L104 - Thu 30 Jan 1986 / Jeu 30 jan 1986
HEALTH CARE ACCESSIBILITY ACT (CONTINUED)
The House resumed at 8 p.m.
ORDERS OF THE DAY
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. Harris: When I began my remarks on Tuesday evening, I indicated that I was not particularly pleased to enter into this debate because I was not particularly pleased the debate was taking place at all. I indicated negotiation, co-operation and other measures of working with the Ontario Medical Association, the federal government, individual groups of physicians or individual groups of specialists are far more the order of the day than this very heavy-handed piece of legislation. These are far more the order of the day if we want a quality health care system, such as the one we have had in Ontario, still to be in Ontario after this foolishness is finished.
I made reference to the short title of the act, which is probably the biggest joke of all: the Health Care Accessibility Act. The act has absolutely nothing to do with health care accessibility. As was predicted by many people, including members of my caucus, by physicians and by the OMA, the act is leading to accessibility problems. If the minister does nothing else, and he appears not to want to do anything with the act itself, perhaps he might be honest with himself and change the short title of this act to the Health Care Inaccessibility Act.
I also briefly commented that what makes this act even more scary for the people of Ontario -- teachers, dentists, lawyers, architects, all the professional groups; unions and any collection of workers in whatever field -- is that it is not an isolated case. It is the second very strong, overly heavy-handed piece of legislation introduced by this minister, supported by this Premier (Mr. Peterson) and supported by this fledgling, new, struggling, wandering government that Ontario has, a government that appears to be striking out on some very narrow, populist issues in an effort, for some reason or other in a short time, to try to convince the population it can act and is not afraid to act.
When it comes to issues which its polling tells it are supported by large numbers of people, we have seen it is not afraid to act. I am really not sure whether to blame the minister entirely for this short-term, populist behaviour. The Premier has a very strong hand in this; the four horsemen have a very strong hand in this. It is not an effort to improve the health care system; the primary purpose is not even to ban extra billing. Its primary function is a political one, designed by those architects of political strategy behind the scenes to put an image on this government party that it is one that can act.
It is a very cowardly, despicable, low-life form of action when a party, for what I believe to be personal, partisan, political reasons, attacks probably the most fundamental service that has been built up and provided to Ontarians over so many years of careful negotiation and avoidance of confrontation.
There have been problems in the past. It is never easy. It is an ongoing struggle. However, when one preserves, and the end result is to preserve, it will be a far superior health system to the one that will result if the Premier forces his minister to carry on with this cruel joke on the people of Ontario compared to what was there before.
I mention that it comes in the context of Bills 54 and 55. Those two pieces of legislation together make this bill that much more scary for everybody in Ontario, for every group of workers and professionals.
Whatever profession one is in, when one decides to go into business in a province -- in one case it is the pharmacist whose business is the retail business of buying from the drug companies at a wholesale price -- he sets up an operation, builds his building, pays his capital costs, taxes and staff, and sells those drugs, along with other items in his store, to the people of Ontario.
8:10 p.m.
Then a government comes along -- I guess it was the Conservative government, with the member for Muskoka (Mr. F. S. Miller) as the Minister of Health at the time; I am sure somebody will correct me if I am wrong -- and says: "We should have a government insurance program to protect some of the segments of society who are less able to afford medication, particularly the senior citizens who are at an age when their medication becomes more frequent. We will come up with an insurance plan to help alleviate that situation for our senior citizens."
So far, no problem. It could be a hardware operator; hardware stores could be next.
The government negotiated with the pharmacists and said: "We would like to put in an insurance plan for which we will pay the costs. Can we sit down and negotiate with you the fee you will charge based on this insurance plan?"
Unwittingly, the pharmacists during that period said: "That makes sense. We are not that concerned about who pays. We are independent business people. If the government is going to pay for an insurance scheme insured by the government, yes, we will co-operate. We will sit down and negotiate a fee schedule." Everything was worked out and away they went.
They entered into that agreement on the understanding that there would be negotiation and that it was for insurance, not state price-setting. It was not the state suddenly stepping in and saying: "We do not care what your costs are, what you think or what margins you think you need. This is what you are going to be paid."
Then it evolved into the formulary stage in the negotiations and what not. At that point, I suspect some pharmacists probably became a little unhappy, as any business person would, and said: "Now the government is setting these prices. It has not worked the way we thought it would. We have to negotiate with our own association."
There were problems, as one would imagine. Some pharmacists were able to buy cheaper than others and some had problems, but they reacted as business people always do. They formed co-operatives so they could buy better and they survived by the rules of the day.
One can imagine the same thing happening to operators of hardware stores. The government would say: "No more negotiations. We are not happy with what you are charging and the way it is going. We are having difficulty getting you to see our point of view, so we will tell you what you can charge for your products by legislation, not by negotiation." That is what happened to the pharmacists. That is what they are facing with this government.
Now we come to the doctors. I mention it and I thank you, Mr. Speaker, for allowing me to relate it. This bill in isolation may have been just one little politically motivated thing that was a shot in the dark. However, it is clear to all the professionals in the province that whenever a populist cause comes along, whenever the government is able to engineer, by whatever means, a public opinion poll showing that 80 per cent of the public thinks bread costs too much --
Hon. Mr. Kerrio: It sounds like rent control and what the member's gang did.
Mr. Harris: If the minister wishes to join with me in expressing his concerns about rent control, I invite him to do so.
Hon. Mr. Kerrio: I am in favour of it. We have done it.
Mr. Harris: I am comfortable in expressing my concerns about rent control. I do not think he has heard me say anything different. I am very comfortable being on the record expressing my concerns about long-term rent controls.
Hon. Mr. Kerrio: The member cannot have it both ways.
Mr. Harris: I know. That is why I am expressing my concerns. I remind the minister that if he wishes to put his foot in his mouth and open his yap, he had better stand up behind it. I am prepared to do that. I have grave concerns about carrying on with rent controls, and I assume from his conversation that he does too.
Mr. Breaugh: The member for Nipissing did not even support his own throne speech.
Mr. Harris: I have no difficulty in saying that I have never supported every single thing that has been in any throne speech, my own or anybody else's.
Mr. Breaugh: On a point of order, Mr. Speaker: This needs to be clarified --
Mr. Speaker: Under what standing order?
Mr. Breaugh: Standing order 28(e). This party supported a speech from the throne that had this in it.
Mr. Andrewes: What is standing order 28(e)?
Mr. Speaker: I will look that up.
Mr. Andrewes: The member for Oshawa said that with an almost straight face.
Mr. Harris: Due to the loose lips of those around, I have digressed. I would like to get back to the situation with the medical profession. It is surely an honourable profession, one that has evolved in Ontario.
I do not know when the first medical school was founded in Ontario, but it is a profession that evolved in a way somewhat similar to the pharmacy profession. A doctor would go to medical school, meet the qualifications of the Canadian Medical Association and the Ontario Medical Association and do all the things he had to do to get a licence to set up practice. He would put up his shingle, open his door and say: "Here I am. Here is what I charge. I am here to help you."
History has shown that long before the Ontario health insurance plan, insurance premiums and free health care, in every community throughout the province those who could not afford it just did not pay. Doctors did not get paid any money at all. But if there was a single case, surely they were very rare, isolated cases in which patients were denied access to a doctor for lack of ability to pay.
As medical care became more expensive and we came into a new age of technology, and with some of the diseases we have in the modern age, the possibility of disaster for a family or individual in a crisis increased. That was when health insurance was brought in, and nobody would argue against some form of insurance to protect an individual against a disease-related or health-related disaster. We had health insurance; we then had government health insurance in a joint-sponsorship role. We paid an OHIP premium and the government paid a share.
The government paid all of it for many citizens, such as senior citizens and those on incomes below certain levels. Then we got into problems as health care costs escalated. The ability of the government to fulfil the expectations of physicians was severely curtailed, and we had pretty tough negotiations involving the government and the plan and the physicians. That is predictable. Until this government took over, the fee schedule was always worked out in negotiation with the doctors.
I want to tie this to what has happened with the pharmacists and I would like to refer to some comments made by others. In particular, I wish to associate myself with some of the comments addressed to the Legislature by my colleague the member for Cochrane South (Mr. Pope).
8:20 p.m.
