Manitoba Hansard — 29 November 1990 (Sitting 35B, 35th Legislature, 1st Session)

35-1-35b

Manitoba — Debates (Hansard)

MG-8048 First Session - Thirty-Fifth Legislature of the Legislative Assembly of Manitoba DEBATES and PROCEEDINGS (HANSARD) 39 Elizabeth II Published under the authority of The Honourable Denis C. Rocsn Speaker VOL. XXXIX No. 35B - 7 p.m., THURSDAY, NOVEMBER 29, 1990 Printed by the Office of the Queens Printer. Province of Manitoba ISSN 0542-5492

MANITOBA LEGISLATIVE ASSEMBLY Thirty-Fifth Leglslature Members, Constituencies and Polltlcal Afflllatlon NAME ALCOCK, Reg ASHTON, Steve BARRETT , Becky CARR, James CARSTAIRS, Sharon CERILLI, Marianne CHEEMA, Guizar CHOMIAK, Dave CONNERY, Edward, Hon. CUMMINGS, Glen, Hon. DACQUAY , Louise DERKACH, Leonard, Hon. DEWAR, Gregory DOER, Gary DOWNEY , James , Hon. DRIEDGER, Albert, Hon. DUCHARME, Gerry, Hon. EDWARDS, Paul ENNS, Harry, Hon. ERNST, Jim, Hon. EVANS, Clif EVANS, Leonard S. FILMON, Gary, Hon. FINDLAY, Glen, Hon. FRIESEN, Jean GAUDRY,Neil GILLESHAMMER, Harold, Hon. HARPER, Elijah HELWER, Edward R.

HICKES, George LAMOUREUX, Kevin LATHLIN, Oscar LAURENDEAU, Marcel MALOWAY, Jim MANNESS, Clayton , Hon. MARTINDALE, Doug McALPINE, Gerry McCRAE, James, Hon. MclNTOSH, Linda MITCHELSON, Bonnie, Hon. NEUFELD, Harold, Hon. ORCHARD, Donald , Hon. PENNER, Jack, Hon. PLOHMAN, John PRAZNIK, Darren, Hon. REID, Daryl REIMER, Jack RENDER, Shirley ROGAN, Denis, Hon. ROSE, Bob SANTOS, Conrad STEFANSON, Eric STORIE, Jerry SVEINSON , Ben VODREY, Rosemary WASYL YCIA-LEIS , Judy WOWCHUK , Rosann CONSTITUENCY Osborne Thompson Wellington Crescentwood River Heights Radisson The Maples Kildonan Portage la Prairie Ste.

Rose Seine River Roblin-Russell Selkirk Concordia Arthur-Virden Steinbach Riel St. James Lakeside Charleswood Interlake Brandon East Tuxedo Springfield Wolseley St. Boniface Minnedosa Rupertsland Gimli Point Douglas Inkster The Pas St. Norbert Elmwood Morris Burrows Sturgeon Creek Brandon West Assiniboia River East Rossmere Pembina Emerson Dauphin Lac du Bonnet Transcona Niakwa St. Vital Gladstone Turtle Mountain Broadway Kirkfield Park Flin Flon La Verendrye Fort Garry St. Johns Swan River PARTY.

Liberal NOP NOP Liberal Liberal NOP Liberal NOP PC PC PC PC NOP NOP PC PC PC Liberal PC PC NOP NOP PC PC NOP Liberal PC NOP PC NOP Liberal NOP PC NOP PC NOP PC PC PC PC PC PC PC NOP PC NOP PC PC PC PC NOP PC NOP PC PC NOP NOP

LEGISLATIVE ASSEMBLY OF MANITOBA Thursday, November 29, 1990 The House met at 7 p.m. CONCURRENT COMMITTEES OF SUPPLY SUPPLY-HEALTH Mr. Deputy Chairman (Marcel Laurendeau): Will the Committee of Supply please come to order? This evening this

section of the Committee of Supply meeting in Room 255 will be considering the Estimates of the Department of Health . Does the Honourable Minister of Health have an opening statement? Hon. Donald Orchard (Minister of Health): Mr. Deputy Chairman, I do. Mr. Deputy Chairman , I am pleased to present today the working Estimates of the Manitoba Ministry of Health for the fiscal year ending March 31 , 1991. I will be asking this committee to support Government's request of $1,671,448 ,300 , an increase of $108,581,000 , or 7 percent over the Adjusted Vote of $1 ,562 ,867,300 for the yea r previous .

As in previous years , I want to pay tribute to the literally thousands of dedicated workers throughout the health care system. A time of change is always difficult and the health system is certainly undergoing changes . The many people of the system and the staff of both the ministry and the Manitoba Health Services Commission can be commended for their willingness to embrace new challenges and to put, always, foremost the well-being of Manitobans whom they serve. Also, Mr.

Deputy Chairman, I would again like to thank the community groups, professional associations, universities , voluntary agencies and individuals with an interest in the health system whose counsel continues to make contributions to decision making as we continue to build on the partnerships that are a feature of the ministry's activities. Mr. Deputy Chairman, there has been a renewed mandate for this ministry since the last time I rose in the House to present my Estimates. I spoke at that time of the way we have stabilized the health care system and begun the process of changing the system.

Our goal was not just to change, but to manage the system change to meet current challenges and demands by applying principles of innovation, sound management , affordability and quality care as criteria for evaluating and changing services and programs . When I first became Minister of Health in 1988 I was faced with a health system which was in need of repair, which lacked direction. Mr. Deputy Chairman , the first order of business was to take care of those many outstanding urgent matters.

We have spent two years correcting the major problems and inequities in the system, and I would just like to share with my honourable friends a couple of examples of what I mean . When first we came to Government in 1988, ambulance funding for the Province of Manitoba was $2.2 million, it was the lowest funding level of any province in Canada, lower than Newfoundland.

That was not satisfactory and today you will be asked to approve spending of $6.4 million in ambulance funding in the Province of Manitoba, a very, very substantial increase and I dare say an increase of larger proportion than any other single line of funding in any other ministry of Government. We took the problem very seriously and we resolved it in this case with additional resources. *

(2005) The Standing Committee on Medical Manpower, very essential to the recruitment , retention of physicians in rural and remote Manitoba , their funding was doubled. Into research, a very needed component for not only economic activity in the Province of Manitoba, but to provide researchers who also in many cases serve as clinicians , an additional $800,000 per year on a $1.1 million budget, a significant increase representing a significant commitment by this Government to the research activities in the medical field. That did not include the $1 million annual contribution to the Strategic Health Research Fund,

2220 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 a total of $4 million that will be committed to health research with a focus on a development of industrial initiatives in the Province of Manitoba from the health research field, nor does it include $260,000 annualized for four years at the St. Boniface Collaborative World Health Organization Research project into quality of care for cancer patients . With those few examples, and there are many more that we will get into as we proceed through the Estimates, we have made a solid commitment to very needed areas of reform that we inherited.

I say that without pointing any fingers to anybody here because when I leave this office, the next Minister of Health will inherit difficulties that he will prioritize and resolve as he sees fit. We are now halfway through the fiscal year, and I would like to talk for a moment about some of the actions taken. We undertook a vigorous AIDS outreach program called Street LINKS. It has been launched to get health information, health services and health promotion messages to those most at risk.

In addition, the Immigrant and Newcomer AIDS Awareness pro ject, the post-secondary peer-assisted AIDS education program, and additional physician education has strengthened the delivery of AIDS education. We are continuing to expand the number of operating room hours at the Health Sciences Centre. The second phase of the innovative approach towards improving mental health services begun in the previous Session will continue with the implementation of a strategic long-range plan for the care and treatment of the mentally ill.

We are continuing to improve our management information systems, and let me give just one example. This year, the Manitoba Immunization Monitoring System was implemented to track and monitor Manitoba's immunization rates. This is the best immunization-tracking system in Canada and will allow us to better protect the health of Manitoba's children.

In response to the increase in cultural diversity of Manitoba's society and increasing numbers of immigrants and refugees, there will be additional initiatives to address the special needs and barriers to health services of the multicultural community and to aid us in providing guidance and direction and that, of course, will be advice from our recently formed Multicultural Health Advisory Committee . We will initiate a strategy to deal with substance abuse. We will be consulting widely and will focus on youth as our first priority.

Work is proceeding immediately towards the construction and establishmen t of a 12-bed treatment centre to provide treatment for adolescent women-first in Manitoba. Major health promotion programs have been expanded and implemented in 1991 and include a health promotion task force to solicit public input for development of health promotion strategy and healthy public policy. Workplace health promotion projects currently being evaluated have resulted in a fourfold private-industry contribution towards health promotion.

The comple tion of the first phase of a major heart health survey, in the beginning of development of a strategy to deal with heart disease, the No.1 preventable killer-this is well underway. The project Class 2000 or anti-smoking project in school-very, i;uccessful , very, very innovative, and we intend to continue that involvement of students in the anti-smoking campaign. The establ ishment of the Women's Health Directorate to improve community health prevention and health promotion services to women.

We are con·tinuing to support the World Health Organization Collaborative Centre on the quality of life and cancor care with the Manitoba Cancer Treatment and Research Foundation . The centre is researching ways of including a quality-of-life factor into cancer treatment, and at the same time, we are committed to a new linear accelerator, which will improve our radiotherapy services at St. Boniface Hospital. The Health Services Development Fund has approved 13 projects for funding.

They were among 122 proposals submitted to the fund, were assessed by a steering committee and were selected on their merit, on the basis of their ability to meet the funding criteria and the long-term health benefits they will provide for the people of Manitoba. I will detail these projects later in the Estimates . *

(2010) Mr. Deputy Chairman, these actions have not been taken in isolation. We realize that a businesslike approach was needed. If health can be

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2221 thought of as Canada's fastest growing business, then the business lacked three fundamental elements . First, a strategic plan, business plan if you will, including the development of realistic goals in the Manitoba context; secondly, appropriate information and data on which to base sound decision making; thirdly, systems management. The actions we have taken, in addition to correcting some long-standin g problems and inequities, have been the first steps in moving the health system to a sound businesslike footing.

Fortunately, there are opportunities for change. For example, Manitoba has the best data base in the country in the form of nearly two dec ades of validated detailed claim data. We have recognized this opportu nity and begun the process of using this data base to assist us in sound decision making and in formulating a long-ra nge strategic plan. It is possible to link this data with census information and other socioeconomic data which will allow us to link service delivery with health outcomes for the first time in Canada.

We are working with Statistics Canada and the Canadian Institute for Advanced Research to bring this about. This proposal is known as the Manitoba population health data base and will help us to assess Manitoba's health care needs, and to develop realistic and effective policy options. That is also why I announced this summer the establishment of the Manitoba Centre for Health Policy and Evaluation.

The Manitoba Centre for Health Policy and Evaluation will, for the first time in Canada, establish a research centre which will give us the ability to evaluate the level of health among Manitobans, monitor the use of resources within the health care system, provide specific measurements appropriate to various sectors of the health care system to monitor quality of care, forecast the impact of new programs or technology before implementation, and lastly , prov id e sound information for peer review standards.

The centre was established with a grant of $3.5 million out of the Health Services Development Fund to the University of Manitoba . This centre is expected to be economically self-sufficient within three years by securing contracts in the health industry for technical trials, and clinical and policy research . We have high expectations for the centre.

