Dr. Swann Debates Government Motions: Provincial Fiscal Policies – 22 March 2017

Taken from the Alberta Hansard for Wednesday, March 22, 2017

Government Motions: Provincial Fiscal Policies

Dr. Swann: Thank you, Madam Speaker. I’m pleased to speak to the 2017-18 budget. I think a lot of what we are expressing in this House is degrees of comfort with debt and degrees of comfort with borrowing and degrees of comfort with protecting public services and infrastructure. What we have seen in the past at least 20 years, since I started paying attention, is a PC government that has not kept up with either infrastructure or human services needs. In fact, it has allowed those things to slip on the basis of balancing a bottom line that doesn’t recognize environmental deficits, human deficits in access to services, care, housing and health care, and doesn’t recognize that liabilities related to infrastructure don’t go away if you don’t spend the money.

During good times and bad we faced the same challenge in the previous 20 years at least, where we were not keeping up with some of those key elements of a civil society. We’re now facing a true challenge for all of us, and I think a lot of what we’re debating here is how quickly we should be moving on some of these deficits and how much we should be borrowing and indeed how we should be paying for it. The latter I’ll leave to the end, but I think that’s a crucial one that we still haven’t come to grips with in a lot of respects.

If we have a difference of opinion on this side in the Liberal caucus, it’s primarily around the pacing of change in this province and the lack of connection to what’s happening on the ground and a recognition that small business is continuing to suffer. There’s a recognition also that some of these new, dramatic changes, all of which I think had to be brought into place, including the carbon levy – how we can balance those things out in a thoughtful way and try to reduce the impact on everything from small business to nonprofit organizations and various services and generally low-income earners that are going to be adversely impacted by the knock-on effect of all the changes at once that are increasing the cost of living? Obviously, we can’t wait for oil prices, and this is the perfect time for borrowing for infrastructure. This is a stimulus for our economy, and it’s going to keep people employed. The question is how much and how we’re going to pay it off.

Clearly, if we’re looking at trying to both minimize our impact on future generations and budget appropriately, health care has to be a primary focus for our attention. It is by far the biggest expenditure of government, and it has grown by up to 8 per cent per year for the last decade, again leaving us in a position where the expectations are there, public expectations and professional expectations, that it’s going to continue and that they’re always going to have exactly what they need. The Minister of Health is in a very difficult position trying to balance the needs of people and the professional demands and the infrastructure demands, the technology demands, the growth of all these new technologies.

[The Deputy Speaker in the chair]

But she has to make tough decisions, and I think some of the positive decisions that she’s made are around the amending agreement with physicians, some of the drug cost issues that we’ve managed over the last few years to bring under some control. But there are a number of areas – and I’m a constant thorn in her side about prevention and early intervention and health promotion – which continue to get less and less relative to the population and cost-of-living increases.

We are gradually getting into the position where we are faced with a sickness care system. This is not a health care system anymore; it’s a sickness care system. We spend virtually all of our money on managing people after they get sick and break down when there are tremendous studies showing evidence of reducing the incidence of mental illness, addictions, injuries, reducing the incidence of lifestyle diseases, heart disease, and cancer by working with families, especially high-risk families, those that often consume most of the health care system. In fact, as some of you may know, it’s about 5 per cent of the population that consumes 50 per cent of our health resources because of their chronic, long-term, complicated illnesses. Many of those are seniors, but many of them simply are born with poor-functioning bodies and they need a lot of medical care in and out of hospital. If we focused more attention on some of those folks and managed them better, we would also reduce substantially some of the costs that we’re dealing with.

It’s disappointing not to see more significant changes in the health care system where we could substantially reduce, not tomorrow but in the years to come, the impacts on emergency departments, on EMS services, certainly on hospitalizations. Alternate level of care beds is one that we’ve often talked about, spending somewhat over $75 million a year on people that shouldn’t be in hospital at all and that could be saved by getting them into long-term care. To their credit, they’re building some new long-term care beds, but we’re way behind the curve on that and wasting a tremendous amount of money and increasing the suffering of people because they’re not where they want to be and they’re not in the best place, in a hospital where they can get other infections and are often neglected at the preference of other people who are sicker.

The lack of an integrated plan for mental health. I’ve harangued the government on this for some time, and it’s been brought to maybe a peak with the opiate crisis. We see so many different organizations doing their own thing without an integration across them all to serve people with the social services they need, the housing, understanding and communications between police and health services and social services and even the education depart-ments and First Nations, that need to have much more thoughtful and open communication. These people come in and out and in and out and in and out, and we know what they need, but we’re simply not providing them with the integrated, co-ordinated care that they need.