On January 14, the honourable member pointed out to the minister that "the people of this province believe we have one of the best health care systems. They are immensely satisfied. They do want to see some improvements, but they recognize this as one of the best health care systems in North America. They do not want the likes of the member tinkering with a very good health care system that is providing service to the people of this province.
"They do not want this negotiated through the Globe and Mail every week. They want the health care system to work because they recognize it is a good system."
Hon. Mr. Elston: They speak with one voice and certainly with one script.
Mr. Harris: No. I am going to quote several other members from all sides of the House. "They want everyone to work at improving it, but they feel it is one of the best health care systems in North America and they are all proud of it.
He goes on to say: "We all have an obligation to recognize that fact and to try to work together in a co-operative way with the professionals, with the private sector, working together, not shutting them off from negotiations because they do not adopt the member's preconceived notions of the conclusions he wants. They want an open-door policy where the professionals, the patients, the people of this province all have a right to have their say and to talk to the Minister of Health.
In another part of that day, he made reference to some comments the minister made when he moved second reading of the bill:
"He said he did not want to see a two-tier health care system in this province, one for the financially disadvantaged and another for the so-called rich, as if that goal is somehow different from the goals that all of us in this House share; as if that was somehow different from the concerns of caring professionals who are practising medicine in this province; as if somehow he alone had that concern and he alone had the answer to resolve that concern and that the professionals had no role to play in that resolution."
I am very comfortable in associating myself with that viewpoint.
Mr. Haggerty: How is the member going to vote on it?
Mr. Harris: Is there some doubt about how I am going to vote on it?
Mr. Haggerty: You talked on the pharmacists' bill and you did not vote on it.
Mr. Harris: Was I not here for the pharmacy bill?
Mr. Gillies: The member was away that day.
Mr. Harris: Had I been able to cast a vote by proxy, I would have voted with my constituents. I will be voting with my constituents and with the people of Ontario when I vote on this bill. I am not sure what my party is doing. I am not committing myself to that. If I did not state it and there is some doubt, I will be standing up under whatever forum we have for this vote and voting on this bill.
He went on to say: "It is the same attitude towards the pharmacists. Somehow they have no role to play in the resolving of this issue of drug costs in this province. Somehow they should be kept out of it. It is his right as the Minister of Health to dictate the settlements and he will let them know, when he introduces the legislation, exactly what they are going to be."
We talk about the fundamental importance of the quality of the health care system in the province, not only with respect to the involvement of the Ontario health insurance plan and the Ontario drug benefit plan, but also with respect to the role of individual professionals who understand their professional obligations. In the context of those professional obligations and of a deep personal concern for their patients, they want to make sure of a high quality of care at an affordable cost.
Our party is calling on the minister, the government and the Premier to work with those caring professionals and those associations. Let us resolve the issues of accessibility and universality that do indeed concern all of us in this Legislature.
I also share my colleague's viewpoint when he points out that section 3 says the minister will try to arrive at some mechanism. This reminds me of the Minister of Natural Resources (Mr. Kerrio), who tells the anglers of the province: "I have not been able to negotiate anything with my Treasurer. I have not been able to assure you of anything, but I am coming to you anyway to say that in the event I might be able to negotiate something in the future I have not been able to get in the past, do you think you will support me on this?"
Hon. Mr. Kerrio: Is that section 4 of the bill?
Mr. Harris: It is section 3, but it reminds me of that. It is a silly way to proceed.
Hon. Mr. Kerrio: Those poor guys over there are hurting terribly.
Mr. Harris: This does not lay out the mechanism. There is no guarantee of a mechanism for the doctors of the province, who happen not only to be fairly important but also to be the important carriers of the health care system. There is no mechanism at all to give them some input into the fee discussions. The matter has not been resolved. It has been legislated, or attempted to be, but on a doctor-by-doctor basis it has not been resolved.
We agree that we need a resolution of the universality and accessibility issues. That has to be our goal, but the government must do it through negotiations. It must work through the negotiation process to maintain this great health care system in Ontario in the same way it was created.
I want to refer to a few other remarks that were made later that evening:
"Everyone acknowledges, not that we have a perfect health care system, and that is the reason for some of the legislative changes, but that we have one of the best systems in North America.
"Its foundations are historic and relate to the respect and the involvement of individual professionals as private practitioners, not public practitioners, and to an atmosphere of co-operation and consultation among the various people who deliver health care services to individual citizens of this province.
"My viewpoint, and I think that of our party, is that whatever we do and whatever changes have to be made, we would be the first to admit that issues of accessibility and universality, as two of the five principles of the national health care system, have to be addressed by this government and the Legislature. While we are prepared to address and support moves to improve accessibility and universality, we think one has to move in the context of the existing professionals and their organizations in this province as they now exist."
There were a couple of other little points I wanted to make very briefly on those remarks. The member for Cochrane South spoke about specialty groups, and they particularly interest me because, as members know and the minister will know if he quits negotiating his forest management agreement, in northern Ontario there are problems attracting specialists and keeping them there for many of the specialty services.
8:30 p.m.
We understand in the north why we must travel to more regional centres, most of them in southern Ontario. We understand why there are some surgical procedures and pieces of equipment it is just not economical to have in every hospital and town throughout the province. However, there are still services that could and should be in the north and we must continually strive to provide them in northern Ontario and other areas of the province away from the centres.
With respect to specialty groups, we feel this legislation will certainly affect us in the north. When doctors are unhappy, when they look to alternatives to practising as civil servants in a socialized state, the specialty groups are those that very likely will look to alternatives other than practising medicine in Ontario.
I suggest to the minister there has to be direct negotiation on some individual fee items. It may concern the Ontario Medical Association and the specialty groups. It may cause some problems, but perhaps it will be far less destructive than this piece of legislation. We offer this to the minister as one alternative. Our party hopes the minister will look at these alternatives.
In any set of negotiations, confrontation provides little gain. Our party cannot support or condone actions that affect patients in this province in the way they now are and in the disastrous way they could. We want to see high-quality health care continue. We want the doctors involved in it and negotiations with the doctors to end the impasse.
We want to protect the doctor-patient relationship as well as the accessibility and quality of health care to each and every Ontarian. The basis of that has to be an ongoing private and not public relationship between doctor and patient. That is the foundation of the entire medical care system and it always should be, no matter how the members opposite try to deny it, undermine it or ignore it. That is the foundation of health care in this province and that is what we want to see continue.
We do not want to see it deteriorate. We do not want to see world-class doctors potentially working six, seven, eight months a year because of ceilings. That is a very real possibility the way this government is going. We do not want to see confrontation. We do not want to see doctors who have always opted in and never extra billed before now deciding to pull out of the system.
I do not think the Minister of Health (Mr. Elston) or the Premier want to see it. Maybe the four horsemen want to see it, so the Premier can show how tough he is.
The governing party and its coalition partners really have to spend more time with the professionals of this province trying to address and resolve the issues before this legislation comes in. That is the main point the member for Cochrane South wanted to make.
Before the minister introduced this legislation, he should have gone into detailed negotiation. No matter how tough, no matter how much he is turned off by the OMA or any other group, he should keep at it. He should get into the issues on which he can agree, keep the doors open and continue with some of the other interests that we in this Legislature all have a common interest in resolving.
I want to allude briefly to some of the feelings of people in my riding and to a few comments from those in other parts of the province. I would like to point out to the Legislature and to the minister the viewpoint of Dr. Philip Simms of Haileybury, which is just north of my riding in the riding of Timiskaming. I suspect, and I do not say this in a critical way, that the member for Timiskaming (Mr. Ramsay) likely will not want to share this viewpoint of one of his constituents, so I feel I should. It is a copy of a letter addressed to the Premier:
"I am writing to you about the recent proposed legislation, Health Care Accessibility Act, introduced to the provincial Legislature, December 1985.
"I very strongly oppose this legislation. I feel it infringes on my rights as a practising medical professional. I am an opted-in physician of my own choice. However, it is important for me that I retain the right as a professional to determine the worth of my services. I feel it does allow me to retain some autonomy for myself and for my patients from the government.
"I am a family physician, general practitioner, who is working full-time at the grass-roots level, seeing patients from all walks of life, including the not so financially well-off, disabled, etc., to those who are financially more fortunate. I am not aware of one single case where a patient was deprived of needed medical care from an opted-out specialist."
