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Decentralized Democracy

House Hansard - 162

44th Parl. 1st Sess.
February 16, 2023 10:00AM
  • Feb/16/23 10:12:01 a.m.
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Mr. Speaker, I rise to present a petition on behalf of the residents of my riding of Aurora—Oak Ridges—Richmond Hill, principally Iranian Canadians, who are urging the Government of Canada to expedite the implementation of the sanctions that it placed on the Iranian regime and the IRGC and to continue to support the fight for human rights for Iranian women, children and political prisoners. While this government has implemented some of the most far-reaching sanctions of any country and there are signs that the pressure from the protests internally and from sanctions from many countries, including Canada, is resulting in positive movement, the sanctions must continue. The petitioners are calling on the government to invest resources to expedite the continued enforcement of these sanctions and not only ban sanctioned persons from entering Canada, but investigate and remove those who are in Canada as soon as possible. They also petition the government to freeze and/or seize any Canadian financial assets belonging to those who are sanctioned. I would like to add that many Iranian Canadians were hesitant to sign this petition requiring their full name and location, for fear that they or their families would be targeted by the IRGC, both abroad and in Canada. Their fear is real and they call on the government to continue to implement and increase these sanctions until freedom and peace for Iranians in Iran, Canada and elsewhere are restored.
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  • Feb/16/23 10:13:28 a.m.
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Mr. Speaker, I am so proud to present this important petition, and I am hoping that we will see many more of these come forward, demanding that the Canadian government urgently follow through with the actions against the Iranian regime, which includes making the regime, the IRGC and top leaders inadmissible to Canada, expanding sanctions against those responsible for human rights violations and denying them entry to Canada, and investing more money to allow sanctioned Iranian persons' assets to be quickly frozen and seized. Petitioners ask that the regime and its most senior officials, including the IRGC, be immediately banned from entering Canada, that current and former senior officials who are present here be investigated and removed from the country as soon as possible, and finally, that the Government of Canada, along with its partners and allies, have Iran removed from the UN Commission on the Status of Women, which is the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women. I am so proud to present this with 31 signatures from Aurora—Oak Ridges—Richmond Hill.
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  • Feb/16/23 10:14:38 a.m.
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Mr. Speaker, I am also honoured to rise today, like my hon. colleague from Aurora—Oak Ridges—Richmond Hill and my colleague from the Conservative Party. A number of us have received petitions from constituents and concerned Canadians about the appalling situation for the citizens of Iran. The Islamic Republic of Iran, the petitioners note, has demonstrated a history of violence against its own citizens, including the killing of 1,500 protesters in November 2019, and the Islamic Revolutionary Guard Corps is at the epicentre of the Iranian regime. We know that women in Iran have long faced legal, political, economic and social challenges, and we have seen increased violence in a crackdown against women and girls, who are being killed even for the simple failure to wear a scarf as prescribed by the regime. The women and girls have been at the forefront of the recent uprising. The petitioners are calling on the Government of Canada to follow through with actions against the Iranian regime, which include making the regime, the IRGC and top leaders inadmissible to Canada, expanding sanctions against those individuals responsible for human rights violations, denying them entry into Canada and, through the Minister of Global Affairs and the Government of Canada, along with our partners and allies, having Iran removed from the Commission on the Status of Women within the United Nations. These and many other measures the petitioners hope the Government of Canada will pursue with vigour.
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  • Feb/16/23 10:16:35 a.m.
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Mr. Speaker, pursuant to Standing Order 43(2)(a), I would like to inform the House that all New Democratic Party speaking slots will be divided in two.
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  • Feb/16/23 10:17:00 a.m.
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Mr. Speaker, I ask that all questions be allowed to stand.
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  • Feb/16/23 10:17:03 a.m.
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Is that agreed? Some hon. members: Agreed.
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  • Feb/16/23 10:19:21 a.m.
