Hansard Transcript 1993-Jul-26 vol. a | Legislative Assembly of Ontario

Mr Murray J. Elston (Bruce): I rise today to let the folks in Ontario know about the 1993 Bruce county hosting of the International Plowing Match. That match is being held on September 21 through the end of the 25th, and all the people around the Walkerton area, in particular the Johnston family, and Bruce county and Brant township are looking forward to entertaining more people than have ever been entertained before at a match of this sort.

As everyone knows, in 1976 Bruce hosted what has been, I think, the most successful match ever in the province, and this year it looks like Jim MacKay, the president of the Bruce County Plowmen's Association, and Jack Cumming, who is the chairman of this year's international event in Bruce, have planned a very wonderful event indeed.

Along with the regular sorts of events of course there will be lots of activity, the professional plowing contest held for the real farming personnel of this province and internationally, and also for those of us who plow on these very special occasions.

I extend again to all members of the Legislative Assembly an invitation to plow with us in Bruce county, in Brant township, my home township. I know David Thomson, the reeve, and the council will be willing to entertain all of us as we try to get things straight, at least for once. We're all invited to the international plowing match September 21 through 25 in Brant township, at Walkerton, Ontario.

FOREST INDUSTRY

Mr Leo Jordan (Lanark-Renfrew): The effects of the NDP's forestry policies are devastating the industry's operations in Ontario, both large and small.

Due to the opposition pressure in this House and from the Ontario Lumber Manufacturers' Association, the Minister of Natural Resources will now delay the 100% increase on stumpage fees. Although this was perhaps the correct decision, I think it was the only option, given the fact that the minister was prepared to charge an additional $11 tax per cord on employers who only make $8 profit per cord.

This planned tax grab shows just how desperate and out of touch this government really is. The minister's decision last Thursday to delay the stumpage fee increase until October 1, 1993, was a clear admission that his policies were not well researched.

However, I think the minister has still missed the point. Small independent contractors and small mills cannot afford to have their rates on parity with large integrated mills. Any new increase in stumpage fees will result in major job losses throughout Ontario. The only logical course of action is to scrap the plan of raising stumpage fees altogether.

Thank you, Mr Speaker, and the plowing match that the member for Bruce just described will be in Renfrew county in 1994.

GO TRANSIT

Mr Larry O'Connor (Durham-York): I have received a lot of phone calls and letters over the past couple of weeks about the decision by GO Transit to cut its peak-hour Uxbridge-Elizabeth Street terminal bus service.

In fact, I was at a meeting on Monday, July 19, held by the planning committee of the Uxbridge township council that took deputations from residents and the council, and GO Transit officials were present at the meeting to explain how their decisions were based on subsidy rates and ridership. That's fine for them, but that doesn't deal with the rage of my constituents from Uxbridge who have no public transportation alternative to get to Toronto.

I attended another meeting Thursday night that was held in Stouffville. Both Uxbridge and Stouffville residents were present because both groups of commuters feel threatened. The Stouffville residents are protesting the time of the GO trains as being inconvenient for people who have flexible work arrangements or child care commitments. The earliest train departs from Union Station at 5:20 pm.

I want the members of the Legislature to realize how GO Transit decisions in dealing with the expenditure control plan have impacted on my constituents. Many of these residents will be moving away from these areas after investigating GO services that have been stolen from them.

My constituents not only want to help GO Transit, but they've put together a riding profile, they've put together alternatives, and I hope the GO Transit officials will take these into serious consideration.

COMPENSATION FOR AIDS PATIENTS

Mrs Barbara Sullivan (Halton Centre): Once again, I speak to the House on the question of a compensation package for those who have contracted the HIV virus through a tainted blood supply. Once again, I bring to the attention of the Legislature that the Minister of Health is stalling in this important area of public policy, where she has made a personal commitment.

Time is running out for haemophiliacs and blood transfusion recipients who were infected with the AIDS virus. The government has admitted its culpability in the matter, and while other governments, such as Nova Scotia, have acted in a forward-looking manner, this government has stalled.

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Hemophilia Ontario has maintained all along that the compensation requested is not a matter of benevolence or welfare; it is a recompense for grievous injury. The fallback of the social assistance system isn't adequate to address this injury. A compensation package is required.