We know there are some examples which have to be addressed. This physician in Haileybury does not know of a single solitary one.
"I refer patients to both opted-in and opted-out specialists. I challenge you and your NDP colleague, Mr. Rae, to cite any examples of this.
"What worries me with this legislation is another example of government intervention, for not only political gains but a supposedly perceived problem which really is not a problem at all.
"I am afraid that if our present system continues to be socialized that within the not-too-distant future, five, 10, perhaps 15 years down the road, we will find ourselves with a health care system like our neighbour, Quebec. In fact, I read that you are in favour of their type of system. You obviously have not looked at it closely nor have worked within that system. I have first-hand experience, as I work in a community which is close to the Quebec border, and I see quite a significant number of French-speaking, English-speaking and native Indian patients, from Quebec. They come over to Ontario because they can receive better health care. I find the Quebec regie overburdened with a huge bureaucracy, an underfunded, neglected hospital care system and a group of demoralized doctors. I would find it most unfortunate if our profession had to unionize to protect our professional and patient rights. However, this is a real possibility if this type of government intervention continues."
He goes on and relates another example:
"As another example, one just has to look at Great Britain where they have two health care systems, the public system which is there for the less well-off. I have first-hand experience working in that system during my training and the patients wait long periods for health care and the quality is less than ideal. Their second system is a private system, which is supported by the better-off, and naturally they get better health care.
"If our health system is allowed to evolve along the Quebec regie then the well-off members of our communities will find the health care they want with our large neighbour, the United States along our southern border.
"I would suggest that this legislation be dropped and leave well enough alone.
"I would suggest that you address the more important issues; such as underfunding of a number of large hospitals around the province, and a good example recently pointed out to the public is the Princess Margaret cancer hospital in Toronto."
That was Philip G. Simms, a doctor in Haileybury.
8:40 p.m.
To help the minister understand what is happening in North Bay, I wanted to read very briefly from an editorial about what the city doctors of North Bay think of the whole mess. On January 22, 1986, there was an article in the North Bay Nugget about what is happening here in Toronto. Little do they know some days. It says:
"Premier David Peterson laid down the law Tuesday for the Ontario Medical Association, saying his government has no intention of withdrawing a bill to end extra billing by doctors before the two sides meet to review the health care system."
It goes on with a few other things; then, talking about Dr. Myers, it says:
"Myers's letter said the government had refused the association's offer last fall to review the health care system -- including the billing question -- and instead proceeded with a `legislative hammer.'
"`In short, it was you, not we, who refused to negotiate,' said Dr. Myers, who added the association had provided assurances that `the financially disadvantaged would be exempt from any direct charges by physicians' while such a study was taking place."
That was not a bad compromise to this heavy-handed legislation. The association basically said: "Withdraw the bill, sit down and negotiate. During that period of negotiation, while we are trying to find the solutions that you, the government, we, the doctors, and the people of Ontario want and deserve, we will at least guarantee that nobody financially disadvantaged will have to pay any direct charges."
We all know the response of the Premier and the Minister of Health. It had to do with putting something in one's ear.
I want to quote a couple of little sections of an editorial by John R. Hunt, who lives in Cobalt. The member for Cochrane North (Mr. Fontaine) may know John Hunt; he is very active in the mining industry and writes in support of it. He will not always agree with the minister. He did not always agree with the member for Nipissing. However, he brings out a couple of good points.
Part of his editorial criticizes the doctors. He does not criticize the doctors for their position or their stance, but for doing such a lousy job of communications that some people in the province actually believe the crap and hogwash that is being perpetrated about them with Bill 94.
He talks about a group of men and women who deal with thousands of people every day and yet who have almost completely failed to win public support, or even public understanding. That is because they have had some measure of confidence and perhaps trust -- it appears it has been misplaced -- in the public, in the politicians, in the government and in the Liberal Party. They have concentrated on their medical practice, whereas they probably would be far better off today had they concentrated on how to negotiate with governments. He says:
"On the extra billing issue, the doctors are morally right. They don't want to be denied the freedom to opt out of OHIP and charge what they like.... I think the doctors are right in fighting against the erosion of their freedom. There's not much more argument for government price-fixing for medical services than there is for fixing other prices."
Editorially, that is what the North Bay Nugget thinks of the legislation; at least what it thought on January 22.
On January 20, there was an article in my local paper reported by Bill Radunsky. He is a fine reporter with the North Bay Nugget. He refers to himself as the Nugget medical reporter, but he also reports on a number of other issues in North Bay. This is his report of a meeting held by the local medical association:
"Ontario Medical Association plans to demonstrate to the provincial government that doctors are unhappy with proposed legislation banning extra billing are similar to those already adopted by the North Bay and District Medical Society.
"Society president Dr. Howard Eckler said he was pleased with the protest measures established by the OMA council on the weekend, which fall in line with local thinking.
"The idea is not to adversely affect patient care, since the doctors' battle is not with the public but with the government, he told the Nugget this morning. Dr. Eckler attended the OMA council meeting.
"The OMA is urging Ontario doctors to pull out of OHIP and extra bill for each service they perform. The amount charged above the set OHIP fee schedule is expected to be largely token.
"Opting out of OHIP was the tactic adopted by the North Bay society at its meeting last Wednesday, which was attended by 65 of the approximately 70 local members."
It is not just the president speaking; it is 65 out of 70, which appears to me to be a greater turnout than I have seen for any ratification vote of any union in Ontario. Perhaps I am wrong, but it sounds higher to me. It is certainly a higher percentage than we as politicians are able to attract to the polls to vote for or against us, whatever the case may be. It is pretty well unanimous.
"Most members are North Bay physicians, although there is a smattering of doctors from communities surrounding the city.
"When a doctor opts out, it means instead of OHIP paying the physician directly for medical services rendered, OHIP pays the patient, who in turn is responsible for paying the doctor.
"North Bay's decision to opt out in protest actually follows Timmins's lead. Timmins doctors had made the same decision a few days earlier."
The report continues:
"After last Wednesday's society meeting, Dr. Eckler said: `We felt that it (the legislation) was a heavy-handed kind of act with inappropriate fines.'
"He said while the name of the provincial bill is the Health Care Accessibility Act, nowhere does it address the business of accessibility.
"`It's a catch-phrase the government is going to be using. It's a lie they're perpetrating.' "The act prohibits extra billing and sets fines for failure to comply at as much as $10,000." That is what 65 of the 70 doctors in North Bay and area think of this minister, of this Premier and this government. They are liars.
The Acting Speaker (Mr. Morin): Order.
Mr. Harris: I am sorry, can I not read?
The Acting Speaker: Order.
Mr. Epp: On a point of order, Mr. Speaker: I believe the member has used unparliamentary language. I believe he should withdraw it.
Mr. Harris: I was reading from the outset.
The Acting Speaker: May I ask the member for Nipissing if he said the members of this House were liars?
Mr. Harris: Oh no, Mr. Speaker.
The Acting Speaker: Can I hear what you said?
Mr. Harris: Sure. I will be glad to go over it all. Let me go right back to the Nugget of Monday, January 20. Perhaps it is going to have to be put back into context because the minister appears to be --
The Acting Speaker: Order. Will you please answer my question.
8:50 p.m.
Mr. Harris: I did answer your question. I did not say that I said they were liars. I was quoting an article in the North Bay Nugget. It was Dr. Howard Eckler. If that is in order, Mr. Speaker, I will not go back over it; if it is not, I will.
Mr. Gillies: I think the member should go back over it.
Mr. Harris: Do you want me to go back over it, Mr. Speaker?
The Acting Speaker: Yes.
Mr. Harris: Or should I leave it and carry on?
Hon. Mr. Kerrio: The member should do what he will. We are listening.
Mr. Harris: I just want the House to know that even though I was challenged on my statement, the Speaker has ruled I was in order. It was a good ruling.
I will refer to the Legislature and to the minister a letter I received from Dr. F. James Brennan. It was addressed to the Premier. I have a note to myself to read this whole letter. That means I agree with the whole shooting match: "Dear Mr. Peterson:
"I think you should be aware of my feelings as I consider the implications of the proposed Health Care Accessibility Act, 1985.
