Hon. James McCrae (Government House Leader): Madam Speaker, I move, seconded by the honourable Minister of Natural Resources (Mr. Cummings),
THAT, in the case of all bills referred to committees of this House during the present session and proceeding to enactment, Legislative Counsel be given the authority to take the following steps at any point before publication of the acts:
(a) change all section numbers and internal references necessary to give effect to amendments to bills adopted by this House and its committees; and
(b) without in any way altering the intended legal meaning make minor changes to bills to correct obvious errors like spelling, numbering, cross-referencing and capitalization errors and to correct punctuation and formatting that is not consistent with Manitoba style.
THAT the Legislative Counsel be required to mark all changes made pursuant to this authority in red ink in the affected blue bills as soon as possible after the end of the session.
Motion agreed to.
Mr. McCrae: Madam Speaker, I move, seconded by the Minister of Natural Resources (Mr. Cummings), that Mr. Gerry McAlpine, member for the Electoral Division of Sturgeon Creek, be appointed Deputy Chairperson of the Committees of the Whole House.
Motion agreed to.
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Mr. McCrae: Madam Speaker, on a matter of House business, I believe there is agreement that immediately after the next motion is moved and dealt with that we would move to consideration of government bills in the order listed on the Order Paper, and that at four o'clock the House would move to private members' hour. Thus, when five o'clock arrives, it will really be six o'clock and at that time we would adjourn.
This is an opportunity, I guess, for me to say Merry Christmas and Happy Holidays to everyone, and I hope that we all return to this place some time early in the new year refreshed, and that we have a peaceful time in the meantime.
Madam Speaker, I move, seconded by the honourable Minister of Natural Resources (Mr. Cummings), that when the House adjourns today it shall stand adjourned until a time fixed by Madam Speaker upon the request of the government.
Motion agreed to.
Madam Speaker: For information purposes and clarification for routine this afternoon, there will be now one hour, from three to four, approximately one hour of debate on second readings. At four o'clock private members' hour will commence, and be one hour in duration, which should bring us to five o'clock. At five o'clock the House will consider it six o'clock and adjourn for the holiday season. [agreed]
Mr. McCrae: Although I did suggest we move in the order the bills appear on the Order Paper, would you be so kind to call Bill 13 initially or as the honourable member for Burrows (Mr. Martindale) might direct during the course of the hour. What about Bill 17? Are we going to do that one?
Madam Speaker: On the proposed motion of the honourable Minister of Health (Mr. Praznik), Bill 13, The Prescription Drugs Cost Assistance Amendment Act (Loi modifiant la Loi sur l'aide à l'achat de médicaments sur ordannance), standing in the name of the honourable member for Selkirk (Mr. Dewar).
Is there leave to permit the bill to remain standing? [agreed]
Mr. Tim Sale (Crescentwood): The Pharmacare program in the province of Manitoba was of course introduced under the Schreyer government and has made it possible for now more than 20 years of families and seniors to be able to afford the drugs that they need to maintain or to restore their health.
Mr. Ben Sveinson, Acting Speaker, in the Chair
I think we need, in putting in context these changes which of course need consultation with the pharmaceutical association, with patient groups and with others before they are considered for passage by this House, but in the process I think we need to reflect on Mr. Justice Hall's royal commissions to realize just both how far we have come in the area of Pharmacare and what a great distance we have yet to go.
Mr. Acting Speaker, Mr. Justice Emmett Hall in his royal commission report which was received--the commission was struck in 1957, and the report was received in 1960. Mr. Justice Hall indicated that the most important overall concept of providing publicly funded health care across Canada was to put in place a seamless kind of system. By that the justice and his many advisors, many of whom still are and certainly those who are not still active in the field, were the leading people in health care planning in Canada from Dr. Hastings to Claude Castonguay to the Castonguay-Nepveu commission to the Miller task force here, to people like Bob Evans and many others who took a great--
The Acting Chairperson (Mr. Sveinson): Order, please. I do not mean to interrupt the honourable member for Crescentwood, and it is nice to see members from across the way talking and smiling and doing their thing, it is nice to see that kind of thing happen. However, while another person has the floor, I would ask that all honourable members try to do the responsible thing and allow that person to speak.
Mr. Sale: Mr. Hall put in place recommendations for what has been called a seamless system. For example, he foresaw the need to cover not simply direct medical care in the form of doctors' services and the services of hospitals, but he foresaw the need to include dentistry, pharmaceutical costs, mental health costs, home care costs.
Indeed, members who have not read the summary of the Hall Royal Commission would really be interested to see the tremendous foresight that was shown in compiling that report because the compilers, who represented, I think, all traditions of political thought in this country from all sides of the spectrum, understood that it does not make sense to cover only part of what people need. I would like to explain why that is the case, not just in terms of simple justice which I think is obvious, but in terms of the distortions that introduces into any kind of human service. Take, for example, the case of a senior who is on a very limited budget and requires a particular medication, whether it is a diuretic or a heart medication or some other form of long-term medication, the absence of taking that medication, Mr. Acting Speaker, I think we all know what happens. The senior gets very sick, may die, but certainly gets sick and needs to go to hospital, needs a great deal of medical attention in order to simply regain the state of health that would have been maintained in the first place if that senior were able to take the drug that was needed.