Last Thursday, Hemophilia Ontario was told that there would be a meeting, at which time the government would present its proposal for a package. Instead of that meeting, they received a call saying there would be no meeting to present that proposal. Further, they learned from the media that Health Minister Grier had told reporters that no compensation package would be announced until September.

Many of the HIV-positive hemophiliacs and transfusion recipients are nearing the end of their lives. Many of those who are dying have dependent families, many of whom have been financially ruined by AIDS. One or two of the people who were infected by the AIDS virus die every week. Hemophilia Ontario rightly asks if this government is expecting a settlement by attrition. We certainly hope not.

ALIENATED PARENTS ASSOCIATION

Mr Gary Carr (Oakville South): A group of people in my riding have formed an association of parents whose children have been alienated from them by their ex-partners. They are the Alienated Parents Association. They have no significant relationship with their children, and this in some cases has lasted for years. In fact, their children have been encouraged to see them as unfit and mentally unbalanced. Their children have no experience to draw on, are young and vulnerable, and are being used as a pawn in a deadly game.

Members of the new association feel it's time that the public is made aware of the existence of these deprived parents and just how large a segment of the population they are, and that their story is told. They know their children deserve the love and support of both parental figures; otherwise, their ability to form future relationships and their mental wellbeing may be at risk. They are good and loving parents, and there's a great need to educate the public, the school system and the legal system in order to stop this injustice.

A member in my riding, Mary Anne Morrison, at 338-7175, is available if you need the assistance of the Alienated Parents Association or if you can assist with this worthwhile association.

RURAL ECONOMIC DEVELOPMENT

Mr Randy R. Hope (Chatham-Kent): I want to take a moment to call to the attention of this House the fact that the third party is truly out of touch with rural Ontario. It's clearly indicated in the Toronto Sun, where I find out they're asking a Liberal to be a Tory, which is very close.

Last week the member from Don Mills stood in his place and actually suggested that putting manufacturing in rural settings was "out of whack." As a member of a rural riding, I must once again take exception to the comments of the members opposite.

Rural Ontario is made up of much more than feed stores, as the member from Don Mills suggested. In my riding, farmers have gathered together to bring an ethanol production facility to Kent county, a facility that will not only create much-needed jobs but will also create a market for their corn, a market needed since the federal cousins of the member opposite started signing the free trade agreement.

Farmers are studying the feasibility of production of tomato paste in a shut-down facility in Chatham. Farmers and rural communities in Ontario are progressive in seeing the future, and their future means finding creative manufacturing bases to produce their crops in Ontario.

When it comes to telecommunications, rural Ontario is once again a leader. Smart Talk Network started in Kent county with eight employees. Two years later, the company has 165 employees and expects to hire another 200 employees over the next two years in the city of Chatham. This company from rural Ontario supplies long-distance service to Ontario, Quebec and British Columbia and will soon be expanding to Manitoba.

Feed stores are not the answer for rural Ontario; productivity is.

KIDNEY DIALYSIS

Mr James J. Bradley (St Catharines): The patients who are involved with the kidney dialysis unit at Hotel Dieu Hospital in St Catharines are eagerly awaiting the announcement of the Minister of Health or at least the funding to be forthcoming so that this project may be undertaken.

Members of the Legislature may be aware that this issue has been raised on numerous occasions over the last couple of years. I had the opportunity, with some of my Niagara colleagues, to attend a press conference at which it was announced that the funding for the renovation of the haemodialysis unit in St Catharines at the Hotel Dieu Hospital would be forthcoming.

I have been in contact with a patient who is a spokesperson for the patients who take advantage of the facilities that are there, and he has informed me that as of last Friday the funding had not yet reached the Hotel Dieu Hospital.

I call upon the Minister of Health today to flow the funds, which were promised appropriately several months ago, in order that the very crowded conditions that those of us from the Niagara Peninsula witnessed on a tour that all the members took of the facility can be overcome, and that the facilities provided for the patients will be such that they will be served in an appropriate manner and that the staff which have been so dedicated in providing this service under adverse conditions will indeed be in a better position to assist those patients.