In the first three years, some of the deliverables will include the Manitoba population health data bank restructured as a basis for research on the determinants of health to support healthy public policy, a review of health service utilization to improve efficiency and quality of service , identification and policy options of health problems of those at highest risk of ill health such as Natives, refugees and immigrants, health care facility funding criteria . Most of all we expect to obtain the information we need to make sound and creative strategic decisions to improve the health status of Manitobans.

The centre is one component, but of equal importance is the development of health goals and a strategic plan. That is the consultation and partnership building which we have carried out, and are continuing to carry out among Manitobans, be they users of service, health professionals, volunteers , or businesses. That is why we have established the Health Advisory Network and its task forces. That is why we held a major consultation at Portage la Prairie to which we invited the major health care stake holders of the province to begin the process of developing realistic health goals.

That is why we have carefully examined the health studies from other provinces and asked for wide ranging feedback and comments from Manitobans. There is growing recogn it ion that the determinants of health go beyond the health care system and include socio-economic factors such as unemployment, housing, geographic isolation, and lack of social supports. Therefore, strategic planning must also go beyond the health care system as formerly structured and include other aspects of Government.

That is why the Human Services Committee of Cabinet was mandated to consider the development of policies, programs , and legislative initiatives across departmental lines. That is why an interdepartmental steering committee on healthy public policy was established to identify and develop priorities and opportunities for impr oving health status through interdepartmental co-operation on policies and cost effective service delivery, and to develop policy and program recommendations for Government. •

(2015) Prevention of substance abuse, impaired driving, suicide prevention, food and nutrition policy are just a few areas where interdepartmental co-operation and healthy public policy are required. I digress for a moment to share with my honourable friends the kickoff breakfast this morning of the first conference of its type in Canada,

2222 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 or in-service is the proper terminology, on ritual abuse and Satanism in Canada . We have brought together experts , international and national, to advise 85 departmental personnel and staff from four ministries of Government, Health, Education , Family Services and Justice, to provide the very best knowledge available on ritual abuse and Satanism, in Canada and in North America, so that our professionals can recognize and identify early any evidence of participation in cult activity, et cetera.

That is a very pro-active healthy public policy initiative based on early intervention , education, knowledge and prevention. It is the first in Canada, and already, even though the conference just started this morning, we have had in the past several weeks a number of inquiries from across Canada wanting to know if they can emulate that initiative in prevention and education. Mr. Deputy Chairman, our strategic plan will not just be a listing of desirable health goals, it will be linked to sound management pract ices .

For example, priorization and resource allocation for programs and services will incorporate outcome and effectiveness criteria. That is why we established the Health Services Development Fund, in part, to provide the opportunity to test the effectiveness of new innovative ideas and technologies; that is why we reorganized the Policy and Planning Secretariat to include the Program Evaluation Directorate; that is why we are considering other ministry and system organizational changes and management techniques, suc h as envelope accountability systems and facility system audits. Mr.

Deputy Chairman, we are building strong foundations and we are taking a long-range perspective. Each year will see a new phase in the development of our long-range strategic plan. Over the next number of years you will see actions and initiatives aimed at implementing the long-range strategic plan. We are managing very complex and very necessary changes and nothing less than the future health and well-being of Manitobans is at stake. Mr. Deputy Chairman, the challenges we face are immense and they are not unique to Manitoba . Now let me digress from my remarks formally.

I have had the opportunity to represent other portfolios in Government at provincial territorial ministerial meetings, transportation, communications, and at those each ministry in each province brought a unique pernpective and there was seldom unanimous co-operation and focus on the issues. Such, I share with you, is not the case with the Ministers of Health, provincially and territorially, across this country.

It does not matter whether you are a Liberal Minister of Health from the Maritimes, or Quebec, or Ontario, or now a New Democratic from Ontario, or Conservative, or Social Credit, the issues are the same in each and every province and territory. The challenges are the same, the resources are, limited and demands are unlimited.

We have had the ability, as Ministers of Health provincially and territorially, to come around the issues in a unanimous and apolitical fashion, and when we meet we leave our political hats outside the door, and that makes for policy planning and sharing of information and initiatives that is valuable to the health care system because all of us, regardless of who governs, face the same kind of challenges.

It is a unique group of Ministers, I can assure you, and one of the initiatives that emanated from that co-operation around common difficulties and problems was my suggestion , at the Victoria meeting of Ministers, provincial and territorial, the suggestion that all of us are challenged with the issue of problems and specific policy areas around the issue of nursing. My colleagues, provincially and territorially, agreed in Victoria this year , that Manitoba would host and they would participate in a national sympos ium on nursing that commenced Sunday of this week, in the evening.

We went through two and a half days of probably the most focused, and the most innovative, and most rewarding symposium on the issues facing and challenging nursing today and into the future that has ever been held. It was unanimously agreed to by Liberal, New Democrat, Social Credit and Conservative Health Ministers, because all of us face challenges in finding the worth, the value, and recognizing the worth and the value of nursing in the health care system-a very successful symposium at Manitoba's suggestion.

Although the Manitoba economy is among the strongest in the country, reduced federal commitments: have lead to a reduction in transfer payments to Manitoba of $1 .07 billion less than expected . A't the same time, service cost and demands continue to escalate.

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2223 Over the last 20 years, the number of physicians has more than doubled as a proportion of the population. Professional wage and salary demands have also gone up. The public sector wages and salaries have lead the way in terms of increases. Between 1974-75 and 1989-90, Manitoba health expenditures increased by 178 percent. Clearly we cannot and will not continue in that direction. The strategic planning process which we have begun has already shown results.

The partnerships we are building in promoting health and fostering healthy public policy and health promotion at work and in redirecting mental health, community health and continuing care are all beginning to bear results. *

(2020) Let me give you just one example. In coming to grips with the spectrum of caring for cancer, we called on a range of stakeholders and experts to meet and advise. Representatives came from the entire continuum of care consisting of research, prevention, screening, primary care treatment, rehabilitation, continuing care, coping and palliation. This consortium crossed many jurisdictions and involved stakeholders with very different perspectives on orientations.

I am pleased to report that there was unanimity about the need to work together to refocus more on prevention and outcome and to make the cancer envelope part of a larger strategic plan to manage system change. Mr. Deputy Chairman, that is the kind of co-operation and partnership building that is needed. From time to time, the Members opposite will seize on problems and issues that arise in this complex health care system and will take the opportunity to castigate my ministry. There may even be times when Members opposite are correct in their identification of a particular problem or concern.

We will do our best to respond to those problems. There is something we will not do. We do not intend to build policy on the issue of the day. That kind of approach does not serve the patient, the taxpayer, health professionals, the Government or anyone. What we will be doing is to continue to build our long-range strategic plan to take the health care system into the future. I close by saying to my honourable friends, the Opposition Critics, that I enjoy their contribution. I simply indicate to them that the challenges are larger than the political Parties of this province or of this nation.

We have enabled over the past two and a half years that I have had the opportunity to serve with my confreres and colleagues in health across Canada to approach the issues of health in an apolitical fashion to resolve the problems with one goal and one goal only in mind. That is to continue having in Canada a health care system that is universally accessible that is most effective and most quality assured in terms of its services that it provides to all of its citizens.

We cannot solve the problems and meet the challenges of the future unless all of us approach health care from the standpoint of developing a better health care system, and utilizing resources that are currently being focused across this nation on health . Anything less will be irresponsible on our part. I thank you, Mr. Deputy Chairman, for the opportunity to introduce the spending Estimates of the Ministry of Health. Mr. Deputy Chairman: We thank the Honourable Minister of Health for those comments. Does the critic for the official Opposition Party, the Honourable Member for St. Johns, have any opening comments?

Ms. Judy Wasylycla-Lels (St. Johns): Yes , Mr. Deputy Chairperson. I am pleased to make some opening comments at the start of our review of the spending plans for the Department of Health. I want to start by saying I am new to this area as critic for the New Democratic Party. I am not going to pretend I have yet acquired full knowledge and understanding of all the issues in this very complex area. I am not here to be only critical. I will give credit where credit is due.

I will start by commenting on the Minister's opening remarks and indicating that he has listed many initiatives that we are supportive of and will continue to offer our congratulations on such initiatives. I also want to say I do not have a prepared opening text outlining all of our concerns , but I have many thoughts that I have acquired over the last number of days and weeks in the Legislature that I have been dealing with, with the Department of Health as critic for the New Democratic Party. This Estimates process, this review of spending plans by the Department of Health, allows the

2224 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 Opposition really the first opportunity to go into this area in some detail and to hold the Minister and, indeed, the whole Government accountable for its actions, for its inactions, for what we would identify as cutbacks, for its increased fees in some areas , and for what we feel is still a general lack of direction. •

(2025) Mr. Deputy Chairperson, the Minister has presented us with a long detailed overview of his department. As I said, many of the initiatives he has outlined I support and will continue to support, but I get little assurances out of those opening remarks by the Minister in terms of the difficult troubled times we are facing with respect to health care. In fact, the most troublesome issue for me is what I still sense as a lack of vision for the future of our health care system.

I am pleased that the Minister has indicated that the issues before us, the crisis at our doorsteps, is something that must be addressed, not on a political basis only but on a cross-political Party basis . I would add to that on a broad community consultative basis, because I do believe that we are at the most serious critical juncture in the history of our health care system in Manitoba and in all of Canada. What is clearly required is a strong vision, is a clear plan for dealing with these troublesome times. I think we all agree that Manitoba has one of the best health care systems anywhere.

We are interested in ensuring that we can maintain our health care system as the best anywhere, but as has been noted by others and, I think, specifically in reading over the opening remarks of the speech delivered in 1988 by one of my predecessors, Jay Cowan, he said this is a fragile system. This is a tenuous system, and its future and our ability to ensure that we can continue a strong position for Manitoba in health care, our ability to continue a position of excellence in health care , is dependent upon a strong continued vision from the Government of the Day.

As I said, I think we are at a very serious juncture. I think what has brought that home for me, in no uncertain terms, are the developments of the last few weeks pertaining to the whole area of financing of our health care system. We all know, we have all talked about the declining revenue from the federal Government, the plans by the Conservative Government in Ottawa to slowly reduce its share of dollars for our health care system to the point where direct federal spending in health care disappears.

We may disagree on the exact date when that may happen, and I hope we have a chance in this Estimates debate to pursue that, but I think the reality is clear. The federal Government is intent on getting right <>ut of the field entirely and that on its own is a most troublesome development made very clear by the federal Minister of Finance's own statistics. Our concerns have grown enormously by the reaction of this provincial Government, the Conservative Government here in Manitoba, to those trends, to those statistics, to those developments.

The knowledge that we have gained over the last few days about this Government's intentions with respect to the federal Government policy and spending patterns is frightening, is very, very disconcerting for not just me and Members in the New Democratic Party, but I dare say for the vast majority of Manitobans. Keep in mind, we know that well over 80 percent of Manitobans believe that we have a fine health care system , and they believe that, because it has always upheld the principles of universality, accessibility and quality.

They know full well, without even having an economics degree or a statistician's ability to analyze these results, that we are headed on a disastrous course, that we are in serious trouble without a very, very strong position on the part of the provincial Government, without a vision for the future that will deal with some of those issues that have brought about this whole set of circumstances, the growing expectations among Manitobans and Canadians for maintaining a quality , accessible, affordable health care system.

