L095 - Tue 21 Jan 1986 / Mar 21 jan 1986
HEALTH CARE ACCESSIBILITY ACT (CONTINUED)
The House resumed at 8 p.m.
HEALTH CARE ACCESSIBILITY ACT (CONTINUED)
Resuming the adjourned debate on the motion for second reading of Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act.
Mr. Villeneuve: It is nice to be able to return this evening to debate what is a most important issue and a bill that will alter and, unless it is changed, inevitably make the health delivery system in Ontario inferior to what it has been for the last 18 years or so.
I previously touched on a number of situations that covered areas in other jurisdictions, such as Europe, that have socialized medicine to a degree. Inevitably, the path on which this government and this minister are leading the province is not going to be good for the nine million people who live in Ontario.
I have a better knowledge of the eastern section of the province and I hope members do not mind if I refer to that region more than to the urban, western or northern parts of Ontario because I like to deal with the area I know best.
The act is misnamed when it is called the Health Care Accessibility Act. Unless changed, it should be called the conscription of the medical profession and the regimentation of the patient. That is what will occur unless this act is changed rather drastically.
In the riding I very proudly represent, Stormont, Dundas and Glengarry, in the far eastern reaches of this province, there are two hospitals, one at Winchester and one at Alexandria, both of which are underfunded. I have had occasion to speak on their behalf to attempt to obtain additional funding for projects that were very worth while, projects that have made these places of healing considerably better over the last number of years. However, funds are always limited and therefore we have to fight. We have to fight other ministries, such as Agriculture and Food, etc. The health delivery system is one of the most expensive ministries within this government.
The Macdonnell Memorial Hospital, which is one that traditionally has been underfunded, has come to me again recently. It is very short-staffed. It requires at least eight nurses or nurse's aides simply to meet the skeleton crew requirements it has been accustomed to having over the last number of years.
The Macdonnell Memorial Hospital is a chronic care hospital. It needs additional funding. The Hotel Dieu Hospital in Cornwall and Cornwall General Hospital could well use a considerable number of additional dollars on an annual basis. This government intends to use the Health Care Accessibility Act to camouflage the real needs of the health care delivery system in Ontario.
I have covered the health care system Britain used to enjoy and what it now has to live with. I also touched on the situation in Sweden, which leaves a great deal to be desired.
Mr. Philip: By most of the world.
Mr. Villeneuve: It leaves a great deal to be desired, as my friends on the left realized last night. I do not believe it had been drawn to their attention. I do not believe the picture had been focused.
Mr. Philip: Has the member been there?
Mr. Pope: Has that member been to Etobicoke General Hospital lately?
Mr. Villeneuve: I have been to many --
The Deputy Speaker: Order. The member for Etobicoke (Mr. Philip) is not in his seat. The member for Cochrane South (Mr. Pope) is upsetting the House. Will the member for Stormont, Dundas and Glengarry carry on?
Mr. Villeneuve: Thank you, Mr. Speaker. I would not like to proceed with an upset House. I have not been to Sweden, but I have been to many hospitals in Ontario and I have spoken to many of the people who benefit from the health delivery system we have in Ontario, which is next to none.
Mr. Pope: Etobicoke General.
Mr. Philip: You made a mess out of Etobicoke. It was not until I exposed the mess that you gave them extra money.
The Deputy Speaker: Order. The member for Etobicoke is disrupting the House. Carry on, please.
Mr. Villeneuve: Mr. Speaker, it has been a difficult day. The benches on this side were very vacant.
Mr. Breaugh: We are walking out.
Mr. Villeneuve: We would not miss them. The benches on this side were vacant earlier today. We now are back discussing a situation that is very much a concern of every citizen in Ontario. I must bring these examples to the attention of the House because the party on the left seems to think that the direction in which it is taking the government of this province is the way the province wants to go. We will stand up and be counted and unless this bill changes, we are not going with this bill.
Mr. Philip: The same as happened on the last bill.
The Deputy Speaker: Order. If the member will address the chair, he will not be distracted by interruptions.
Mr. Villeneuve: Mr. Speaker, I know you have not distracted too many people lately and I thank you for that.
Interjections.
Mr. Villeneuve: That is unparliamentary.
In West Germany, 92 per cent of the population are covered by a public health care system. The exceptions are white-collar employees and executives. In the great country of West Germany, virtually all who are exempt have coverage with private health care plans that are equal to the public health care scheme. The eight per cent privately insured pay, in proportion to income, less than the mass covered by the public agency.
There are more doctors in West Germany. There are 21 per 10,000 persons compared to almost 18 in Canada, yet doctors' waiting rooms are crowded. There are 117 hospital beds for 10,000 compared to Canada's 54 per thousand. The annual hospital bill is $11 billion for a population of 61 million.
8:10 p.m.
Hospitals operated by municipalities, universities and churches are almost all self-supporting from payment for patients from the insurance agencies, but some get subsidies from the local government or university owners. Fund-raising campaigns are unheard of.
We are speaking of the kind of situation in which the party on the left is leading the government of this province and the government is allowing itself to be led by the nose, unbelievable as it may seem.
Mr. Wildman: Is the member against 92 per cent of the population getting good health care?
Mr. Villeneuve: Ninety per cent of the people in this province are saying, do not change our health care system; we like what we have.
Turning to the United States, where 10 per cent of our best specialists will gravitate to shortly after Bill 94 is introduced. I go back to what I said last night when I adjourned the debate. In the city of Ottawa, we have Dr. Keon, one of the best heart specialists anywhere, bar none. I can recall just before Christmas there were photographs of Dr. Keon and probably six or eight of the heart transplant patients. One of them bears the name Villeneuve and that makes him all the better.
Mr. Philip: Dr. Keon is a urologist.
Mr. Villeneuve: Mr. Speaker, this man is making derogatory remarks about the best heart specialist we have in Canada.
Mr. Pope: He must be in charge of Etobicoke.
Mr. Villeneuve: Is the member in charge of anything in Etobicoke?
Mr. Philip: I am in charge of everything in Etobicoke.
The Deputy Speaker: Order. Will the member please address the chair?
Mr. Villeneuve: I am sorry. This stuff from the left is rather embarrassing and I know you do not like it, Mr. Speaker, but we have to bear with it. It is one of the burdens this government has to carry.
US health costs over the past 15 years have risen from six per cent of the gross national product to 9.5 per cent, a rise in expenditures from $43 billion to $245 billion.
Interjections.
The Deputy Speaker: Order. The member for Cochrane South is disrupting the House. Will the member please discontinue?
Mr. Villeneuve: US costs have risen annually by 13.2 per cent while Canada's increases have been under 10 per cent. Hospital care accounts for about 40 per cent of the US total health bill, compared to 50.5 per cent in Ontario. Doctors' services add up to 18 per cent compared to 17 per cent in this province. Roughly 90 per cent of the population have some hospital insurance which they pay for themselves. Nevertheless, the New York Times has reported that half of all personal bankruptcies in the United States are as a result of catastrophic medical bills.
Mr. Wildman: That is what he wants in Ontario.
Mr. Pope: For example, in Bellwoods --
Mr. Villeneuve: For example, in Bellwoods they have a member who makes a lot of noise in this House and sometimes we wonder if he really knows what he is saying.
Mr. McClellan: I am the only one who is not disrupting the House.
Interjections.
Mr. Breaugh: Now back to the gibberish.
Mr. Villeneuve: I always thought this was a serious place to come to; however, tonight I do not know what has happened.
Mr. McClellan: I do. The member is speaking.
Mr. Philip: His speech reminds me of the top of my desk.
Mr. Gillies: It reminds me of the member for Etobicoke's head.
Mr. Villeneuve: Getting back to this very serious business, on Wednesday, which is tomorrow, Cornwall medical doctors are to end free services. This concerns me tremendously because the city of Cornwall and the township of Cornwall, so well represented by my colleague the member for Cornwall (Mr. Guindon), and the riding of Stormont, Dundas and Glengarry, represented by yours truly, will be faced with a situation in which the Cornwall doctors decide to begin charging for a variety of services they normally provide free in order to protest the proposed Ontario legislation that will ban doctors from extra billing their patients.
The doctors have nothing to lose. The patients of this province, the nine million people who live here, are going to be the losers. This is what it is all about. The best health care system in the world is going to be torn apart limb from limb. We will be losing the best 10 per cent of our medical practitioners. They will be going to the United States.
Last night I quoted a situation where I took my son from the Osie Villeneuve arena a week ago Sunday.
Mr. Wildman: We heard about that last night.
Mr. Villeneuve: Right, my friend. The member for Algoma (Mr. Wildman) quoted an experience as well. The member is a late-blooming hockey player and suffered some late-blooming injuries. He was very well looked after by the medical system in Ontario and he does not deny that.
The patients of Ontario will wind up in lineups. They will not be able to have medical treatment on Saturday and Sunday or to see a doctor of their choice after 5:30 in the evening. We are heading into a catastrophic situation in the delivery of medical service in the province.
My dad is 77 years old. On the Sunday between Christmas and New Year's Day, he was not at all well. I phoned the local doctor in Moose Creek, a great little town, where he lives. The doctor said to bring my father along as soon as possible. Within 10 minutes we were in his office on a Sunday night. The doctor's diagnosis was that it looked as if it could be a coronary. We had him in the Hotel Dieu Hospital in Cornwall within half an hour. The hospital knew he was coming and they were ready.
If Bill 94 comes into effect, this doctor will not even be prepared to answer his telephone on Sunday, let alone see a patient and have him admitted to hospital.
Hon. Mr. Van Horne: That is a very serious comment to make about your doctor.
8:20 p.m.
Mr. Villeneuve: The government is hoping doctors will use their medical ethics. It is putting doctors in a situation where, if they want to lean and bend their ethics, the government hopes they will not. This is what we are talking about and the people of Ontario had better realize it. We are not protecting the medical profession because doctors earn $80,000 or $90,000 a year. We are protecting the people who use the medical profession, our senior citizens, our young people, the people who have been in accidents.
This is a lot more important than the government wants to admit. They are using this as a camouflage to cover up some of the shortcomings they do not want to deal with in the health care delivery system. A 2.7 increase in doctors' incomes will cost $50 million. Within 36 months we will have spent $100 million plus to pay off the medical practitioners, the doctors of this province. I do not think this is fair.
I am winding down. Some people say this is an improvement to the health care system of this province. It is anything but an improvement. It is the beginning of the tearing apart of the health care system we have been privileged to enjoy over the past 18 or so years. I reiterate in closing that the title, the Health Care Accessibility Act, is a misnomer. I emphasize that it is the conscription of the medical profession and the regimentation of patients.
I thank the House for the opportunity to express my concerns and the concerns of the 50,000 residents in my riding.
