Mr. Dave Chomiak (Kildonan): Madam Speaker, I move, seconded by the member for Swan River (Ms. Wowchuk), that

WHEREAS there are currently a number of semi-private or private for-profit clinics in operation in the Province of Manitoba; and

WHEREAS in January 1995 the federal Minister of Health wrote to the provinces giving them until October 15 to end the practice of allowing private for-profit clinics to charge "facility fees" before she would impose a penalty in the form of a direct reduction in transfer payments equalling the amount people are paying in user fees; and

WHEREAS Manitoba will lose up to $400,000 as a result of the Minister of Health's failure to stop for-profit clinics from billing Manitobans; and

WHEREAS the Minister of Health has considered and approved proposals to limit health care services, such as physical exams, unless patients can pay out of pocket for them; and

WHEREAS, despite recommendations for action, the minister has not moved to control the growing number of private labs or develop conflict-of-interest guidelines in this area; and

WHEREAS more and more services, like eye examinations, are being deinsured and more user fees, like the $50 Northern Patient Transportation fee and the $300 ostomy fee, are being imposed; and

WHEREAS the five principles of medicare as outlined in the Canada Health Act are portability, accessibility, public administration, universality and comprehensiveness, principles which are violated by the proliferation of private for-profit health services and user fees; and

WHEREAS these charges are leading to the Americanization of our health care system.

THEREFORE BE IT RESOLVED that the Legislative Assembly of Manitoba urge the Minister of Health to review all decision to move to private for-profit health services in Manitoba; and

BE IT FURTHER RESOLVED that this Assembly urge the minister to go on record as opposing the development of a two-tier health system and the further privatization of health care services.

Thank you, Madam Speaker.

Motion presented.

Mr. Chomiak: Madam Speaker, I think it is appropriate that, as we move into Private Members' Business, we should have left the government's business, which is another privatization scheme. We are moving now into the area of health care where the government is going in spades to privatize everything that moves in health care. I think it is appropriate that members of this Assembly and that the citizens of Manitoba have an opportunity to discuss not creeping privatization--in fact, this is galloping privatization that is occurring under this regime.

Do you know that the truth was revealed to Manitobans this February when we revealed and we provided to Manitobans what the government intentions were in terms of health care? The government cabinet document, the Treasury Board document signed off by the Minister of Health (Mr. McCrae) and endorsed by the entire cabinet, said that it was Manitoba Health policy to deliver health care privately, that it was Manitoba Health policy to move to private delivery of health care. This was not just home care. It was Manitoba Health policy to delivery health care privately.

Without endorsation from the public, without any mention in the election campaign except vague assurances that health care would be protected--just as we had vague assurances that MTS would not be privatized--the Minister of Health and members of this cabinet went around the province saying that health care would be protected. And what do we see, Madam Speaker? We see the biggest move towards privatization in Manitoba history and probably in Canadian health history. There is no province that is moving to privatize as members opposite are moving to privatize. Even Ralph Klein, who has been sent on his heels in Alberta, has not privatized to the extent that this minister is privatizing health care.

Madam Speaker, what is most deplorable about this policy, it is being done without input from the public. It is being done without any kind of input from the public. The Minister of Health (Mr. McCrae) likes to stand up and make pronouncements that he consults. I ask you, who was consulted in the public when the minister decided to deinsure eye examinations? Who was consulted in the public when the minister decided that he would remove from medicare the eye examinations? Who in the public was consulted when the minister this year decided to reduce the number of visits an individual could have to a chiropractor? Who consulted? Who did the minister consult? Who was the minister consulting when he decided to conditionally approve the elimination of physical examinations, the elimination from medicare of physical examinations? Nobody in the public.

It continues, Madam Speaker. Who did the minister consult when they decided to privatize the home care equipment program? Who did the minister consult when they decided to privatize the home I.V. program? Who did the minister consult when they forced VON to set up a private for-profit subsidiary to the nonprofit corporation in order to bid on the government's privatization contracts in home care? Who did the minister consult with when he decided to privatize and charge fees for these services?

Madam Speaker, who has the minister consulted with as he now is in the final stages of determining how he will downsize, rationalize the lab system, both inside the city of Winnipeg and outside the city of Winnipeg? Are we going to see a move towards a nonprofit system or are we going to see a move towards a privatized system, a privatized system run by the privates?

The minister has report after report after report on his desk about the lab system. The minister has his own reports from his own groups, his own secret groups studying the report that says that private labs are creaming off the best services in terms of the lab system. What is the minister doing? The minister is now meeting with private lab interests to have private lab interests take over the lab system in the city of Winnipeg and outside of the city of Winnipeg.