Shock is too mild a word to express my feelings and those of others around the kinds of statements that have been made this week, over the last several weeks by the Minister of Finance (Mr. Manness) , by the Premier (Mr. Filmon), and even by the Minister of Health (Mr. Orchard) himself. The suggestion that this Government, in looking at its options to deal with that kind of federal Conservative policy, including the option of withdrawing entirely out of a federal national health care system, is absolutely incredible to all of us.

More than that it is scary and it is frightening, bHcause pursuing that kind of searching for options can only put us on a devastating disastrous course of action. •

(2030) November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2225 (Mrs. Linda McIntosh, Acting Chairman, in the Chair) Our concerns about the present Government's response to the federal Conservative Government's policies and actions rest with our perception of no concerted strategy to oppose the federal Government's decisions around spending. They are followed now by the comments made by the Minister of Finance and the Premier, this week suggesting, not ruling out, that the option of withdrawing entirely out of a national health care system is a very real possibility.

Those concerns are not as a result of a particular ideology; they do not flow out of a need to make political points. They are founded on a belief and a philosophy accepted by most people in this country that we must maintain a national system of health care with the standards of accessibility, affordability, universality, and portability. The concern and outrage of the people of Manitoba to those statements is not only a result of a deep desire to keep in place the best possible health care system, but also out of a recognition that we have a cost-effective efficient health care system now.

It is an affront to people everywhere to hear that options must be developed in response to this federal policy because of the national debt, when in fact people know that health care spending has been flat over the last number of years . It has not contributed to the increase in the national debt. Furthermore, all of the statistics and all of the data suggest that Canada and all of the provinces have managed to keep the costs of health care under control since the universal health care system was introduced.

So the concern, and the arguments, and the feelings, are about deep-felt belief and interest in maintaining a quality universal accessible health care system, but also out of very good economic sense, because they know, and we know , and I believe the Minister of Health (Mr. Orchard) knows, that moving in any other direction will only lead to a more costly system.

One only has to look at the countries, the two countries, among all industrialized nations that do not provide access to health care for all citizens, and see that spending by those countries is much higher from all other nations who are engaged and involved in some sort of universal accessible health care system. (Mr. Deputy Chairman in the Chair) I hope that through this review of the spending plans for the Department of Health that we can clarify some of these issues and in fact come to some agreement about how we can work together to solve this critical issue. I agree with the Minister of Health (Mr.

Orchard) that the issues are complex, and they require all of our input and all of our ideas. I want to urge the Minister of Health to take a message back to his Premier (Mr. Filmon) and all of his colleagues that we need more than the input of people in the Department of Health, the Department of Finance, all of the MLAs around this table and in the Manitoba Legislative Assembly. We need the input, advice, and feelings, of the people of Manitoba.

It is absolutely unacceptable to us, and I believe to all the people of Manitoba, that decisions are being made , options are being considered, without the input of Manitobans on such a critical issue. I cannot think of another example in recent times when a major issue was before a province, this province, that some sort of public consultation and massive review involving the people of Manitoba was not undertaken. I think it is most regrettable that the Minister of Finance (Mr.

Manness) is about to sit down at a very important meeting with other Ministers of Finance from across the country, without having had the benefit of the input, feedback, and feelings, of the people of Manitoba. Our concerns about the vision of this Governmen t and a long-term strategic plan of this Government do not just remain with this Government's response to federal Conservative policies and plans. They also emerge out of the actions taken by this Government on its own.

How can we have faith in a Government, that it will be fighting Ottawa for a fair share of national wealth to maintain our health care system, if it has already, in two budgets , underspent its own health care budget? How can we feel confident that the priorities of the people of Manitoba are being addressed in the face of reduced federal spending, when this Government has time and time again taken actions which have cut back on the delivery of health care services for the people of Manitoba? There are many examples, Mr. Deputy Chairperson. Just to cite a few, and these have been cited time and time again.

I think we have to look at

2226 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 the fact, for this Minister of Health (Mr. Orchard) in the short time-three years-that he has been Minister, we have had many situations of confrontation and conflict with people in the health care field. As one example, I cite the unprecedented demonstration of nurses demanding input into decisions affecting them and their patients. We have cited in the past the fact that hospitals in Dauphin, in Portage la Prairie, in Thompson, in Carman, have all been forced to close beds due to shortages of nurses.

We have mentioned the fact that the intensive care unit in Thompson closed last March when 15 nursing positions were vacated. We have talked about how nearly half of the emergency doctors in Winnipeg's community hospitals left their jobs last year in search of better working conditions. We have referred to the situation when Misericordia Hospital suspended emergency services indefinitely last July when six out of 10 doctors left after months of treating patients who had been kept waiting in corridors for more than a day.

We have mentioned to the Minister that in Brandon, patients are paying upwards of $800 per eye to have cataract surgery performed in private clinics because hospital waiting lists stretched to two months. We have also mentioned that over the past year the waiting list for open-heart surgery at the Health Sciences Centre went from four to eight months, and the patient load doubled. The list goes on and on, Mr. Deputy Chairperson.

There are too many examples of regressive cutback actions on the part of the Minister and his colleagues in the provincial Government of Manitoba for us to believe that this Government is serious about health care being available on a quality basis for all Manitobans regardless of location, regardless of region, regardless of situation in life. •

(2040) Mr. Deputy Chairperson, the Minister has had three years to begin to show some evidence of his stated commitment to turn around our costly institutional-based health care system into a community-based preventative wellness model. When I look back at his statements made in 1988, in 1989, and now tonight, it seems to me we are hearing the same thing over and over again. A lot of talk about studying the issues, a lot of reviews being undertaken, a lot of consideration being given to alternative models, but no evidence , no sign that we are moving one step in that direction . This budget, Mr.

Deputy Chairperson, I think says it all. There is absolutely no indication in this budget that we are moving ou r health care system towards a community-based preventative model. In fact, the opposite appears to be the case. Our review of the material provided to date, and we hope that this will become clear in this Estimates debate, is that in fact the resources continue to be put in the direction of institutional based care. All of the increases appear to be on that side of the equation. Well, Mr .

Deputy Chairman, you do not demonstrate a commitment by shoring up our institutional side of the health care system. If you are committed, if the Minister is committed, to turning that model around and looking at different options and looking at a model that over a long period of time will actually help us deal with the cost factors, deal with people's expectations, then there must be evidence, there must be some sign, there must be a signal, there must be some examples, there must be some real concrete initiatives taken that move us solidly in that direction.

Many experts have commented and given advice to the Minister of Health (Mr. Orchard), to the Province of Manitoba, to the Government of Canada, about what direction we should be moving in. Yet, to this date, there appears to be little evidence that our Minister of Health, and the Conservative Government of Manitoba are serious about such endeavours and initiatives. We will pursue that later, Mr. Deputy Chairman .

I do not want to take up too much more time except I want to conclude by putting on record what I see as the model of this Government and putting on record an alternative vision for the people of Manitoba, if I can just find it. It was right here. An Honourable Member: Pass. Ms. Wasylycla-Lels: No, no wait a minute. I will find it, and I will come back to it later.

Let me paraphrase the sentiments that I wanted to put on record, and the Minister will know the author and know his research and his studies, and that is the work done by John McKnight, who has presented, and shown to all of us, tho different models and different options that one can look at in terms of health care, education, and social services. He has listod, and he describes what I think is the

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2227 model of this Government and that is a therapeutic vision and model for health care for the people of Manitoba, one that puts a great deal of emphasis and attent ion on treatment and on therapeutic services provided one is able to afford the fee for those services . He shows how that model and that vision is in sharp contrast to a community vision for health care or education or social services , a model that helps the community to help themselves . Mr.

Deputy Chairman, I hope that through the course of the next few days and who knows , maybe weeks, that we will be able to explore some of these options and get a clearer sense of where the Minister of Health (Mr. Orchard) and his Government are headed . I hope that we can work together to deal with the crisis at hand to preserve universal, accessible, quality health care that is designed to meet the challenges of the '90s and beyond. Thank you. Mr. Deputy Chairman: I would like to thank the Honourable Member for St. Johns for those comments.

Does the critic from the Second Opposition Party, the Honourable Member for The Maples have any opening comments? Go ahead. -(interjection)- Thirty minutes . Mr. Guizar Cheema (The Maples): Mr. Deputy Chairman, thank you for letting me speak, even as a third Party, 30 minutes. First off, I j ust want to express my thanks to the Minister of Health (Mr. Orchard) , whom I have worked with for the last almost three years . Even though we had some bad times, most of the time we have achieved a lot of things, and I think that is positive. I want to express my same feelings with the Member for Thompson (Mr.

Ashton) , who is not here today, but he was very helpful in the last Se ssion, and before that the Member for Churchill. I want to express thanks to the Minister's staff , who have been very helpful on a non-political basis , who never put any hurdles in my work during the past two and a half years. It was very positive. Above all, I want to express thanks to my caucus who has given me this opportunity again to participate in what I think is my role. I think it is a very wide role I could play during these four years. Let me just-(interjection)-I am coming there. You know , you are obstructing my thoughts .

If I go back to my speech, you will be in trouble. I wanted to express thanks to all the volunteer groups, all the organ izations who have worked on the various health care committees and all the organizations who have helped not only us, but the Minister of Health and the Opposition Party . I think it has been very positive . As the Minister of Health (Mr. Orchard) said, this is the one area where at least the three Parties can work together, and he has outlined, the Ministers are working.

I want to reassure him that we will continue to work on a positive basis , and of course from time to time it is our job to bring some of the negative impacts , but that is the role of the Opposition . As long as we have some positive suggestions, I think it is a positive move . Mr. Deputy Chairperson , I want to go back to some of the opening statements the Minister has made. He has made it very clear that our health care costs have continued to rise, and it is about $1.7 billion now. It has gone up about 178 percent for the last 10 years, and the population was almost stagnant by the rate of 6 percent.

Everyone knows that we have a problem , but I think the answers are not easy. It will not come with any special political Party, and it will not be any specific model for any province . There has to be a model of common sense , that is the only approach. If you go through all the research everyone is doing , I think that is the inference that is drawn from most of the studies. The greater responsibility is on the present administration, because if we look in 10 years time it is going to be the-if we do something right now the impact will be felt in 10 years .

Otherwise , in four years we will go through problems here and there, but as the Minister of Health said, people will come and go but these issues will stay. Only those people will remember who will do their contribution, a positive contribution, and I think it is very crucial. I think the Minister had the opportunity to do that. First of all, I am disappointed in one aspect. The Minister did not touch the financial aspect of the health care system, as for the last one week that has been a matter of a major public debate.

It is unfortunate the Minister has not given a single word in his whole paragraph, has given any explanation, because I think it does not matter what the Minister says or we say. If we do not have money we will not be able to fund any programs. •

(2050) 2228 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 I think as long as you have funding coming from the federal Government, especially in Manitoba, where we do not have many resources in terms of the-our social programs depend upon the equalization and the EPF payments, and if we give up on those payments, the poor, the underprivileged will suffer. I think the Minister must address this issue . So far, he has been very quiet, even in the House. Maybe he was not given the opportunity, but I think it is very important for him to make a clear statement.

