whatever credence I can being a Member from the far reaches of the country.
May I call it five o'clock, Mr. Speaker?


Mr. Deputy Speaker:: Order, please! The time allocated for consideration of Private Members' Business has now expired.
At 5 p.m., the House adjourned, without question put, pursuant to Standing Order.

Monday, January 23, 1984