So Mr. Hall and health economists by the dozens since have pointed out to governments that it is really penny-wise and pound-foolish not to provide a full and continuous spectrum of services. If you are going to insure anything 100 percent, you pretty much have to insure everything that is medically necessary because the failure to do so means that people, in the absence of their ability to get the service they need here, wind up in a much more expensive situation over here. That, of course, is the reason why the Schreyer government introduced home care, why it was maintained under the Lyon government, and why it has been--although badly damaged in times under this current government, it still is maintained and it is maintained at a level, if I may say, that is higher than some other provinces in Canada, and that is a good thing. It was much higher than other provinces in Canada under the Pawley and Schreyer governments. Unfortunately, it slipped somewhat.
It is still a very good service, and we are very pleased that the minister has backed down from his ill-advised attempts to privatize all of home care in Winnipeg and all of the nursing services. I think that was a wise move on the government's part, whether they planned to do it or not or whether he invented it on his feet, nevertheless the climb down was welcomed by home care recipients and by those who have known that that is a cost-effective as well as a humane way of meeting the needs of sick people.
The same is true in regard to Pharmacare, Mr. Deputy Speaker--Mr. Acting Speaker, I beg your pardon. There have been many studies, some of them which might seem self-serving by the pharmaceutical associations of Canada, but all of them which I think have a great deal of useful truth in them and that is that in the past 25 to 30 years, advances in drugs have made it possible for people to remain in their homes or in communities and to maintain a level of wellness which was previously unobtainable without the use of those drugs. This government and every government in Canada and, I think, all opposition parties have welcomed and urged the development of a Canadian drug industry that undertakes extensive research and development and is located in provinces across Canada.
Unfortunately, the central body of that research is done in Montreal where the centre of the drug industry in Canada is, but Manitoba has a small and growing pharmaceutical industry. I believe that the industry really began to take off under the HIDI initiative, which was started again under the Pawley government and has been maintained and built on by this government, wisely, the initiative to focus on the health pharmaceutical sector. So we have new companies in Manitoba that have sprung up, more recently, the merger of two companies here which was well remarked on and whose senior staff I have had the opportunity to meet with, who I think are providing both very good research and very good products as well as very good employment opportunities for a growing number of Manitobans.
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So it is in everyone's interest that sound research and sound development in use of pharmaceuticals takes place, because it is so clear now that if we did not have psychotropic drugs for example we would not be able to have many people with debilitating mental illnesses able to share a normal life in the community with their families and with their friends. If we did not have drugs to lower blood pressure on a safe and consistent basis over many years, we would have far more people dying prematurely of stroke. We would have far more people unable to work because of chronic high blood pressure. So no one I think debates the efficacy, the appropriateness of working to develop an ever larger array of useful pharmaceuticals. But what this government unfortunately has done is to go in the opposite direction, and they have gone against the best advice of Justice Hall and all those who followed him, from Doug Angus, Pran Manga, Bob Evans; people who are here in this province--John Horne, David Fish, Anna-Lee Yassi--and any number of Canadian health economists who have said it is not good economic policy to only ensure some services or only ensure some drugs.
So the changes that are proposed in this act allow in general terms more discretion to take more things away from the public sector, to remove the responsibility of the minister, and to give it to some faceless committee, so that the accountability of what is listed and what is not is no longer before elected officials.
Let us review, Mr. Acting Speaker, what this government did when it gutted the Pharmacare program. While it is true that for a small number of Manitobans the 100 percent coverage has been a benefit, it is equally and, in fact, considerably more true that for the 100,000 Manitobans who used to receive significant Pharmacare benefits but now receive virtually none that the program effectively has become a welfare program for low income people or for very sick people.
Now that goes against the fundamental principles of wellness and prevention, which this government likes to talk about but does not like to act on. When you make it difficult for moderate income or lower middle income people to take the drugs, to access the drugs that they need to maintain health, you are simply playing with a time bomb.
I have had far too many constituents who have said to me, my drug bills are now in the $1,500 to $2,000 a year, and when you combine that in some cases with the fact that in some of those homes, as the minister probably knows, one of the spouses is in a nursing home, with the increase in nursing home fees, the increase in Pharmacare fees and the dropping availability of home care support services--not the intense nursing services, but the support services--seniors are being very, very seriously squeezed by the decisions of this government.
Any one of the decisions by itself was problematic. When you take any senior who has worked hard all their life and has a modest income and suddenly they have to find another $1,200 to $1,500 for drugs where previously they were paying $300 or $400, that is a serious impact. When you cascade on top of that, the other things that are happening to seniors and which are made more possible under this bill, were it to receive passage, then you see that what we are doing is putting in place the conditions not only that make it difficult for seniors and others who have chronic and major drug costs, we are putting in place the conditions to cost ourselves more than we ought to spend.