TAXATION

Mr Noble Villeneuve (S-D-G & East Grenville): For many years, it has been a matter of fact that because of taxes Ontario is a much more attractive place to live and to do business than the province of Quebec. By far the main reason for that was our comparative tax advantage and less restrictive government regulatory environment.

Beginning with the former Liberal administration, and continued by this government, Ontario is becoming a much less attractive place in which to live and do business. Last week, the Ottawa Citizen reported that a married taxpayer earning $40,000 a year saw his or her income tax advantage drop from over $2,000 in 1983 to a tax disadvantage of almost $100. Half of the drop occurred under the Liberal administration and continues in free fall with this government.

The NDP tries to describe the current situation as a revenue shortfall. Let me suggest to them that what many residents of eastern Ontario see when they look east: The revenue shortfall they see is their own personal revenue. They see the NDP claim of cost-cutting, but they also see no change in patronage appointments or in favoured NDP political projects.

Mr Gordon Mills (Durham East): You should talk.

The Speaker (Hon David Warner): Order, the member for Durham East.

Mr Villeneuve: They see NDP claims of cutting cabinet size, but they see more cabinet ministers. They see the NDP announce program cuts and then they see confusion in the social contract legislation. They see that the deficit continues to rise. They also see Ontario doing nothing when Ontario businesses are shut out of Quebec and when Ontario commercial vehicles are harassed on Quebec highways.

This is a terrible situation and it must change soon.

PICKERING AIRPORT LAND

Mr Jim Wiseman (Durham West): I rise today as I'm gravely concerned about plans that the federal government has for thousands of acres of land in the northern part of my riding; to be more specific, the Pickering airport lands.

I have been involved with this community since the early 1970s when I joined a group called People or Planes. Our fight was somewhat successful. We were, however, unable to prevent the massive expropriation of 18,600 acres of land, which drove thousands of people from their homes, many of whom had roots that extended back many generations. This assault caused a complete change in the complexion of the community almost overnight.

Since that time, other families have moved into these homes. This long-term tenancy has transformed the desolate post-expropriation area into a community once again. Many of these families have raised their children in these homes. They've developed their own roots and a strong attachment to this community. Now their fate is uncertain once again. Nearly half of the 350 leases have been reduced to 30-day renewals.

But why now? Why sell this land when the province, the region of Durham and the town of Pickering are all in the middle of a number of critical planning processes?

The feds have been announcing that they would be selling this land for almost a decade, but this time I believe they're really going to do it. My concern is that this land has great potential, not only now but for future generations. It makes up a substantial portion of the green space of the GTA. How can anyone begin to put a price on its value?

I have extended an offer to the federal government to join in the extensive planning processes that are taking place in this area.

It has been 21 years and I'm still fighting for this land. This is a fight I will not give up until something positive results from it.

SPECIAL REPORT, OMBUDSMAN

The Speaker (Hon David Warner): I beg to inform the House that I have today laid upon the table a special report of the Ombudsman, Ontario, on the cases of Ms R., Ms M. and the Ontario Human Rights Commission.

VISITORS

The Speaker (Hon David Warner): I would invite you to welcome the Ombudsman, who is seated in the Speaker's gallery. Welcome.

I would also invite all members to welcome to our gallery this afternoon, seated in the Speaker's gallery, Mr Harry Greenway, member of Parliament, the House of Commons, London, England. He is joined by his wife, Carol, and son, Mark. Please join me in welcoming them to our assembly.

Interjections.

The Speaker: Order. It is now time for oral questions and the honourable member for Renfrew North.

Mr Sean G. Conway (Renfrew North): The member for Durham East perhaps has a question he might wish to put to our visitor.

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ORAL QUESTIONS

TRANSPORTATION

Mr Sean G. Conway (Renfrew North): I have a question to the Premier and it concerns his social contract. The Premier and his government, as part of their social contract, appear to have committed their government to a new policy which could very well see, within a short period of time, hundreds of thousands of young people as young as four years of age being bused to school, not as they have traditionally been bused in almost all cases in the yellow school buses but, rather, as part of the social contract arrangement, these young people in urban environments could very well find themselves being bused to school in municipal buses which do not of course have many of the same special safety provisions that are built into the yellow school buses.