The Minister has held many press conferences for other reasons. I think he could have one for this reason, which is very important, and just make it very clear just where you stand and what is the policy of this administration. If the Minister would take the positive words he should be able to grasp some of the negative words also. If you would just go through some of the articles we have seen recently in regard to Bill C-69. If you look at the statistics by the year 2004 we will not be able to fund any programs , any medical program if the funding is being cut by the federal Government.

I would encourage him to talk to his Minister of Finance who has made very vague statements, and I think in a way what they have done they have laid down the foundation for their ideological philosophy or have some kind of user fees in the future. I think that is the message most of the public is getting and that needs to be made very clear which direction, which way this administration is going to take the health care system and how they are going to fund -(interjection)- hold the comment. Can he just let me speak? I let your Minister speak. Mr. Deputy Chairman: Order, please . Mr. Cheema: Mr.

Deputy Chairperson, that is a very important issue and I think an issue, not only for this Minister, for the whole Government. I just want him to take it very seriously, not from a negative aspect for his personal approach, but at the whole approach of the present Government. The next issue I think the Minister has outlined some of the positive achievements they have made . I want to outline a couple of them which I feel very strongly they are going in the right direction .

One of them is the area of Manitoba Health Services, I think that is one example that at least three political Parties worked very hard, even though we did not get any credit, but still I think the people who are getting services they appreciate the fact that the progress has been made in that area. The other area where progress has been made is in the area of the research and establishing a centre at the Health Sciences Centre which is going to be self-sufficient in three years.

I think that is very positive to use the data, not only for Manitoba, for the rest of the country, because it is going to be very hotly debated in the future. It is going to be one of the major discussions among the groups in the years to comE,. Mr. Deputy Chairperson . I want to turn to some of the negative things now. If you look at the Minister's statement, some of the statements are very vague. He has said they were going to have long-term planning, but so far except for one long-term planning in the mental health care system nothing has been released, at least to us.

We are not aware of anything that happened for the last two years. I think if the Minister is hiding something or the Minister knows more than we know or he does not want to tell us, I think it will be well appreciated if he would outlirn~ some of his policies during this Estimate process. I am hopel'ul that he has said that the Health Advisory Network has been functioning and contributing and he said from the beginning we do not need to study and we want to have made-in-Man itoba policies. I want to see how many policies they have develope d and how many policies the Minister has implemented.

I think that clearly leaves the impression that either the Minister is just going to release slowly one by one over a period of two or three weeks or he is not going to tell us what they have achieved so far in some of the immediate areas. We have not heard anything in terms of the alternate ways of community-based health care as the Member for St. Johns (Ms. Wasylycia-Leis) has outlined some, of the things that should be done, but nothing has been said and even during the election campaign no promises were even made for the community-based health care system. I think that is unfortunate.

I do understand that it is difficult with $1.7 billion, where are you going to bring the money, but with a four-year plan, I think we will understand, the public will understand if you are going to have a buffer zone for a year or two to shift some of the programs and have those programs implemented, but we have not

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2229 seen anything. I would like to see some positive move in that direction . The other area where the Minister promised last year, and I am just going back on his words. I could read his speeches and read all the press clippings. He was telling us that he is going to reorganize the whole hospital system in Manitoba. He was going to reorganize the teaching hospital. They were going to produce some hospitals of excellence . I do not dispute that. I think that is one of the ways to go about this. Nothing has been done so far.

If the Ministe r, today, when he has an opportunity for four years-they do not have a minority Government , they do not have to be afraid, they should make a decision now. We will support any positive decisions, because you cannot have all the services, specialist services, at each and every hospital. It is not economical, and does not make much sense. There is an example that some of the major sub-specializations you do not have to have even in each province . Some of the things can be done in Ontario , some in Alberta, some in B.C.

Like, you do not need a heart transplant centre, you do not need a major liver transplant. They are being done in Ontario. So some of those things thatthe Minister has said, I am hopeful that there are discussio ns going on among the provincial Health Ministers and make sure some of the suggestio ns are there so that the money can be saved . That is a very valuable way to save money, because if you are going to do one or two major things in a year and have so many resources allocated , and the Minister has not said anything about that. I think it is very unfortunate.

The second aspect is about the reorganization of health services in the rural communities . I mean, we have seen the building of hospitals and some of them for rational reasons . I am not afraid of saying it, some of them probably , maybe , due to political reasons. There has to be a centre of excellence. There has to be a centre of excellence, not in each and every community , but in the concentrated area, so that they can save money . The Minister knows that. His staff will tell him, the statistics are very clear that in some of the rural hospitals, the vacancy rate is very high.

Some of those patients are coming to Winnipeg and occupying beds here. They could be using in those communities, but only on one condition, if they have the resources in terms of the staff, nurses, doctors, and other staff we do not have. The Minister has even increased the budget , but no progress has been made in real terms. Still those hospitals are empty. It is a very expensive way of dealing with the health care system.

Even when his own Advisory Network was going around on the province and some suggestions were made, why not use it at Swan River Hospital for gallbladder surgery and move them so that first of all people do not have to travel? Secondly, when you come to Winnipeg you spend money here, too. Some of the economy is coming through some of the communities. I will give one credit here, that the Thompson hospital at least has started a dialysis unit. It is going to save a lot of money in the long run, a very practical way of dealing with things. They have to move in those directions .

If the Minister would move in those directions, he will not face criticism from us. Very positive money will be saved in the long run. That is why, as the Member for St. Johns (Ms. Wasylycia -Leis) has said very clearly, we will support him, but we need to see something on paper. I want to have a look at what plans are there from the Minister, and we are not going to run away with them, and have a political gain. If you look at the election result , anything can happen. So rather we do something positive for the people, rather than looking after our own political colours. *

(2100) The other important area-I am disappointed in terms of the hospital situation in the City of Winnipeg . The Minister knows and it is very clear that if you have a hospital bed, it is going to be occupied . I do not mean that we have to create extra beds in each and every hospital. If you have alternate ways of providing outpatient surgical clinics, as they have done at Seven Oaks Hospitah-Victoria , I guess, is in the process of going through that same state-I think the further expansion of day hospitals will help in the long run. The Minister is going to ask from where the funds are going to come.

I think some of the funds over a period of four years, some of the reorganization can be done. He does not have to be afraid of criticism, because I think he will do a better service as he has said, rather than a four -year plan, rather than act on a daily basis. We have not seen any progress in that respect. I think the Minister should move in that area.

2230 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 The other area of concern has been the total lack of plan in terms of the recruitment of physicians , nurses, physiotherapists , and all the health care professionals in the rural communities . Even though the funding has been increased-there has been about $400,000 that was increased last year in the standing committee on medical manpower-but still there are a lot of vacancies . What is happening in Europe, the things have changed .

There may not be many people coming here to practise medicine, because when you have freedom in your own country you may not come in a 44 minus . I think you have to start looking at other ways of providing the health care delivery in those areas. There are a lot of physicians in this country. I do not know why the Minister is hesitant to use those physicians. Probably he could take a lead in that direction. Qualified people would rather work in a hospital than in a hamburger store. We have a list-he knows that-of a number of people in Winnipeg who are waiting to get basic training.

I think it is very unfortunate that some of the money is not being used for them. They are being told that they have to raise their own funds. You have to get the comm unity support to have internship positions. Recently, there are one or two places in Manitoba who raised money through the rural communities . I think the Government should change some of the rules and make sure some of the funds are made available for those students, who have come to this country for various reasons, either for economical or political reasons. No progress has been made .

Even though the Minister has said that there are positions, nobody is applying. When you are creating systemic barriers of various exams, various things, you are never going to get there. It is very difficult even in normal circumstances to progress in a new country. When you put up a lot of hurdles, you will not achieve those things . The number of difficulties we are facing, I can go with a long list of difficulties, but we are going through the Estimates process line by line. I just want to request of the Minister of Health that let us take a non-political, rational approach during these four years.

I have said to him a number of times , achieve, at least if not for this year or next year but for the next generation, a good health care system . Without the proper planning, it does not matter whether Mr. A or Miss Bis the Health Minister, it will not function. I think the Minister is in a fortunate situation . You have two Opposition Parties trying to help you rath1H than scream at you, even though from time to time we may have to do that. It is the right opportunity . We sincerely hope that next year, even with the change of the Cabinet, he will still be Health Minister.

I do not know what is going to happen. An Honourable Member: Oh, I thought you were my friend. Mr. Cheema: I am. That is why I am saying that we hope to havE, the continuity of the health care system, the Minister of Health should be there. The other area where we will go into more detail is the mental health area. I do not want to take up their time right now. I would like to thank the Members of the committee for letting me speak as a third Party. Mr. Deputy Chairman: We thank the Honourable Member for those remarks .

Under Manitoba practice, debate of the Minister's salary is traditionally the last item considered for the Estimates of the department. Accordingly, we shall defer the consideration of this line and now proceed with consideration of the next line. At this time we invite the Minister 's staff to join us at the table and we ask the Minister to introduce the staff members present , please . Mr. Orchard: Mr. Deputy Chairman , my Deputy Minister Frank Maynard; Tammy Mattern is coming from Admin and Finance, and Ulrich Wendt. Mr. Deputy Chairman : Item 1.(

b) Execu ti ve Support:

(1) Salaries $417,000.00 . Ms. Wasylycla-Lels: Mr. Deputy Chairperso n, I would like to start with what I think is the most critical issue of the d:ay, an issue that really impacts upon everything else that is before us in the area of health care. I see that this area does involve itself in policy initiatives , addressing emerging health care issues and program strategies, and efficient management of health care resources, so I think it is only appropriate that under this line we begin the discussion of the critical situation at hand for Manitoba and Canada.

I want to start by asking the Minister for some information on the actual situation for Manitoba right now, vis-a-vis federal finances, vis-a-vis federal direct financial involvement in health care. The Minister will have seen the information that we tabled in the House. I would like to ask him, first of all, if he is in agreement with, and has information

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2231 to back up, that provided by his Conservative counterpart or colleague in Ottawa, Mr. Wilson , in his statistics that he tabled in the House last July? Is the Minister familiar with those statistics now, and does he agree with that trend line? Mr. Orchard: Mr. Deputy Chairman, I think that we owe it to Manitobans to get right down to the issue of the financing of our universal health care system . For a number of years, as my colleague the Minister of Finance (Mr.

Manness) has pointed out over the last three days, there has been concern expressed by the provinces that the federal Government, over successive administrations , has chosen to reduce their continuing contributions and support of health and secondary education in the provinces. That is a problem.

That is enough of a problem-and I cannot give you the month because I simply do not remember but it was a problem identified by the provinces roughly 17, 18 months ago-that we had the only meeting that has happened between provincial Health and Finance Ministers to discuss exactly the issue that my honourable friend is talking about. One of the easiest things that we can do is to centre around this issue and harness it in a partisan political fashion. I am not defending my Conservative cousins in Ottawa.

I would not defend Audrey McLaughlin if she was doing the same thing , and she would be, and I would not defend Mr. Chretien if he was doing the same thing . The one thing that we cannot have is-my honourable friend in her opening remarks, and I made a little note on one of my sticky pads here, left the impression very willingly, after I have listened carefully in the House, as she has done, that we are considering an option of withdrawing from the federal health care system . That is simply not an accurate statement, but that is the kind of narrow partisan approach to this issue that gets us nowhere.