The minister, by failing to meet the basic Pharmacare needs of all Manitobans, is putting at risk the ability to control the costs of the health care system for all Manitobans, because it is a documented fact that when people do not take the drugs they need they wind up sicker, longer, and in many cases they wind up in hospital inappropriately.
No one, I think, over here would argue that all drugs and all prescriptions are properly used, that there is no abuse in that area. Of course, there is, but for the most part people use their drugs the way they are supposed to be used. I am too often told by seniors: I have to choose between adequate food and my Pharmacare bills. I do not have the flexibility anymore with my wife in a nursing home, my home running down or my apartment running down, my food bills, my travel bills to help look after my wife in hospital. I am talking about someone like Mr. Wirth, for example, whose case I raised here in the House last week, who is paying $22,000 a year out of his income for his nursing home care, which is not in a nursing home, it is in Victoria Hospital, plus his own drug bills, plus the costs of maintaining his home which was previously a family home. He just does not have the ability anymore to stay in his own home, because of the cascading effect of the charges that have come about because of the changes that this government is making.
Mr. Acting Speaker, when you add on top of that what is going to happen to every senior in this province, because of the federal government's cuts to the seniors benefit, and I hope the Minister of Health (Mr. Praznik) knows the impact of that change, because there has been a great deal of misinformation put out by the federal government in regard to the change in the seniors benefit. Seniors have been told--and I am sure that the Minister of Agriculture (Mr. Enns) has probably received this information, that his benefits, such as are not taxed back, will continue unchanged by the seniors benefit when it comes into place. I believe all seniors have received that information from the federal government, but what the federal government has not told seniors is that you lose your pension income deduction and you lose your age deduction when the seniors benefit comes in, and that is for all seniors, not just ones who are going to be 65. It is for everybody.
Now, the Minister of Health (Mr. Praznik) is a lawyer, and he has done lots of these calculations in his head. What does it cost a couple who suddenly lose approximately $8,000 in deductions? What is the tax impact? Three thousand plus in an age deduction and a thousand each for pension income deductions. The seniors benefit has an impact on modest-income seniors of $2,200 per year per couple, $1,200 for a single person of a modest income, Mr. Acting Speaker.
The problem that we have going in regard to all of our senior services is that a few years ago the pundits and the theorists began to say, listen, seniors are pretty well looked after. We have cut the poverty rate way down. It is really the working poor who are the problem now. Everyone looked at it and said, well, that is probably--you know, there is some truth there. So everybody rushed to cut seniors benefits, each level of government cascading cut on cut, and no one has sat down and said, what is the whole impact here of the changes that we have made over the last four or five years?
I want to underline to the minister, although the issue of the federal benefit is not specific to this act, that seniors are looking at very, very serious consequences, and the near retired are looking at even more serious consequences because the new seniors benefit, which is not taxable, that is true, but the tax-back rate on the new seniors benefit for people who have an income of only an additional amount equal to the seniors benefit--that is, the seniors benefit for a single person will be $11,000-and-something; for the next $11,000 of income the tax-back rate is 76 percent because the seniors benefit is clawed back for everyone at 50 cents on the dollar, and, in addition, people pay income tax.
So I think the minister needs to take very seriously what is happening to many seniors and needs to address with his colleagues federally the impacts of all of the cuts and changes on a typical senior household. This has been done by the Canadian Association of Retired Persons, by the Canadian Council on Social Development, and those data are available to the minister should he wish to take a look at them, and I would urge him to do so before he meets with his colleague.
There is a particularly good study by the Canadian Association of Retired Persons which was done by a Mr. Kelm that I think the minister would find very useful. Mr. Kelm is a retired actuary in Toronto and might even not be a member of the NDP, I am not sure about that, but I would commend that study to the minister.
Mr. Acting Speaker, the changes that are being looked at here unfortunately do not take into account the needs of people with multiple sclerosis in regard to their ability to receive Betaseron and Copaxone. We know that these are very expensive drugs, but there are also very substantial benefits for a proportion of that population. We would have wished that the minister would have taken an early opportunity to announce that this coverage would be extended to those who could benefit from those drugs.
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On the other hand, Mr. Acting Speaker, the bill does do a very important thing, and I commend the government for this, and that is to follow through on the promise to make it possible for midwives to write prescriptions. That, of course, is also an important initiative which, while it took far too long to achieve and while we are still some significant time from having midwives actually out there in the field in any numbers, it is nevertheless important that the government has followed through on the promise to make it possible for midwives to write prescriptions.
I want to draw the House's attention, however, to the fact that we have been talking about this particular change for more than a decade. The government took a great deal of time, and in fact sat on the midwifery report for well over a year before making it public and taking a stand on it. So the action of making it possible to prescribe drugs is welcome; the timing is abysmally slow.