Madam Speaker, what we are seeing in this galloping privatization is something fundamentally dishonest. At least if the government would stand up and say, this is what our policy is, this is where we are going, then the Manitobans would have an opportunity to debate it but they are not doing it because what is the essence of privatization? The essence of privatization is taking a publicly operated service and putting it right on the backs of the citizens of Manitoba and making them pay, because they have to pay for all of these services. That is where the user fees come in. That is where the move towards a two-tier system comes in, and that is where this government and this Minister of Health (Mr. McCrae) is taking us over and over again throughout this system.

Madam Speaker, a case in point is the eye examinations. If you want your eyes examined, now you have to pay. I was at a public debate with the minister when I talked about user fees, and the minister said, these are not taxes. Now what are you going to call these fees? You call them contributions; you call them co-payments. They call them everything but what they are, user fees and a tax on the sick. User fees and a tax on the sick.

Madam Speaker, the minister will get his opportunity to speak and he will get his opportunity to debate, but what this amounts to is taking a service that is offered to the public, privatizing it and making the users pay, making the public pay. These amount to taxes, taxes on the sick, a two-tier system, and we have seen it in spades in Manitoba. We have seen it in home-care equipment. We have seen it in home care. We have seen it in the provision and the charge of facility fees. We have seen it in the, you know, now if an individual wants an eye examination or a hip or knee replacement, they can get it done in the public system that has the longest waiting list in the country, or they can now get it privately at a fee, and this is being encouraged by the government.

The minister suggested, the minister has said on many occasions, this is great. It reduces the waiting list, and that just betrays the basic lack of understanding of how the system works. By suggesting that somehow if you pay for the service and reduce the waiting list you are doing a service in Manitoba, is in fact totally contrary. What you are doing is charging user fees on the backs of those that require the service, on the backs of the sick, and we have seen a greater proliferation of user fees under this jurisdiction than we have seen in any other time in Manitoba history. We have seen a privatization like no other privatization.

Madam Speaker, what is the end game? What is the government's goal? It is very clear. It was in the Treasury Board submission signed by the Minister of Health, endorsed by cabinet, and it said that they are moving towards user fees in the future in home care and that, as the government privatizes the service and as individuals get charged for the service, they are going to have no choice but to pay this user fee.

So we are going to have a core of services, a small core of services being offered by the government and the rest will be subject to if you can afford to or not afford to, and this frankly fits in with the Conservative philosophy towards health care, which is fundamentally that it should be there for catastrophic purposes and that is the extent of it. The Conservative philosophy is that medicare is there for catastrophic and after that you are on your own and after that you pay.

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I know that was said by the Prime Minister, and I was shocked to hear that by the Prime Minister to this day, but what the Minister of Health does not recognize is that every one of his policies in this area is taking us exactly to that conclusion by narrowing the core services offered in Manitoba and you have already this year narrowed the core services dramatically. You are doing precisely that and, by privatizing services, you are forcing individuals to pay for a cost that was formerly paid for out of general revenues and was formerly paid for universally under our health care system.

So in its drive towards privatization, the government is not only costing us additional funds in terms of penalty payments from the federal government, but what they are doing in addition is putting in place a two-tier system that will see Manitobans have to pay for health care services that were formerly offered universally and within the system.

No better place or recognition of government policy exists for us to confirm this government's policy initiative than to look in Bill 49, where over and over again in Bill 49, the government has provided regional health authorities with the ability and the need and in fact has directed regional health boards to charge user fees, to charge fees for services that were formerly offered. We are going to see with the move towards regional health authorities, particularly in light of the fact that the minister has already indicated that $100 million is going to be removed from the budgets of rural and northern Manitoba over the next three years, we are going to see the imposition, unlike any other time in Manitoba history, of user fees within our health care system outside of Winnipeg. I dare say something that is already occurring in the city of Winnipeg in the form of user fees for so many health care services is going to now expand outside of Winnipeg under the regionalization model. I suggest and I think that we will stand corrected that when we see the shakedown and the ultimate resolution of how the government is going to deal with its superboard system in Manitoba, we are going to see more and more services deinsured.

Just this year, one year after an election campaign, a year and a half after--well, in fact, the budget came out a year after the election campaign--we see the deinsuring of services for chiropractors, we see the deinsuring of eye examinations, we see the deinsurancing soon of physical examinations, we see the deinsurancing of lab tests, we see the attempted privatization of 100 percent of home care and a cabinet document that indicates that only core services would be paid for by the government but the rest would be paid for as a user fee--and it says so in the document--by the public.