When we talked about this issue from Opposition, as early as 1984 and '85, we were in Opposition and my honou rable friend was in Government, we attempted to put a level of intellectual honesty in the province's approach and concerns to the federal Government because you cannot go down there crying wolf with information that can be circumvented with facts. You have to go down there with legitimate cases and you have to go down there and you have got to fight with reasoned and principled approach, which I believe we have been doing, and I believe all provinces have been doing. •

(2110) The issue is larger than the current federa l Government, and that is where I want to get around tonight with my two honourable critics, particularly my honourable friend, the official Critic of Health. I want to explore the issue of financing of health care, and I want to explore it along the lines-and I want us all, as has been offered by both Opposition Parties, to approach this issue on a non-partisan basis, on the basis of trying to focus collective wisdom. Leave our political hats outside the door and let us come to some common solutions. (Mrs.

Linda McIntosh, Acting Chairman, in the Chair) Now, the issue is federal participation in funding of Health and post-secondary education, the issue is also the level of transfer payments from Ottawa. Now it is money, cold and simple, it is money. There are ways that you can resolve the money problem , and I want to ask my honourable friend, the official Opposition Critic, does the New Democratic Party of Manitoba still for instance adhere to the philosophy they used from 1981 until their defeat in 1988, of the creation of $500 million plus deficits to finance ongoing program costs in the Province of Manitoba?

That is an answer that is needed by Manitobans in making decisions as to who has the ability to govern, and who has genuinely the vision of repair for provincial programs, because that is one source of money. The issue is money, that is one source of money.

I want to ask my honourable friend, the official Opposition Cr itic, does her Party, the New Democratic Party, still adhere to the policy that they lived by during the Pawley administration, of which she was a part, that Manitoba is an artesian well of new taxes, that there is no limit to it; it will keep on flowing in; that there is no limit to the taxation that we can impose on Manitobans. Does the New Democratic Party after the '88 election, after the '90 election, still adhere to that philosophy that they can go to the people of Manitoba with demands for increasing taxation? Because that is a source of money.

I guess I would like to know, also from my New Democratic Party Critic, does the official Opposition

2232 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 adhere to approximately a one-third dedication of the provincial budget to health spending as they did in the past, as we did when we were last Government? Or does my honourable friend now see the ability to take more resources and maybe move up to 35 percent, 40 percent, 45 percent, 50 · percent of the provincial budget dedicated to Health? Because that is another source of money. If my honourable friend has changed in that fundamental policy to inject more money into health care, then there are a lot of people very anxious in the Ministry of Education.

You know, schools and universities throughout the province will want to know if the money is going to come from them. It certainly would not come from Family Services, because every day in Question Period the Members of the official Opposition ask for more money there, so I know they will not be asking for a reduction in spending there, a dedication to health. Will it be from the departments which support our infrastructure , Industry, Trade, Highways , Natural Resources, Rural Development? Is that where the money will come from? Because that is penny-wise and pound-foolish.

I mean you cannot stop the engines of economic growth . Even Bob Rae, Premier Bob is saying that we need an economy that generates wealth so that we can spend it. So I do not think maybe my honourable friends would want to move money from there so I do not think they have got that option. What I am coming down to with my honourable friend is, money is the issue. You have a federal Government that is reducing it and it is apolitical federally because it started under the Liberals; it has continued under the Conservatives; it would continue under the New Democrats . The issue is money.

Where does the money come from? Before we can continue with any discussion, fundamental questions have to be asked and I would genuinely appreciate an answer from my honourable friend, the NOP Health Critic. Would the NOP raise the deficit again? Would they go to Manitobans for more taxation? Or would they take money for Health from other departments? I am also anxious to know what the Liberal Party position might be on that because those are pretty fundamental questions. There was an election fought around those very issues, a scant four or five months ago. So the issue is money.

The challenge and the question is, where does it come from? Let us have that debate right here tonight . Ms. Wasylycla-Lels: Madam Acting Chairperson, well, that was a most interesting defence of the Mulroney Government agenda, if I have ever heard one. I think the Minister of Health (Mr. Orchard) has conveniently chosen to ignore the question that I posed because he does not have the answer and I will be asking that question time and time again until we start getting some answers.

If he wants to keep it on a non-partisan basis so we can work together in terms of the crisis at hand, then we should be sharing that information and talking about solutions to the situation because for him to deflect this serious issue now and talk about, just as his colleague , the Minister of Finance (Mr.

Manness) , did in the House yesterday and start talking about the national debt and the deficit and how we must be looking at health care in that context, only leaving the impression that cutbacks to health care, restraint in this area is all right if we have this bigger problem to deal with, conveniently ignoring the fact that health care has not-and he knows the statistics, and if he does not, I will be glad to read them into the record-health care costs have not risen over the last number of years. They have remained flat. Health care as a proportion of our gross national product has remained flat.

National debt that has been growing over the last number of years is no vvay at all related to health care. He knows all of the statistics which show how our system in Canada , and in Manitoba, has been most cost effective. We are not talking about additional money going into health care. We are talking about a fixed share of wealth in this country going to health care. He started his speech today by suggesting that Manitoba's economy was in fine shape, by talking about the growth in Manitoba's economy, just as his colleague in Ottawa, Mr.

Wilson, has done in his propaganda, suggesting that growth and investment in Canadian businesses has been averaging about ten percent a year, more than twice the rate of the United States. He goes on and on with statistics suggesting and talking about the growth in the economy. Juxtapose that against the health care situation. Not a growth, a fixed proportion based on growth in the economy . Have we seen a ten percent growth from the fedeiral Government in spending for health care in line with the ten percent growth we have

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2233 seen in businesses' growth in the economy? No, we have not even seen, not even in increases according to inflation. We are now seeing declining spending to the point where federal spending will disappear by the turn of the century. •

(2120) I do not need to sit here and take that kind of nonsense from the Minister of Health (Mr. Orchard). He knows the statistics; they speak for themselves . I want to get right to those figures and ask him once more: Has he looked at Michael Wilson's statistics, tabled in the House of Commons on June 26, 1990? Does he accept those statistics? Does he have a plan of attack dealing with that kind of situation? Has he forecasted these statistics provided by his Tory cousin in Ottawa, to let the people of Manitoba know by what date the federal Government will be out of direct spending in health care altogether?

Mr. Orchard: Madam Acting Chairman, my honourable friend at least contributed something to the debate in her last answer, where she said that the New Democratic Party is not asking for additional monies to finance health care. If she did not say that, or did not mean to say that, I will give her the chance to correct that. -(interjection)- That is interesting. I am pleased that my honourable friend, the New Democratic Party Critic, has at least clarified one aspect.

My honourable friend has showed-I presume they are statistics that come from the federal Government attached to the last federal budget, which project their contributions towards health care in Canada in terms of their contributions towards the provinces. I also am assuming from my honourable friend's discussion that she is concerned that there is not enough money going to be coming from Ottawa. If that is what she is concerned about, if that is wrong, I will give her the opportunity-I do not want to get off on the wrong argument with my honourable friend.

Is that one of the concerns you have, that there is not going to be enough money from Ottawa? Is that what you are concerned about? You go ahead. Ms. Wasylycla-Lels: Madam Acting Chairperson, · at least with his colleagues, the Minister of Finance (Mr. Manness) and the Premier (Mr. Filmon), there was some acknowledgement of the serious situation facing Manitoba with respect to transfer payments from Ottawa. Finally, we have got a public recognition from those two individuals that federal transfer payments are declining, that they are declining rapidly, and that we are facing a serious situation in Manitoba.

They are accepting and acknowledging that trend line because of, I am sure, information provided by Mr. Wilson in Ottawa, and I am sure because of dozens of other presentations and analyses of the situation at hand. I am asking the Minister of Health (Mr. Orchard), because this is a health matter, what his information shows. Has he done research, has his department done research to show what the trend line is for Manitoba, what it means for Manitoba? Can he tell us, based on that information-can he project for us what is the date of the last direct payment for health care from Ottawa? Mr.

Orchard: Madam Acting Chairman, as has been the case, even when my honourable friend had a role in Government, the Department of Finance makes those projections, has the staff with the knowledge, the role, the mandate. That is what they are paid to do, and the Department of Finance provides those analyses, those projections. My honourable friend may, or may not, have had the opportunity to participate in the Department of Finance Estimates, but the Minister of Finance (Mr. Manness) has been answering those questions over the last number of days in the House, and answering them with a great deal of clarity.

I do not propose to answer them with greater clarity; I would not attempt to. Now, let me get back to where I was coming from with my honourable friend. Two statements: first, no more money needs to be put into health care, but the concern is that there is going to be a decrease in federal contribution toward the funding of health care, a concern I told my honourable friend about.

Some 17 months ago Ministers of Finance provincial and Ministers of Health met in Moncton to discuss those issues, long before this current set of statistics came out, to develop a national Health-Finance Ministers' position to present to Ottawa, and that was done. Now this is why we have to have this discussion tonight, and my honourable friend has to be a part of this discussion, whether she likes to or not. My honourable friend makes the case that there is a levelled percent of monies that have gone to support health care as a percentage of the gross national product. She is almost correct.

It has been growing, but it has not been growing at a greatly enhanced

2234 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 rate over the last number of years. To say it is flat is not accurate; it has been growing. The one thing that my honourable friend has to acknowledge-and I know that this is difficult for possibly a New Democrat to acknowledge-is that over the last two decades in this nation of Canada and it was started in 197 4 with a budget put dow~ by John Turner, as a Liberal Finance Minister-'? 4, I believe it was; well, we will not argue about a year or two-and the greatest growth of expenditure in the federal budget has been in interest costs.

Surely my honourable friend must acknowledge that that has been the greatest drain on resources, the greatest threat to cash transfers to the provinces for support of health, post-secondary education and any other program that the provinces might finance through equalization payments or EPF funding, or direct development agreements, or any other source of money from Ottawa. All have grown at a flat or lowering rate, because the resources of the federal Government have been gobbled successively in increasing amounts and percentage of budget by interest payments.

Now that Is the exact same circumstance that we have in Manitoba, and that is why I placed my fundamental question to my honourable friend about two or three questions or answers ago. I do not need to remind my honourable friend, but I will. When we were last In Government in 1981, the annual bill that the Province of Manitoba, the taxpayers of Manitoba, you and I, paid totalled slightly less than $90 million based on the accumulated debt in 1981 of 111 years of Government of all political stripes , two World Wars, a depression, need I say more.

Six and a half short years later of Howard Pawley and the NDP and my honourable friend, the New Democratic Party Health Critic, that interest bill had grown to where today with some modification downwards because of better management under Clayton Manness' leadership in Finance, it is only a mere $550 million . (Mr.