My question to the Premier, in the absence of the Treasurer and the Minister of Transportation, is, can he confirm that his government is prepared to contemplate a new school busing policy which would see tens of thousands of young Ontarians, many of them as young as four years of age, being transported to school, not in the very safety-conscious yellow school buses but rather on municipal buses?

Hon Bob Rae (Premier): I think I'll refer this question to the Minister of Education.

Hon David S. Cooke (Minister of Education and Training): I can tell the member that in terms of busing policy for the schools in the province, we are obviously first and foremost concerned about the safety of students in the province. Secondly, we're also concerned and interested in any and every way that taxpayers' money can be saved.

The member will know that there are some areas of the province, at least at the secondary level, where the public transit system is used by the secondary students. With respect to his specific question about school boards at the elementary level looking at using municipal transit, I'm not aware of specific cases. If he wants to raise them, I would be glad to look at them. Certainly, our ministry and this government would look at all of these issues in terms of saving money, but first and foremost, safety of students.

Mr Conway: There can be no doubt that the primary concern here for all members must be safety, and the safety of young children, many of whom are four and five years of age. That's why I was astonished to read in the appendix to the municipal-provincial agreement which the government of Bob Rae has signed that the provincial government seems to be clearly committing the province to a process that is going to see tens of thousands of very young students in urban Ontario being shifted off yellow school buses and on to municipal buses. It's very clear from this appendix.

Hon Mr Rae: No, it is not clear from the appendix.

Mr Conway: Well, the Premier wouldn't answer my question. I don't even think they know what's in their own social contract. Every day is a day of discovery, particularly as we race down to fail-safe day, August 1.

The Highway Traffic Act is replete with regulations that attach to yellow school buses, which must meet certain very stringent safety conditions that are nowhere attached, as I understand it, to municipal buses. Will the government give an assurance to parents and students that the safety of their children and those students will in no way be jeopardized by the social contract agreements that the Rae government has already signed?

Hon Mr Cooke: This government of course would give the assurance that children's safety is not going to be put at risk, but I think we have all learned to understand that questions from the member -- making statements that tens of thousands of students are going to be put at risk because of his interpretation of a particular segment of the social contract legislation is absolute nonsense at its worst, and fearmongering for students and parents, which is unfortunate, but we've become used to that kind of fearmongering from this member.

Mr Conway: The accord that the Rae government has signed in the municipal sector commits the provincial government to an action plan to get on with integration in this connection, to transfer these responsibilities from school bus operators to municipal transit authorities in urban areas.

I can understand how the government might want to discount what I have to say, but the Ontario Motor Coach Association has today issued a release highlighting its concern around the safety question. Is the Minister of Education and Training aware of the concerns on the safety count that the motor coach association has raised?

Is the Minister of Education, the member for Windsor-Riverside, aware that in his own city, in recent times, Ernst and Young have concluded a study which indicates that when one compares the cost of running the current system of school busing versus the municipal system, the municipal system, to which the Rae government wants to move, is substantially higher in cost? Is the minister, the member from Windsor, aware of that study as well?

Hon Mr Cooke: Well, I certainly will take a look at the release the member is referring to. I haven't seen it today. We'll take a look at it. But I can assure the member that there is no grand plan to move all the students in this province from the school buses, which he says are safer than municipal buses. There is no grand plan to do this. It's an exaggeration, inappropriate at the least, for the member to make that kind of an accusation today.

The Speaker (Hon David Warner): New question.

Mr Conway: I think it's time that the Rae government read its own social contract, because it's quite clear that the Minister of Education and the Premier do not know what's in this appendix, which clearly commits this government to this very significant new process.

The Speaker: And your second question?

ONTARIO HYDRO CONTRACT

Mr Sean G. Conway (Renfrew North): A second question is to my friend the minister responsible for Hydro. I want to say to my friend the minister responsible for Hydro that since the interesting discussion of some six or eight days ago, when members of the Legislature and Hydro ratepayers were painfully made aware of the polling that was going on over at Hydro, the $1.3 million worth of money that Hydro does not have that's been spent to ascertain the love interests of ratepayers across the province, since that time, my mail has been busy.