So, Madam Speaker, I do not know what it takes to try to persuade the government that its course of action is fundamentally wrong. It took a major strike and it took a public awareness campaign unlike anything ever before hereto seen in Manitoba with respect to home care to convince the government that Manitobans were against the privatization of home care. Notwithstanding that, the government continues to privatize--home care equipment program, home I.V. program, the VON service that had to set up a subsidiary at government direction. The minister in his comment indicates a misunderstanding, precisely indicates the problem. The minister says that VON has always been privatized.

Does the minister not realize there is a difference between nonprofit and for profit? Does the minister not realize that the We Care's of the world are for profit and VON is not for profit? Does the minister not realize that the We Care and all of the minister's friends in the personal care home sector and all of the government's privatization in that sector are for profit and that the money goes into the pockets of shareholders rather than back to patient care? Does the minister not recognize that fundamental difference? I am afraid not and probably that accounts for the fact that the government has so clumsily embarked on this scheme.

Before it is too late, the minister--I will give the government credit. They backed off in terms of the home care strike at least in terms of a small proportion of what they privatized. They are still privatizing 100 percent of the nursing service. Will the government take a step back, look at what they are doing to the health care system in Manitoba, look to a system that now has the longest waiting list in the country, look to a system where the government through its cuts and its mismanagement has caused grave difficulties and look to themselves, not to the nurses and the doctors and patients as the problem, and the way they put the system together and give assurances that user fees are not part of this government's plan?

Privatization is the wrong way to go. It has been demonstrated over and over again in major studies and it is not the way to go. Stop following the New Zealand model in terms of the regionalization. If the government were to do that, I would think that perhaps the public and we in the opposition might be prepared to look with more favour upon any attempts to try to change a system, but as the government moves on its fundamental privatization model with its move towards user fees and its association with private companies and its directives, then I think that Manitobans will continue to be suspicious of all of the government's attempts and all of the government's health care reforms.

I urge members of this House to support this resolution against privatization, against a two-tiered health system and in favour of a universal health care system that meets with the needs and the requirements of all Manitobans. Thank you.

Hon. James McCrae (Minister of Health): Madam Speaker, I welcome this opportunity to participate in discussion of the resolution brought forward today by the honourable member for Kildonan, who for a number of years now has been the official Health critic for the New Democratic Party. He puts a lot of energy into his work and I appreciate that in a person. He puts so much energy though that he sometimes does not always get the approval or approbation of his colleagues on his side of the House before speaking for the party he represents. He tends in his presentations and his participation in the public debate on health issues to engage in words and phrases that have become somewhat hackneyed. Words like "privatization" and "two-tier" and "on the backs of the sick" and "user fees," those kinds of hackneyed expressions that have nothing to do with any logic. There is absolutely no scholarship in any of the contributions the honourable member makes, and he simply does not do his homework.

For my three years as Minister of Health, I have been listening to the hackneyed bleatings and ejaculations of the honourable member for Kildonan (Mr. Chomiak) and, frankly, I find that simple repetition does not work anymore. It might have worked for Stanley Knowles or Tommy Douglas in those halcyon days of the CCF and the New Democratic Party, but those days are over. We are in the '90s now and the people of the '90s are frankly tired of hearing the bleatings and ejaculations that come from 50 years ago that have absolutely no relevance to what is going on in the real world today, but I still listen in the hope that as the honourable member for Kildonan practises his skill as an orator, there will be actually something that is relevant to the '90s and beyond because Manitobans are desperately looking for leadership from all of the participants in this Chamber and that includes leadership from the Health critic for the New Democratic Party.

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But he has gone on, Madam Speaker, ad infinitum, ad nauseam and indeed ad absurdum from time to time in his contributions to debate on health in this country and he really does no service to those forward thinkers like Tommy Douglas, a forward thinker as it turns out like Bob Rae who had to learn the hard way to become a forward thinker. He did not start out that way but circumstances have now conspired such that Bob Rae is now rewriting the way it should have been. His book is a good example of that; I commend it to the reading of all honourable members opposite in the New Democratic Party. Indeed, members of the Liberal Party might be interested as well since Bob Rae replaced the Liberal government in Ontario and it may be that having been replaced by a Conservative government in Ontario, Bob Rae's writings of today might be of interest to honourable members opposite. They might get a hint as to just what it is that is wrong with their approach to their style of leadership in the '90s.