Deputy Chairman in the Chair) That is the fastest growing line of expenditure in any department of Government, $460 million which could go to finance health care in Manitoba or any other number of programs. 1'.hat is why if we are going to talk about the issue of financing our universally accessible health care system, my honourable friend has got to come clean on behalf of her Party and answer to Manitobans whether she and her New Democratic Party colleagues adhere to the $500 million plus deficit annual that drove this province into bankruptcy and interest payments that went from $90 million to $550 million on an annualized basis today, cutting the very underpinnings of expenditures into health that all Manitobans wanted. *

(2130) My honourable friend has to answer the second question. If you are not going to continue deficit financing as practised by Howard Pawley and herself in Government, then do you believe you can go to the taxpayers for more and more tax dollars, because you did that, too? Or will you take more money from all departments? That is the fundamental question that has to be answered because only when you are honest enough and open enough with the people of Manitoba will they understand what your vision is for solving health care and othE1r funding challenges in Government.

If you duck around and skip around and waffle and will not answ1~r that question, then Manitobans will judge you as they have in the last two elections. They will judge you. I again say to my honourable friend, she makes the issue that your concern is no money from the federal Government. That is a legitimate concern that all of us share. When you have a third of your taxes federally going to pay an interest debt, you know that one is paid first. We all could require hospitalization tomorrow. The interest bill would be paid first, because it is called statutory debt. By law we pay it.

That is why we can borrow it. So let us talk financing and let us talk about the issue of where the money comes from, because my honourable friend has said it does not need any more; we just need to maintain it the same way. Well, where is it going to come from? Interesting question. I have my answers. I have laid them out in my opening remarks tonight. Our path is clear. Our direction is concise over the next four years. Ours is achievable. I want to see what your vision is. Manitobans want to see it, too. You can share it with us tonight without fear of retribution.

I will just tell them what you say, if you say it. Ms. Wasylycla-Lels: I know that the Minister is very anxious to avoid answering any of these questions, because it has become a very hot controversial matter in the recent week. He will do everything he

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2235 canto do so. He knows the vision I bring to this table. He knows that it is a vision similar to the majority of Manitobans, that health care is a priority, must be treated as a priority by Governments whether provincial or federal. He knows that I and the majority of Manitobans believe that you do not deal with the national debt on the backs of quality health care and patients in need.

I would believe, if he was not working so hard to try to avoid the questions, that he might even concede the point that health care deserves to receive a fixed share of growth in the economy, something that is not happening now. I would believe that if he was not such an apologist for the Mulroney Government around this table he would concede that health care has not contributed to the national debt over the last number of years, that health care spending has remained relatively stable over the last number of years, and that in fact, as the pie grows, the share to health care is getting smaller and smalle r.

That is not an appropriate Government policy, not an appropriate policy response to a very serious, important issue, that of quality health care, something that is a right for all individuals in our society today, access to quality health care . I want to try to get the Minister to have a positive dialogue here and just ask him again if he recognizes the declining pattern or the declining share from federal sources for health care. If he is saying that his department does not do any analysis of this and that it is all done by the Department of Finance, I am not asking him to give me detailed figures .

I would assume that the Minister of Health (Mr. Orchard) is a key player in all of these discussions, and I would assume that his staff are key advisors to the strategy of this Government in trying to devise the best plan of attack out of such a critical situation. What are this Government's projections in terms of federal spending? When do they think we will be receiving the last direct payment from the federal Government , and what is the strategy to deal with that situation? Mr. Orchard: My honourable friend has asked the same question three times now.

I have indicated to her on three occasions, now the fourth occasion , that yes, federal Government is reducing their commitment to health care through EPF funding . They are-even more dangerous-probably going to reduce their transfer payments, their equalization payments, which will affect all programming in the Province of Manitoba. That is right. That is exactly the dilemma that, contrary to my honourable friend, who tries to say that health care is the priority as if only New Democrats care about health care, we all care about the system.

We all work very hard to maintain the system and maintain its ability to deliver quality and accessible care, so do not try to monopolize the "I care more" monopoly. It does not work. What Manitobans will not agree with my honourable friend, even though she would like to say it, is her solution. First of all, I do not know whether they know what her solution or her Party's solution is; I have not heard it yet. I have not heard it yet. I put my solution on the table.

I am willing to go into it and expand on every detail that is in my opening remarks, because the Province-and I will tell my honourable friend unequivocally-cannot afford the Howard Pawley, NOP Critic of Health, 500-plus million dollar deficits today or tomorrow or the next year. They cannot afford that. I have not heard my honourable friend indicate whether she has learned that lesson or whether the New Democratic Party has learned that lesson. Manitobans understand that.

Now, the other thing that my honourable friend has not yet talked about-and we have made an election commitment twice on taxation levels in the Province of Manitoba, where we have made commitments to maintain current levels and reduce where possible. We are the only political Party (

a) that has committed to do it, and (

b) has delivered it-the only political Party in Canada. I have not heard my honourable friend say whether the tax orgy of Howard Pawley and the NOP would be continued under Gary Doer and the NOP. Why not? Do you not want Manitobans to know whether you are going to raise taxes or float the deficit through the roof? Do you not think Manitobans have to know that, because they know where we come from? What I am trying to get my honourable friend down to-and she is part way there.

She is part way there in that she admitted for the first time that I have ever heard admitted by anybody in the New Democratic Party, that there is-and I wrote it down-not a need for additional monies into Health, the first time I have ever heard a New Democrat say that we ought to

2236 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 spend-I am going to read words into her mind, and she can change it. She can change it if it is right. I am assuming that what she is saying is that the New Democratic Party believe that we spend our health care dollars smarter. Rather than trying to put additional resources that we do not have in the system, try to reform the system into a smarter spending system, I think that is what she said. I am not sure, because I want to tell my honourable friend that is where we are coming from.

If you want me to walk you through the opening remarks, I will point out to you the strategies, the processes that are already in place, the demonstration projects which reform the health care system and move it away from the institutional system into the community-based system, as both honourable friends have suggested. The strategies are here, and they are working in many ways. We have brought in reform policies. Now, I want to just deal very, very briefly with my honourable friend's, the New Democratic Party Health Critic's, commitment to health care reform.

One of the criticisms she put is that we are not changing the health care system to a community-based system, and we will not change it by shoring up institutional care, were her words because I wrote them down. Just prior to that, she laid out five problems, four of which were extra funding to the institutional system that she believed we should pour more money in and then turned around on her heels and spun around and did a 180 in 14 words or less and said, you do not change it by shoring up the institutional care system . I mean, you cannot have it both ways.

If you want more open-heart surgery, if you want more cataract surgery, if you want more emergency doctors at the Misericordia as you said, if you want open beds because you said beds were closed , then how can you square that with criticizing us for putting our monies in the institutional side of the department? Make up your mind and be consistent, because I want to tell you that the issue of tern porary closures of beds because of staff shortage was not a funding issue. It was a supply issue, temporary in some cases. Misericordia emergency doctors was more than money.

It was organizational, management and other factors. Cataract surgery-you do not like the clinic in Brandon that started up under Howard Pawley and the NOP, why the hell did you not stop it then? Let us at least be a little honest in our criticism . Open-heart surgery-how many more procedures would you like to fund, because each and every year we presented a budget, including this one, that there would be more open-heart procedures. *

(2140) We put a $:3.5 million expansion into St. Boniface Hospital for diagnostic equipment to do the safest procedure possible in angioplasty to avoid open-heart surgery and the expense of practice of open-heart surgery. When my honourable friend says that open-heart surgery line-ups are too long and the waiting list is too long, and says we should go to community-based care, are you suggesting that we have an open-heart surgery unit on the corner of Portage and Main in an out-patient clinic? Give me a break. Give me a break.

What we are going to do tonight, if we stay at it long enough, and if my honourable friend gradually lets herself tell the public where they are coming from, we are going to find out whether the deficit is the route that the NOP are going to take or that the taxes are the route, or whether they are going to follow and agree with the policy we have set in motion of reforming the health care system and spending smarter within the existing budget, because that is where we are coming from as Governmen t .

That is the kind of work and commitment and understanding that we have built out in the community amongst professional groups, institutions, clinics, administrators and many groups involved in health care, that we have had an opportunity to work with, either my senior staff or myself , directly. We are going to win that. We are going to win that battle better than any other provincial Government , because I tell you right now that we have a higher degree of understanding and co-operation from those managing institutions, professional groups, both nursing and physician and other professional groups in health care.

We have a greater degree of understanding of the problem and what the solutions can be. There is not unanimous agreement with the approach, but I will tell you we are a light year ahead of any other province in Canada in terms of having that kind of co-operation

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2237 to making the health care system work better for all Manitobans . That is why this debate is so critically important to understand what the vision of the future is of each political Party. I have laid my vision out in black and white, and I have handed it to my honourable friend for tearing apart, for criticism, for analysis. All I heard was the words "we have a vision" from my honourable friend , the official critic. I do not know what that vision is. I want to find out tonight.

I want to find out how it is going to be financed, because I think Manitobans want to have those answers. Ms. Wasylycla-Lels: The Minister can stall all he wants and read whatever he wants into anything I say. He is very good at doing both and not representing my comments or the feelings of Manitobans accurately at all. He knows full well that I, along with many others, in fact the majority of people, I believe, feel that health care deserves to be treated as a priority issue and concern in our society today and deserves to receive its fair share of growth in the economy.

As the economy grows , health care should not be falling behind but receiving its share of that growth--not more, not big increases beyond that, simply a fixed share of growth in our economy. I want to know, does the Minister believe that the current formula is fair or not under the federal Government? Is he in favour of a formula which is devised to provide declining revenues to the Province of Manitoba to the point where, by the year 2004, there will be no direct federal payments to health care for the Province of Manitoba? Is that the formul a he is satisfied with?

If not-and I assume he is not because his colleagues, the Minister of Finance (Mr. Manness) and the Premier (Mr. Filmon), have said they are not-what is the strategy of the Minister of Health (Mr. Orchard) and the Department of Health for trying to turn that situation around and get the Conservative Government in Ottawa to put in place, reinstate a formula that is meaningful, that recognizes health care as a priority and assures that health care in this country receives a fixed share of growth in our economy? Mr. Orchard: Mr. Deputy Chairman, I am intrigued with my honourable friend's proposition.

She knows the answer to the question. The Premier stated it; the Finance Minister stated it; I have stated it tonight. My honourable friend says we need a fixed share of the economy. Ms. Wasylycla-Lels: Growth. Mr. Orchard: Now she has added growth. That is an interesting proposition . That means that under my honourable friend's formula, this year in a recession with declining growth potential in the economy of Canada, she would accept gladly and willingly a cutback in the amount of funding from Ottawa, and say, well, that is good because it is a fixed share of the growth.

You know, that is maybe something my honourable friend would not want to talk about in too many circles. Now that we have the Leader of the New Democratic Party (Mr. Doer) in here, maybe he would like to answer the questions, because why not really get it right from the top?

I have been trying to find out from his Health Critic whether they, as a Party, would continue the practice of Howard Pawley and the NOP, of $500 million plus deficits in the Province of Manitoba, and whether they would continue with the policy of Howard Pawley and the NOP of substantially increasing income taxes and all other taxes in the Province of Manitoba? Are those their two policies. Mr. Gary Doer (Leader of the Opposition): You want me to answer the question? Mr. Orchard: Yes, I do want you to answer the question. •

(2150) Mr. Doer: I would gladly answer the question, because I cannot understand how, with the political honesty that we took in giving and providing a balanced budget of some $40 million surplus two years ago, a so-called Conservative Government, who used to preach to us day in and day out, could do two things, remarkably, three things at the same time. One is, they are not creating any wealth. We have a stagnant, flat economy that is going from full-time jobs to part-time jobs, and obviously, they have no engines of economic development to provide for the needed social services in this province.