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moved: That, given that, (i) during the 2021 federal election campaign, the prime minister was harshly critical of the Conservative Party of Canada proposal to encourage “innovation” in the health care sector by expanding for-profit provision of publicly funded services, (ii) the prime minister has now dramatically changed his position and has lauded as ‘’innovation” Ontario Premier Doug Ford’s proposed expansion of for-profit clinics, (iii) for-profit clinics would poach workers from the public system and lead to longer wait times, (iv) there are multiple public reports of two-tier health care in Canada, where people are charged for faster access to care, such as family doctors or surgery, the House call on the government to: (a) express disappointment that the prime minister has promoted Ontario’s for-profit health plans as “innovation”; (b) ensure that recently announced health care funding is not used for the expansion of for-profit health care, but instead used to rebuild and innovate within the public system by hiring more staff and reducing wait times; and (c) enforce the Canada Health Act and immediately move to close loopholes that allow for the growth of two-tier health care in Canada. He said: Mr. Speaker, Canada's health care system is based on the principle of access to care based on need rather than ability to pay. A well-designed, well-funded single-payer system can provide fair, effective and high-quality care to make this a reality. Our public health care system is certainly facing some challenges, but the solution lies in strengthening our public health care system, not weakening it. If we introduce private funding, then need will come second to ability to pay. That would result in less accessibility, longer wait times and higher costs in the public system. It would also lead to increased administrative costs, in other words, more money for insurance companies and less money for health care. Introducing private payment prioritizes care based on ability to pay, not need. It leads to worse access and wait times, as well as higher costs in the public system. It also leads to higher administrative costs, which means less money for patient care. There is not only little evidence that private, for-profit investor-owned corporations can provide better quality care or reduce costs. In fact, there are many examples that show precisely the opposite. Those seeking to improve the quality, equality, access, efficiency and equity of health care services in Canada can do so by focusing on strengthening our public system rather than dismantling it. Proponents of privatization claim that increasing private pay and/or private for-profit delivery will reduce wait times, either overall or for those in the publicly funded system specifically; reduce costs to the public system; and lead to better health outcomes. There is perhaps no more serious and dangerous myth in Canadian politics today than that statement. I want to review the situation today and some of the factors that show this is not the case. Everyone deserves health care when they need it, no matter the size of their wallet. No one should need to wait in pain because there are not enough health care workers or because the wealthiest jump the queue. However, under successive Liberal and Conservative governments, today people are waiting in pain for hours, days or weeks, and sometimes months or years. Folks are losing their quality of life while they wait for surgery. In addition, health care workers are run off their feet, burned out and exhausted in every corner of this country. The Prime Minister could make things better for patients by hiring and rebuilding the public health system. Otherwise, he can contribute to making the crisis even worse by helping to fund for-profit schemes that will poach staff from the public system. We are not surprised the Conservative Party loves for-profit care. It will make billions for corporations and rich CEOs. This is right out of the Conservative playbook: starve a public service and use that as an excuse to hand it off to the private sector. A condition of federal health care funding should be investing to fix public universal Canadian health care, not funnelling funds and staff into for-profit facilities. New Democrats want health care to move towards more public delivery, not farther away from it. If new bilateral health agreements do not result in thousands of new health care workers in our public system, it will fail. Ottawa urgently needs to partner with the provinces and territories to help provinces train and hire more health care workers, respect current health care workers and pay them better, and recognize the international training of thousands of health care workers who are already in Canada and ready to work. During the 2021 election, the former Conservative leader said that “he would support provinces in introducing privately led health care ‘innovations’”. At that time, our current Prime Minister told Canadians this was evidence that a Conservative government would threaten Canada's public health care system, saying that the Conservative leader “believes in a for-profit, private health care system and he will not tell people what exactly he wants to do with that.” My, how things change once one is in office. The Prime Minister recently reversed his position by calling Ontario premier Doug Ford's private for-profit clinic scheme an example of “innovation”. Let us just quickly review the privatization plans by Conservative premiers across the country. Doug Ford has said that he wants to divert funding from his province's hospitals towards for-profit surgical clinics. His plan includes an expansion of private cataract surgeries, MRI and CT scans, minimally invasive gynecological surgeries, and knee and hip replacements. Ontario's plans to contract out to private for-profit clinics for cataract surgeries is expected to cost the government 25% more per surgery. Moving only hip and knee replacements to for-profit clinics will benefit owners, with an estimated windfall of half a billion dollars annually. The