As I say, the honourable member for Kildonan displays no evidence whatever of utilizing any logic in his contribution. There is no scholarship, there is no homework evident in any of his comments today.

Madam Speaker, all of which is to say that the honourable member and his colleagues, they pay no heed whatever to the concept that as a nation and as a province we should learn to live within our means. This is a strange, new concept to New Democrats, but the thing that is interesting about this is that it is not a strange new concept to virtually every other Canadian living in this country today. We all have to live within our means and in doing so make adjustments to the way we live so that there will be something left over to pass on to future generations.

Sometimes I am tempted to think that the messages put out by honourable members opposite have a flavour of something that is desirable. There is no doubt that the honourable member for Kildonan and his colleagues are actuated by honourable sentiments; I do not quarrel with that. What I do quarrel with is that reality is a total stranger to honourable members opposite. It is as if they are working in some world outside this planet that does not exist except in the imagination of people like the honourable members for Concordia (Mr. Doer), Crescentwood (Mr. Sale), Kildonan (Mr. Chomiak) and one or two others over there who pretend to leadership aspirations.

It was Tommy Douglas, Madam Speaker, who honourable members opposite like to credit with the fact that we have a health care system in our country. Well, we had a health care system before Tommy Douglas came along, a gentleman I knew and was honoured to have made acquaintance with and to report faithfully his utterances in the House of Commons for some eight years. Mr. Douglas was a gentleman I think all Canadians came to respect and, in some cases, revere because he helped bring to us something that is very important to all of us and that is a government participation in a health system.

But the system that Tommy Douglas helped bring into being was based on a private-sector philosophy which called for a fee-for-service system for the payment of medical services. That is something that clearly requires review today. I am sure that Tommy Douglas, if he were with us today, would be urging us to do that, and he would be chiding the honourable member for Kildonan not to be so silly and foolish in trotting out a diatribe that is clearly of a 50-year-old vintage.

If you understand, Madam Speaker, that in the last 50 years our world has changed more than all of the changes during the whole of civilization. It does not take very long to figure out that the New Democrats have some catching up to do. They are so hidebound in their philosophy and ideology that there is no room for doing the right thing any more in the minds of members of the New Democratic Party here in Manitoba.

Well, is it not strange that when New Democrats elsewhere are charged with the responsibility of actually doing something instead of just talking about it all the time, you will find that in provinces which are led by New Democratic administrations you will see a number of similarities to what is going on in those provinces to what you see here. Although I must say, under Bob Rae and under Roy Romanow, the changes that we are seeing in health care are somewhat more significant. If there are cuts, there are deeper cuts; if there are changes, those changes are more sudden that what we see here in the province of Manitoba. So it is almost like those provinces do not exist, those administrations do not exist, Bob Rae never walked on this earth, and Roy Romanow is someone who has just gone astray, I guess. While we do not know much about Mr. Clark yet, because he has not really had much of a chance to show anybody what he can do, what we have seen so far we are a little nervous about.

But clearly honourable members opposite must come to grips with the fact that we are late into the 20th Century and nearly in the next millennium. If they do not come to grips with that, their message will continue to be irrelevant and will become more and more irrelevant as we go forward into the next century.

The concept of living within your means, though, is not a new concept, it is a concept that has been around ever since the New Democrats came along. In those early days, Madam Speaker, I think that was a concept they embraced, but here in the province of Manitoba they have clearly given up that part of their legacy and decided to go for the political brownie points rather than bring forward constructive, realistic and relevant alternative solutions to the problems we face as a province. For example, when facts and reality escape them or do not work for their particular very base, I suggest, objectives, then make something up.

We saw an example of that today in the Legislature during Question Period. The honourable member for Kildonan (Mr. Chomiak), thinking that he could perhaps bring some attention to the pressures that have been placed on the dialysis program over the years, decided that he would introduce a letter into this Legislature. He brings forward a letter written by an official in the Health department to the leadership of the dialysis program. Well, he decides that out of a four- or five-paragraph letter, a couple of paragraphs in that letter ought to be removed because, you know, here in the Legislature we cannot make a distinction. We need to be spoon-fed our information by the honourable member for Kildonan (Mr. Chomiak).

Well, it was a piece of chicanery that the honourable member for Kildonan did not get away with, I am happy to say. The document that the honourable member produced when looked at in its entirety tells quite a different story than the story being portrayed by the honourable member for Kildonan. Now, I do not need to go, I do not think, chapter and verse again into the commitment of this government to the health care needs of Manitobans, but I guess since the New Democrats feel that repetition is the only way to get a point across I have to engage in that sort of thing myself.