In concluding my remarks on the whole issue of these changes and on this bill, Mr. Acting Speaker, I want to return to what I think were the most unfortunate changes that were made in the Pharmacare program. When very significant deductibles were imposed of 2 percent and 3 percent of income prior to any payment and to then allow 100 percent payment is a principle that I think if the minister went to any of the social policy people in the field, right-wing, left-wing, centre-wing, it would not make any difference, all of them would say to the minister that it is bad-program design to have 100 percent coverage after zero coverage in one step. One more dollar, and it is 100 percent covered; one less dollar, and you get zero. That is a bad program because it encourages abuse and it discourages responsibility.
If the government cannot afford to provide free needed prescription drugs, then the notion of a scale deductible would be a sound policy. From a program point of view, it is sound policy because there is then no incentive to behave other than to use the drugs properly because you are paying the same proportion of the cost up to some reasonable level. Other provinces have an upper limit beyond which they do provide total coverage, but it is a sliding process.
There are many texts written on how to design an income support program. I have never ever seen one that suggests that it is a good design principle to go from no coverage to 100 percent coverage, with no graduation in the process at all. It simply is bad-program design. So when the minister made these changes, he not only disenfranchised over 100,000 Manitobans from receiving benefits under a program that was very important to them, he also put in place a program that was very badly designed and led to tremendous distortion in the first year. The minister will remember all of the people who reached their threshold and then went out and filled prescriptions because they were then at their threshold and they could prebuy for the next year or the next period of time at the government's expense. That, of course, is the behaviour you would predict from a program that is that badly designed.
So I would wish that at some point in this next year or so, next few months, perhaps the minister will come back to this House with a better-designed program, with a program that recognizes the other fundamental principle, and that is that it makes no sense to not provide needed prescription drugs for all who need them and to not overcharge them and not make it difficult for them, because in the absence of taking those drugs, we are shooting ourselves in the foot, Mr. Acting Speaker. We are shooting ourselves in the foot, and then, of course, we need to go to a hospital anyway. We are shooting ourselves in the foot because we are encouraging people to get sick by discouraging them from taking the drugs they need because they cannot afford them.
The third thing I would ask the minister to pay particular heed to is the cascading effect of the charges that he has put in place, particularly for seniors, because I would wager that in the next year or so, we are going to see a great number of seniors in deep, deep economic distress because of the changes of the federal government cascading on changes that they have faced from provincial, particularly health care, but also things like the $75-tax credit change. They all add up to a very big burden, and I do not think the government has taken the time to add them up and recognize the scale of that burden, Mr. Acting Speaker.
Thank you very much for the opportunity to address this bill.
Mr. Daryl Reid (Transcona): Mr. Acting Speaker, I am pleased to rise to add my comments on Bill 13, The Prescription Drugs Cost Assistance Amendment Act. This is an issue that is important to my constituency. I know I have had the opportunity to talk with many people in my community not only those who have called me specifically with health-related issues, but people who I encounter throughout the community. In fact, I have done a survey some time back about the government's change to the Pharmacare program when it occurred on April 1, 1996, and the effects that it was having on the people in my particular constituency.
People living in Transcona or elsewhere in the province of Manitoba have for some time recognized the value of the Pharmacare program and its importance to the families, my family being one of those who would utilize the Pharmacare program and at that time, prior to the 1996 changes, recognized that there was quite a substantial saving to the families as a result of the Pharmacare program. It indeed helped many families--mine included--and low-income families who fall above the government's threshold that they have established and that it was a benefit to the families.
But the government chose in 1996 to change the particular Pharmacare program. In fact, we saw it as a tax increase on those families in the province here, and we put together a number of examples to try and illustrate quite clearly what the impact was going to be on a family. An average working family, where there were married with two dependent children, with an income in the range of some $47,000 annual income, that the current annual deduction at that time was $237, that was the deductible that those families would have to pay. Well, under the changes that the government brought forward on the Pharmacare program in 1996, of course, that same family, its deductible would rise from $237 to $1,155 before any of their drug costs would be covered under the Pharmacare program. I think that that government moved in the wrong direction of that and particularly in light of the fact that you now have and you brag quite openly about this surplus and you have had successive budget surpluses, as you have indicated. In fact, I think the number last budget total count was $577 million and now you continue to gouge the families of Manitoba through your Pharmacare surtax or tax--if we can call it that--by the changes that you made in April of '96.
To give you another example, because that first one I gave you where the deductible rose from $237 up to $1,155, a 387 percent increase for that family. The cost of living for that family, even if they did get a raise, for that average family would have been in the range of 2 or 3 percent. That would be, no doubt, the maximum that they would have received by wage increases for that family if they got anything in that particular time. Another example, a family of four living at the poverty line, total annual income for the whole family, both partners working and perhaps even some of the older children working, would have been $31,000 and if you do the calculation for that family, the annual deduction would have been $237. Under the new system that the government has brought in under the Pharmacare program, $662 is the deductible for that family, 179 percent increase for a family at the poverty line. I do not know how you can justify that. I do not understand the logic that you used.