owners of Herzig Eye Institute, one of the top private surgery clinics that lobbied the Ford government to expand private cataract surgeries, have donated thousands of dollars to the Ontario Conservatives. In a recent throne speech, Manitoba premier Heather Stefanson announced her government's intention to seek out private partnerships to deliver health care. Saskatchewan is moving forward with plans to reduce its backlog of surgeries by privatizing certain procedures. In January, Alberta announced that it is contracting Canadian Surgery Solutions to perform more than 3,000 orthopaedic surgeries covered by the provincial medicare plan. Why are they doing this, and how are they getting away with it? There are several loopholes here, but I want to itemize one of them. There is a serious loophole in the Canada Health Act. As we speak, private clinics across Canada are advertising to prospective patients that within weeks they can get surgeries that typically take six months or more under provincial health plans. All the patient has to do is pay them $20,000 to $30,000, depending on the clinic. CIHI estimates that the average cost per joint replacement operation in public hospitals in Canada is $12,223, which means that the private clinics are charging patients roughly double what the surgery costs the provincial medicare system. To those who claim that private surgery is cheaper, one can tell right away that when one adds profit and extra administrative costs, diverting money to the private system will cost our public system more. Doug Ford says, “Oh, that is okay. We are still paying for it with public dollars”. Why would Canadians ever tolerate paying twice as much for surgery in a private system than they would in the public system? The Canada Health Act prohibits extra billing. This means that doctors are banned from charging patients more than the medicare rate for an insured service. However, private clinics are getting around that by operating only on patients from other provinces. Imagine the loophole in this country where, if one is in Manitoba, one can sell a private surgery to someone from Ontario but not somebody in Manitoba. This violates the fundamental principle of the Canada Health Act. It is a gaping loophole in our system. We are calling on the government to close that loophole right now if it truly cares about public health care as it says. It is not only those kinds of surgeries, though. Maple, a Loblaws-funded virtual care business based in Toronto, is charging patients $69 per doctor's visit or $30 per month for 30 visits per year if one wants to go bulk. In-person service would be covered by Ontario's public insurance plan. Ontario has insured virtual visits under OHIP, but Maple has found a way around the province's rules by connecting patients with a nurse practitioner or physician outside of the province. This is another gaping loophole. That is not to mention the odious practice that has been going on in this country for years, where people appear at private clinics only to be upsold. They come for cataract surgery but are told that if they want a better lens, they have to pay more. That kind of introduction of private pay and access to health care is a fundamental violation of the medicare system that Canadians hold so dear in this country. Let us talk about the evidence against privatization. A recent study led by Dr. Shoo Lee, a professor emeritus at the University of Toronto and former pediatrician-in-chief at Mount Sinai Hospital, looked at international experiences to determine what impact private financing would have on Canada's health system. That study found that private financing, both private for-profit insurance and private out-of-pocket financing, negatively affects the universality, equity, accessibility and quality of care. It is not just that study. A recent study of England's National Health Service found that as outsourcing to the private for-profit sector increased from 2013 to 2020, so did the rates of death from treatable conditions. I look forward to hearing any questions. Let us stand up for public health care in this country and make sure that every dollar of public funding goes to public health care in Canada.
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  • Feb/16/23 10:29:38 a.m.
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Madam Speaker, I appreciate the motion brought forward by the New Democrats. I have always felt that a good, healthy debate and discussion about Canada's health care is long overdue. I welcome the idea of bringing the Canada Health Act into the debate. My question to the member is specific. When I was the health care critic in the province of Manitoba, I used to argue that one of the greatest threats to Canada's health care system was not only the issue of financial resources, albeit that is critically important, but also the way we manage changes. We could probably have a healthier health care system if we saw more provincial comparisons, learned the best practices and looked at ways to improve or manage the changes necessary to meet future demand in our health care system. Can he provide his thoughts on that?
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  • Feb/16/23 10:30:48 a.m.
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Madam Speaker, I do not disagree that provinces and territories should be sharing information and best practices, but the debate today is about national leadership. It is about the member's government and what it is going to do to help ensure that we not only protect but also strengthen and expand our public health care system. When the Prime Minister of the member's government is applauding a privatization plan by a Conservative premier in this country, that is not the kind of national leadership we need. We want the government to say plainly to Canadians that every additional dollar of health care funding in this country will go to strengthening our public health care system and not be diverted to private, for-profit care. That would make our public system worse. It would increase costs, extend wait times and make care for Canadians worse.