Mr. Mackenzie: After hearing the last speaker, I do not think I have ever been prouder in my life to be a New Democrat, and in clear contrast to the Conservatives on the issue of the public health care system we have in this country, to stand against extra billing while the Conservatives heap scorn on public health care plans around the world and stridently support two-price health care by supporting doctors' rights to extra bill.
That is exactly what we are talking about. We are talking about fairness, justice and the right of the people of Ontario to be entitled to coverage whatever their means. An injustice is being done, even to physicians, by the kind of presentation we just had.
Maggie Thatcher's best efforts in Britain, and the member made reference to it, will not remove the public health care system in that country, nor will we see it removed in any free country in the world that has established comprehensive public health care, because the people simply will not stand for it.
Let me also make it clear that some of the more strident voices in support of extra billing do no justice to their cause. The charge of state terrorism is fantastic. I could not believe I was hearing that in this House from a former cabinet minister when it came from the member for York Mills (Miss Stephenson).
I sat and read a letter in the past couple of days from a doctor in Kingston who I thought was a disgrace to his profession. I do not know how one can make statements such as these: that because the public wants extra billing, his patients no longer have any faith in him and how can he cover them; or that somehow if we bring in extra billing, democracy and freedom are dead. Is he saying that democracy and freedom are dead in almost every other province in this country where they have banned extra billing? My God, what a charge.
As I was driving here the other day in my car from Hamilton, I listened to an open-line phone-in show on one of the Hamilton stations. Dr. Myers, the head of the Ontario Medical Association, was asked whether the doctors were prepared to take strike action. He said, and the quote is close to exact because I called the station to make sure, "Well, no, they would have to go back to the members of their association because it is democratic unlike some unions."
The insults, the inferences and the statements are totally out of order. In looking at the issue, I picked up an article from the Toronto Star. I have the occasional difference with the Star, but I thought this was one of the most thoughtful and best articles I have seen in a long time. Perhaps I can quote a little of it. It is from the Toronto Star of Tuesday, January 7, 1986, and was written by a Toronto physician. I suppose he is suspect to Tories because he happens to be a member of the Medical Reform Group of Ontario. It is by Michael H. Rachlis, a gentleman I do not know.
In that article he says:
"This month we have seen the resurrection of many myths that extra billing is a good thing for patients and the health care system. It is claimed that:
"It is the better doctors who extra bill because the Ontario health insurance plan fee schedule pays no bonus for experience or skill;
"These doctors spend more time with patients and no one has been denied access to care because of extra billing" -- I am going to deal with a specific case of that in just a moment -- "and
"Many of our best doctors will leave the province because they will lose their freedom to practise medicine as they see fit.
"What is the truth?
"There is no evidence that doctors who are opted out are more skilled than their colleagues. Few doctors are opted out in northern or eastern Ontario. Few general practitioners (4.6 per cent), paediatricians (2.4 per cent) and internists (3.9 per cent) are opted out. Opting out is concentrated in certain specialties: anaesthesia (58.3 per cent); psychiatry (27.6 per cent); obstetrics (33.8 per cent); surgical subspecialties (31.1 per cent); and geographic locations, particularly Toronto and the Golden Horseshoe. To say that better doctors opt out is to claim there are few good doctors in eastern Ontario or in general practice.
"The Ontario Medical Association itself is largely responsible for the OHIP fee schedule not rewarding skill. The OHIP schedule was adopted directly from the OMA schedule in 1971 and set at 90 per cent of its value (on the estimate that prior to medicare, 10 per cent of doctors' fees went uncollected). The OMA list of fees, which has existed since 1922, has never had a special bonus for experience or expertise. Officials within the Ministry of Health have said they would be prepared to consider any system of merit pay as long as the total bill for doctors' services did not increase."
There are a few more interesting things in this article.
"The evidence shows little difference in practice style between opted-in and opted-out doctors. Professors Alan Wolfson and Carolyn Tuohy of the University of Toronto conducted an exhaustive survey of opting out, which was published by the Ontario Economic Council in 1980. They found no difference between opted-in and opted-out practices in patient loads, hours of work or waiting time for appointments. There is no good evidence that, on average, opted-out doctors spend more time with their patients.
"There have indeed been patients who were hurt because of extra billing. Some opted-out doctors are considerate in their billing practices but there are some who extra bill everyone and expect the patient to ask for a reduction. A 1980 study by professors Chris Woodward and Greg Stoddart of McMaster University, for the Hall review, found serious problems with access to services because of extra billing. Nearly 20 per cent of respondents said they had reduced their own visits to physicians and nearly five per cent said they had not sought care for a sick child.
"There is little fear that doctors will flee Ontario if legislation is passed banning extra billing. All provinces except Alberta and New Brunswick already have such legislation. The United States has more doctors per capita than Canada and all the desirable practice locations are taken. An average doctor could find work in Texas but only west of the Pecos, not in Dallas or Houston. It is also unlikely many highly skilled specialists will leave. They could have left Ontario years ago and made at least as much as two or three times as much money in the US. They are no more likely to leave when the province bans extra billing. The US is rapidly becoming an unattractive place for those doctors who value their freedom of practice."
Incidentally, a doctor who opposes extra billing made such a remark to my leader when he visited the hospitals only last night. The doctor said his option to go there was not valid any more because he would not want to move to the US to practice.
8:30 p.m.
"In the United States, large corporations are taking over the practice of medicine and 30 per cent of the physicians are employees." They are employees of these large operations in the US. "They are sometimes told how many lab tests to order and when their patients should leave hospital. In Ontario, opted-in doctors have freedom to practise with almost no government involvement.
"Thus it is clear that there is a need for legislation banning extra billing and that neither doctors nor patients are likely to suffer from such a prohibition. Public opinion polls have consistently shown 70 to 80 per cent of Ontario residents oppose extra billing, and the Liberals and New Democrats garnered nearly two thirds of the votes in the last provincial election with a ban on extra billing in their platforms.
"The Ontario Medical Association must realize that in a democratic society the interests of powerful minorities must be subordinated to the will of the majority. Physicians would do well to remember that they have been given a monopoly by government for the practice of medicine. They do not have to compete with the nurses, physiotherapists or others. The public provides their patients with insurance so they never have to worry if their patients can afford suggested treatment. The public provides them with hospitals and skilled staff to assist them to care for their patients. The public also pays over 95 per cent of the cost of physicians' training, which is estimated at well over $100,000."
This was written by a doctor who practises here in Ontario.
"The rhetoric of the Ontario Medical Association and the Association of Independent Physicians damages their cause and reduces the credibility of all doctors.
"As a group of physicians, we appeal to the OMA to realize that extra billing will be ended and sit down and talk with the government. There is still much to negotiate in the legislation, including a fee-bargaining process that would be fair to the profession and to the public. With an end to extra billing, the medical profession should begin talks with the government, consumers and other health care workers to deal with the other problems of the health care system. If the OMA wants a respected seat at that table, they should act responsibly now."
I repeat once again, this is an article that was in the January 7 issue of the Toronto Star, and I think it tells the story much better than I can.
Let me also tell members about a personal case I dealt with. It is too bad the member for Cochrane South is not in here because he did help me on this. This is not an odd case; I have it on a fairly regular basis in my constituency. In the first week or two of the election campaign, a lady came to me who had never come to us before, I have reason to believe that is because she supported the party to my right, and she said to me: "I have got a problem. I hate going to a member. I have never asked for anything in my life. I am on a very limited income. I have got my little house," and it was up in the north end of my riding, "and I am trying to get by but, Mr. Mackenzie, my income from family benefits, because of a problem in terms of age to qualify further, is $450 a month." There is also a child staying with her who is paying her $100 a month. She said, "That is my total income," and we checked it, $550.
She had to have her jaw rebuilt, and she had gone to the only doctor her dentist wanted her to go to for this particular operation, and he told her the cost, over and above what was covered by the Ontario hospital insurance plan, was $600; two operations at $300 each. She said she could not afford it. The only concession she could get from that doctor was that he would accept the fee at $100 a month. Members should try to take $100 out of an income total of $550. She had not been able to get anywhere with the issue on that, and she came to me.
I guess I was lucky. An election had been called only about 10 days earlier, so I got on the phone to the member for Cochrane South, who was then the Minister of Health, and I said to him, "Alan, you and I disagree totally on this issue of extra billing, but I have a case now that just stands out so clearly, outlining the problem we have in this province with this issue, that something simply has to be done." I gave him the details of the case, the woman's name and everything I had on it, and he said, "Leave it with me." I am not sure that would have happened, maybe I am being a little bit biased here, if we had not been into an election. He said, "Leave it with me," and sure enough, a couple of days later I got a call back. He said, "Go ahead with the arrangements," and they had to be made within about a two-week period, "it will be covered."
Alleluia, I got hold of my constituent. She was happy. The operation has been done. I do not know what actually went on in those phone calls, but I do know it was resolved by phoning the doctor. So we had to involve the minister and it had to come from a member to put pressure on the Minister of Health to get to that doctor to get that woman that kind of coverage.
There is no reason on earth for these kinds of restrictions on people in Ontario, and they do happen. That is why I am so damn proud to stand here tonight and say I believe in the banning of extra billing. It is one of the tenets of this party that we have to have one price, equality in the medicare system and that we cannot allow the two-price system we have in Ontario.
Even from the Tories I am appalled at the kind of rhetoric and the kind of defence I hear, the attacks generally on public health care right across the world, not just here, when one starts mentioning other countries that would not do away with that system. W hen I hear the hogwash and the crock we get from those people over this issue, I am glad to say I stand here and will stand in public and will stand in front of doctors, if necessary, because most of them are not the way those people make them out to be. Most of them have at least some feeling for the case that is being put here by Dr. Rachlis.
On this issue I just love it. The more those people put their position forward the way they have, the prouder I am to be on the other side of the issue and to say that this is one issue I am very proud to stand on. I hope we pass this legislation as soon as possible.
Mr. Stevenson: I am very pleased to join in the discussion on this bill. I am going to direct most of my presentation towards the consumers, the patients, the users of the health care system in Ontario. Very little time will be spent actually talking about the positions of the doctors on this particular issue.
I will build a good bit of my case on a specific incident that is likely to happen in my riding if this particular bill is passed. I will point out very clearly to the minister, if he chooses to come back into the House, how accessibility to health care in the riding of Durham York will most certainly be affected.
Oh, the minister is here. Pardon me. He is just in a different chair.
It is good to ask the question, do we have a good health care system. In Ontario 80 per cent to 85 per cent of the people say yes. That sounds a little bit like a commercial that is currently on television talking about a particular aspirin product.
If we want to look at the situation as it has been in the recent past, we find that about 12 per cent of the doctors have opted out. The figures vary a little but, depending on what source one uses, somewhere between five per cent and seven per cent of the bills that come into the Ontario health insurance plan are extra billed. Clearly, many of the people in Ontario are not exposed to extra billing. Many of the opted-out doctors or specialists do not, by choice, extra bill some of their patients. In fact, I suspect that if one actually got the numbers out and did the calculation on the number of billings that certain doctors make and on the way those billings are made, one might find that some opted-out doctors actually save the system money.