"In the 10 years that I have been in practice in Ontario, following six years of medical school and eight years of post-graduate training, I have attempted to furnish to as many patients as I could handle the best medical care I was able to provide. Accessibility of patients to me by appointment has been limited only by the constraints of time -- it is possible to deal adequately with only a limited number of patients in a given period of time. Accessibility to me in medically urgent situations when I have been on call (an average of 100 hours per week, 52 weeks per year) has been absolutely unrestricted. No patient has ever complained that I have been unavailable when needed or that I was too highly paid for my services. Indeed, not only have I always accepted the OHIP rate for my services as payment in full, but also the terms of my appointment in the faculty of medicine, Queen's University, include a provision whereby all my professional income above a negotiated ceiling goes to the university. I am aware, of course, that the vast majority of my patients have no idea what I have been paid for looking after them, but I cannot recall one who has asked.
"I infer, therefore, that in terms of accessibility and fees charged, my patients have been satisfied with the service I have provided. You and your government state, however, that there is widespread dissatisfaction among the people of Ontario over the way in which doctors are paid and that excessive fees are hindering access to good medical care. If my patients truly support your position, then I feel betrayed and emotionally unrewarded for the services I have rendered.
"In my practice I attempt to establish a doctor-patient relationship based on mutual trust and confidence. If I am to believe that you are carrying out the wishes of my patients in order to remedy a fault in my practice of which no patient has complained to me, then obviously I have lost that trust and confidence. Without it my only rewards for looking after a sick patient are the fee I receive and the intellectual satisfaction of solving a medical problem; i.e., of treating a disease rather than a patient. This is not the climate in which I wish to practise medicine. I cannot believe that this is the climate in which the people of Ontario wish medicine to be practised.
"As concerned as I am about the above issue, as a citizen of a free society I attach much more importance to the effects of the proposed legislation on my personal freedom. Heretofore I have always felt free to choose whether or not to accept the OHIP benefit as payment for my services. If working within OHIP is like being in prison, being able to opt out and extra bill is like possessing a key to the prison door. Freedom is available to me and, therefore, I am free. Without it, I am a slave. I find particularly galling your public pronouncements to the effect that most doctors"
Mr. Morin-Strom: Mr. Speaker, on a point of order: Do we have a quorum?
The Acting Speaker ordered the bells rung.
8:59 p.m.
The Deputy Speaker: A quorum is present. The member for Nipissing.
Hon. Mr. Kerrio: Mr. Speaker, I do not see a quorum of Tories.
The Deputy Speaker: Order, member for Niagara Falls. The member for Nipissing has the floor.
Mr. Harris: I am delighted the member for Wentworth North (Mr. Ward), the parliamentary assistant to the Minister of Health, has joined us --
Hon. Mr. Elston: He has been here all along. We have been here together.
9 p.m.
Mr. Harris: The minister should not get that hurt look on his face. The minister has been here all along, but I am delighted the parliamentary assistant is here. Has he been here all along?
Mr. Pope: The whip is here too.
Mr. Harris: The member for Brampton (Mr. Callahan) is here, so we are ready to roll again. Before I was interrupted by the government's inability to keep a quorum in the Legislature --
Mr. Polsinelli: Mr. Speaker, on a point of order: Being a new member of this Legislature, I wonder whether it is appropriate to conduct the business of this House with 22 Liberal members and six opposition members present.
The Deputy Speaker: Yes, it is.
Mr. Gillies: Mr. Speaker, on a point of order: The honourable member is a new member, but anyone could tell it would take 22 Liberals to equal the six opposition members.
The Deputy Speaker: That is not a point of order.
Mr. Harris: I believe I was quoting from a letter from Dr. Brennan, whose views I want to share with the Legislature and associate myself with.
The Deputy Speaker: The member will be reading excerpts from the letter and not the whole letter.
Mr. Harris: Exactly. I would assure the Deputy Speaker that I will quote only those sections with which I wish to associate myself.
Mr. Pope: Answer the question from the member for Brampton.
Mr. Harris: Did the member for Brampton have a question?
Mr. Callahan: No. I will give the member a little bit of leverage, and then I will rise on a point of order.
Mr. Harris: Dr. Brennan says: "I have lost that trust and confidence. Without it, my only rewards for looking after a sick patient are the fee I receive and the intellectual satisfaction of solving a medical problem, i.e. of treating a disease rather than a patient. This is not the climate in which I wish to practise medicine. I cannot believe this is the climate in which the people of Ontario wish medicine to be practised.
"As concerned as I am about the above issue" -- I believe I was just around this point -- "as a citizen of a free society, I attach much more importance to the effects of the proposed legislation on my personal freedom. Heretofore, I have always felt free to choose whether or not to accept the OHIP benefit as payment for my services. If working within OHIP is like being in prison" -- and this is the point I was at -- "being able to opt out and extra bill is like possessing a key to the prison door. Freedom is available to me, and therefore I am free. Without it, I am a slave.
"I find particularly galling your public pronouncements to the effect that most doctors, because they do not opt out of OHIP, do not care about the abolition of opting out. Nothing could be farther from the truth. Do you really believe that any doctor, or any other responsible citizen of a free society for that matter, could be apathetic to legislation which imposes a form of slavery upon him?
"If you were to attempt to force everyone to work for the state, you would be faced with open rebellion. By imposing such legislation on a small and particularly defenceless segment of the population, you are doing something worse. This is a shameful and cowardly act.
"Within the limits imposed by the ethics of my profession, which are much more stringent than the limits imposed by the laws of the land, I will do everything in my power to prevent passage of this repugnant legislation. If I and those who agree with me fail, then the options available to me will be:" -- his first option, should the government be successful in ram-jamming this stuff down our throats -- "(1) to retire from the practice of medicine and find a different job if I wish to remain in Ontario where I was born and have lived 39 of my 42 years as a free citizen; (2) to move to a different province or, more likely, a different country if I wish to continue to practise medicine in an atmosphere of professional freedom; or" -- his next option appears to be the one the minister, the member for Brampton, the Premier and members of the third party seem to feel will happen; they feel doctors will not leave the province or the country and will not go into some other profession; they seem to feel doctors will exercise this option -- "(3) to continue to practise medicine in Ontario, providing care to citizens who I feel have betrayed and abandoned me and who, therefore, have no right to expect me to regard them as anything other than organisms harbouring diseases which I am required to treat by a master whose primary concerns about medical care are that everyone gets the same and that it does not cost very much.
"The third option is the one that offers the path of least resistance and is probably the one which will be taken by most doctors. Regardless of which path each individual doctor chooses, however, medical care in Ontario will be in a much sorrier state than it is now. This will be your responsibility and your legacy to the people of Ontario."
For some reason or other the Premier, the minister, the parliamentary assistant and the member for Brampton appear to support that view. He points out in the letter that his curriculum vitae is enclosed, but I want to skip that part so I am not quoting the whole letter verbatim. I would like to flip right over that sentence and go to --
Mr. Pope: I want to hear that sentence.
Mr. Harris: Which one? "My curriculum vitae is enclosed"?
Mr. Pope: Yes.
Mr. Harris: No. I would like to skip that. If members want to hear it, they can wait. There are other honourable members who will be speaking. They may be quoting from sections of this letter themselves.
"I am not a political activist and this letter represents my first attempt to exert any direct influence on those who make the laws at any level of government. My financial interest in the proposed legislation is much less than that of the average Ontario doctor, as noted above. I am otherwise just an average medical practitioner striving to maintain a high standard of practice against increasingly formidable odds, and an average citizen of Ontario who is appalled that a small group of citizens, whose value to society is acknowledged to be high, is in danger of having its economic freedom forcibly removed for the `good of society.'"
Mr. Pope: Just a second. Do you know the minister is now signing letters of apology over there; apologies to doctors?
Mr. Harris: "A society which will tolerate this is not a good society" --
Mr. Pope: Are you listening to me or not?
Mr. Harris: The minister is not signing letters of apology to the doctors.
Mr. Pope: I thought he was.
Mr. Harris: He is signing fund-raising letters.
Mr. Pope: Fund-raising letters?
Mr. Ruprecht: I would not drink that water, Mike.
Mr. Harris: Who said that? Was it the member for Parkdale who suggested I not drink the water?
The letter ends, "A society which will tolerate this is not a `good' society and does not deserve to be free.
"Yours sincerely, F. James Brennan, MD."