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  • Feb/16/23 10:31:40 a.m.
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Madam Speaker, I thank the member for Vancouver Kingsway for his presentation and for speaking on this. I know he is very well aware that there is a difference between federal and provincial health care. The majority of health care in Canada falls into the provincial jurisdiction. He sort of alluded to this, but could he provide his thoughts on whether we need to sit down, look at the Canada Health Act and consider that section straight off the bat? Do we need to address that for Canadians?
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  • Feb/16/23 10:32:17 a.m.
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Madam Speaker, we absolutely need to open up the Canada Health Act, but we need to do it for the purpose that the NDP is talking about today. This is to close the loopholes that are allowing private, for-profit care to creep into our system. Right now, we have a shortage of doctors in our hospitals. We have a shortage of nurses in this country. Staff are burnt out at every hospital. How can it possibly be a positive development to allow private clinics to drain people from that system and then allow access based on private access to care? We have to add profit and administrative costs to the system. By the way, the United States pays 31¢ out of every dollar to administration. In Canada, we pay under 2%. Administrative costs are much higher in the private system. If we drain those workers, what is going to happen to the wait times in the public system? Obviously, they will get longer. We need to close the loopholes to make it clear that all publicly insured services in this country are delivered in the public health care system. Let us build up our public system. Canadians deserve to have timely access to world-class care. They are not getting it now. New Democrats will continue to make proposals so they can get that.
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  • Feb/16/23 10:33:30 a.m.
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Madam Speaker, it is very nice to hear my colleague speaking French. His accent is excellent. I would like to once again remind him that Quebec and the provinces are the ones responsible for the health care model. The Supreme Court clearly ruled in that regard in Chaoulli. It stated that a person who is waiting for surgery cannot be banned from using private health care. What does my colleague think about that?
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  • Feb/16/23 10:34:47 a.m.
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Madam Speaker, I respect my hon. colleague's position. Actually, health care has been ruled by the Supreme Court of Canada to be a shared jurisdiction in this country. We cannot even find the words “health care” in our Constitution. The provinces have jurisdiction over the establishment and maintenance of hospitals and also regulation of the professions. The federal government has its spending power; the criminal law power; and peace, order and good government. We will not fix health care in this country. By the way, I do not think Canadians care about jurisdiction. What they care about is that, when they get sick and they need care, they can go to their public system and get timely access to world-class care. That is going to take all levels of government working together to deliver it.
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  • Feb/16/23 10:35:34 a.m.
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Madam Speaker, the pandemic was hard on Canadians. It was particularly difficult for health care workers, including nurses, doctors, personal support workers, long-term care workers, maintenance staff, and so many others. For three years, they have been on the front lines of this pandemic with no relief in sight. The government called them heroes, but those accolades have not been backed up with tangible investments in pay, working conditions or mental health supports. It is absolutely unacceptable that investments in mental health have not come to frontline workers, including health care workers, when the Liberal government is sitting on $4.5 billion of unspent mental health dollars. I remind the government that this needs to change. Today, we are talking about the privatization of health care in Canada. The Liberals' recent health care negotiations with the provinces have not produced change or protections. The solutions that Canadians were expecting to hear to improving their access to care in this country did not come to fruition. Canadians did not hear of plans to address the staffing shortages of doctors or nurses. As Tim Guest, the CEO of the Canadian Nurses Association, said, “While CNA is encouraged by the federal government’s commitment to prioritizing health-care workers, the need for a pan-Canadian health human resource (HHR) strategy and urgent action to address critical nursing shortages were not clearly addressed.” The current Liberal government must address the human resource crisis in the care system in Canada immediately. The Prime Minister has an opportunity to make things better for Canadians by working with the provinces and territories to hire and rebuild the public health system and its human resource sector. Alternatively, he can continue to make the crisis worse by funding for-profit schemes that will poach staff from hospitals and the public health care system that all Canadians rely on. I remind the Liberal government that allowing for-profit care to take over Canada's health care system is not only a contravention of the Canada Health Act, but also a costly project for Canadians, both in dollars and in lives, as the hon. member mentioned earlier. We have only to look at the catastrophic outcomes in private long-term care during the pandemic to see that. The courts are also warning us of the folly of private health care. The Supreme Court of British Columbia looked at the impact of private, paid health care in its 2020 ruling on the Cambie case and found that “...the introduction of duplicative private healthcare would lead to increased costs and diversion of human resources, which would be contrary