8:40 p.m.
I have represented the riding of Durham York for almost five years. We checked the records today and, as far as we could tell, we have had only two complaints about extra billing in five years. One was from a person who had not been extra billed and who was complaining only about the principle of the system. In the other situation a couple had in fact been extra billed, and that was before the time our current leader, the member for St. Andrew-St. Patrick (Mr. Grossman), brought in the request that patients be told before treatment that they would be extra billed by the physician, and before patients had an option to do something about it. There have been two statements of concern in five years.
To go quickly through the situation in my riding, in the Durham portion of Durham-York, virtually all, if not all, the general practitioners and most of the specialists are opted in. Of the municipalities in the riding, a few people in Brock use the hospital in Orillia, some use the hospital in Lindsay and others make use of Uxbridge and Port Perry hospitals, which are in the riding of Durham-York. The people who live in Uxbridge and Scugog generally use the hospitals in Port Perry and Uxbridge, and some of the people who live in the rural part of Pickering also use those hospitals.
In the York section, most of the general practitioners are opted in and it is possible they all are; I do not know of any exceptions, but there could be a few. Many of the residents of East Gwillimbury and Georgina use the Newmarket hospital. A number of specialists are opted out at the Newmarket hospital.
However, in five years of representing that area, there has been only one statement of concern from a person who had been extra billed. I refer primarily to the situation in Newmarket, although some of the transfers from Uxbridge and Port Perry to the bigger Toronto hospitals will be extra billed on occasion.
It is clear that the specialists involved are treating this issue with great sensitivity. They show consideration for those over 65, for those on welfare and for those who simply cannot afford the cost. With the specialists having that sensitivity, care and pride in their profession, the people in the area I represent have been extremely well served over many years and are justifiably proud of and very pleased with the health care system that exists in Ontario. A number of them are quite upset that we are now tampering with that valued system.
There has been no concern about the accessibility question in Durham-York; it is quite the opposite. If there is a question about accessibility, it refers to problems of underfunding. A good example of this has occurred in the Newmarket hospital where no elective surgery is being conducted this week because no beds are available.
Let us look for a minute at where this issue really comes from. We have looked at various polls. Some are official polls, some were taken by newspapers at election time, some are the polls various members have taken and so on. About 80 to 85 per cent in most of the polls say the health care system in Ontario is very good. Beyond that, if one asks their major concerns about the health care system and where they might choose to make improvements, they say certain hospitals could use more beds, certain hospitals could have additional equipment and certain cancer treatment centres could use some extra funding. Those are the sort of responses we get.
Very infrequently does one see the issues of opting out or extra billing raised independently by people who respond in these polls. If one asks people if opting out or extra billing is a concern to them, a fairly high number, 65 per cent or 70 per cent, will say yes. In a number of the polls, the issue of extra billing is somewhat a manufactured issue.
We just have to look back to the situation of the federal Liberal government prior to the last federal election when Monique Bégin brought this issue to the fore. She recognized the fact that if the issue was mentioned, many people responded positively to it. I guess many would suggest the issue was brought forward by Ms. Bégin to save the federal Liberal government. It did not work, but it was part of the confrontational tactics the Trudeau government used with such great success for so many years.
Why do we see it being raised now?
Mr. McClellan: It is because the Mulroney government passed it.
Mr. Stevenson: I will get to the federal Conservative situation and the cost in just a minute. If somebody would --
Interjections.
Mr. Speaker: Order.
Mr. Stevenson: Mr. Speaker, if you would just feed the seals over here, I will carry on and get to their concerns.
Mr. Foulds: It is better to be a trained seal than an untrained one.
Mr. Speaker: The member for Durham-York (Mr. Stevenson) is quite correct. Will the members please stop interrupting him and let him proceed?
Mr. Stevenson: Why the particular timing of this issue? Is it purely political or is it to honour some marriage contract that was made between the governing party and the New Democratic Party in this province? I will very clearly show it is not being done to improve the health care system in the part of the province I represent, and most certainly it has not been introduced to increase the accessibility of health care in the great riding of Durham-York.
Interjections.
Mr. Speaker: Order.
Mr. Stevenson: If we were doing one of these polls and asked a few follow-up questions, I wonder how those being polled would respond to a slightly different approach to some of the questions.
First, I would draw to the members' attention the cost of the system. It is true the federal Conservative government in Ottawa is retaining certain transfer funds to provinces who are not ending extra billing. In Ontario's case, this is approximately $50 million. That is a lot of money. It could be put to a number of uses in the health care system, but I point out that $50 million is approximately half of one per cent of the total health care budget in Ontario.
Mr. McClellan: Yes, that is right; what is $50 million to a Tory?
Hon. Mr. Wrye: What is $50 million between friends?
Mr. Foulds: Keith Norton said that was too much to pay for northern medically necessary travel. He said that was too expensive.
Mr. Speaker: Order. The member for Port Arthur (Mr. Foulds), the member for Bellwoods (Mr. McClellan) and the member for Windsor-Sandwich (Mr. Wrye) will please stop interrupting the speaker.
8:50 p.m.
Mr. Stevenson: It is quite clear that to maintain the harmony of the Ontario health care system the government at some point or another will have to renegotiate with the physicians. One can ask what that renegotiation is likely to cost because, inevitably, it is going to happen. The best estimates of most people would be a minimum of $100 million, possibly $150 million.
It is quite clear that it is going to cost considerably more than the federal transfer payments that are currently held back. That difference in cost between the transfer payments and the increased cost of the extra renegotiation could provide a lot of hospital beds in Newmarket or some new equipment in Uxbridge or Port Perry.
The second question that I would like to have asked of some of the people consulted in polls relates to the delivery of health care: will such a bill improve accessibility?
I want to read a brief letter from a doctor who is a consulting obstetrician in the Uxbridge Cottage Hospital.
"Dear Ross: Please find enclosed a letter which I am handing out to all my patients over the next few months while the proposed legislation is being debated at Queen's Park.
"As you may or may not know, I have served as a consultant at the Uxbridge Cottage Hospital since 1968 and have billed the Ontario Medical Association tariff on occasion, particularly for large surgical procedures when I have made special trips back to the Uxbridge hospital to care for these patients post-operatively. It simply would not be feasible to operate on them there and conduct proper post-operative care at the present OHIP tariff.
"You might be interested to know that if the proposed legislation is passed in its current form, I will certainly be resigning my post as consultant obstetrician at the Uxbridge Cottage Hospital and unless they can find a suitable replacement that will, in effect, close down the obstetrical department for anything but the most straightforward, routine deliveries. This will, in effect, mean that any complicated obstetrical cases will have to be transferred by ambulance either to Toronto or Oshawa. In other words, the legislation, rather than making free medical care equally acceptable to all, will, in effect, just do the opposite for certain members of the Uxbridge community."
That is a letter from Dr. William Dale.
I can assure members that the women of the Uxbridge area, who have relied so heavily on that sort of backup to the excellent general practitioners working in the Uxbridge area are upset about the possibility of losing Dr. Dale as a consulting obstetrician. I can say one thing for sure, they are not impressed with the minister's idea of increased accessibility. That is not what they had thought of as improved accessibility.
There is a second consideration. I can think of the case of a plastic surgeon who has been called out in the middle of the night to serve a person who has been brought in from an accident with a severely lacerated face. I wonder whether that plastic surgeon, who is currently opted out, will get up in the middle of the night to go and look after that accident victim under the OHIP tariff. I wonder whether the doctor on duty will do the service to that person. That is a very real question. I do not pretend to have the answer, but I can say that the stimulation and the pride of working in the health care system will most certainly be diminished. We will see in time what the answer to that question will be.
I will also raise the case of a situation with obstetricians. Again, I quote from another letter, this time from an obstetrician. One part of it says: "More importantly, how may the proposed legislation affect you, the obstetrical patient? If the legislation passes, we obstetricians will likely choose to work in large groups, removing much of the personalized care you now receive. Conversely, many obstetricians may choose to act as consultants, coming into the picture only when problems arise."
The relationship between a patient and a doctor is a very special relationship for many patients, particularly if there is a severe illness or an important situation at hand. This special relationship, this special trust and confidence, is not greater in any situation than between an expectant mother and her general practitioner or obstetrician.
If there is a possibility of obstetricians working in groups and reducing the one-on-one relationship, if the special doctor-patient relationship between the expectant mother and the doctor disappears, it will most certainly reduce the care women get in this type of a setup. That, too, is not my vision of what improved accessibility is all about.
Up to this point I have dealt with the issue from the point of view of the consumer or the patient. I want to digress briefly on one point to indicate how this legislation appears to one of the many sincere professionals in my riding who takes great pride in his practice, and for that matter great pride in his contribution to the community and to society.
This is a letter to the minister from John Stewart, a doctor in Port Perry:
"Dear Mr. Elston: Recently, you have introduced legislation to regulate the amounts that persons may charge far rendering services under the OHIP benefit plan. Perhaps you would like to know my feelings as a grass-roots physician who does family practice and who does not belong to any specified political group. I suspect there are many others with similar feelings.
9 p.m.
"In 1902, my paternal grandfather began the practice of medicine in this province and in 1920 my maternal grandfather initiated his practice of medicine in Ontario. In 1940 and 1942 respectively, my father and my mother graduated in medicine. In 1972, I too became a physician in this province. I have two cousins currently practising medicine and an aunt who graduated in medicine, an uncle who practised medicine and another aunt's father who was a medical colleague of my two grandfathers. There are others more distant, but these are the more immediate in my family who have chosen to follow the profession of Hippocrates. It is a long tradition and one of which I have been extremely proud.
"Members of my family have contributed much to their communities, both in medical and nonmedical fields. My grandfathers were both heavily involved in the building and beginning medical staff of the Toronto East General Hospital. My father was president of the Canadian Association of Medical Clinics and president of the Canadian section of the International College of Surgeons as well as chief of surgery at his hospital.
"I have served as chief of staff and president of our medical staff as well as being the founding president of the Big Brother Association in North Durham, the first president of the school PTA and president of the local community theatre, among other community and hospital committees. It should be emphasized perhaps that the time involved in these areas has been unpaid, freely donated time.
"For the past 12 years, I have practised medicine and have always billed OHIP directly. Over that period of time, I have seen the OHIP schedule of benefits become separate from the OMA schedule and gradually pay about 30 per cent less than my association's fee schedule. I have always felt that the OMA fee schedule represented the true value of my services but that by accepting the OHIP benefit, I was doing my part to contribute during economically difficult times in the province.
"Given this background, your proposed legislation has made me extremely angry and totally disillusioned. Your proposed legislation will essentially make our association fee schedule illegal. Obviously, you think that our services are worth 30 per cent less. Your legislation states that you `may' enter into agreements to provide for methods of negotiating and determining the amounts payable. Our experience with the present contract has already proven that a signed contract for benefits may also be changed without agreement.