9:10 p.m.
I would also like to put on the record some of the concerns of Dr. Earl Myers, president of the Ontario Medical Association. They are concerns he expressed about the Health Care Accessibility Act, which we say is the health care inaccessibility act.
The minister has indicated that the viewpoints of Dr. Myers are not unbiased comments. They are not unbiased; they are biased. They are representative of the doctors' position. They sound similar to some of the statements we heard on Tuesday evening from the member for Humber (Mr. Henderson).
"The executive committee of the Ontario Medical Association met this morning in an emergency session to discuss the implications and ramifications of the legislation introduced yesterday by Ontario Minister of Health Murray Elston.
"It is the conclusion of the executive that the so-called Health Care Accessibility Act is not only an excessive and oppressive use of government power, but also a slur on a profession which has an unparalleled record of public service to the people of this province."
Mr. Callahan: Who wrote that? It is very nasty.
Mr. Harris: This is a statement by Dr. Earl Myers, president of the OMA.
"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 patient, a right held by every other professional in our society. That in itself is an act of outright discrimination against all physicians, whether opted in or opted out.
"The Ontario Medical Association has told Premier David Peterson on numerous occasions that access by patients to required medical treatment is being denied every day throughout the system; for example, inadequate facilities for the aged both in institutions and in the community, lack of accessibility to timely cardiac and other surgery, and lack of accessibility to adequate mental health services to a large portion of the community. We have pleaded with him to address the true problems of accessibility in co-operation with us. Only such a co-operative effort will work. However, we have been unsuccessful in our efforts.
"Accessibility is not being denied -- nor has it ever been denied -- by physicians because of their billing practices.
"What the government of Ontario is doing with this legislation is perpetrating a lie" -- in other words, he is calling the government and the Liberal Party liars -- "while at the same time deceiving the population of this province as to the true reasons why legitimate access is being denied patients for inordinate periods of time.
"The legislation is an act of violence against the medical profession of this province. The financial penalties included in the legislation are so far out of proportion to the offence as to be ludicrous. It is also a farce when it states that physicians may opt out but not charge above the OHIP level. Such an empty concession makes a travesty of professional freedom. It is meaningless and a further perpetuation of the lie.
"Finally, our overriding concern is that if this legislation passes into law, an angry and alienated profession may be less willing to provide its traditional accessibility to the people of Ontario because of this government's heavy-handed actions.
"In the next few days the OMA will be informing its more than 17,000 members of how this legislation will affect them as supposedly self-governing professionals. Once that has been accomplished, then we will address what strategies are open to us as a profession to fight this act of unjustifiable intervention and conscription."
That was back on Friday, December 20. It was quite a nice Christmas present for the members of the OMA, and since that time they have not changed their minds. They have repeatedly asked the Premier and the minister to sit down and negotiate, to withdraw this bill while they worked out the problems together. The Premier, the minister, the parliamentary assistant --
Mr. Pope: The member for Humber agrees.
Mr. Harris: No, the member for Humber does not. The rest of them do, though, including the member for Sault Ste. Marie (Mr. Morin-Strom), who, if he is wondering when he is going to have an opportunity to speak, will have an opportunity to speak this evening and give his views on this legislation. He may also want to comment on where greenhouses should be located in the province but we will leave that up to him to decide.
I have pointed out that the vast majority of the North Bay and District Medical Society has voted to opt out of the Ontario health insurance plan because of its concerns with the Liberal legislation. There are special problems in northern Ontario that the legislation does not address, and I have touched on them several times throughout my remarks. Worse than that, it does not attempt to address them. There is already a shortage of doctors and specialists and this legislation will worsen this problem.
I have not mentioned a letter to the editor from Dr. Alan Aylett, which also appeared in the North Bay Nugget.
Mr. Callahan: Mr. Speaker, on a point of order: I bring to your attention standing order 19(d)4, which refers to a member who is reading "unnecessarily from verbatim reports of the legislative debates or any other document."
I would not want to indicate that I was playing favourites when I rose on a point of order with reference to the member for Cochrane South. Surely these matters could be tabled if he considers them of such importance, recognizing that if there are only five Conservative members in the House it cannot be a matter of great importance to them.
The Deputy Speaker: May I discuss with the member for Brampton his point of order? That was not an appropriate point of order because I had already mentioned this to the member for Nipissing and he assured the House he was going to read only excerpts and not whole letters.
Mr. Callahan: With all due respect, Mr. Speaker, that last letter was read from "Dear whoever" to "Yours sincerely."
The Deputy Speaker: That is not a point of order.
Mr. Harris: This is a new point.
The Deputy Speaker: No. Order. The member for Nipissing will please resume his seat. I have ruled on that point of order. The member for Cochrane South is ahead of you on a new point of order.
Mr. Pope: On a point of order, Mr. Speaker: I happen to agree with the member for Brampton, but in any event I do not see a quorum.
The Deputy Speaker ordered the bells rung.
9:14 p.m.
Mr. Polsinelli: On a point of order, Mr. Speaker: I was wondering whether you could indicate whether it is appropriate for the member for Cochrane South, as a Conservative member of this House, to call for a quorum when there are only five Tories in attendance.
The Deputy Speaker: That is not a proper point of order.
Mr. Harris: Before I was interrupted by the government's inability for a second time this evening to maintain a quorum in the Legislature, I was referring to a couple of excerpts from a letter to the editor of the North Bay Nugget by Dr. Alan Eckler. He stated:
"Over the next few weeks we will all witness a conflict during which the Ontario government will attempt to make medical doctors civil servants. For those of you with a reasonable intellect, you will surely believe that the issue of extra billing is a socialist red herring and vote-getter."
Those were some of the statements made by Dr. Eckler. I do not want to go into his whole letter. He quotes from a rather long dissertation in one of Ayn Rand's books, Atlas Shrugs. If some of the members have not read that book, I can bring it in and read it into the record.
Mr. Pope: Is the member wondering why a doctor does not believe in the government any more?
The Deputy Speaker: Order.
Mr. Harris: He quoted some excerpts as well.
Mr. Gillies: I have a letter here.
The Deputy Speaker: Order. The member for Nipissing has the floor, please.
Ms. E. J. Smith: Ayn Rand believes in survival of the fittest. That fits into the member's philosophy pretty well.
Mr. Harris: Let me go on with some of the other statements from doctors in my riding.
Hon. Mr. Ruprecht: On a point of order, Mr. Speaker: Will you kindly instruct the member to make sure he does not read unparliamentary language into the record?
The Deputy Speaker: That is not a point of order.
Mr. Harris: Mr. Speaker, that is a fair point. We may want to show the proper decorum and respect for this Legislature by addressing the member for Parkdale (Mr. Ruprecht) properly when he comes in. Is that the junior minister?
I would also point out to the member for Parkdale that if some people in the province think some of the statements by the Liberal minister and Premier are bald-faced lies, it is only fair for me to read those into the record as they have stated them.
Other doctors go on to say: "The very real issue cannot be extra billing, because very few doctors in Ontario extra bill. This is one way of recognizing special qualifications, special talents and expertise, and the right of professionals to make contractual arrangements with their clients. No one forces us to go to doctors who extra bill and, with virtually no exception, those doctors who do extra bill make special arrangements or forgo the extra billing, depending on their patients' personal financial circumstances."
That is the way medicine is practised in North Bay and that was the way medicine was practiced in North Bay before this legislation was introduced. Now there are problems in the system.
One other says: "This legislation is another example of Liberal confrontation as opposed to negotiation. The medical community has indicated a willingness to negotiate, but the Liberal government and its leader have stated repeatedly, `There is no room for negotiations.'"
9:30 p.m.
Before I finish with my first file this evening, I want to associate myself with some, though not all, of the remarks of the member for Humber. I thought he gave a very thoughtful and excellent speech in this Legislature on Tuesday evening. I do not intend to rehash it. Before I go into some of the points on which I disagree with the member for Humber, I will associate myself with just a few of his points that said it perhaps better than I could, and struck a strong cord with me.
He stated: "2. I do not wish to defend so-called extra billing. Excellence in health service rests on the wish of men and women to be their brothers' and sisters' keepers. It is an important milestone in human civilization that access to first-rate medical care has become a right, not a privilege. Extra billing, as presently practised, may threaten equality and accessibility, although, to be fair, physicians' services are already more equal and more accessible than virtually any other area of professional endeavour."