There is another train of thought that says if you tell a lie often enough, after awhile that lie becomes the truth. There are shades of that here on a daily basis. Somehow we have got the attention of honourable members opposite when we raise issues like this. [interjection]

Methinks the New Democrats doth protest a little too much. They are a little too cute by half, especially today when they blank out half a letter that they have tabled in this House, they kind of betray their own intentions and the game that they are playing. The fact is that dialysis services are an important service to be provided, and if you look at the growth of that program in Manitoba, there is ample evidence that this government is certainly committed to the people who require dialysis services, and nothing, no gamesmanship the honourable member for Kildonan (Mr. Chomiak) might play, is going to change that.

Now, maybe he was urged on by his friend the honourable member for Crescentwood (Mr. Sale) today in playing that type of a game. It is not usual for the member for Kildonan to carry on like that. Maybe he spent some time on the weekend with the member for Crescentwood and learned a few parliamentary tricks from him, and maybe the honourable member for Kildonan can be forgiven for that little game that he tried to play today.

But as I say, Tommy Douglas, one of those architects of the health system that now needs restructuring and change--and he would be one of the first to suggest that needs to be done--brought in a system that required government to be responsible for those things that the member referred to, and the Prime Minister also referred to it, as services required in catastrophic circumstances relating to doctors and hospitals.

What is totally lost on honourable members opposite--or maybe it is not, Madam Speaker--is that the Canada Health Act does refer to services that are of a medically necessary nature. A few moments ago the member for Burrows (Mr. Martindale) was pointing out the five principles of the Canada Health Act: universality, portability, accessibility, public administration and comprehensiveness, and applying that to the total of all aspects of the health care system when he knows, or ought to know--and if he does not, he belongs where he is, in the opposition--that those concepts apply to those medically necessary services talked about in the Canada Health Act.

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Well, where has he been the last 25 years? The health system has changed already, and we are into a lot more things than simply hospitals and doctors and it is right that we are. It is quite a challenge for every jurisdiction to apply those principles to every service. Yet all provinces in this country of ours maintain that we ought to do everything we can to achieve the ideals that I just recited from the Canada Health Act in all aspects of our system. It is a very hard thing to do, and provinces are grappling with that issue. Manitoba takes a back seat to none. In fact, we lead this country in terms of our commitment to health care, 33.8 percent of all our spending being on health care. We lead this nation, and no province can surpass us in that regard.

So all of the hackneyed bleatings and ejaculations of the honourable member for Kildonan (Mr. Chomiak) aside, I think we can go forward with some confidence that we have a government that is totally committed to the health care concerns of all Manitobans. Thank you.

Mr. Peter Dyck (Pembina): Madam Speaker, I also wish to put some comments on the record regarding the resolution that the member for Kildonan (Mr. Chomiak) had introduced into the House. I agree as well that there needs to be openness of the government to debate issues that are relative and pertinent to Manitobans. As I was listening to the member for Kildonan go on almost endlessly with some of the issues that he felt were of great concern to him, I was reminded of a letter that I received today from one of my constituents, and this letter certainly applauded our Minister of Health and our government for the approach that we were taking in health care and applauded the government in the fact that the health care that they had received had certainly met their needs. They were speaking specifically of a very grave situation, where a member of their family had been subjected to cancer, and so they were appreciative of the assistance, of the good health care that we have and the opportunity that they had to participate in this. So I want to, with that, commend our Minister of Health for the good work that he is doing.

Madam Speaker, the member opposite also indicated, he mentioned the whole area of the optometric society, the fact that now there were fees that had to be paid by those who wished to have eye examinations. I would just like to relate an instance from my own constituency, in discussion with some of the doctors and physicians there in indicating that it is interesting how, when there is something that is free, people have a tendency to take advantage of it, and it was indicated there there are people who come in as often as eight to 10 times a year in order to have eye examinations when they know full well that their eyes have not changed, that there is nothing special that had taken place, but they enjoy the interaction and the contact that they have with the doctors.

It reminds me of another instance, and the honourable member for Portage (Mr. Pallister) made me aware of it, that within the last while, there was--I am not sure if it was a constituent, but someone within the Portage area who had visited the optometrist 55 times in one year.

An Honourable Member: A medical doctor.

Mr. Dyck: Visited a medical doctor 55 times. Certainly this is an abuse of a privilege that we enjoy within the province of Manitoba.