"In short, you are conscripting the medical profession. OHIP already limits the number of some services (e.g., complete physicals), and now your government will decide how much you will pay for each service. At the same time, you openly tell the consumer that the system is totally accessible but place no responsibility on the health consumer for wise use of his or her health care visits. The physician will be trapped in the middle between totally open-ended access and limited, unilaterally decreed funding.
"In the past, I have always had the choice of opting out in order to provide sufficient quality time for my patients if the squeeze became too great. Now I fear the choice will be to provide mediocre, assembly-line medicine, to work longer hours for less pay or to cease to practise medicine in this province. I also fear that the majority will choose adequate, efficient medical care, with an ever-increasing referral pattern and further decentralized care.
"There will no longer be any place for a person with special skills nor any incentive to develop them. It will become like the bland but nutritious institutional meal -- certainly able to sustain life but consumed only out of necessity and avoided whenever alternatives exist.
"Will the profession fight this legislation? I think yes, for I certainly will. It is a supreme insult to myself and my heritage. It is an immediate blow to the esteem of hardworking physicians across the province. It is a slow poison which will destroy the excellence which has been the norm for our medical care.
"I will not be conscripted in this matter without a fight; of that you can be sure."
It is signed "John Stewart, MD."
Here is a person who I know, as I stated earlier, is one of the very sincere professionals in my riding and an excellent doctor. Given that sort of attitude and concern for the direction in which the health care system is going, I really wonder how the quality of health care can be improved in this province. Is that really the kind of accessibility we are after with the introduction of this bill?
It is quite clear -- and this is item 5 that I like to raise when doing some polling and asking opinions of people -- that some people want to pay an extra amount of money to get extra time with their chosen doctor. They knowingly and willingly are prepared to pay something extra for an extra half-hour of time for the discussion of their situation.
This legislation is taking that choice away from those people. It is not just taking the choice away from the doctors; more important, it is taking the choice away from the residents of Ontario. The minister will certainly be aware that if one wants extra time with one's lawyer, one can pay some extra money and get that time. If one wants extra time from one's local carpenter, who may be doing some work on one's house, or some extra time from the painter to do a little extra job on the place, then one can pay a little extra and get the sort of service one hopes to obtain.
Why is this option being taken away from the people of Ontario? Surely their health and their health care are of special concern to them. Why is the government taking that option away? Is this the sort of accessibility the people of Ontario are looking for?
If we wish to look at some of the things that could happen in this province if we bring in this legislation in an unaltered form, it was evident when the ban on extra billing came to Quebec that 287 doctors moved from Quebec to Ontario. I called a friend of mine in Quebec, and it is common knowledge that all sorts of cash is changing hands under the doctor's desk in Quebec.
One can call it tips or whatever one wants, but it is quite clear that this practice is going on in a very free manner. If anyone thinks this legislation or any laws against extra billing -- we will not call it that; we will call it "special cash considerations" -- will stop it, certainly one can think again.
Hon. Mr. Wrye: My goodness. That might even be illegal. We would not want that.
Mr. Stevenson: The minister is putting the professional people of this province in a position to be crooks.
Interjections.
The Acting Speaker: Order.
Mr. Stevenson: The people in the New Democratic Party will have their opportunity to speak and to put forward their dogma in just a minute. I will listen to their presentation and I trust they will extend the same courtesy to me.
The Acting Speaker: I would encourage you to ignore the interjections and address your remarks to the chair.
9:10 p.m.
Mr. Stevenson: It is also very clear that there will be an increased number of referrals; that goes almost without saying. There will be all sorts of behind-the-scenes consultations. I wonder whether that is the sort of medicine we want to see.
With any group of independent people -- I do not care whether they are doctors or what they are -- if someone comes along who is not their boss and says, "Thou shalt conduct your independent business in a certain way," it is human nature that there will be some reaction to that sort of heavy-handed activity. I cannot believe there will not be some unfortunate reaction to this heavy-handed activity by the current government.
If some members think there have been two types of health care in the past, I can almost assure them there will be at least two types of health care in the future: one, intensive care and, two, do not care. I suggest this is the first step of the British medicare system. Some aspects of the British system are excellent. There are also some aspects of it that I am sure no one in the province wants to be associated with.
The British medicare system is 33 years old. It is a service for about 56 million people, who are entitled to full free health care. However, it is becoming clear that there are substantial waiting lists in the public system. We see many trade unions that traditionally were vehement opponents of the private medical system now negotiating in their settlements for coverage under private insurance plans and access to private doctors.
If such a thing as co-insurance were available in Canada to cover the cost of opted-out physicians, and if this co-insurance could be totally paid for at the expense of the employers, I wonder whether the New Democratic Party would be taking the same position on this bill. As I mentioned earlier, I suspect few of us want the British system in Canada.
In summary, I want to review a few items. I have indicated that this legislation will not improve the accessibility of high quality health care to the residents of Durham-York. I have given one very clear and specific example of how it will definitely reduce accessibility for the users of the system in Durham-York. That relates to the practice of obstetrics, an area where one would like to have high quality care as close to home as one can get it.
I have suggested the quality of service will decrease. Time will tell whether that occurs. It will be no surprise to me if, 10 years from now, our service has declined and if that is specifically related to the passage of this bill. I have stated there will be at least a two-tiered system and I suspect it will be a three-tiered health care system established in Ontario as a result of this legislation.
If the legislation is passed in the present form, the residents of Ontario will live to regret its passage. I say to the minister there is still time to pull back and negotiate with the doctors to see if there is not some other way of coming to an agreeable solution on part of the thrust of this bill. There is still time to save the excellent health care system we have in this province.
The real answer to accessibility is more beds and more equipment in some of our hospitals. The passage of this bill will only aggravate that situation, because there will have to be renegotiations with the doctors, which will most certainly add extra costs to the system, and that money will not be going to beds and equipment.
I ask the minister to quit trying to manipulate the health care system and to quit playing with something that is so successful. Fine-tune it, yes; anybody would agree that from time to time there need to be some changes, and I would support some of the changes. However, the sort of confrontational politics the minister is practising is too dangerous for the high-calibre system we have in this province. Surely our health care system is too important for his present approach.
Mrs. Grier: I rise to join in this debate and to indicate my support for the legislation that is before us. I share with the member for Hamilton East (Mr. Mackenzie) his pride in the tradition and philosophy of my party and the fact that we are here tonight to support it, but I rise also with a certain sense of sadness.
I regret that this debate is necessary in 1986 in this great province. I regret that the matter before us could not have been resolved by reasonable discussion between reasonable people and has been brought to the stage of having to pass legislation. I regret also that while we are having this debate, one of the heroes of my party and one of the fathers of medicare, Tommy Douglas, lies gravely ill and that the battle he fought and thought he had won has to be fought again. Perhaps there is a lesson in that, a lesson that the battles for justice are never fully won and have to be refought time and time again, as long as the forces of reaction continue to exist.
What is also distressing are the terms in which this argument is being couched, extremist terms such as "totalitarianism" and statements that this legislation should emanate from behind the Iron Curtain. The leaders of the Ontario Medical Association do themselves no credit with the statements they have made, and their defenders in this House do themselves no credit either. What is being attempted is to strike fear into the hearts of those least able to protect themselves: the elderly, the disadvantaged and the poor.
Mr. Harris: That is crap.
Mrs. Grier: I resent the fact that those threats are being issued.
Mr. Harris: That is a pile of crap.
Mr. Mackenzie: She is right on.
Mr. Harris: That is the worst pile of crap I have heard since I have been here -- terrible, terrible crap.
The Acting Speaker: Order.
Mr. Mackenzie: I guess it hurts.
Mr. McClellan: Why does the member not leave? If he does not know how to behave, why does he not leave?
The Acting Speaker: Order.
Mr. Wildman: Mr. Speaker, on a point of order: Is "crap" parliamentary?
The Acting Speaker: If you have a point of order, please stand up --
Mr. Wildman: The point of order is whether "crap" is parliamentary.
Mr. Cureatz: Mr. Speaker, if I can be of assistance on that point of order, my understanding of May's parliamentary procedure -- and I look to the member for Oshawa (Mr. Breaugh) for some direction -- is that if a particular word tends to incite members, it might be unparliamentary. I do not think it has incited any member at the moment; so I think the word is appropriate.
The Acting Speaker: Thank you for your ruling.
9:20 p.m.
Mrs. Grier: The only members who have been incited are those members who have been distributing the garbage. I sat here for two nights and listened to it.
Mr. Gregory: That really is crap.
Mrs. Grier: Perhaps the word that was used by the former minister is unparliamentary, but I will substitute "garbage" because that is what we have been treated to and what we have been hearing.
Mr. Harris: I think "crap" is a little more appropriate.
Mrs. Grier: I resent the fact that one segment of our population, one profession, the providers of one very essential service, can hold the rest of us to ransom by their threats. It has been very interesting that in the arguments around this legislation, the medical profession has restricted itself to high principles; freedom and their rights.
What we have heard from the speakers to my right tonight and last night has been reducing the issue to its very basic fact, money. When we have to be told that in order to get adequate time with a doctor, we must be prepared to put up more money, I am not quite sure what that does to the professionalism of the medical fraternity.
Mr. Gregory: When did the member last refuse a pay raise? Money is important.
Mrs. Grier: Money is very important. l do not think anyone in this province is denying any doctor his right to be adequately recompensed for the work he does.
What we are finding is a great element of hypocrisy in this debate. Today we heard the Leader of the Opposition (Mr. Grossman) suggesting there should be more bargaining with the doctors, with preconditions that have been laid down and are entirely unacceptable. I wonder whether the members of that same party would advocate the same kind of bargaining between other elements in society with the same preconditions laid down.
We have heard support to my right for the withdrawal or reduction of essential services. I seem to remember that same party advocating back-to-work legislation or denying the right to strike to a number of other essential services in our community.
If the system of medical insurance we have in this province is imperfect and requires alteration, I would remind members it is not a system that was designed by my party or by the party that is now the government. It was designed and put in place, with all its imperfections -- the results of which we are now seeing -- by members of the Conservative Party.
The threats that are being issued by the medical profession and its defenders are a threat to a very basic right, the right to freedom from fear of illness and the debt that might well provoke. Surely, as a society, we are able to offer people security from that fear in this day and age. I strongly suggest that all the opponents of this legislation, before they travel to a jurisdiction such as the United States where there is not that security from fear, make sure they are well covered by a private insurance plan. They do not want to risk the medical debts that might result if they became ill in that jurisdiction.
This whole debate and the fact we have to have this legislation points out the damage that has been caused by the monopoly in the provision of health care services, which has been attributed to the medical profession. This monopoly has contributed to the rising health care costs that are a concern to all of us. It has prevented other health care professionals such as midwives and nurse practitioners from participating as equal partners in the provision of health care to the people of this province. It might be called a closed shop in another context.