A senior, a single senior living in the province of Manitoba whose current annual deduction before April of '96 was $134. Some might consider it an onus; if you are a senior on a fixed income, no doubt $134 would be. Considering the seniors I have talked to in my community, some of them are living below the poverty line and have their budget stretched to the limit just to try and make ends meet. Well, their annual deductible went from $134 for this one particular woman in my constituency who is a widow, and under the new system she would be paying $465, a jump from $134 to $465, a 246 percent increase for this widow. I am not sure how you can justify that.
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There are many examples that I can give, but two-thirds of Manitobans are now cut off the Pharmacare program. I am not sure how you can justify that. This is a preventative measure. It costs substantially more to put people in hospital and treat them than it does to give them the necessary prescription drugs to prevent them from having to enter the hospitals. So it is a preventative program, and yet you have moved away from preventative programs and now people have to enter hospitals. This is a tax on Manitobans; let us be clear about it.
We think back to the changes this government has made in the health care system since they have been in office, and of course we can look back to the fiasco when they hired Connie Curran to come into this province at $4 million U.S. tax free to make, what? What kind of recommendations? How has it changed the health care system? Was this a wise investment of Manitoba taxpayer dollars?
Now we have rethermalized food coming into the province of Manitoba under this government's plan. It is going to cost us nearly 400 jobs in the province of Manitoba, some of them your own producers living in your own communities. That is the impact is going to be, and I am worried about these people and the jobs they have. I want to have quality food products for the people that are in our hospital facilities and in our personal care homes, but if you are bringing in rethermalized food--and I have seen that food. My honourable colleague the member for Concordia brought examples to this House where you could not tell the difference--member for Kildonan (Mr. Chomiak), pardon me, where he brought examples to this House where he showed quite clearly that you could not even tell the difference whether this was porridge, gravy or mashed potatoes.
Now I do not know about you, but I would not eat that type of food unless I was being spoon-fed it. If I were in a hospital bed, I suppose, that would be the only way you could get it into my mouth, but I would not eat it if I were any conscious person looking at that. It was not appetizing in the least. I took a look at the toast. Any one of you know, just take a look in your own fridge at home. Put a piece of toast in there and take it out a couple of days later. What is the condition of the food when you thaw it out, the toast? You are going to have a soggy piece of bread; in fact, you might not even be able to tell that it is bread, and yet you are going to feed that to the sick and the vulnerable in our hospitals. I think it is the wrong move.
I think we should be using Manitoba-grown products to support the produce people here in the province of Manitoba. We should have the value-added industry to produce those products here in the province of Manitoba. We should be giving quality food to the people that are in our hospitals, not the kind of garbage that you are now having under experiments at the Riverview and other centres here in the city. We think you are on the wrong track on this, and I am sure the public will demonstrate that clearly to you as time progresses--[interjection]
Yes, and I am reminded here by my colleague the member for Crescentwood (Mr. Sale) about the Minister of Health (Mr. Praznik), and he must be embarrassed, at least he was here on the day when it was pointed out to him. He said with great fanfare that he was going to bring in a sample of this food from the Riverview Health Centre for his Tory caucus cabinet meeting, or caucus meeting that he was having this week, only to find out that he had brought in a special chef from Nestle to prepare this food and a full-course turkey dinner, a full-course turkey dinner, no doubt to feed the turkeys that were going to eat it.
An Honourable Member: What did the patients have that day?
Mr. Reid: But the patients that day had rethermalized food, macaroni and peas.
Now I do not know how the Minister of Health (Mr. Praznik) and his colleagues can sit here in this Chamber and say that it is fair for his caucus colleagues to have what he called a meal that was prepared at the Riverview Health Centre come into this Chamber, when we know full well that that meal was not the same meal that was prepared for the patients of that particular health care facility. So, while you had turkey, dressing, gravy and all the trimmings, the patients of Riverview Health care had Kraft dinner, no doubt, and peas. Now, you call that fair for those patients that are in that facility?
I have a family member that just came out of there. I was in there looking at the conditions, beautiful facility, but the food that they were being served is not appropriate for them.
I do not know how this aids in their recovery to feed them--[interjection] Yes, I have had family members recently in the hospital, and I have looked at the quality of food, and I have looked at the overworked conditions of the nursing staff in there. I have had calls from people in my constituency who have family members in the hospital today who tell me--in fact, one particular case, the constituent's father was a doctor now retired, and there was not even appropriate health care staff to look after him in the hospital. Now my constituent asked me: does the government think that this is quality health care to have a person that is in the health care condition that her particular father is in and not have adequate health care staff available? In fact, my constituent tells me that the nursing staff of the hospital have been instructed to tell the families of the patients: we cannot help you; go out and hire additional staff to come into the hospital to look after your family members.