Two is, they have taken a $40 million surplus that they received--$4 million a month were coming in more than they were spending when they came into office-and turned it into-if you take a look at the flimflammery of the fiscal stabilization fund. I support the concept of the fiscal stabilization fund, but they have taken that to close to a $384 million deficit, in other words, a $400 million swing in less than 24

2238 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 months. No Government in the history of this province has ever ratcheted up a deficit so much, because they have no financial stability, no planning. Thirdly, the only breaks really-there is a marginal break for people, which we supported in the budget of '89. In fact, it was our election promise in '89-about $70 million in corporate tax breaks since they have come into office. I think they have a problem, because they have a promise on the books, a couple of promises on the books . Remember where the old term "flip-flop" came from?

Flip-flop Almon, I think, is the term. It was not our headline; it was the media, the objective, unbiased media, that produced this term. They analyzed the fact that they had promised to get rid of the payroll tax, the health and post-secondary tax immediately, and the Premier (Mr. Filmon) then wentto a position, then the Leader of the Opposition, oh, we will get rid of it in three years. I might say that the Liberals did the same thing, Guizar . I think you have changed your position on that again though, have you not? Have you not? You cannot tell me? Okay.

Typical, but they-you moved to the left then, so you have probably changed your position . In answer to the question, you first of all-I would say to the Minister of Health (Mr. Orchard), you cannot sustain, in the long run, a health care system the way you are going, because you have no financial vision. You have no understanding of the role of the private and public sector working together, and- Mr. Deputy Chairman: Order, please. Mr. Doer: You are creating part-time jobs- Mr. Deputy Chairman: Order, please. Mr. Doer: -not full-time jobs in our economy. Mr. Deputy Chairman: Order, please. Mr.

Doer: He asked me a question. Mr. Deputy Chairman: The Honourable Member for Concordia (Mr. Doer) has the floor right now, and I would really like to hear what he has to say. So if the other Honourable Members want to carry on a conversation, please take it outside. Thank you. Mr. Doer: Secondly, the deficit is a problem, but it is a problem that the Member should recognize. They were getting $4 million a month surplus. We paid a political price for it. We had the political courage.

This Government, because it has no idea of where it is going-i ts only goal in the last 28 months was tc, get re-elected-has not been able to build upon the financial successes of their predecessors. Thirdly, now we have a health care system where the Minister of Finance (Mr. Manness)-1 do not know whether he got approval from his partner from Pembina, ·the Minister of Health (Mr. Orchard)-muses about the provinces taking over the medicare system in this country, verified in a Brandon Sun

article and questioned repeatedly by the Member for St. Johns (Ms. Wasylycia-Leis), repeatedly and pointedly . Mr. Deputy Chairperson, it is our great belief that the Lloydminster manifesto that was agreed to by his boss, the Premier (Mr. Filmon) , is a recipe for disaster for Manitoba, because we are not the same as Alberta and British Columbia. The sooner this Government realizes that, the better off we will be, in terms of our dialogue and consultation, going to the table. The Mem bE,r for St. Johns has been asking a very legitimate question all week.

The Minister of Health tables a statement, an opening statement. The Minister of Health will table press releases, et cetera, et cetera . The Premier said after Meech Lake there will never again be closed-door meetings of the First Ministers or Premiers and major Ministers, and maintain any credibility with the people of this country. I believed him. It is time that the Minister of Health (Mr. Orchard) leans on his colleague, the Minister of Finance (Mr. Manness), to table and make public the document and position we are taking to the Finance Ministers' meeting next week.

It is the most important issue we may deal with in the Session. It is the most important issue Manitobans may have to address in the '90s. The Minister of Health knows that, and I think it is worthy of a good intelligent debate , rather than just going back and forth blaming the reporter and blaming each other. I think we should know what the know position is, and we should debate it in the benefit of all Manitobans. That is the answer to the question the Minister of Health posed to me. I thank him for the question. Mr.

Orchard: I really appreciate my honourable friend's explanation, but he did not reject $500 million plus doficits of Howard Pawley. I just want to give my honourable friend-I was slightly out in my

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2239 figures with his Health Critic, so I want to make sure that my honourable friend has them right, because this is the legacy of the Party he was part of under Howard Pawley 's leadership legacy . An Honourable Member: Judy and I left you a surplus. We were in Cabinet two years- Mr. Deputy Chairman: The Honourable Minister . Mr. Orchard: Mr. Deputy Chairman, in 1981, when Howard Pawley and the NOP came into office, the annual interest bill of the entire debt of the Province of Manitoba was $90 million, give or take a million .

Today , and I just did the calculations-I just did the calculations today-it is $537 million projected debt today. That is down from two years ago when we took over Government from the current Leader of the Opposition (Mr. Doer), of the New Democratic Party, as Leader and could-have-been Premier of the New Democrats. From $90 million in 1981, and I believe the figure was to $560 million in 1988, an increase in anybody 's money of $470 million fuelled by Howard Pawley deficits of $500-plus million a year.

That $470 million, should we not be paying it today, would mean a surplus budget today, a mega surplus budget last year , a surplus budget even in the year my honourable friend was defeated at the polls , in 1988. If it was not for Howard Pawley and the NOP, Mr. Doer, Ms. Wasylycia-Le is and all of the other people who believed they could spend their way to prosperity, we would not be having an argume nt today over where the resources come from for Health, Education , for any other department of Government.

That is why-although my honourable friend, the Leader of the New Democratic Party, has not said they will reject $500 million deficits and massive increases to taxation levels in Manitoba , I think he said they do not really like them , but maybe they would have to do them. I do not know where he comes from. Can my honourable friend , in answering the question, at least acknowledge, because of Howard Pawley Government deficit financing 1981 to 1988, a sixfold increase in interest which must be paid first and takes $447 million additional tax revenues from Manitobans to pay interest costs, not program costs.

Will my honourable friend at least admit that is the legacy of the Government he was part of when they left office in 1988? Mr. Deputy Chairman: Order, please . I would like to caution all the Honourable Members to keep their remarks relevant to the item under consideration , 1.(

b) Executive Support :

(1) Salaries . I have allowed considerable latitude in this area, however , we are getting off topic . I would appreciate it if we brought it back, and I will be calling you out of order from this point on. Mr. Doer: Dealing with the issue at hand, it is an important issue in health care, because there is no question , the ability of Governments-there are two issues here. There are about three issues, one is the way we reform our health care system, the ability to support it financially, and the vision and principles we have in health care. These are the fundamental issues, obviously.

That is where some of the questions and points are being raised by the Member for St. Johns (Ms. Wasylycia-Leis), in the vision and the position the Government is taking into the Finance Ministers ' meeting next week . There is no question, all provincial governments ran debt in the recession period, the '80s. There is also no question that debt is increasing in the early '90s under the Minister 's same Cabinet. In fact, I was in a Cabinet that lowered the deficit to a surplus. I was only in two years .

We took it down from $500 million to under $300 million, and we took it down from there into a surplus which we left you. It was painful. There is no question about it. Nobody can tell me that it is easy to do. *

(2200) The Minister, interes tingly enough , was in a Cabinet with Sterling Lyon, who was only in Cabinet for a couple of years, and the deficit went up. In the last year, '81-82 fiscal year, that he was responsible for, his last budget was in the 180 range, if I recall correctly . I do not have any papers in front of me. There is no question that debt is a problem for all of us, and a challenge for all of us. I think the fact that it is around 10 cents on the dollar is a manageable problem in our province , but it is something all of us should be aware of, because it is important.

I hope the Minister of Health (Mr. Orchard) can provide us with his advice to the Minister of Finance (Mr. Manness), and the position the Minister of Finance will take to the meeting next week, because that comes to an issue that is very relevant to Executive Support. It comes to the essence of

2240 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 Manitoba's vision and the message at the Finance Minister's table . You know, we are only temporary stewards of departments we receive, or temporary stewards of jobs we may have, Opposition , Third Party, Government. We are only temporary, and the position that Ministers may take are maybe long term in its ramifications for the Province, the people, the patients and the health care workers. I am hoping the Minister of Health (Mr. Orchard) can tell us and table the position that his colleague, the Minister of Finance (Mr.

Manness), will take to that Finance Ministers' meeting next week, so we can end discussions and debates of health care through clippings, start to know exactly what we are talking about and what it means for our province. We have tabled numbers in the Chamber and studies from western Canada, not eastern Canada, about who puts into Confederation and who takes out.

We also recognize this is not just a slot machine argument, when you put a nickel in, you put a nickel out, because we think health care is a fundamental principle of the country, that the same kind of health care system should be available to somebody in Corner Brook as somebody in Dauphin or Neepawa , and the same as in Whitehorse. It goes beyond just the finances, although that is one aspect of it. I am hoping the Minister of Health in his-he can sometimes be very frank, and he can sometimes be very clever in his debating style.

I would hope that through these Estimates we can be very frank on this issue, and we can find out exactly what we are dealing with next week, because it is very important for us. Mr. Orchard: Mr. Deputy Chairman, I really appreciate my honourable friend's observation that decisions of Governments affect future Governments. That is why I wanted him to at least acknowledge his role in Government, 1981- Mr. Doer: I was not in Government then. Mr. Orchard: Your Party. Will you accept responsibility from Howard Pawley, or do you cut and run from Howard Pawley?

I mean let us get it right on the table. -(interjection)- Mr. Deputy Chairman: Order, please. I would like to remind the Honourable Minister that we are dealing with No. 1 Administration and Finance (

b) Executive Support:

(1) Salaries $417,000.00. Mr. Orchard: You see, my honourable friend, the current leadur of the Opposition (Mr. Doer), has stated very clearly and very correctly that decisions of Governments can affect a long time into the future. That is why I asked him if he acknowledge--because you know he is a great one at cleansing his soul on television, you know, we did make mistakes and we openly admit it. Mr. Doer: Something you have never done. Mr. Orchard: Oh, yes; oh, yes. I have admitted to mistakes, Mr. Deputy Chairman Mr. Doer: When was that, Don? Mr. Orchard: It was only once. But, Mr.

Duputy Chairman , fundamental to any discussion of program financing, whether it is this ministry or any other ministry, is an admission, just a simple admission. My honourable friend did not do it, that from 1981 when we left Government and Howard Pawley and the NOP took over, the annualized interest bill that Manitoba taxpayers paid increased by $450 million a year, because that is more resource on an annualized basis than we are talking abo ut in this discussion with federal financing . My hono urable friend does not want to acknowledge annualized increases in interest from Howard Pawh3y and the NOP.

It starves programs, starved them under him. Mr. Doer: Why are you running a deficit? Mr. Orchard:: Because our interest bill is $537 million, and we pay that first. That is a statutory obligation, and you know it. You drove it through the roof. If my honourable friend wants to do a little further confession-there is not even a television camera here for you--but you can do it anyway. Just admit that is a problem, a major problem, and it is not one that this current Government created or the Sterling Lyon Government created, or even the Ed Schreyer Government created.