I was struck by a request I recently received for support of a project for a day treatment program for ex-psychiatric patients; an application for funding that had been submitted by a hospital. Because the ministry feels it is better if these projects are organized by a community board, to and behold the application made room for one to be appointed. However, it was not in place to design the project or make the application. The community board was going to be created by the doctors at the hospital after the funding had been awarded. That seems to be the same as some of our major housing developers forming cooperatives to qualify for nonprofit mortgage funds. That is one of the results of the kind of monopolistic health care system we have created. We need alternatives within our present system.
My family and I receive our health care from a community health centre that was funded and supported by the previous government. The present Leader of the Opposition, when Minister of Health, paid great tribute to and advocated more such community health centres across this province. I was grateful as a member of the board of that centre at that time. I hope the principles he enunciated then will be recalled as he takes part in this debate.
We have in community health centres dedicated professionals, relieved of the pressure of counting patients, who have the freedom to be doctors and not entrepreneurs and who work co-operatively with social services and with the community in order to provide health care. What this debate teaches us is we need more of those kinds of alternatives within our province, more community-based health centres, so that those who perhaps do not want to be subjected to the kind of medical treatment we have heard described by my colleagues to the right can find somewhere else to go.
The health care system in this province faces many difficulties and problems, many issues that we would be better served to spend our time and our talents debating than the one before us tonight. We have a shortage of chronic care beds and a lack of mental health facilities. We have overcrowded hospitals and we have inadequate nursing home care, just to name a few of the problems. It is time we got on with passing this legislation and got down to addressing some of the really serious problems of health care in this province.
Mr. Cureatz: May I say how proud I am to have the opportunity to address this august chamber with regard to Bill 94 and how very pleased I am that the Minister of Health (Mr. Elston) found it in his treasured time to spend these hours with all of us here. As all members can see, the chamber is overflowing with great anticipation for all the remarks and unrequired remarks that have been received from time to time during what I think is a most interesting debate.
I listened with great interest to my colleagues. The member for Oshawa was going to take last week --
Mr. Breaugh: I want to hear this. This is going to the United Auto Workers.
Hon. Mr. Van Horne: In box-car letters.
Mr. Breaugh: You bet.
The Acting Speaker (Mr. Morin): Order. I refer you to section 23(d) of the standing orders, which says, "When a member is speaking, no other member shall interrupt him except on a question of order."
Mr. Cureatz: I am very pleased the member for Oshawa pointed out the possibility of taking my transcript and forwarding it to the members of the UAW who, I might add, from time to time, have supported me.
The Acting Speaker: Order. Address your remarks to the chair.
Mr. Breaugh: On a point of order, Mr. Speaker: He cannot make an allegation like that and get away with it.
Mr. Cureatz: In reference to the comments of the member for Oshawa about the possibility of taking my transcript, I know he will also include these few humble remarks. I want to make reference to this, because it falls within the ambit of Bill 94. As Mr. Speaker well recalls --
The Acting Speaker: Do not take too long.
Mr. Cureatz: -- the member for Oshawa indicated the possibility of taking my transcript and forwarding it on. I know those transcripts will include my reference that it was reported last week in the Oshawa Times, colleagues of the chamber of this House, who the two highest-paid politicians in the whole region of Durham were.
Mr. Breaugh: Eat your heart out.
9:30 p.m.
Mr. Cureatz: Guess who are the two highest-paid politicians in the whole region of Durham, including my august riding of Durham East, which I have the very humble privilege of representing, the riding of Durham West, which my colleague to the left represents, the riding of Durham-York and the riding of the member for Oshawa, in reference to all the city councillors of the city of Oshawa, including the mayor, and in reference to the chairman of the region of Durham, and no doubt his car and expense account were taken into account.
Of all those people, I know that the member for Oshawa will take my transcript, and in that transcript will be recorded: Do you think it is a Conservative who is the highest-paid politician in the region of Durham?
Mr. Gregory: No.
Mr. Cureatz: That is right; it is not. Listen: Do you think it is a Liberal, like the chairman of the region of Durham, who is the highest-paid politician in Durham?
The Acting Speaker: Order. I fail to see that this has anything to do with Bill 94.
Mr. Cureatz: The member for Oshawa indicated he would take my reference to Bill 94, which, I remind members, is "An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act, the Hon. M. Elston, Minister of Health, first reading, second reading, third reading, royal assent, printed under authority of the Legislative Assembly by the Queen's Printer for Ontario."
The member for Oshawa was indicating that he would take my remarks on Bill 94 and forward them to members of the United Auto Workers. I was just saying that if he is going to make reference to my comments on the Ontario health insurance plan and on Bill 94, I know he would include my final comment on who the two highest-paid politicians in the region of Durham are: They are none other than, and the Minister of Health will find this very interesting, our own member for Oshawa and a gentleman by the name of Ed Broadbent. Have we heard of Ed Broadbent?
Mr. Breaugh: On a point of order, Mr. Speaker: After more than a decade of getting ripped off by two Tory members, we have just proved they are now getting good value for their money.
The Acting Speaker: That is not a point of order.
Mr. Cureatz: That is not going to wash. I give credit to the Oshawa Times and to its reporter for doing that evaluation. I found it most interesting. I know now that the member for Oshawa will be more than pleased to have the opportunity of sending my remarks about Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act. With that, I know the member for Oshawa will allow me to continue.
Mr. Mackenzie: Sure; our guys appreciate talent.
Mr. Cureatz: It is very difficult when I hear comments from the third party. Of course, I am always intrigued by the member for Hamilton East. I can remember discussions like those on bills such as Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act. When I sat in the chair as Deputy Speaker --
The Acting Speaker: Therefore, you should know.
Mr. Cureatz: -- from time to time, I would listen with great interest to the member for Hamilton East. Indeed, when he spoke to legislation like Bill 94, I had no trouble hearing him. In fact, on a particular occasion during question period, when he probably wanted to focus on particular pieces of legislation like Bill 94, he came gallantly into these chambers dressed in -- do members think it was a tuxedo?
Mr. Gregory: I do not think so.
Mr. Cureatz: No, it was not a tuxedo. Mr. Speaker, do you think in regard to his discussion of bills such as Bill 94 that he was dressed in a suit? Do you think it was a suit?
Mr. Gregory: No, I do not think so.
Mr. Cureatz: That is right; it was not a suit. He was dressed in a Santa Claus outfit. He brought his particular point to focus very much indeed. In my learned wisdom, in my position as Deputy Speaker, the only reprimand I gave him in regard to his bringing focus to particular pieces of legislation like Bill 94 was that he should remove his hat, because no member is allowed to wear a hat in the chamber.
I want to bring to the minister's attention the real issue in regard to this legislation. I am worried that the Liberals do not have a continued commitment to the kind of health care system with which we have all become familiar in Ontario.
Mr. Van Horne: Wrong again.
Mr. Cureatz: I know the member for London North (Mr. Van Horne) is very interested in Bill 94. Indeed, I can remember his interest in a trip to Florida that he and I took in a February month. We all had a royal time. I say to the member for London North that this legislation will be a little more severe in terms of its impact on all of us in Ontario than was a particular investigative committee looking at automobile insurance in Florida.
Mr. Van Horne: Or certain land transactions.
Mr. Cureatz: That is exactly right.
Mr. Van Horne: The ice on which was a little thin.
Mr. Cureatz: I remind the member that he is doing the interjecting.
I wonder whether the Liberals realize that they are tampering with things with this legislation. It is probably going to be the thin edge of the wedge. Where does this legislation come from? I bring everyone's attention to the Toronto Sun of Wednesday, May 29, 1985; signed, sealed and delivered. Is that not a great picture? That was the seed for the legislation we see here this evening.
Mr. Breaugh: He finally figured it out; I did not think this would happen.
Mr. McClellan: It took him a long time, but it finally happened.
Mr. Foulds: Give him a pencil and a piece of paper.
Mr. Cureatz: I remind the members of the third party that this is where the seed began. Since they allowed the Liberals to form the government, I want to quote to them in regard to what the seed for this legislation, Bill 94, started from. It started from a particular minister, the Attorney General (Mr. Scott), who said: "We, the Liberal Party, should go now to the people while we are ahead in the polls. We should take advantage of the situation and the dire straits of both opposition parties."
I want to remind the third party of this unholy alliance. Maybe it should not be so proud of this wonderful picture in the Toronto Sun where the seed of Bill 94 took its form.
Of course, we all have to refresh our memories by looking at "An Agreement for a Reform Minority Parliament." Having some familiarity with the rules, I will not read at great length all the particular items that the Liberal and New Democratic parties agreed to, but I will make reference to the particular section
Mr. McClellan: Is that an autographed copy?
Mr. Cureatz: No, it is not, as a matter of fact. I wonder whether the honourable member would provide me with one. I would treasure it forever.
We have to proceed to -- let us count the pages; one, two -- there is a lot in this agreement. We are in for lots of fun if the Attorney General is wrong and they do not go to the people this spring. Lo and behold, here is "Document 2: Proposals for Action in First Session from Common Campaign Proposals, to be Implemented Within a Framework of Fiscal Responsibility." What, no doubt, is that page all about?
Their leader signed this particular document. It says: "Begin implementation of separate school funding." That has started. Not to worry, Mr. Speaker, I am making my way down to Bill 94. It plays an integral part of this famed document that was signed, sealed and delivered by David Rae and Bob Peterson.
"Release present draft legislation immediately. Introduce legislation upon a Liberal government meeting the Legislature and refer to committee for public hearings.
"Introduce programs to create employment and training opportunities for young people."
Do we hear the drum roll? "Ban extra billing by medical doctors."
9:40 p.m.
From Wednesday, May 29, 1985, to January 21, 1986, the first seed of Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act has come to fruition.
I want to take members on a little tour of some of the comments that have been made on Bill 94. I listened with great interest to my colleague the member for Durham-York speak of the concerns he has had in his riding and, with due respect to all colleagues of this chamber, I have listened to comments and concerns on various aspects of the legislation.
Now that I have an opportunity, I think it is incumbent upon me to bring to this chamber's attention what the infamous Newcastle Reporter had to say about its inquiries into Bill 94: "Physicians say principles at stake in opting out ban." This is from the eastern part of my riding of Durham East, taking in communities such as Orono, the village of Newcastle, Crooked Creek, Newtonville, Starkville, Kirby, and Kendal, communities where there are people who are patients and where a community paper such as this reflects those people's concerns.
"Extra billing has less to do with dollars and cents than it does with physicians' rights...." -- there were two doctors interviewed this week by the Newcastle Reporter. "Legislation to curb extra billing is `the thin edge of the wedge,' Durham Medical Society president Dr. Joan Atkinson said Monday.
"Dr. Atkinson predicted other professionals will experience similar government-imposed controls if the province is allowed to implement the changes." -- in regard to Bill 94.