They are far more accessible than the Premier and the minister have been to the Ontario Medical Association.
Mr. Mancini: You know that is not true, Mike.
Mr. Harris: The member for Essex South has accused me of uttering an untruth and I ask that he withdraw it.
The Deputy Speaker: I also heard it. Does the member for Essex South wish to withdraw it?
Mr. Mancini: Mr. Speaker, I am not sure what I am supposed to withdraw. Could you please help me?
The Deputy Speaker: The member for Essex South said, "You know that is not true, Mike."
Mr. Mancini: That is true.
The Deputy Speaker: Would you mind withdrawing the allegation of not being true. Is that correct?
Mr. Mancini: The whip says she needs me here tonight, so I will withdraw it.
The Deputy Speaker: Thank you.
Mr. Harris: I would not want to be unparliamentary, so I will not question the whip's comment of the necessity for the member to be here. I will pass right over that. Thank you very much, Mr. Speaker, and I thank the member for Essex South.
Ms. E. J. Smith: I am standing here with my daggers.
Mr. Harris: Is there a surgical fee? Is the member opted in?
If I could get back to the subject, the member for Humber made another points. He stated: "3. The billing practices of physicians are imperfect; so are the billing practices of lawyers, dentists, architects, psychologists and practitioners of many or most other areas of professional endeavour. Still, improvements in the billing practices of physicians are required, and we should try to achieve that without compromising excellence of service.
"4. Medical practice rests on an historical tradition, thousands of years old, of physicians dealing directly with patients at arm's length from politicians and government. The proposed Health Care Accessibility Act, in my view, substantially alters that historical tradition. I fear it does so with too little real dialogue, consultation or negotiation with physicians representing the mainstream of seasoned clinical endeavour.
"5. Rarely in the history of democracy, in my view, has any legitimate profession been so curtailed by the state in its freedom to negotiate a simple, contractual agreement with a client. Insurers, even government insurers, rarely try to dictate the value of goods or services. Rather, they spell out the amount of coverage."
I agreed with almost all the member's viewpoints, but I will point out the few differences I had. I do not want to read them all. By leaving some out, I do not want the members to think I do not agree with those points. However, I want to highlight a few.
He stated: "7. The Health Care Accessibility Act, with its $10,000 fines and other severe measures, will have the effect, perhaps not fully intended, of placing physicians and other clinical services under the rather direct control of politicians and government, in effect conscripting them to the state.
"8. Experiments in other jurisdictions whereby physicians have in effect become employees of the state have not fostered first-rate clinical care. When all the doctors in a particular society are controlled and accountable to the state, they are not able to do their best work. Do we want our children to get medical treatment from a state monopoly?" This is the viewpoint of the member for Humber. He makes another point a little later:
"11. Perhaps physicians, like the judiciary, should retain an arm's-length relationship with politicians and government. That may be especially so because physicians, unlike the judiciary, serve not the state but individuals and families. Physicians should, accordingly, retain a large measure of accountability to the individuals and families they serve, with suitable safeguards provided by the state. An arrangement whereby all the physicians in a society report to government is ill-advised." That is another viewpoint of the only physician in the Liberal caucus and one whom the Liberal caucus insists on ignoring.
"13. These considerations have not...been adequately addressed. The Health Care Accessibility Act proposes to alter fundamentally a system that has stood the test of time for thousands of years and that has fostered development of a health care system which is, though imperfect, perhaps the finest and fairest in the world. Compare health care with legal services, where justice is sometimes a luxury affordable to the rich." The member for Cochrane South, who is a lawyer, might want to hear this part.
The Deputy Speaker: Order. The member for Cochrane South is not in his seat.
Mr. Harris: "Of course, improvements...may be required, but the Health Care Accessibility Act in its present form is excessive and ill-advised.
"14. The Ontario Medical Association states that it has long taken the position that there are many problems in the health care system needing to be addressed. It wishes to negotiate about all of them. Extra billing can be on the list. Perhaps we could respond to its willingness and negotiate in earnest with Ontario's physicians, respecting their traditions and expertise and treating physicians as partners in the delivery of health care services.
"Physicians have real concerns and real fears about the health care of Ontarians. We should try harder to appreciate their views. It is not good enough in a democracy to say to a group of respected and highly trained professionals, or...to any group: `No. We will negotiate only the means by which we propose to achieve your compliance with our view. Other matters will have to wait. Your view is not legitimate.'"
The member pointed out, quite rightly: "Such a stance by any name is not negotiation. A labour union would not tolerate being treated in an analogous way. How could a government say, `We want to negotiate, but our position is non-negotiable?'"
9:40 p.m.
Those remarks speak for themselves. While many heard them, very few of those in a position to do something about them listened.
I am quoting the member for Humber, and I want to quote one part towards the end of his comments to the Premier and the minister. He says:
"Let us address this problem of extra billing because it is a problem sometimes, in some places and in some fields. Let us address that problem decisively and with vigour, but let us not wreck our health care system in the process."
That is what we have been trying to say since last fall. That is what the Ontario Medical Association has been trying to say. Unfortunately, those who can do something about it have not been listening.
Mr. Epp: The member should remember the dispute in 1982 when they said the same thing about him and his colleagues.
The Deputy Speaker: Order.
Mr. Harris: The member for Humber was not even elected in 1982.
He goes on to say: "Let us fine-tune a world-class system and make it better. Medical treatment is too important, too life-or-death, too critical for solutions that reject the mainstream of seasoned professional input."
That probably comes to the crux of the problem. Unfortunately, in the Liberal government, in the Premier, in the Premier's office, in the four horsemen behind the Premier's office, in the Minister of Health and his parliamentary assistant and in that caucus, we do not have seasoned professional politicians to negotiate with seasoned professional doctors.
Mr. Sargent: Who said that?
Mr. Harris: I said that. I do not want to associate the member for Humber with that. Those were remarks from the member for Nipissing. However, the member for Humber does state:
"Sometimes the state can say to the people: `Wait a minute. Have you really thought about this? Have you really thought it through?' Sometimes the people can say to the state: `Wait a minute. That is not the kind of state we want to have. We want to have an open...flexible, democratic state where problems are resolved by negotiation, reason, maybe compromise, and certainly mutual understanding and respect.'"
How disappointing it must be for the member for Humber to try to address his colleagues in caucus.
Mr. D. W. Smith: He is still a good Liberal.
Mr. Harris: He is an excellent Liberal. He is the only good Liberal sitting in this Legislature. I want to conclude the first file I have in front of me. This is the last document in that file.
Mr. Andrewes: Did the member bring the other file with him?
Mr. Harris: I have other files. If I am provoked, I will be forced to delve into the other files.
Experience in the recent past indicates that approximately 12 per cent of all doctors in Ontario extra bill, and the members of that group do not do it all the time but rather 25 per cent of the time. This means that many, if not most, of the physicians who apply this extra charge for their services apply it only in some cases and not in others. In fact, in the vast majority of cases the opted-out doctor does not extra bill his or her patients. Recent patterns would indicate that only three to four per cent of all Ontarians in the course of a year are extra billed.
That is the problem we are trying to solve with this massive sledgehammer. That is the little tack that has to be tacked in to close the loopholes on our health care system with which this government proposes to come in with a 20-inch spike and a 40-pound sledgehammer.
With that background and those figures in mind, it is helpful, in order to put this issue totally in context, to take a brief look at the recent legislative history as it relates to extra billing.
The Canada Health Act was passed by the federal Parliament more than a year ago, and it provided the government of Canada with the authority to withhold one dollar of transfer payments to the provinces for every dollar that was extra billed above and beyond Ontario health insurance plan fees by any physician in Ontario and in --
Mr. Gillies: On a point of order, Mr. Speaker: It pains me to bring to your attention that for the third time this evening the government has failed to provide the House with a quorum.
The Acting Speaker ordered the bells rung.
9:51 p.m.
The Acting Speaker: A quorum is present. The member for Nipissing.
Mr. Harris: I am delighted to see some of my colleagues have been won over by my opening introductory remarks; as I get into the main body of my speech, perhaps I will be able to win more over.