I also am a great supporter of supplying medical care, the best medical care for each one of the residents within our province. I believe that we need to do that. However, I believe that the word "sustainability" needs to come into play.

An Honourable Member: Living within our means.

Mr. Dyck: Living within our means, exactly right, I agree that we need to live within our means. As the minister indicated during Question Period today, in fact, we had spent $60 million more in '95 than we did in '94, that is, 33.8 percent of our total budget within the province is being spent on health care. So I agree with the minister when he says that we need to live within our means. We need to have a system, a program within our province that is sustainable. If we are going to do this, we need to take that responsibility to heart right now, and I believe, and I know for a fact, that since 1988 we have been working with this in mind, that we can, in all honesty and with great pride, give a province to our children that is going to be one that we are proud of, one that they can afford to live in. But we need to take our responsibility very seriously right now.

So coming back to the other comment I wanted to make regarding the optometrist, and his comments to me were that it was a good idea, in fact, that we had made some changes. We are not saying that people cannot come for eye examinations. In fact, we are saying that if they are below the age of 19 or beyond the age of 65, that the examinations will be free. If, on the other hand, between the ages of 19 and 65, they do come for eye examinations, if the change in their eyes is a point five--now to me, I am not an optometrist, but that is a very small change, and if that has been recommended by the doctor, then, in fact, the examination will be paid for.

So, Madam Speaker, I see this as a step in accountability. I believe that each one of us, you and I, all our constituents, need to take this seriously and need to respond in a way that is appropriate. So if I want to go for examinations more often than that in one year, then certainly I have some responsibility myself to look after that.

Another example that I would like to bring to this House is in discussion with a medical doctor within Winnipeg. He, in fact, indicated to me that he had a real dilemma where some of his patients and clients were coming on an ongoing basis because, again, they like visitations. Now, we know that this is costly. You and I pay for that, so there is abuse of the system. Now, I am not advocating that we need to have a user fee here. What I am saying, is there any way that we can encourage those who are abusing the system to take their responsibility seriously, as well, and not cost the taxpayer the extra dollars that they are costing him today?

Certainly, we need a health care system that is open and that is available to all, but, specifically, to those who need it. That is why we have the health care system and a good health care system that we have today. When a government spends 33.8 percent of its total budget on health care, I believe that is a tremendous commitment that we have shown towards our constituents, towards those who live within the province.

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Madam Speaker, the other area that I think we also need to really look at very seriously is the fact that the federal government has for the past several years been cutting back on their transfer payments. Now, I agree that they need to get their own house in order. However, this does impact specifically on us as a province and on us as a government and our ability to be able to spend the dollars where they are needed the most. In fact, the dollars that we have been cut back are specific to health care, to education and to family services, so there has been very specific criteria put on those dollars, so we must in some way look at how we can fund health care, education and family services with dollars that are being taken away from us.

So, Madam Speaker, as a government, we have a tremendous responsibility to look after the needs of those within our province who need to be serviced with medical needs. Again, I say we do not want to have a system and as a government we certainly do not want to proceed in the direction of saddling our youth with a tremendous debt. In fact, the process and the route that we are taking right now is one of elimination of that debt. I want to at the end of the day be able to be proud of what we have done for our youth, for our province, when we hand over the government to them.

The other area of responsibility that I believe we have taken very seriously is the whole area of the specialty services or procedures such as heart by-pass surgery or hip surgery, knee surgery. These are specialty areas that certainly have increased dramatically within the past few years. In fact, I believe the Minister of Health (Mr. McCrae) today in QP suggested or made the comment that a thousand by-pass surgeries had been done in the past year. This is dramatically up from what took place several years ago, and I applaud the health care system for being able to do this. Certainly, with the advances in technology, with the ability of the doctors to be able to go in this direction, it has been a tremendous benefit to those who need it. On this, too, I can refer back to several of my constituents who have been able to utilize this procedure within the past several years, specifically to hip surgery or hip replacement.

I have a constituent of mine who is in the hospital right today as we speak who had surgery on Thursday and is having his hip replaced. He is a fairly young gentleman and so certainly we want to be able to have a health care system within our province that is going to be sustainable, one that we can be proud of and one that we can, with pride, hand over to our children and our grandchildren. Thank you very much, Madam Speaker.