"Few, if any, physicians in Durham region will be affected monetarily. Instead, the losers will be patients, especially the elderly, who are already faced with an underfunded health system. Dr. Atkinson predicted extra billing legislation will soon be followed by austerity measures within the Ontario health insurance plan itself.
The Liberal government introduced legislation last month in regard to Bill 94. As we all know, and as was reported correctly in the Newcastle Reporter, the legislation has been unanimously supported by members of the third party.
"According to Dr. Paul Hoy," -- a noted prominent Liberal in the town of Bowmanville -- "chief of the medical staff at Memorial Hospital in Bowmanville, the legislation threatens doctors' professional freedoms and signals `repression in the future.'
"Both he and Dr. Atkinson say they can see a future when Ontario physicians will be told how and where to practise.
"`In Quebec, there is a negative incentive for newly graduated physicians to serve in underserviced areas,' Dr. Hoy said. Those who refuse have their fees cut by 50 per cent. By contrast, the Ontario system currently provides a positive incentive for physicians to practise in outlying areas."
I believe this is one aspect not many members have touched on in regard to Bill 94.
"Quebec doctors who opt out are also required to collect the entire fee directly from their patients, he added.
"The outcome in Ontario could be `privatization' of the health profession, as has happened in Britain.... `Some of the best people may find they are not adequately recompensed and will turn to another forum.' Private medicine is `thriving' in Britain today...."
"`In Ontario I felt we have a good balance....' The system provides universality of service and physicians enjoy `reasonable satisfaction.'
"Dr. Atkinson agreed. `It's not my experience that any patient have been unable to receive treatment because they could not pay the Ontario Medical Association fee,' she said."
I earlier indicated these are some of the thoughts and concerns from constituents reflected in the Newcastle Reporter, which in part is represented by the eastern end of my riding of Durham East.
"Most patients who consult an opted-out physician do so with full knowledge that they will be paying more than the OHIP rate, Dr. Atkinson said. She said she makes every effort to ensure her patients are aware of the added cost when she refers them to an opted-out physician. She admitted there could be circumstances where patients, or those responsible for their care, might overlook the fact. `I would be very surprised if the fee was not waived in these cases,' she said.
"Medicare was a physician-conceived plan.... What began as a scheme to insure hospital treatment" -- I know the Minister of Health is taking careful note of these comments -- "has become a system that allows patients to consult doctors for sore a throat. `I feel it is appropriate to protect oneself against commonplaces'.... protection is provided by the right of doctors to opt out of the system.
"Dr. Atkinson sees the root of the problem embedded in the modern North American perception of health care.
"`They (government) have made it (OHIP) an open-ended system not because there are so many doctors but because there are so many patients,' she said. `I do not want to hammer away at senior citizens, but we do have an ageing population.'
"Technology has provided us with improved treatments, medically and surgically she said. The result is a public expectation of health care entirely devoid of pain. `I do not blame people,' she said, `but you have to realize that we live in an age where they want tendonitis cured so that they can get away for a ski weekend.'
"`Fortitude is not a common characteristic; nor is delayed gratification,' she said.
"Dr. Hoy said he would prefer to see the government moving to correct abuses of the medicare system by means of `fine tuning.'
"The OMA and most of its members feel there are significant issues, apart from money, involved in the issue of opting out, he said."
Far be it from me to bore you at great length but I have always found it of great interest that when our own Minister of Health has been asked questions pertaining to this area he has indicated he is willing to negotiate in regard to the fine-tuning. Indeed, looking into my crystal ball, I have a feeling that if the minister followed that method as opposed to this method, there would be less resistance to what is taking place this evening in the chamber.
To the member for Wentworth North (Mr. Ward), whom we all know, I say that the member for Fort William (Mr. Hennessy) should be in the cabinet. I am pleased he is sitting in the second row getting used to the chair. I remind him we are all waiting expectantly for the next shuffle to take place. However, there is a long row in front of him.
9:50 p.m.
Looking into that crystal ball with regard to Bill 94, I can only say that no doubt after the great, tumultuous debate that will take place and after great ramifications across the province about what the doctors have indicated they will do, and on the possibility of this legislation passing, notwithstanding the fact that I and my colleagues will be voting against it, the minister will inevitably have to turn back to the fine-tuning aspect of the legislation.
As he drives in that chauffeur-driven limousine with the yellow lights on the front -- and, as the Treasurer (Mr. Nixon) indicated when he was House leader for the opposition not such a long time ago, always worrying that the yellow lights will zap someone -- when he is making his way back to the riding of Huron-Bruce, where no doubt the people respect him because he is returned regularly to these august chambers, he will be wondering: "Did I do the right thing? Did I have to come forward with Bill 94 and live up to the accord that was signed back on Wednesday, May 29, 1985? Did I have to cause rift and strife in Ontario, or could I have circumvented all those problems by first looking at the fine-tuning aspects of the bill?"
If he looks, with those solemn, doe-like eyes, I know he will be quaking. As a former colleague of ours used to say, "Heart of hearts, that I speak some grain of truth." Yet he laughs and smiles and makes interjections even though he is not in his seat.
I remind him that already we have seen the first measure of discontent in the Liberal Party. I bring to members' attention what the member for Humber (Mr. Henderson) had to say today in regard to this. What was it he called Bill 94? I ask the Minister of Education (Mr. Conway). He called it a draconian piece of legislation. I love that word.
I remind the eminent cabinet ministers who are gleefully making their way back to these chambers, making notes of my remarks and thinking of the possibility that I might not be correct, that instead of this kind of forcefulness in regard to Bill 94, fine-tuning of the legislation would be more in order.
One would have thought the Minister of Education would have learned his lesson after taking an eight-month hiatus on a world trip that took him to China. I can only think that is where he got these preposterous notions in regard to this kind of -- what was it the member for Humber said? It is interesting, as an aside, how the riding of Humber always produces most interesting colleagues of ours in these chambers. Who was the last one? Morley Kells, who was Minister of the Environment.
That brings me to another interesting point. I am surprised that the Minister of Education, having traversed this planet, would support this kind of legislation. I would have thought that he would know better. I can forgive the Minister of Health; after all, he is in dire straits. Made a member of cabinet, a fledgling lawyer from the Bruce Peninsula, he newly accepted his Queen's counsel appointment only to tear it up in the face of the draconian four who really run this government.
Mr. Hennessy: The four horsemen.
Mr. Cureatz: As the member for Fort William has indicated, are the four horseman the real authors of this act regulating the amount that persons may charge for rendering services that are insured under the Health Insurance Act? Is it the Minister of Education, the humble little boy from the Ottawa Valley? Where could he have come up with such a preposterous or, as the member for Humber says, draconian piece of legislation? Or was it the Minister of Labour (Mr. Wrye) who came forward with this legislation'? Is he the real author?
Sometimes I wonder who the real government is when we see legislation like Bill 94, because upon occasion when I am making my weary way along Wellesley Street West, at the windy corner of Bay and Wellesley, whom do I happen upon? None other than our Minister of Labour and one Clifford Pilkey. That name might ring with familiarity among all of us here this evening. Maybe it is really Clifford Pilkey who has come up with this draconian legislation. I want to remind the Minister of Labour, if I were him I would not listen to Mr. Pilkey all the time, as great a politician and as great a leader in the labour movement as he is, not only in Ontario but Canada, and indeed as great at fostering children -- Allan Pilkey is the very resourceful and successful mayor of Oshawa.
If the Minister of Labour is not the author of Bill 94 and Cliff Pilkey is not, I wonder if the buck stops with none other than the Premier (Mr. Peterson).
Interjection.
Mr. Cureatz: l have to remind the member for Fort William that our colleague the esteemed, flamboyant member for Grey-Bruce (Mr. Sargent) is not the Premier of Ontario, but with his support of Bill 94 he is well in line for an upcoming cabinet post which he will no doubt successfully fill.
I would like to bring to the members' attention my concerns about who the real authors are; the hidden agenda with regard to Bill 94. We saw the Minister of Housing (Mr. Curling) come forward with a great deal of legislation regarding landlords and tenants, but there was and still is a suspicion there is a hidden agenda in that legislation. Maybe there is a hidden agenda in terms of the authors.
Was the author of Bill 94 none other than Hershell Ezrin? People say, "Who is Hershell Ezrin?" It is important that members of the chamber realize some of the players around the Premier. I have a suspicion Mr. Ezrin may be the author of Bill 94. He is 39 years of age and became the Premier's chief of staff in April 1982. He was a member of the team that negotiated the historic accord with the New Democrats last year that brought the Liberals to power. A man with that kind of authority from the Premier must have some input with regard to Bill 94.
Let us look at Mr. Ezrin's background to see if he did have input in Bill 94. He was born in Toronto. That does not necessarily require a gold star.
Mr. Speaker: I am listening carefully and trying to tie this in.
Mr. Cureatz: With great interest, Mr. Speaker, you will see how his background was no doubt determinative in his being one of the true authors of Bill 94, to refresh members' memory, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act.
He has a master's degree from Carleton University, where his graduate work focused on developments within the Progressive Conservative Party of Canada. He is a former president of the University of Toronto Liberal Club. Probably that is where he first got the seeds of thinking about legislation such as Bill 94.
In 1969, he joined the Department of External Affairs in Ottawa and subsequently became Canadian consul in both New York and Los Angeles. No doubt his world travels allowed him the opportunity of looking at other health systems. One would think a person of his qualifications and in-depth knowledge would know better than to be one of the authors of Bill 94.
10 p.m.
In 1981, he served as executive director of the Canadian Unity Information Office -- what a great success that was under the Trudeau administration -- and as a member of the federal-provincial relations office of the federal cabinet. He worked on the repatriation of the Canadian Constitution. Indeed, bringing our Constitution home is a feather in his cap, but one would think he would have learned from those negotiations something about Bill 94, because I bring to his attention that the member for Humber indicated that this legislation is draconian and oppressive.
One would think Hershell, who was deeply involved in the Constitution for our country, would know better than to bring draconian and oppressive legislation into Ontario. He should have thought of what he did in such fine accomplishments as the negotiations to bring our Constitution home.
The Minister of Education says, "Do not take Hershell so seriously." I can say with confidence to the Minister of Education that Hershell had a little bit to do with Bill 94, but he smiles and, as I look behind those rose-coloured glasses, he says the real author probably, maybe, was Gordon Ashworth, the real person behind the hidden agenda.
We should take a look at his attributes, because they will give us an insight into where the real people are in terms of writing Bill 94, this draconian legislation, as the member for Humber indicated. Ashworth is the link between the Premier and the federal Liberals, including senior advisers like Senator Keith Davey and Jerry Grafstein. Now the plan unfolds.
Mr. Gregory: Not that same old gang.
Mr. Cureatz: That same old gang from Ottawa has found its way down the Ottawa Valley to Highway 401. I wish the Minister of Transportation and Communications (Mr. Fulton) were here. I would remind him of the bumps in the road.