That is what my constituents are telling me that they are being told if they are worried about the health care and the staffing additions in the hospitals. I am talking about last week being told this--I am not talking months back--last week. So maybe the Minister of Justice (Mr. Toews) can afford, through his family income, to hire additional staff to come into the hospital to look after his family member or his loved one. Other families in our province cannot afford that. It is an onerous financial burden that you are placing upon the families and upon the people that are in hospitals at the most vulnerable point of their lives.
I want to talk a bit about the other health care issues, because it does deal in some way with Pharmacare. I know the Minister of Health has been asked this question, and I am not sure if I will have another opportunity to ask him this question, but there is a problem at the Health Sciences Centre under the mental health system in that particular facility. Now, I know I have written to the minister and my Leader has written to the minister on Dr. Seshia, and I am not going to get involved in the management decisions that are taking place in that particular facility, but what concerns me about that particular health care facility, knowing of people that have utilized that facility, and it is my understanding in talking to others in the community that deal daily with situations such as this, is that there is not a certified person in charge of that particular mental health facility.
I have waited now for some weeks for the minister to respond to my letter, and I hope he will shortly so that I can apprise my constituents of what is happening in that particular health care facility, because I want to make sure that the people who are going into that facility receive the care from people that are skilled and trained in those areas so that they do not have to guess on whether or not the doctor that is providing the treatment has the necessary certification and is qualified to instruct or perform any medical procedures or to prescribe any drugs.
For the benefit of my constituents, I am asking the Minister of Health (Mr. Praznik) to respond to those needs. That is why I sent a letter to the minister asking him for some advice in this matter.
The Acting Speaker (Mr. Sveinson): Order, please. I have asked all honourable members in the Assembly to respect those that are speaking so that they are not interrupted. I would also ask those that are speaking to address their remarks to the Chair and to try to keep their remarks pertinent to the bill in question. Thank you.
Mr. Reid: Through you to the members opposite, as I would normally do, but I neglected to do it at the beginning of my comments--through you to the members opposite, I ask you to take a look at what is happening in the Health Sciences Centre, the mental health facility, because there are problems there, and there are serious problems. I do not want to see anybody put at a disadvantage or not receive the appropriate health care services that they require, particularly in these situations.
I also want to, when talking about this Bill 13, and I am aware that Bill 13 has some five sections in it, four of them more specifically designated to reform the particular act or to amend the particular act, but I am worried about the future of the Concordia Hospital.
I believe, Mr. Acting Speaker, the government House leader has a few comments, and I will yield the floor to him with the understanding that I can resume my comments.
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Hon. James McCrae (Government House Leader): I thank the honourable member for Transcona for the accommodation. This is by way of House business and not meant to take away from his time.
Earlier today I tabled a letter of understanding between myself and the honourable member for Thompson (Mr. Ashton) respecting the spring break and respecting the Interim Supply bill. At the time it might have been good if we had asked that that become an order of the House by way of unanimous agreement, so that is what I am asking for now, that the letter tabled earlier be agreed to unanimously.
The Acting Speaker (Mr. Sveinson): Agreed? Agreed and so ordered.
Mr. Reid: To resume my comments about the Pharmacare program and Bill 13, but I want to talk a bit about Concordia Hospital because I have received correspondence from constituents, people I talked to in my community about the future of this particular facility, and I know the government has made some changes to its structure of the delivery of health care services in the city of Winnipeg and, in fact, throughout the province of Manitoba, when we have now gone in the city here to the Winnipeg health care authority, I believe is the appropriate term to use.
My worry here is, and I am going to put this on the record although I hope it does not come to pass, that the government may be intending to use this particular body to change the structure of the Concordia Hospital facility from one currently of acute-care, 24-hour basis to one of a geriatrics facility. Now, if this is the government's intention and plan to use this particular body to make those changes, I can assure the minister there is going to be a large hue and cry from the community, and you will be hearing from me on this because I think this would be a wrong step because this particular hospital not only serves the northeast section of the city of Winnipeg but also serves the outlying areas of Springfield, Birds Hill, Anola, Oakbank. So it is an important hospital facility, acute-care facility, for all of these communities, and we think it would be the wrong direction for the new body, the Winnipeg regional hospital authority, or the government in its instructions to this body to make those changes to that particular hospital.
In Bill 13, Mr. Acting Speaker, I am concerned because this government has levied a tax upon the people of Manitoba, those who had used the Pharmacare program, increases anywhere from 100 percent to 250 percent on their prescription drug costs. In fact, I have had occasion in the past to correspond with the ministers of Health for people who have had drugs that were delisted, and their doctors were prescribing these to them, to these patients, only to find out that they did not have access to these drugs unless they wanted to pay for them out of their own pockets.
I am worried about the section in the bill under Section 2, and I hope that the minister is not intent on this because it would definitely be in the wrong direction. It appears to be that the government is intent on having a payment of fees, as it says, to be met by different manufacturers of drugs. My worry here with respect to this particular bill is that this could be the door opening to allow the drug companies of North America, perhaps around the world, to pay a fee to the government of Manitoba to have their drug listed as the drug of choice on the preferred list that the government has. If that is the case, I think we are doing a disservice to the people of this province in that there are no doubt suitable alternatives through the generic drug manufacturing industry that would be equally as appropriate for them to be prescribed as it would be for the government to have a preferred drug list, as the drug companies are trying to corner the markets.