Mr. Frank Pitura (Morris): Thank you, Madam Speaker, for the opportunity to say a few words about this resolution. I think, when we talk about health care and we talk about health care in this province that historically goes back a number of years people in this province know that health care is very important for them in their personal lives. It really does not matter whether you are in the urban centre of Winnipeg or in rural Manitoba, people have come to expect to have health care available to them. Many of the communities, when they were first established and started to grow, the first thing that communities did was try to attract a doctor into their community to establish a practice there too so that health care could be administered to anybody who needed it in the community. As time went on a lot of communities in rural Manitoba were successful in building local hospitals. In fact, even in the city of Winnipeg, there were two or three major hospitals that were built by the various religious groups.

In the event that time went by and medicare was introduced, and if memory serves me correctly, I think that medicare was introduced in this province by a Conservative government. So medicare, everybody who was in it, insured for medical services within the province of Manitoba no matter where you lived. However, there were fees attached to that service at that time, and when the NDP government came in after that, I would have to say that they eliminated the fee structure so that medicare became free to all those who participated in the program.

But as we come into today's world, Madam Speaker, we are looking at some what we would have called fantastic changes occurring in the way we have to view health care, in the way we expect health care to be delivered. Today we are looking at a severe reduction in federal transfer payments to the provinces, such that it is very difficult to cope with those reductions and trying to maintain the services. There are also fantastic advances in medical technology, technology that today or 10 years ago we would never have dreamed that that kind of technology would be with us today.

In fact, I was just looking at the news the other day where in Irvine, California, a drug has been developed for use for people who have a problem with memory loss, and I thought that they are going to be doing some tests with that drug on human beings in the next two or three months. I thought that it would be just perfect because sometimes I forget a lot of things, Madam Speaker, and I thought it might be useful for me to have that available. But there are so many advances taking place in medical technology and they are expensive. They cost a lot of dollars for this technology. So we are faced with federal reductions in transfer payments, advances in medical technology that are expensive and also, at the same time, since medicare came into Manitoba, it has been possible for accurate statistical information to be gathered to find out how the health care system is operating within the province and to be able to track it, track the entire system, and the possibility to even track individuals going through the system. So this whole area then provides a basis for making some of the changes that we are looking at in health care and the delivery of health care in Manitoba today.

We talk about the legislation that has come through on RHAs, establishment of RHAs and there may be a lot of reasons and a lot of good reasons given why there might be some problems with RHAs but, Madam Speaker, we have to have a difference, a change in the way health care is delivered in Manitoba. Just looking at the way health care is delivered today in terms of being piecemeal, you have acute care, you have personal home care, you have the public health nurse, you have the home care all going in their own directions, and in order to make fully efficient use of health care in Manitoba it is important that all these services become integrated. How they become integrated may be up for debate, but in terms of the direction this government is going, we believe strongly that the RHA system of having these local boards established to integrate the entire health care delivery throughout Manitoba is an important and the right step to go, because the ultimate goal of health care in this province has to be patient care. If you have that as your objective at all times and everything else that you do with respect to health care delivery works in to meet the needs of that patient, then ultimately you will end up achieving the best possible service to those patients.

Another thing that we are also faced with as we go into the 21st Century is that in Manitoba as in respect to all provinces in Canada is that we do have an aging population, a graying population where the largest majority of our people will be in the graying area, and I am probably one of those, Madam Speaker, who are entering that era. So health care is going to be that much more important that it will still be in place, it will still be available to everybody who needs it now and into the future, and one of the ways that it can be done is by integrating the entire delivery system.

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So what do we do to provide health care? Well, if you take a look at some of the areas, if we just take a look at the home care situation as an example, and I say that given the right circumstances that there is always room in whatever we do for having some competition. We take a look at home care--and I think previously in the House we had great discussions on home care--that with home care and home care delivery in this province that the costs for home care have gone up dramatically over the last nine years or so starting at I believe--and I am guessing now at the numbers--it was $34 million in 1988 and now sitting at in excess of $90 million for the delivery of the program.

So if you take a look at the costs, the increased costs of medical technology, and if you take a look at the way the Home Care program is operating, you can also identify that although it is a very good program and it is well liked by all people who use it, there are certain difficulties with the program as well. One has to ask--if you are going up some $60 million over a nine-year period and then the number of patients going onto the system for receiving home care are not going up proportionately to the dollars that are going into the program, you can explain it somewhat by the increased costs of medical technology.

On the other hand, Madam Speaker, there are also some inherent inefficiencies in the program that have to be addressed. I have had constituents approach me and ask why the home care worker that comes to their place--there is a different home care worker that goes to the neighbour's house basically within an hour of each other in terms of appointments. So there are things like that that are evolving out of the system in terms of inefficiencies that have to be addressed. Putting some of that system into competition will ultimately result in more efficiencies coming through the public part of the program so that both programs are delivered more efficiently to home care patients. If the whole system, of course, is integrated as a result of the entire--with the RHAs being put into place, then ultimately everybody will be a winner in terms of receiving health care in Manitoba.