Mr. Speaker: Order. The member is really straying now.
Mr. Cureatz: With regard to Bill 94, I want to tell you, Mr. Speaker, that I am this far away from admonishing you about what happened in question period today. I have had the opportunity of serving in that chair, and in listening to legislation like Bill 94, I always had time for the opposition. Indeed, I was criticized, and we can all name former cabinet colleagues who were critical of me, for taking time for the opposition.
I want to remind the Speaker in my discussion of Bill 94 that this time for raising discussion and concerns in regard to legislation such as this and the time of question period are the only place where opposition members have the opportunity to express their concerns and frustrations, as they arise under Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act.
I know the Speaker is greatly concerned about allowing opposition members an opportunity to have their say because, after all, the government has brought in Bill 94. It is running the province. We do not have the newspaper, radio or television coverage to focus continually our concerns about this draconian legislation, as the member for Humber has indicated. We have only this forum, the forum to which we have all been duly elected and where we have the responsibility of representing our ridings.
Was Gordon Ashworth the real author of Bill 94? I say that without a doubt Hershell Ezrin had some input. He is a person who should have known better because of his negotiations over the Constitution. He should have thought of negotiations with the medical profession, not of pitting government against profession, patient against politician, patient against doctor and politician against politician.
I feel very confident, as I have already indicated to the Minister of Education, that if he and the gang of four had taken a more, if one will excuse the word, liberal approach to Bill 94, that would have allowed an opportunity not for confrontation with the Minister of Health but for negotiation. That is what concerns me.
Mr. Philip: If this is this a term paper, it is worth only a C minus.
Mr. Cureatz: It is getting late in the evening. I see I am going to be provoked by the member for Etobicoke. With Bill 94 now in front of us, I am not surprised he should show some frustration. Under the last minority government he had a very powerful position as chairman of a committee, and I might say he did a fine job in running that committee and asking for Speaker's warrants. No doubt he is feeling a degree of frustration with regard to Bill 94 in not being able to flex his muscles as in the old days. That is why he is a little concerned about my comments.
Mr. D. S. Cooke: The member should sit down.
Mr. Cureatz: I can only say to the member for Windsor-Riverside (Mr. D. S. Cooke) that I know his support for Bill 94 is in recognition of the signed coalition agreement of which I have a copy. I have been assured I will get an autographed copy from the member for York South (Mr. Rae) and the Premier.
Notwithstanding the member's support for the Liberal government, I can say sincerely that in my past experience, which includes the opportunity of running this chamber, I am more than pleased he has returned to support Bill 94 along with his Liberal colleagues, as opposed to a particular baseball player who had the opportunity of trying to unseat him. However, I digress.
I want to bring to the attention of the chamber some other aspects of my community with regard to Bill 94. I want to bring to the members' attention a paper that is well respected in our community. I am sorry the member for Oshawa saw fit to leave and not to listen to my remarks. The Oshawa Times, a prominent paper, on Saturday, December 21, indicated with regard to Bill 94, "Extra Billing Ban `An Act of Violence.'" Under that headline it said, "MDs vow a court battle."
We are talking about the city of Oshawa, of which I represent a good portion. As the member for Oshawa so rightly indicated, it is a fairly active labour community. Yet we have this paper, in the full knowledge of the labour orientation of our citizens in that fine city, using a headline to grab the attention of my constituents, many of whom are labour people, to Bill 94.
The Oshawa Times said: "Calling Ontario's plan to ban extra billing `an act of violence against doctors,'.... association president Dr. Earl Myers, told a news conference Friday he won't know what legal strategies his 17,000-member group will use until the final wording of the bill has been determined.
"`But there is no doubt we are going to take this act to court,' Myers said."
That was expressed in the Oshawa Times to grab the attention of the people of Oshawa, a highly unionized city, and to focus their concerns and cast their minds upon the confrontation this Liberal-NDP coalition government has brought to Ontario.
I know some colleagues on my side of the House in my party would gladly agree with me that never did we have those kinds of confrontations when we were in government.
Mr. Wildman: They are the government in Ottawa and it is their fault.
10:10 p.m.
Mr. Cureatz: Did the honourable member ever get that sewer plant built in his riding? I can remember how he badgered the former Minister of Northern Affairs about the sewer plant. Now we are talking about issues of greater concern that affect all of us in Ontario.
The Oshawa Times had this to say about Bill 94:
"The long-promised Health Care Accessibility Act introduced Thursday by Health minister Murray Elston bans doctors from charging patients more than the amount permitted under the province's insurance plan."
It goes on to further clarify and elucidate the finer aspects of the proposed legislation to its readers:
"Any doctor found guilty of overcharging could face a fine of up to $10,000 for each offence and could be ordered to repay the patient for any excess he is billed."
I say to the Minister of Health, to the Minister of Education, and to the esteemed, very vocal Minister of Northern Development and Mines (Mr. Fontaine) that this is the kind of draconian legislation and kind of reference that the member for Humber reported so loudly on CBC radio this morning. He should be ashamed. I give credit to the member for Humber for his initiative, to his very strength from the guts of his body to say no to Bill 94 and no to this kind of terrible divisive legislation that is going to undermine the health care system in Ontario which was built so strongly by the Conservative Party over a number of years.
The act, which probably will not become law until the spring, also covers dentists who offer services in hospitals. It denies rights. I think this is what the member for Humber was saying to all of us. Perhaps I can try to mimic our Ambassador to the United Nations as he used to screech so loudly down there in the third party in the front bench where, for only a few months, I had the wonderful opportunity of listening to him.
"`The legislation purports to deal with access to health services, but all it will achieve is to deny the right of a physician to make a simple contractual agreement with his or her patients, a right held by every other professional in our society,' Myers told reporters."
"Myers said the government is trying to cover up the lack of accessibility, a lack of hospital beds and incidents where people are dying of coronaries while waiting for heart surgery."
If that is the case, if the government is trying to cover up, as reported in the Oshawa Times, I can only go back to one of my main cores of concern about who the real authors of this legislation are. Are they the four horsepersons of the apocalypse, or are they the hidden-agenda persons to whom I made some reference.
I can only bring to the attention of members one who, no doubt, had input with regard to Bill 94. No doubt, Moira McIntyre, had a very important say with regard to Bill 94. She is the Premier's eyes and ears of the Legislature. She briefs the Premier every morning and before daily question period after monitoring committees, keeping abreast of stories in the media and goings-on in the ministries. Was she speaking with the New Democratic members with regard to the goings-on in the committees in the Legislature? Is that what was taking place?
Interjection.
Mr. Cureatz: This is really hurting the member for Windsor-Riverside. I want to say to him with regard to his concerns about Bill 94 that when I was Deputy Speaker I always had difficulty distinguishing between the member for Windsor-Riverside and the member for Bellwoods. Time and time again it was the moustache that always threw me.
With regard to Bill 94, I have now a greater problem. Now I cannot tell him from the Liberals over there. This is getting most confusing. I think he would feel much more comfortable making his way across the floor of the House. He should have held out for a cabinet post, because I have heard him speak passionately time and time again with regard to legislation that was being put forward -- good legislation, I might add -- by the former Conservative government. I would listen with great interest and no doubt the member has the same kinds of concerns about Bill 94. However, he shakes his head. He says he is not one of the authors.
Here it is: "Moira McIntyre, who is 29 years old and is from Brantford and has a degree in political science and English from the University of Waterloo was hired" -- here is where she has had some say in regard to Bill 94 -- "by Robert Nixon in 1983. Nixon did not know her but knew of her family. Her mother" -- and this is what grieves me so, I have large crocodile tears in my eyes -- "is a staunch Conservative." One would have thought, with that kind of fine family background, she would have known better than to help formulate legislation the member for Humber has indicated is draconian and divisive.
I wanted to bring to the members attention some of the concerns of people in my riding as reflected in the Oshawa Times. I had made my way down to a paragraph that says: "About 12 per cent of physicians have opted out of the Ontario health insurance plan and can extra bill patients."
Hon. Mr. Wrye: Does the member for Durham East get paid by the line?
Mr. Cureatz: I say to the honourable member, that is a very good point because now that his Premier has taken away our QCs and brought forward draconian and divisive legislation such as this, his government is not long for this world. The Minister of Health, who had a humble, small-town law practice in the community of Wingham, will be making his way back to that fine community after he is defeated by those fine constituents. The Minister of Health will have to think about practising law again and charging by the line and will not be worried about bringing in draconian legislation such as Bill 94.
"About 12 per cent of physicians have opted out of the Ontario health insurance plan and can extra bill patients, but in some specialties the percentage of opted-out doctors is much higher, for instance, 67 per cent. `Some specialists may respond to the legislation by packing up and leaving Ontario or by cutting back on services offered patients,' said Myers.
"Passage of the Ontario legislation, which is similar to that in Nova Scotia and Manitoba, will leave Alberta and New Brunswick as the only provinces that permit extra billing. Under the Canada Health Act, provinces are penalized $1 in withheld transfer payments for every dollar the doctors charge. By the time Elston's bill goes into effect, Ontario will have lost a lot of transfer payments."
Some people quote that money is the root of all evil. Far be it from me to make any comment on that. I would have thought this Liberal administration, the four horsepersons of the apocalypse, would have thought beyond the money aspect, towards sensitivity in regard to legislation such as this, and about the possibility of negotiation. However, the four horsepersons do not want to negotiate.
10:20 p.m.
We have made reference already to the accord and how under the signed agreement, document 2, eight lines down, there is a specific reference to banning extra billing by medical doctors. I can only refresh the members' memory that it was our illustrious Attorney General, albeit a new member to the chamber, wet behind the ears, who has grasped his responsibility with great sincerity. I can only say to him that this legislation may not pass until early fall.
I can only remind him of his concern that the kind of legislation, this Bill 94, that is being brought out by the four horsepersons is pitting doctor against patient and patient against politician in this province.
Indeed, that was indicative of his anxiety, of his continual fostering of divisiveness in Ontario, as seen under Bill 94, this draconian legislation, where he indicated, "The Liberals should go to the polls now, before we very rudely antagonize everybody in the province." After all, it has been the pharmacists, the doctors, the farmers and, indeed, the honourable member.
Although the Attorney General has no familiarity with the farming community in downtown Toronto, I can assure him that, with regard to Bill 94, the kind of divisiveness that the four horsepersons have started is going to continue, and his government will not be long for this world.
I would advise him that the legislation in regard to Queen's counsels has not been passed yet. He should not pass it, because he will be practising law sooner than he realizes, and oh, how he will lament the loss of the title of Queen's counsel. He will say: "Woe upon me and my government colleagues of that time when we were bringing forward such draconian legislation as Bill 94, legislation to offend the farmers and legislation to offend lawyers with their QCs."