Now, we know this government is in favour of the 20-year prescription protection for the drug companies, and we know it was your government that had some say in what happened and that you never voiced any concerns contrary, raising the price of prescription drugs in the province of Manitoba, but I am worried that you are moving now to allow these particular name-brand drug manufacturing companies to have their product corner the market by having it put on the preferred list.
Well, if that is what you are going to do, I think it would be the wrong move, and I only raise this because I am not clear on what your intent is. We have not had a chance; we have not had--[interjection] Well, Mr. Acting Speaker, perhaps the minister, who did not provide us with a spreadsheet to explain these changes, would have helped us to understand what that means to have a payment of fees. Who is going to pay those fees and for what purpose are those fees being paid? So I am not quite clear on what the minister's intent is with respect to the payment of fees.
In the other section of the bill, the minister is making some changes, and what we are also worried about with this is that because we know that this government receives a certain amount of financial contributions from the particular drug companies, that is another reason why we are worried that you are going to put these products on the preferred list.
In addition, the government is going to make some changes with respect to who would be allowed to prescribe drugs, likely no doubt from a specific list. Previously the government had listed the dentists and the pharmacists as two professional groups that would be allowed to prescribe drugs, and the government is now adding midwives no doubt in light of the government's legislation which we had before us in this Chamber last session. If there are needs in situations where there are midwives that are involved and there is no doctor available in that situation and we need to have certain drugs done, and the people that are administering or prescribing these drugs are trained and are aware of the conditions of the patient, then it may be appropriate for them to undertake to issue or prescribe these drugs. I am not an expert in these areas. I hope that the minister through his department will take the necessary precautions to make sure the people that are being given these new powers will exercise them in the most appropriate fashion, and that they will indeed be given the training to allow them to make the appropriate decision on when and where to make those decisions.
I am also aware through my colleague, but more importantly, through my own family member who happens to have multiple sclerosis. I know my colleague the member for the Interlake (Mr. Clif Evans) has raised this with the minister here in the House dealing with the listing of Betaseron and I think the alternate is Copaxone, if I recall correctly, to have that particular drug listed so that the people suffering with multiple sclerosis can lead a normal life because it is my understanding that these particular drugs can make a significant change to the medical condition for people suffering with MS. I ask the minister to with all haste undertake the necessary due diligence in looking at these particular drugs to make sure that the appropriate tests are done but in as quickly as possible a fashion to make sure that the patients can utilize these drugs if they are going to alleviate the pain and suffering that they have and to improve their quality of life.
In the bill itself, Bill 13, the minister is now going to delegate some of his responsibility, in fact shift the responsibilities to the particular committee that the minister has, in setting up or determining which drugs are or are not on the list the government has of the insured drugs. Now, of course, the minister I guess in this case does not want to make those decisions any longer so he is going to shift the decision-making responsibility on to this particular body. I am not sure if that is the appropriate course of action to take to let another body. I take it that there must be some fair amount of expertise on that particular body, but we are not quite clear on whether or not that should be appropriate for the government to make those changes.
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There may be other areas that the government is proposing. I wish the minister would have tabled a particular spreadsheet to explain in more detail his intent with respect to these changes on Bill 13, the Pharmacare program. But I do know that overall his Pharmacare program has disadvantaged a great many of Manitobans; in fact, two-thirds of Manitobans are now paying this increased tax as a result of your changes to the Pharmacare program. These changes, I hope, will not further disadvantage Manitobans, including the people that live in my community of Transcona, and we will be watching very closely the comments of the minister with respect to this bill and his comments in committee when we have an opportunity to question him further with respect to his intent on Bill 13 and the changes he is proposing here today.
So, Mr. Acting Speaker, with those few comments I will turn the floor over to my other colleagues who may also wish to add their comments with respect to Bill 13, but we will be watching the minister's comments on Bill 13 when it does go to committee. Thank you for the opportunity to speak to the bill.
Ms. Jean Friesen (Wolseley): Mr. Acting Speaker, I, too, am glad to have the opportunity early on to put some comments on this particular bill on the record, because it is one that affects my constituents, many of whom are seniors and some of whom live in very serious and straitened circumstances.
Indeed, I was yesterday at the west Broadway neighbourhood centre where we were having a Christmas dinner. I sat down with a group of seniors, and I would say within two or three minutes, the one issue that was raised with me was the cost of drugs. People started talking to me about the way in which their drug costs had been altered, about the increase in taxation that they saw that the government had brought. Being straightforward-speaking people, they were very clear that what the government had done was to impose a tax upon them and yet at the same time try to maintain that it was not a tax increase. Nobody is fooled by the kind of platitudes which the government has uttered on different and many occasions about its so-called record in not increasing taxes. No senior in west Broadway, I think, respects that position.