It is solely, exclusively, the creation of Howard Pawley's Government. The numbers are there in clear, unequivocal, black and white, with clarity that anyone who can add and subtract simple numbers will tell. That $450 million, as I have said and I will say again, has a greater impact-that extra $450 million of interest annually, because of debt of Howard Pawley and six and a half years of Government under the NOP-than the issues we are talking about now. -(interjection)-

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2241 Mr. Deputy Chairman: Order, please. Mr. Orchard: My honourable friend, the Leader of the Opposition Party (Mr. Doer), wishes to discuss with my colleague, the Finance Minister (Mr . Manness), his discussions that he will have with Finance colleagues across Canada next week. He is welcome to do that with my colleague, the Finance Minister (Mr. Manness).

Tonight , my honourable friend wants to debate Health Estimates, and I am prepared to put the vision of this ministry, of this Government, on the direction of health care into the future against any vision my honourable friend or his critic might be able to put forward. We can do that tonight, tomorrow, on into next week, as long as my honourable friend wants, because I am pleased with the direction we are taking, the results we have attained already and the benefits that we will be able to clearly show to Manitobans as we see our health care system change and evolve into the 1990s .

My honourable friend, if he wants to, can just do that one last good thing for his soul and fess up to 450 million bucks of extra interest per year, compliments of Howard Pawley and the NDP. Mr. Deputy Chairman: Order, please . Mr. Cheema: Mr. Deputy Chairperson, finally I have my turn now. Can the Minister tell us-there are three basic issues here in this area. Number one is the total financing of health care system. Out of that, the federal part and the provincial part, and how these two parts are having an impact on the rate of escalating health costs. Those issues have to be discussed.

Can the Minister just tell us what is his policy, the policy of his administration, first , on the issue of federal transfer payments? Does he agree with the Finance Minister (Mr. Manness) or the Premier (Mr. Filmon) on the so-called policy they have recently announced that they are going to take to the national Ministers of Finance? He has said very clearly it does not matter what program we are going to ask, money is going to come, money is going to be needed. Where is the money going to come from, there are only two sources?

If the first source , or major source, of income which has been in the past-and he has pointed that as of 1976 there has been a slight-and with the present, even the Government of Canada has kept the money only at the rate of 2 percent. By the year 2004, it is going to run out. Basically , even if they do not do anything, we will be in trouble. If you are going to take a major responsibility of $1.7 billion of health care today, how are you going to fund those programs? Can you tell us simply in yes or no terms? I mean, we have gone through this for the last one hour, and I am sure we will continue with this.

The basic question is: How would you secure your funding from the federal Government? Mr. Orchard: I think with obvious difficulty, and that is why the Finance Ministers are meeting. That is why Finance Ministers and Health Ministers met 16, 17 months ago in Moncton, to come around this issue, because it does not seem to matter who the federal Government is. That is the difficulty. *

(2210) Mr. Cheema: Can the Minister then tell us? I mean, he recognized the problem. You do not have to be a genius or the Minister of Health or a Member of the Legislative Assembly to understand that it is a basic, fundamental structure of our health care system that part of the funding comes through the federal Government, because of our province, the resources, the economy and so many factors that are dependent. We get our major funding of post-secondary education and health from the federal Government.

If you are going to take over the major programs in health care, and you are going to fund that program by yourself in Manitoba, how are you going to fund those programs then? That means you have to either raise taxes , or you have to cut the program, or you have to take, as you have said, money from the existing other programs. What are your options then if you are going to take over the national program? Mr. Orchard: My honourable friend is doing the same kind of word in mouth aspect that the official Opposition Critic was attempting, leaving the statement that we are going to take over the national program.

That is not the case. Mr. Cheema: Mr. Deputy Chairperson, I will make it clear if, due to my language problem, the Minister is taking advantage. The basic question here is, if the federal part of the programs, if you are not going to accept and you are going to take the different directions because of the difficulties you are going to face in the future and, depending upon all those factors, if you are going to take the responsibility of

2242 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 the medicare program by the provincial Government, how are you going to fund those programs? It is a simple question. It is not something written in another language. Mr. Orchard: The simple answer, Mr. Deputy Chairman, is, with difficulty. That is why the Minister of Finance (Mr. Manness) has convened a meeting next month of Finance Ministers, to try to come to a provincial united approach to the federal Minister of Finance. We have tried that once before. I mentioned that to you already.

We tried that once before in Moncton and still there is declining participation by the federal Government. You see, why this debate is important is that, you know, my honourable friend I think recognizes, and I think even my honourable friend the New Democratic Party Critic recognizes, the reason why the federal Government is undertaking these reductions in transfer payments to the provinces , all across Canada. Their argument simply is, we spend one cent out of three , one dollar out of three , 33 percent of our tax revenues, on interest, and our deficit keeps on growing.

My honourable friend the NDP Opposition Critic may or may not agree with it, but they make the argument that they have essentially lowered the spending of federal Government programs in Ottawa over the last six years, that they have taken and decreased the amount of money, but the interest costs keep burgeoning up. I do not know how they are going to solve that problem under the current economic structures that are in place. That is why the key and fundamental issue we are coming to grips with in the Province of Manitoba, and this is not health related , is economic development.

One of the most understanding individuals whom I have ever heard address the issue of how does Canada get out of its current dilemma is Dr. Fraser Mustard with the Canadian Institute for Advanced Research. I am going to have transcribed his presentation on Monday morning to the National Nursing Symposium. I am going to have it transcribed for one very good reason, so that all Members of the Legislature can have that presentation. I hope I can emulate the slides. You know what his point is? You know what the point he makes is? This individual is one who has a medical background.

He was the Dean of the Faculty of Medicine at McMaster. He identified eight years ago, 10 years ago, that Canada was on the wrong track in terms of our economic development policy. I do not know all of the answers, but I recognize the sanity in what he is saying. He said clearly and unequivocally to the 300-plus nurses gathered in Winnipeg from all across Canada on Monday morning that Governments that do not create wealth cannot afford health care systems or any other system for that matter.

He said the challenge to Canada is going to be able to get an economic ~1ystem working that creates the wealth that allows us to afford our continued social services and other funded institutions that we have come to desire and re!1pect, including health. You see the answer is no longer trying to figure out how you slice up a decreasing pie. We have been doing that now for how many years, nationally? It does not work. It is not working now, and it will not work.

As smug as my honourable friends might want to be in the New Democratic Party with their current Leader federally, it will not change if they were in Government. You watch Ontario if you want an object lesson in how you cannot spe nd and deficit finance yourself to prosperity. (Mrs.

ShirlHy Render, Acting Chairman, in the Chair) I do not have a simple solution to the federal Government's dilemma other than trying to get basic policies in place that encourage investme nt, economic development, and not simply in the resource extraction field , because that is where we got absolutely banner revenues a year and a half ago-was from nickel prices at $9.00 . Now they are down to $4 and $5.00. Our revenues are down again to more normal levels. You cannot predict stability on that. Economies like Japan and West Germany have moved to the innovative technology production.

They are successful-very, very successful--and they are not having these same arguments about resource allocation that we are having in Canada. I do not have a simple answer for the federal Government on where they carve more money out of a decreasing pie, but I do know that we have to get our economic house in order so that we create new wealth so that all of us can benefit from that. We are taking two strategies in Manitoba. One of them I shared in general terms with my opening

November 29, 1990 LEGISLATIVE ASSEMBLY OF MANITOBA 2243 remarks, and when we go through other lines of the Estimates and one begins to appreciate some of the directions in reform of health care where we are hoping that we can provide the same or higher quality service in a different forum at at least evened cost, if not lowered cost, that is reform of the health care system . That is where we are going to make better use of the current dollars we have , because we recognize there is not going to be any new dollars. That apparently was even recognized tonight by the officia l Opposition .

I was pleased to see that. I do not have -(interjection)- I will get your exact words so that you do not cause me a problem. No, it is important. Anyway, you said that there was not additional money into health-I just found it. That is what you said tonight, that there was not additional money to go to health . •

(2220) An Honourable Member: Oh, I did, did I? Mr. Orchard: You mean you did not mean to say that? An Honourable Member: You check the record, Don. Mr. Orchard: Yes, we will. I do not have an easy answer , but I recognize the problems , and we are reacting in Manitoba twofold , with management and system changes in the way we deliver health care in the Province of Manitoba, and secondly , a very pro-active approach to economic development in the Province of Manitoba that we hope over this next four years will yield increasing tax revenues. Mr.

Cheema: Madam Acting Chairperson, my next question is: Can the Minister tell us-he may have the statistics-this year, how much less money have we received from the federal Government, and how much are we going to receive next year and the year after that? Mr. Orchard: I cannot give you the numbers. because I do not even think they are printed in the Estimates book. They are part of the supplements . I think there are still more dollars available from the federal Government to finance EPF in terms of transfer payments . I do not have that. I will have to get that from my colleague the Finance Minister (Mr.

Manness) . Mr. Cheema: Madam Acting Chairperson, if the Minister could provide those numbers sometime early next week , we will appreciate that. and over a period of five years, how much less money will be coming to Manitoba ? My next question is that, as the Minister has recognized, and the Member for St. Johns (Ms. Wasylycia-Leis) has recognized, the two major factors--and everyone knows the health care costs are escalating. This year the budget was given about 6.7 percent, I believe , the total for the provincial budget was raised in the area of health .

For the next year, with the econom ic conditions right now we have in Manitoba, how is the Minister going to have all those programs? Even with the present rate of inflation, how are they going to fund all those programs next year? Mr. Orchard: Madam Acting Chairman , that is exactly why we are approaching-and you know I recommend a revisiting of my opening remarks in terms of what we are attempting to do to put system responsibility in place so that we do outcome analyses .

Just let me give you one small example: One of the advantages of the centre for health policy and evaluation , where I think we are going to be guided and guided very effectively. You might be familiar with the Roos' in terms of their expertise, their international renown and analysis of our health care statistics . Approximately five years ago--and you see we have always judged, or the public perception of how well a program works, and if it is a surgical program. how long the waiting list is? If it is long , it is not working. If it is short, well, maybe it is working all right.

The key question is: What is the medical efficacy of the procedure? Is it increasing, or adding to, or advancing the health status of the individua l in which the proced ure is performed? The example I want to give you is that about five years ago the Roos' analysis of Manitoba's statistics indicated that we were taking out tonsils in Manitoba of children at a rate significantly above the national average . A couple of obvious questions have to be asked . Are Manitoba children's tonsils more medically unsound than children's tonsils in Ontario or Saskatchewan? I think the answer to that is no.

Was there some unique condition in Manitoba which would have led to more of our children's tonsils being removed five years ago? Again the answer , no. The reason why they were being removed is because there was an incentive to remove them within the fee

schedule system. That is as bluntly as you can put it.

2244 LEGISLATIVE ASSEMBLY OF MANITOBA November 29, 1990 When that information was provided to the ~ollege of Physicians and Surgeons, and widely circulated in Manitoba within a year and a half, our rate was approaching the national rate. Now did all of a sudden in that year and a half our children miraculously become children with healthier tonsils? No, I do not think that happened. It is just that no one asked, i

Document details

Collection	Manitoba — Debates (Hansard)
Citation	35-1-35b
Type	hansard
Volume / chapter	35th 1st hansardpdf 35b.pdf
Language	en
Format	pdf
Source	PROVINCIAL
Identifier	a8c3e15b6f57f9e76f56d93e8fa44d665da698cc

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