I’ve raised this week the office of the mental health advocate, who is there to deal with people who feel that they’ve been harmed by the health system, harmed by the mental health treatment they’ve received, and need an advocate for them, just as the children’s advocate speaks out on issues of children in care who have not been adequately treated. With a staff of 40 he is addressing the serious issues of children in care and trying to address some of the deficits in their care. Well, the mental health advocate has two staff and has had the same number of staff since 1990.

How is it possible that we have left this advocate to wither and those patients who have just given up on the mental health system because they’ve never been able to get accountability from either doctors who have not properly managed them or institutions that have not recognized their rights or other services within the mental health system that have violated them in one way or another? With only a single formal review last year and no formal review of a mental health complaint in 2015, you have to know that there’s a serious problem there. That is not about budget saving. That’s about violating basic rights of human beings.

While I’m talking about kind of the relationship between and a more integrated approach, some of you may know about the drug courts. Drug courts keep people with mental illness, addictions out of jail.

An Hon. Member: Right place.

Dr. Swann: Yeah. Right place, right time, right people.

Calgary can manage 25 people in the drug courts. There are hundreds of people that would benefit from being diverted from jail into the community for appropriate services, rehabilitation, treatment and get them on track to lead a productive life. Instead, they’re being sent to jail, which is the very worst place for people with mental illness and addiction. So the drug court needs to be substantially strengthened with finances, and that would reduce the cost on the policing system, EMS, emergency. Again, a tremendous cost savings if we can move on with that.

We have taken a position on this side that the ideal in terms of plasma for this country would be to have our own sustainable supply of blood. So far in the 50-odd years – maybe it’s longer – that we’ve had a blood service here, we have not been able to get to the point where we can manage more than 20 per cent of our own supply of plasma, so we’re having to import it, recognizing that much of the imported blood has been from paid donors. My position is that the ideal would be to have all voluntary donors, all Canadian-made plasma and plasma products. It doesn’t look like that’s possible in the near term, maybe not at all, when you think about the fact that only 5 to 7 per cent of Canadians donate blood, and we need four times that much to sustain blood plus plasma products.

I’ve come to the position and our caucus has come to the position that, while it would be ideal, we have to start to recognize the health care system itself, the public funding for health cannot cover every possible service and product and support. In this case I’m willing to say, especially since we’re importing paid plasma to the tune of 80 per cent today, that it’s time for us to recognize that we will not get that in my lifetime. We need to start moving towards alternatives, ensuring that we have the best testing, the best, safest system possible and make sure that the people that we’re working with have been properly screened before they’re providing their donation.

The vaccination programs are still much below what they should be. We’ve heard from a number of the public health divisions that they’re struggling with children getting only up to 60 or 70 per cent of their childhood vaccinations. We need to make those easier to get and more accessible for people. That also would reduce costs on the heath care system, obviously.

I very much support the lowering of school fees and the recog-nition that in some cases families are not able to feed their kids appropriately because they are spending money on school fees. That’s not an effective and appropriate issue. We can again find both savings and improved outcomes, but it’s not clear to me whether we’re borrowing for these savings. I think the challenge for us in this lowering of school fees is to recognize that there are all kinds of things that we should do, that we could do, and that we must do at some time, but piling this on top of so much other borrowing would not be, in my view, sustainable until we see a plan to repay.

I think that’s part of what all of us are asking for on this side. Everything is possible with a credit card. The question is: how much are we going to start paying for ourselves? How much are we going to pass on to future generations? Will we have a heritage fund in the future? We’re already down to what has been there for the last 30 years, about $15 billion to $16 billion. Thirty years. This is really a sad state to be in. Recognizing that oil prices have been low in the last few years, when are we going to get back to saving some of our nonrenewable resource revenue?

We do support the carbon levy, but we’re not supportive of the way it’s being implemented. It hasn’t been clear how it’s going to be disbursed. It hasn’t been clear on what the limits are. There have been all kinds of promises for this carbon levy that would appear to exceed by far the $3 billion that we’re expecting to bring in. Again, it’s going to stimulate different lifestyles. I think consumers and producers need to pay for our carbon emissions. There’s no ques-tion that all of us are responsible for the carbon and the climate change problem. The question, I guess, is how we manage it. Preferably, in our view, the carbon levy should be revenue neutral for Albertans so they can continue to stimulate the economy with their own revenue.

Now, to be fair, the government is giving rebates to 66 per cent of Albertans. In some cases it’s a little bit hard to know where that’s going, especially given that it’s all based on last year’s tax, and people may not be here following last year. But with all due respect, it’s a reasonable – in fact, I think it’s too generous.

Thank you, Madam Speaker.