He will wish that his letterhead had kept the QC because, as he reported, not in regard to Bill 94 but in regard to the legislation on Queen's counsels, he worked so hard to get his Queen's counsel, writing letter upon letter to various cabinet ministers. He has not seen letters yet. He should wait until the animosity of the people of Ontario comes forward and they start seeing that this Liberal administration has begun to tamper with the fine health care system of Ontario.
By then, I say to him and to the few straggler back-benchers who are there, it will be too late because -- and I will tell him a trade secret -- he has been spending too much time in the chambers helping the four horsepersons pass such draconian legislation.
The member for Wentworth North has not been looking after his riding. He has been here very obediently, like a little puppy dog, standing up for the vote with his coalition colleagues. However, support of this legislation with his continual attendance means that people back in the riding do not know who he is and, to and behold, when election time comes, they will not care who he is. When the little X comes forward, they will ask in their minds: "What was the name of the party that brought forward draconian legislation like Bill 94? We do not want those people any more. We are tired of them bringing forward legislation that makes people angry, that pits people against each other, as Bill 94 is doing."
I would be remiss if I did not also indicate to the members a comment from another paper of some noteworthiness, Oshawa This Weekend, which periodically reports on activities in the city of Oshawa. I want to refresh everyone's memory about the Oshawa Times, how it indicated a concern through its emblazoned heading, "Extra Billing Ban an Act of Violence." That is its flagship in regard to this draconian legislation, Bill 94.
In regard to Oshawa This Week, its masthead indicates some of the concerns that doctors in Oshawa and the region of Durham have in regard to Bill 94: "Local Doctors Want Extra Billing to Stay." This is from a report in Oshawa This Week:
"Physicians should be allowed to extra bill because it is an individual right and allows for a `relief valve' in an underfunded medical system, local doctors say."
"`If the provincial government follows through on its promise to introduce legislation next month to end extra billing, it will "take away my right as a citizen, benefit as a citizen,'" says Dr. Donald Shepley, a Whitby family doctor.
"He says extra billing is `part of our health care system' and `when properly done it allows for proper remuneration where it is due.'"
What he is saying is something I have been trying to draw to members' attention, that the four horsepersons on the front bench who really run everything in this Liberal administration, notwithstanding some of the people who write the hidden agenda, are bringing forward legislation that is pitting professionals against politicians and their patients where, instead, they should be negotiating.
To the Minister of Health, for whom I have a great deal of respect -- and who owes me a dinner, by the way -- I have to say that in his heart of hearts, he does not like Bill 94. If he had his druthers, he would rather have the opportunity of sitting down and negotiating with the physicians. As his training in the learned profession as a barrister and solicitor has indicated, he could do away with Bill 94 and come to an agreement so we would not have what is taking place and undermining one of the finest health care systems in the world.
However, he is not part of the four horsepersons; he is outside the front four. He has no say; neither does the member for Essex South (Mr. Mancini), whom he knows only too well that I admire.
In the continuation of the Oshawa This Week report of the doctors' concerns in the region of Durham, Dr.Shepley, past president of the local chapter of the Ontario Medical Association, which represents Ontario doctors, is quoted as saying that halting extra billing will end a patient's "freedom of choice" on which doctor to visit.
Imagine. All members of the Liberal Party should be ashamed.
Hon. Mr. Wrye: Can the member explain that? Can he explain how that happened? I am not sure how it happened.
Mr. Speaker: Order.
Mr. Cureatz: I say to the Minister of Labour, has he got his marching orders from Clifford Pilkey? Has he got his marching orders? Has he got his little green book? When is the next appointment at Bay and Wellesley? If he is going to be meeting with Clifford Pilkey, who is really running the Ministry of Labour, he should do it out in Queen's Park underneath a bush so we cannot see him. Instead, in the openness he makes every admission that Clifford Pilkey is running the Ministry of Labour.
Hon. Mr. Wrye: I plead guilty to meeting with the head of the Ontario Federation of Labour.
Mr. Cureatz: He should not be so vocal with his interjections, because the truth hurts. Otherwise he would be smiling smugly, pretending he is back in the old days as a radio announcer, where he no doubt wishes he were instead of being told by Clifford Pilkey how to run the Ministry of Labour.
I have just begun, Mr. Speaker, but since it is 10:30, it might be appropriate at this time to adjourn the debate.
On motion by Mr. Cureatz, the debate was adjourned.
COURT RULING
Mr. Speaker: Pursuant to standing order 28, the motion that this House do now adjourn is deemed to have been made. The member for Brantford (Mr. Gillies) has given notice of his dissatisfaction with the answer to his question given by the Attorney General (Mr. Scott) concerning the sentence given a sex offender. The honourable member has up to five minutes to debate this matter, and the minister has up to five minutes to reply.
Mr. Gillies: I want to indicate to the Attorney General the depth of my unhappiness with what I thought was an uncharacteristically weak reply from him yesterday regarding the disposition of the case of George Harkness in Brantford.
10:30 p.m.
I want to indicate to the Attorney General that I feel the cause of justice has not been served in this case and that I do not believe the best interests of the victim, of the offender himself or of the community as a whole have been served by a repeat sex offender being given two years' probation, and in fact leaving his trial a free man after judgement.
In his response to my question, the Attorney General pointed out that psychiatric counselling had been ordered for this offender. I again indicate that I do not see that as the case at all. The judgement given by Judge W. A. MacDonald indicated that "such psychiatric treatment or counselling as may be recommended by the probation officer" would be part of that probation, but the court did not order that such treatment be taken by the offender.
This procedure is inadequate. Probation officers, for all the good work they do, are not psychologists or psychiatrists. I understand the minimum requirement for that type of work is a bachelor of arts degree in social sciences, with no prerequisite of any psychiatric or psychological training whatsoever.
I have talked to the personnel people in the Ministry of the Attorney General. They told me it is not the job of a probation officer to become a therapist or interpret the therapy. They also note that the work load of our probation officers is so heavy that all they will really do in a case such as that of Mr. Harkness is see him once a month, and probably will have little or no time or opportunity to get to know the offender or recommend any type of treatment for him.
I want to indicate the unhappiness that has been expressed by both my leader and myself publicly with that part of the Attorney General's reply to me that indicated, "The sentence in question was regarded as appropriate by the crown counsel in question because the sexual assault, while wrongful, was very brief in duration and in the specific circumstances of the incident not within the category of extreme misconduct."
While I am not an expert in these matters, heaven forbid, and I am not even a lawyer, I would like to know when the duration of a sexual attack became the sole or even primary determinant of it seriousness. I have had the experience in my five years in this House of having served on the standing committee on social development during consideration of child abuse and the sexual abuse of children, which I believe led to a fine report by that committee. I indicate my sincere wish to the Attorney General that new methods, new treatments and a new attitude on behalf of the crown should be brought to these cases.
We are dealing in this case with someone who has been found guilty of a third offence of sexual abuse against children. The very lightness, the almost absurdity of the sentence given this man has caused an unsettling anger in my community. At the risk of overstating, I will say that this type of sentencing leads to such anger in the community that it can lead to a sort of vigilante mentality, which I do not believe is in the best interests of justice. I am sure the Attorney General would agree with me. The community wants justice to be done in a case such as this and it also wants to see justice to be done.
I have had several anonymous calls at my office in Brantford. Some people on the street say, "Do not worry about it, Mr. Gillies, because if justice or the Attorney General will not take care of this guy, I know what to do with him if I ever get hold of him." I do not want that type of feeling on my streets in Brantford. I do not want the parents of children in my community to feel their children are not safe. I believe that the crown should have appealed this case in the best interests of all concerned, to seek some meaningful rehabilitation for the offender and some meaningful protection for the community.
Hon. Mr. Scott: I was anxious to be here tonight because I do not perceive that there is any political issue that divides my friend and me on this important question, which is so typical of many that an Attorney General has to face: namely, whether an appeal should be taken from a decision that has been rendered by a judge in a case of this type.
The reality, which the member understands, and he speaks for his community and for those who feel as he does, is that we have an independent judiciary in this country, which is posed between the executive and the population to decide difficult matters of guilt and sentence. The characteristic of an independent judge is that he is not susceptible to influence from the populace or from the political branch of government that we represent here.
So the problem for an Attorney General -- and it would be the same if the Attorney General were my friend the member for Brantford or, as he happens to be now, me -- is whether an appeal should be taken, because there is no other remedy. I cannot deliver a lecture to the judges about sentencing; they would regard that as an infringement of their liberty. I cannot pass a rule here about sentencing; that is a matter for the federal Parliament, not for us.
All that an Attorney General can do, whether he be my friend or myself, is to appeal. The issue for an Attorney General, should he appeal, always comes down to this: is there a reasonable prospect of succeeding upon the appeal? It would be the easiest thing in the world for me to serve a notice of appeal. It is a two-page document, and my friend would be satisfied, the press would be satisfied and that would be the end of the matter. It would be forgotten until six months later when the Court of Appeal made its decision.
If I wanted to avoid the catcalls of the press and the learned discourse of my honourable friend, I would serve a notice of appeal. It would be the easiest thing. However, that is not what is required. What is required is an assessment of whether the appeal will succeed. Why? Because if the appeal fails, if the Court of Appeal says the appeal is rejected, then that becomes a precedent and a plateau that will represent to the lower judges across Ontario what the Court of Appeal expects.
If an appeal were taken in this most unfortunate case and if it were lost, it would be a signal to the provincial court judges all across the province, which they would be obliged to observe, that this sentence was the norm. So an Attorney General, in deciding whether to appeal, has to decide whether there is a reasonable prospect that the case will be won. After receiving advice from my crown law officers, I concluded there was no reasonable prospect that the case would be won.
It is one thing for the Leader of the Opposition (Mr. Grossman) to herald in this thing that goes out almost daily that it is scandalous, but the reality is that for McMurtry, for the member for Cochrane South (Mr. Pope) or for any other Attorney General the issue is the same.
We considered this very carefully. I am not happy with the sentence. If I were a provincial judge, it is perhaps not the sentence I would have given. However, the provincial judge, an independent judge -- that is the nature of our system -- said, weighing all the factors, that he thought justice was done here. If I thought there was a reasonable chance that the Court of Appeal would reverse his verdict, I would have recommended an appeal and taken one.
In the circumstances of this case there was a momentary touching. There was no violence, there was no aggressive conduct, apart from the act itself, which, as my honourable friend has noted, is by its nature aggressive. There was consultation with the parents, there was an order for psychiatric assistance, there was the suggestion that without this kind of arrangement the accused would have gone free.
However, the determination that the crown attorney made in this case, and that of the judge, was perhaps not the one my friend from Brantford would have made and is perhaps not the one I would have made, but it is within that range of permissible sentences that the Court of Appeal would not have overturned. If it did not overturn it, we must understand that this would send a message to those provincial judges that this is the norm.
I simply observe that it would have been easier and I would have preferred simply to file the paper to please my friend, but that is not my duty.
The House adjourned at 10:40 p.m.