Another example I would like to share with you, Madam Speaker, is the fact that in terms of the changes that are occurring within health care and health care delivery is that with the situation in Morris with the personal care home being not that old of a facility and the hospital being an older facility within the community was that the kitchen facilities of one are now being used to distribute food to both within the community. That is not a major change, but why should there be kitchen facilities in a personal care home which is approximately a block and a half away from the hospital and the acute care? So the hospital facilities were not that modern anymore. They needed a lot of dollars to upgrade them, so it was decided that the food services that were available in the personal care home would be utilized to supply food to both of the agencies.

Another area, Madam Speaker, that shows up is that today heart transplants are sort of a given, that if you have some difficulties with your heart being able to continue to work properly that the possibility of a heart transplant is there, and that it is almost understood that if you do require a new heart that you would be placed on a waiting list. Unfortunately, heart transplants are not done in Manitoba; they are done down in eastern Canada. But that is the type of thing that we have come to expect out of the health care system that that type of an operation and service should be available.

Just spending a little bit of time to some of the things that were brought out in regard to the issue called the Health News when my honourable colleague the Minister of Health (Mr. McCrae) announced Pathways to a Healthy Manitoba, some of the key areas in there that were addressed was the fact that we had the structure for the RHAs which are going to take the integration of health care delivery in rural Manitoba and that there were also going to be two boards established within the Winnipeg area to integrate the delivery of health care within the city of Winnipeg. I believe very strongly that is one avenue that has to be followed so that all the services for health care are delivered on an integrated basis.

There is also the other area where, because of the fact that now all hospitals will be brought into a partnership-type venture, they will be able to benefit from such things as the bulk buying of their supplies. In fact, some of the things that they were talking about was pursuing consolidation of laundry, food services, purchasing and warehousing, as well as other support services, among Winnipeg hospitals.

A lot of this, Madam Speaker, because of the fact that all hospitals require food, all hospitals require laundry, all hospitals require warehousing for storage of products, it makes sense that this integration and partnershiping amongst the hospitals be done so that they could become more efficient in terms of delivering patient care, which is always the ultimate objective. There is also the other area of labs in terms of consolidating lab services. It shows, it is written in here that most of the laboratory work that is conducted in Winnipeg is done by eight labs; however, there are 500 labs available in Winnipeg to do these services. So the question is, should there continue to be 500 labs, or should the services be consolidated into one laboratory?

Madam Speaker, under some of the advantages of consolidated lab services is that they would maintain access to a wide range of rapid-response services, instant, almost very quickly having a tissue test done. They have a higher level of co-ordination between all the labs. There would be standardizing for training, procedures and equipment, which is so important and critical in today's high technology that all the techniques for testing have standardization. Also, it will allow the labs volume purchasing so that they can purchase their basic necessities for operating the lab at a cheap as possible price. Then they would have an efficient, integrated system.

One of the major points is that not only is patient care No. 1 in terms of Manitoba health and this government, but this government is always focusing on preserving the medicare system, preserving the health care system in Manitoba. The things that we do today to this health care system in Manitoba are going to ensure that in the future we will have a health care system, that people who are of my age and younger who are going into the graying area of the population will be able to have the health care system there when they need it and have what they need to have done within the system there available to them.

So, Madam Speaker, the health care system is very important to this government to maintain. It is very important for people in this province to be able to have that confidence that they would have health care there when they need it. So there are many things within the health care system. It takes a long time. Thank you.

Mr. Gerry McAlpine (Sturgeon Creek): I am sorry that I am not going to have more time to speak on this important topic, but when we talk about the privatization of the health care, I think really what we are talking about here or what we should be talking about in terms of health care is responsibility.

As far as the responsibility, when you get into the health care aspect--because I think this is a very serious issue in terms of the amount of money that we as a government and we as a society are having to deal with when we are talking about the sustainability of our health care system. Even back in the '40s, when Tommy Douglas brought in the health care--and he is noted for that. I mean, he goes down in history as being that person that brought in health care.

Madam Speaker: Order, please. When this matter is again before the House, the honourable member for Sturgeon Creek will have 14 minutes remaining.

The hour being 5:30 p.m., this House is adjourned and stands adjourned until 1:30 p.m. tomorrow (Tuesday).