The government has increased taxes. It has increased it in many new and unusual ways, but it does not have the guts, it does not have the straightforwardness, it does not have, I would say, the directness to recognize and to admit and to confirm that these are indeed tax increases, and they are, of course, tax increases on many of those who are in the most difficult circumstances.
Pharmacare, Mr. Acting Speaker, is something which has extended the life, it has extended the well-being, it has extended the wellness of all of our constituents. I think there is no doubt about that, and it is part of the extension of medicare that has come to characterize Canada. I well remember when we first came to Canada in the end of the '50s, early 1960s. We came from a country which had medicare, and we came to a country which did not have medicare. I well remember the fears of my family, my parents, that we were--I think my mother's phrase was, putting our heads into a noose--coming to a country where there was not that kind of security that we had left. There were many other reasons for coming to Canada, and Canada has been a very wonderful and generous country to other immigrants, not only to myself, to my own family. But one of the most exciting things about living in Canada in the 1960s was the way in which medicare was expanded and the way in which in many ways that social democratic philosophy, in fact, became a Canadian philosophy.
I was much struck when we had the last round of hearings on the Constitution during the Charlottetown Accord. So many people came to speak to that meeting and talked about the value of medicare and the value of social programs and the importance of maintaining a strong federal government for the purpose of maintaining and enhancing those kinds of social programs. There were some times I know when people expressed even reservations about that because they said, well, is Canada nothing more than a series of social programs? But, Mr. Acting Speaker, it was clear that to people, being Canadian had come to mean the maintenance of those national social programs which distributed the chances in life a little more equally and which certainly distributed them on an equal basis across Canada.
I remember the doctors' strike in Saskatchewan. I remember hospitalization coming into the province of Quebec where I lived, and those were indeed very exciting times, and they seemed to be an inevitability of expansion of that kind of redistribution of life's opportunities. It made Canada seem a very generous, as it is, a very generous country and one which was recognized that it had wealth and that wealth could be distributed equally amongst all its citizens.
The Schreyer government in the 1960s, end of the '60s and the 1970s, in Manitoba expanded that to include the beginnings of home care and the beginnings of a Pharmacare system, and that was expanded, of course, under the Pawley government as well, because clearly if you are interested in maintaining a strong national and provincial health care system, you must look at Pharmacare as part of that. This was in a period, in fact, when the use of drugs was not nearly so extensive as it is now or indeed that the prices were not so dramatically high.
But, Mr. Acting Speaker, it was a recognition of the importance of drugs in the whole system of prevention and medical treatment of the sick of this country, and I well remember it being brought to my attention. I was canvassing--this was in 1971 I think it was--in Carleton East in Ontario, sitting down with a senior, and I was relatively young and did not have a great deal of life experience. She sat down with me at her kitchen table, she poured out all her drugs on the table and she listed for me the cost of those drugs. She then went through her budget, and she showed me the meals that she was going to have to miss to pay for those drugs. That was before Pharmacare in Ontario.
Now, gradually across Canada the example of both the Saskatchewan and the Manitoba governments has been imitated by others. I would say until the early 1980s that people felt that there was the opportunity to share the wealth of this country through medicare, through hospitalization, through pharmacare and home care with all our fellow citizens, but we began with the Mulroney government a different kind of ethos for Canada. It was the swashbuckling, swaggering '80s, the politics of the '80s that saw only individual heroes, which wanted to take away the collective and the social democratic ethos and framework from Canada, and they began to do that.
They looked at pharmacare as one element of this, and they began the process of much greater protection for the drug companies, much greater emphasis on the producer rather than the consumer, and, Mr. Acting Speaker, I think this continued with the beginnings of the cutbacks to provincial governments of health payments which continued with the Chretien government. I think if there is one thing we share with members of the government side, it is a tremendous dismay and a shock that the Liberal government which brought in many of the elements of hospitalization which had a Liberal face at one time has now begun, in fact perhaps even completed, the dismantling of a national health care system with national health care standards, with an equality for all across Canada, and Mr. Martin as well as Mr. Chretien seem to see no shame in this. Yet they want at the same time to talk about national unity, they want to talk about national programs, and they are dismayed when people I think see them as the destroyers of that national unity that had been there in the '60s and '70s and an allegiance to a growing sense of Canada as a country of generosity and of distribution of wealth.
So what we are seeing as the provincial government in Manitoba has continued with a similar kind of policy is the introduction of user fees in so many elements of society. Canada is becoming not the social democratic society as was created in the '70s or the '60s in Saskatchewan and Manitoba, but it is becoming a society where you must have the money--
The Acting Speaker (Mr. Sveinson): Order, please. When this matter is again before the House, the honourable member for Wolseley (Ms. Friesen) will have 32 minutes remaining; and, as previously agreed, the matter will also remain standing in the name of the honourable member for Selkirk (Mr. Dewar).
It is now time for Private Members' Business.