to the purpose of the provisions to preserve and ensure the sustainability of the universal public healthcare system.” This decision was upheld by the B.C. Court of Appeal in 2022. In its ruling, the justice found that suppressing all private care is necessary to ensure that access to medically necessary care is based on need and not on ability to pay. It also stated, “The introduction of even small scale duplicative private healthcare would create a second tier of preferential healthcare for those with the means to either acquire private insurance or pay out-of-pocket once their benchmark was exceeded.” That is worrisome. No Canadian should have to fight for equal care in this country, but that is exactly what privatization, for-profit care, does. It is not just me saying this. It is the law of the land saying it. This is why it is imperative that the new bilateral health agreements result in thousands of new publicly funded health care workers to fix and support a growing sector of our economy, the care economy, where one in five Canadians already works. If the federal government cannot facilitate this in the agreements, they will be a failure. The current nursing shortage has certainly proven that a lack of human resources in care is past critical levels. I will mention again that it is affecting the mental health care of caregivers. Dr. Katherine Smart, the former president of the Canadian Medical Association, said: What we're learning is more than alarming. It's potentially catastrophic. Time is of the essence. More than a quarter of practising physicians claim low rates of overall mental health. Recent figures show that 20% of front-line health care workers have thought about suicide. A crushing 6% have planned an attempt. A crushing 6% have attempted suicide, and we know that it has happened. The Liberals need to get to work to assist in solving the shortage of doctors and nurses in this country. As the leader of the NDP pointed out, when the Prime Minister took office, there was a shortage of 5,800 nurses. Things are now five times worse. Dr. Smart said that over 50% of physicians and medical learners reported high levels of burnout, compared to prepandemic levels of 30%. Moreover, nearly half of physicians reported that they would likely reduce their clinical hours. Canadians cannot afford any more reductions in access to doctors. With that in mind, I am going to take a moment to highlight, for the Liberal government, news from the labour shortage study out of HUMA this year. The report holds critical testimony outlining solutions that would improve working conditions for health care workers, attract and retain health care workers, and allow for a pan-Canadian human resource plan. These solutions come from health care professionals who know the problems in the system. I would note that not one of the solutions presented in the study was to jeopardize the public health care system by introducing private, for-profit care. Here are eight of the recommendations. First, “work with the provinces, territories and other stakeholders to promote the alignment of educational and training opportunities in health care and other care economy sectors...”. Second, “in collaboration with the provinces and territories, expand training and upskilling capacity for high demand industries, skilled workers, the care economy [and] health care workers...”. Third, “work with the provinces and territories to remove barriers to labour mobility in the health care sector, including through the interprovincial/territorial coordination of regulation and licensing requirements.” Fourth, “support access to care in rural and remote communities by providing further incentives for in-demand health care professionals to work in these communities, including through tuition assistance, loan forgiveness, or tax benefits...”. Fifth, “consider offering additional permanent residency pathways to temporary foreign workers with in-demand skills or experience, including in the care economy...”. Sixth, “review the Foreign Credential Recognition Program with a view to determining how it can better support efficient foreign credential recognition for internationally trained health care professionals.” Seventh, “review compensation and benefits for care economy workers under its jurisdiction with a view to ensuring decent work and a regionally competitive wage; and further, that it work with the provinces and territories to improve working conditions for other workers in the care economy (including but not limited to migrant workers, and those in non-standard employment) and provide adequate compensation, basic health benefits, paid sick days, and workload management.” Eighth, “consider establishing a national Care Economy Commission to develop, implement and monitor any workforce planning strategies for the care economy, including a centralized health care human resources strategy...”. These are the real solutions to the health care crisis. These are the real solutions that would benefit people over corporate profits, and these are the real avenues to solving the human resource challenges in health care. I am going to quote Michael Villeneuve, the former chief executive officer of the Canadian Nurses Association, who said: Canada needs targeted federal funding to help health care systems train, retain, recruit and improve education and working conditions...The federal government has an important convenor and coordinator role to play. It needs to work together with provinces and territories on both short- and long-term strategies. Maintaining the status quo cannot be an option. In closing, at the same time that the Canada health system is on the verge of collapse, workers are burning out, fatigued and taking early retirement. More federal investments are needed. As economist Armine Yalnizyan has been saying loudly, labour needs are set to rise due to an aging population. She says, “...there is no more pressing labour market issue than how we prepare the Care Economy for the decades of population aging ahead...” The federal government needs to take on this challenge and stop wasting time on for-profit corporations and privatization-hungry premiers trying to breach the Canada Health Act that belongs to all Canadians.