Before I was interrupted for the third time this evening because the government was unable to have a quorum in this Legislature, I believe I was talking about some of the history of what led us to this situation. I was at the part about the Canada Health Act being passed by the federal Parliament more than a year ago.
Mr. Mancini: The member should make sure he tells the truth.
Mr. Haggerty: Would the member mind repeating what he said at 8 p.m.?
The Acting Speaker: Order. The member for Nipissing has the floor.
Mr. Harris: Thank you, Mr. Speaker.
It provided the government of Canada with the authority to withhold one dollar of transfer payments to the provinces for every dollar that was extra billed above and beyond the OHIP fees by any physician in Ontario and in the other provinces. In the case of Ontario, this amounts to approximately $4.4 million per month, or $50 million per year, out of a total OHIP budget of roughly $2.2 billion.
This federal legislation, known as the Canada Health Act, also allows for these withheld funds to be released to the province in question if, within three years, they outlaw the practice of extra billing by doctors.
Why three years? I suggest that in their wisdom the federal legislators of the day concluded it might take up to three years of negotiations. In fact, it probably will take up to three years of negotiations provided the government is serious about negotiations. However, we have had a government for the past seven or eight months -- it is amazing how much chaos can be caused in that period of time -- that is not serious about negotiating.
That brings us to the situation we find ourselves in today at Queen's Park. The Liberals, prodded -- or encouraged or enjoined; from whatever viewpoint one wishes to look at it -- by their friends in the NDP, have introduced legislation to ban extra billing; and they have done so, I might add, without any manner of consultation with the medical profession or with other groups who may be affected.
They are moving to do away with this practice in a public opinion environment which, in the most simple of terms, is very favourably disposed to such a policy; but that, too, is misleading.
In a poll taken by the government in the fall of 1984, when the Progressive Conservative Party was still in office -- a poll released by the Liberals in recent months -- people across the province were asked if there were any aspects of health care in Ontario that needed to be changed, fixed or given special attention.
While some 41 per cent of people said there were no changes they would make, seven per cent said they would ban extra billing and/or opting out. The other 52 per cent named things such as more hospital beds and equipment, better preventive medicine and more extensive pollution control.
What this indicates, beyond a generally high degree of satisfaction with the provincial health care system, is that a relatively small number of people will, off the top of their heads as it were, name extra billing as the most urgent problem facing our health care system.
On the other hand, if and when people are asked if extra billing should be outlawed, the vast majority respond off the top of their head in that quick response to the phone call: "Yes. I do not want to pay more."
If I can offer an analogy that perhaps puts public opinion on this issue in context, if we were to ask the people of Ontario to name the most serious problem facing Ontario, probably not very many would mention the high price of milk. On the other hand, if one asked a few minutes later how many people in Ontario would favour lower milk prices, probably a large number -- I would assume the majority -- would ask themselves, "What would I prefer?" A large number would surely respond that they would prefer to pay less.
What I am defending as I speak here tonight is the integrity of our health care system. I am defending the partnership of our health care system. I am defending the partnership that has developed over the years among the government, the people, the doctors, the hospitals and the other health care professions. I suggest it is a partnership that has worked well, and this explains why a large percentage of people, when asked, cannot name a single thing they would change in Ontario's health care system. The vast majority are more than satisfied with the services they receive and with the manner
Mr. Wildman: How about more chronic care beds? How about nurse practitioners? I can think of a lot of them.
Mr. Harris: I do not know whether the honourable member has spoken on this issue --
Mr. Wildman: Yes, I have.
Mr. Harris: If he has, I hope he has pointed out some of them. What I am stating are the indisputable facts that were evident at the time the poll was taken and released to the people of Ontario.
The fundamental reason our party is not in support of this legislation introduced by the Liberals to deal with extra billing is that we do not believe the partnership that has been built so carefully should be put in jeopardy so that the Liberals and the New Democratic Party can deal with a situation that is not a top concern. It is not uppermost in the minds of most people; it affects only a very small percentage.
10 p.m.
The Liberals say that banning extra billing will get us back the $50 million per year that will be withheld by the federal government if the practice is allowed to continue. I have pointed out to members that there is a three-year period to negotiate, not to sledgehammer that mechanism through. I suggest that if the government does sledgehammer the mechanism through, when it comes time to negotiate it will find that the mood of the OMA, the doctors and the physicians will cost the government far more than $50 million and probably in excess of three or four times that amount.
The interesting aspect of this was pointed out very well by the member for Humber when he said that is not the issue. The issue is not whether the feds or the provinces have the money or whether the feds or the provinces pay for it. The public does not care about that. If the taxes do not go to the provinces, they go to the federal government. They do not understand all these transfer payments and everything that goes on. What they understand is the total tax bill.
The member for Humber was trying to point out not only to the House but also to his own colleagues that the issue of extra billing could be resolved through negotiation. It was not a $50-million issue; it was a people issue. People are concerned about their relationship with their doctor.
The Liberals say this bill will improve access to the health care system. What they do not say is that when a similar system was imposed on Quebec more than 200 of the top specialists left the province immediately. They continue to leave the province.
I read a letter earlier from a doctor who practises on the border of Ontario and Quebec. He talked about the number of patients he sees from Quebec because they get better care in Ontario. Where will they go now? Where will those specialists go now?
The Liberals say that under their new system doctors with more experience will get a higher fee from OHIP. What they do not say is that the more experienced and better doctors who get the higher fees will probably see fewer patients, ultimately reducing accessibility to the smaller number of those top specialists who are left.
The Liberals say their policy is motivated by the Canada Health Act. What they do not say is that they were unwilling or unable to sit down with the doctors to see if there was a way to deal with the legitimate question of accessibility without alienating the doctors and without upsetting the balance, the consensus and the partnership that has allowed us to build the finest health care system in the world.
Surely, the preferred approach would have been to have a full, open, complete review of the physicians' billing practices.
Mr. Polsinelli: We offered to negotiate and they refused. They turned us down and would not come to the bargaining table.
Mr. Harris: The member for Humber does not share that view.
Of the three per cent to four per cent of patients who are extra billed in a year, a small number, undoubtedly, have an affordability problem. The OMA has taken some steps to ensure that opted -- in services are available, but they have not been enough. I stated earlier that if the government withdraws this bill, the association has guaranteed that it will sit down and negotiate extra billing and opting out. It will also guarantee that during the period of negotiations no disadvantaged person -- anybody who cannot afford the fees -- will be extra billed.
Why would the government not do that? Why, I ask those members who have opted for what they felt was an easy way out?
We would have applied some imagination and conciliation to this issue so that, together with the medical profession, we could solve the accessibility problem where it exists without creating a half dozen new problems in the process.
Yes, we believe a solution has to be found in a situation which has arisen in which large numbers of doctors in certain specialties, such as anaesthetists and obstetricians, and in certain areas of the province, were extra billing.
It may indeed be time to consider something such as anaesthesia a basic service provided by the hospital, which it is in many respects. It may be one approach. It may be time to negotiate directly with some of the specialists in Ontario.
However, to solve these problems is it necessary to introduce legislation which says to a doctor that even if he does not want to accept a dime from OHIP, even if his patients want to pay his entire fee on their own, a doctor who practises like that, outside the system, and charges more than OHIP fees, will now be subject to being brought up before a provincial court judge as a criminal and fined up to $10,000?
I come back to the point of view with which I started: simplistic and expedient solutions to problems can be popular by their very nature; but at what cost? To stop most of the better-off from being extra billed, do we need to adopt the British health care system?
The Progressive Conservative Party is opposed to this legislation dealing with extra billing. It might be easier and it might in the short term be more popular for us to support it. However, what we do support, and what I want firmly on the record, is accessibility to quality health care at the lowest possible cost to the taxpayers. Particularly, we support the kind of balance, the stability and, as I said earlier, the partnership, of which the medical profession is an important part, that have allowed us together to provide health care second to none.
I want to see that kind of quality care provided in the future. That is why we are going to work hard, not on behalf of the doctors but on behalf of the people, to ensure that the Liberals and the New Democratic Party do not simply achieve an ideological goal in a simplistic fashion and, in that process, damage the world's best health care system, and in all likelihood substantially increase the cost to boot.
We will be looking for a balanced solution that respects the rights of doctors as independent professionals, seeks to build on the partnership of the past and, above all else, ensures the provision of high-quality, universally accessible and affordable health care for the people of Ontario.