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  • Feb/16/23 10:45:25 a.m.
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Madam Speaker, I would first like to commend the hon. member for Port Moody—Coquitlam for her work on labour shortages in the care economy. I appreciated all the quotes she used to re-emphasize what I believe are common characteristics and shared priorities with respect to these investments in the health care system going forward. I would also like to share a quote from Dr. Alika Lafontaine from the Canadian Medical Association: Today’s commitment by the federal government to significantly increase health transfers to provincial and territorial governments is an important step to stabilize and transform our health care systems. The emphasis being placed on primary care, health workers’ support and the modernization of health care is welcomed. I would ask my hon. colleague, who has done considerable work on this, how she would react to all the positive quotes that I have here from SEIU, the Canadian Nurses Association and the CMA? They all seem very pleased. Why is the hon. member not pleased?
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  • Feb/16/23 10:46:27 a.m.
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Madam Speaker, I was not going to share this today, but I will. My mother is 77 years old and she went into an emergency room recently in Alberta because she was having trouble with her eyes. The emergency room doctor treated her, but sent her off-site to a private clinic and told her she would benefit from some additional things. My mother paid $5,000. She is a 77-year-old woman. When my mother walked into the waiting room on the day of her surgery, there were, she told me, dozens of people over the age of 75 sitting in that area. She paid $5,000 to have additional surgery on her eyes. When she went into the operating room, she thought she was getting the doctor whom she had spoken to in the emergency room. It was not until she went back for her second visit that she was told that was not the doctor who did the surgery. She was not told, and she still has not seen that doctor.
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  • Feb/16/23 10:47:31 a.m.
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Madam Speaker, I have a daughter who is interested in becoming a surgeon, and she is pursuing that as we speak. However, I have heard many stories. Even 20 or 25 years ago, friends of mine tried to get into medical school in Canada and simply could not, yet they found places somewhere else outside our very own country of Canada or outside our province of B.C. I have not heard this member talk once either about facilities to train doctors and nurses or about the gatekeepers who are controlling the applicants getting into our current system to become students and then to become doctors and nurses in our very own country. I am kind of curious whether she has a solution or has talked to those entities about possible solutions to fix that problem.
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  • Feb/16/23 10:48:25 a.m.
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Madam Speaker, there is talk about that in the study on the labour shortage in the care economy. About 15 years ago when I was living in Quebec, I was at a dinner and there were conversations around the table then. We knew 15 years ago that there were not enough spots and placements. That is a serious issue. The Liberal government has the opportunity to start working with those organizations and with the provincial and territorial organizations to lift that. I want to point out, though, that we have known this was happening. People were sitting around tables talking about this 15 years ago and the Liberal government and the Conservative government before it did nothing about it.
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  • Feb/16/23 10:49:14 a.m.
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Madam Speaker, we agree with the substance of the motion, in other words, the need to strengthen our free universal public health care systems. In Quebec, we watch these issues closely, but this is not the place to be debating them. We see what is happening in Ontario and Manitoba, as well as the potential abuses, and I think there are some battles to be fought. However, the most important battle to wage, when we talk about staffing, working conditions and labour shortages, is getting the federal government to provide adequate funding to the provinces so that they can carry out their responsibilities. Why did the NDP not call out the federal government's inadequate investment in the latest agreement with the provinces?
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  • Feb/16/23 10:50:07 a.m.
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Madam Speaker, I really appreciate working with the member at the HUMA committee. The member and I had worked alongside each other on the labour shortage study, and we had very similar thoughts, so I thank her for that. The NDP members have been talking for a long time about the need for additional health care transfers and for the Liberals to make up for the deficit funding that the previous Conservative government pulled away. This is something that the New Democrats have been talking about for a long time. This is a failure of the Conservative government of the past and a failure of the Liberal government now.
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