I point out to the Legislature that there is no prize for being tough just to show you are tough. It is better to protect and improve what is already an excellent system. Every health care system needs improvement, by definition. It needs more co-operation, co-ordination, funding, beds and specialists in the north, better mental health programs, more home care for seniors, homemakers' services and better cancer treatment facilities. It does not need confrontation or angry doctors. It does not need fighting job action by doctors or bitterness across Ontario.
10:10 p.m.
I would like to conclude my remarks by requesting the Minister of Health, the Premier and their advisers, the four horsemen as we refer to them, to rethink their position. I ask them to listen to what the people of Ontario are saying, to what the physicians are saying; to take this opportunity now to withdraw this legislation and to accept the hand being offered by the OMA. I ask them to sit down in a spirit of co-operation and immediately get back to the bargaining table to negotiate the solutions we all want for improving access to all physicians and all the services our health care professionals have to offer.
If they were to do this now, I believe the OMA would indeed sit down with them. My party would applaud the government for recognizing the serious error of the method by which it is planning to proceed, in which it is proceeding, and instead getting back on the course set by my party for the past number of years with respect to health care in Ontario.
Since political advantage seems to be the only motivation I can think of for their plan to proceed this way, I believe in all seriousness it would be to their political advantage as well. I mention it only because the political objective seems to be their number one objective these days.
I offer this suggestion and my personal and political support for such a move. I would applaud that action because I believe the delivery and maintenance of the excellent health care system we have in Ontario is far beyond what should be a partisan issue. I implore this of the minister, when he comes back, and the Premier, whom I have not seen throughout any of this debate. I may be in error. The Speaker may point out that -- oh, there is the minister -- that the Premier did in fact sit through more than 30 seconds of this debate, but I have not seen him here.
The minister and the parliamentary assistant are there, and I ask that they take that message back to the Premier. I thank you for the opportunity for me to express my opinions tonight.
Mr. Offer: On a point of order, Mr. Speaker: I think it is important that we all realize that a model parliament held at the University of Toronto has just elected a majority Liberal government for the first time in its history.
The Acting Speaker: That is not a point of order.
Mr. Harris: On a point of order, Mr. Speaker: I would like to point out to the Legislature that, unfortunately for that model parliament, they were all members of the school of architecture and they probably will not be there next year.
The Acting Speaker: That is not a point of order either. Are there any other members wishing to participate in the debate?
Mr. Andrewes: I really had not anticipated a lull in the debate that would allow me to give my comments. Nevertheless, I am willing to carry on from my colleague the member for Nipissing (Mr. Harris) following the rather stimulating comments he was making on Bill 94.
The member for Nipissing is offering me his notes as he leaves the House. I would not want to deny him the privilege of making his comments here, nor would I wish to repeat any of those comments. A certain degree of originality is required and expected from each member. I know Mr. Speaker will be watching carefully and diligently to determine whether the brief comments I might make in opposition to Bill 94 are in order and not a repetition of what was said earlier.
Although this bill has a long and detailed title -- I wish I could lay my hands on the document I was going to refer to.
Mr. Charlton: Mr. Speaker, on a point of privilege: Perhaps you could direct the member to make up his mind whether he is going to make remarks on the bill instead of standing there saying he might make remarks.
Mr. Speaker: That is far from being a point of privilege.
Mr. Andrewes: I extend my apologies to the member for Hamilton Mountain. I appreciate the opportunity he gave me to search for my copy of Bill 94.
Mr. D. S. Cooke: Has the member found it?
Mr. Andrewes: Not yet. I do intend to make some comments.
The title of Bill 94 is An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act. The bill carries a lengthy and detailed title, but it has been given a shorter title, which in the view of the Liberal Party is perhaps a more politically attractive title, the Health Care Accessibility Act.
The bill deals with the fees that doctors, dentists and other professionals may charge for the services they render. It is not detailed or lengthy. It is very specific and refers to various and sundry professions in the medical field, particularly those represented by three associations, the Ontario Medical Association in respect of physicians, the Ontario Dental Association in respect of dentists and the Ontario Association of Optometrists in respect of optometrists.
10:20 p.m.
The issue I wish to begin with in discussing this bill is the term "accessibility" in the short title, Health Care Accessibility Act. I am sure the minister chose the term very carefully, when he made his opening statement in the House on December 19, when he introduced this piece of draconian legislation. Here is the statement by the Minister of Health, a former Queen's counsel, to the Legislature re introduction of the Health Care Accessibility Act, 1985. In the third paragraph on the first page, the minister begins by saying:
"The principle of accessibility to needed health care without any regard for an individual's financial circumstances or ability to pay is in jeopardy in this province. I believe the principle of accessibility must be preserved and protected, and our government is determined to see that the people of Ontario have that protection."
That is a very noble objective; I cannot quarrel with that objective. I ask the minister and his colleagues, who have been hesitant to speak in this debate, with the exception of the member for Humber, the member for Brampton and maybe one or two others, to demonstrate to me where the principle of accessibility is in jeopardy in this province. Perhaps one of the Liberal members would be bold enough to stand up in this House and demonstrate for us in clear and certain terms where the principle of accessibility is in jeopardy.
Mr. Speaker: Order. It is the tradition of this House and of many other parliaments that a member may ask the member who has the floor whether he can ask a question. If the person speaking allows a question, the member may ask it.
Hon. Mr. Elston: May I ask a question of the member for Lincoln?
Mr. Speaker: Does the member for Lincoln agree or not?
Mr. Andrewes: I have been in this House for only about five years. I am a relative newcomer. I came to the House in 1981, the same time as the honourable member who wishes to ask me the question. However, I believe the routine is that when one sits on this side of the House, one asks the questions and those on the other side of the House answer them. In the words of the government House leader, "We propose and you oppose." Is that not the standard procedure?
Mr. Speaker: I understand your answer is no.
Mr. Andrewes: I would be delighted to have a question asked of me by the member for Huron-Bruce (Mr. Elston).
Hon. Mr. Elston: My question is whether the honourable member would yield the floor so we could wind up this debate. I will be pleased to answer his several questions about the difficulty of accessibility. Will he yield the floor and allow us to put those examples on the floor of this House?
Mr. Andrewes: I would remind the member that it was Thursday, December 19, when the Minister of Health introduced this draconian piece of legislation. At that time he was given ample opportunity to demonstrate to the people of this province and to this Legislature the grounds on which he could make this bold and brazen statement that the principle of accessibility to needed health care, without any regard for an individual's financial circumstances or ability to pay, is in jeopardy in this province.
I have read this document very carefully. I have read the companion notes that go along with it and I have read other details. In fact, I have read the minister's briefing book --
Hon. Mr. Elston: On a point of order, Mr. Speaker: The member was asked whether he would allow the question; he said he would allow it. I put the question; he has not yet answered.
I request an answer from the member for Lincoln so we can proceed to demonstrate the various points that he has requested I provide to this House.
Mr. Speaker: I hardly think that is a point of order. However, the member allowed a question at some time or other. I am sure he will get to the response.
Mr. Andrewes: I find this rather an interesting debate, because there is within the standing orders ample opportunity for members to register their discontent with the responses to questions. I assume the member for Huron-Bruce is registering his discontent with the answer I gave to his question, so perhaps we should have a late show. Is that permissible, Mr. Speaker?
Mr. Speaker: It is not permissible.
Mr. Andrewes: Then perhaps I will carry on and in the fullness of time I will give the honourable minister my response to his question, because it is right and proper that he should ask me that question.
Nevertheless, I will carry on. I hope he is here tomorrow so that in the brief comments I might make after routine proceedings we may get into the substance of my answer so it can go on the record and the minister can provide me with suitable verification for this bold and brazen statement which he made on December 19 when he introduced this legislation.
The minister in his opening statement is alleging that within the health care system today there are problems with accessibility. If he could verify that and demonstrate it, perhaps I would want to say something different about this bill. I am going to demonstrate for him, through the context of this debate, many instances in which there are indeed problems with accessibility in the health care system, but they do not relate to medical practitioners opting out; they do not relate to dentists extra billing; they do not relate to those other professions that are cited in this legislation.
On motion by Mr. Andrewes, the debate was adjourned.
The House adjourned at 10:30 p.m.