I have received an envelope, a brown envelope; my favourite kind of envelope, a brown envelope. But the envelope contained some very interesting new data. I'm just wondering whether or not my friend the minister responsible for Hydro is aware of the following: that in October 1991 -- it seems to be part of the earlier poll referred to, the so-called Goldfarb poll, which was $1.3 million worth of data collection. But it appears there's more. It appears that a Mr Greg White of Market Vision Research was given, in October 1991, on an untendered basis, an opportunity to do $1.3 million worth of poll analysis for Hydro.

Is the minister aware that Market Vision Research has been given a $1.3-million contract, on an untendered basis, to develop a communication strategy to assist Hydro in making its customers consume less in the coming years?

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Hon Bud Wildman (Minister of Environment and Energy): Mr Speaker, as you will know, in the business of polling, it is quite normal for firms, particularly the largest firm in Ontario that is responsible for serving the ratepayers of commercial, residential and industrial across Ontario, to have included in polls some lifestyle questions to determine what kind of people are providing which kinds of answers with regard to the electricity-consuming public.

Having said that, we will agree that there may in fact have been on occasion in the past in the history of Ontario Hydro some excesses, and it is for that very reason that we brought Mr Strong in to restructure the corporation so we don't have the continuation of these kinds of wasteful practices in the future.

Mr Conway: Supplementary to my friend the minister, this untendered contract appears to have been let during the pontificate of one Marc Eliesen. It is to cover a period of October 1991 to October 1993, the first of three parts valued at $1.3 million, and Mr Greg White of Market Vision Research, who is expected, for his $53,000-a-month retainer, to commit himself at least half-time to this project; he must commit himself, according to the terms of this contract, to at least half-time. He is to develop a strategic plan to assist Hydro to develop a marketing strategy to develop -- get this -- "among other things, the psychological precursors that will be necessary to reduce hydro-electricity consumption in Ontario in the coming years."

Is the minister not concerned? Is he not, like the rest of us, just fed up with on the one hand hearing that Hydro is broke, up to its neck in red ink, so broke that it of course can't contribute anything to the social contract, yet it continues to give up, on an untendered basis, multimillion-dollar contracts to develop psychological precursors to help us all conserve? Is the minister aware of this boondoggle and will he take steps to stop it forthwith?

Hon Mr Wildman: I suppose the member was speaking ex cathedra when he was talking about a pontificate.

I would say that the member knows that the current decisions that are being taken to restructure Ontario Hydro are being taken at a time when we now have a chairperson and a board having the responsibility to ensure that we do indeed cut the use of Ontario Hydro's product, electricity, in the province and that we ensure that the operations of Ontario Hydro are done in the most effective and most economic ways possible.

I do not have the information about the particular contract, which I understand from the member was let in 1991. I will look into it and report back to the House.

Mr Conway: I appreciate that, because I've got to tell you, the people of Ontario, at least the people I represent, are fed up with this kind of crap. Week after week they face tax increases --

The Speaker (Hon David Warner): Would the honourable member choose better --

Mr Conway: -- and job losses; they're told that we must all share the pain to get out of this misery. They want to believe, but every week -- last week we were told $1.3 million was spent by Hydro to do field research to find out about things like their love life. Now we're told that another firm has been hired at $1.3 million for just the first part, October 1991 to October 1993, to analyse that field research and to provide strategic advice to develop the psychological precursors that will help us all reduce electricity consumption. I mean, the people have had it to their teeth.

This contract is in three parts. It can be terminated, according to the information I have, with fairly short notice. The first phase of it, $1.3 million, is concluded in October 1993, but it's very clear that a second and third phase, committing millions more, undoubtedly, is contemplated.

The Speaker: Could the member place a question, please.

Mr Conway: Will the minister give me and, more importantly, the Hydro ratepayers this assurance: that he will inquire into this and ensure that at the end of this phase one $1.3-million boondoggle, this kind of insane spending at Hydro will stop?

Hon Mr Wildman: I've already indicated to the member that I will inquire into this matter and I will respond to the House. I also agree with the member that the kind of insane spending we've seen at Ontario Hydro which, under his government, completed Darlington at a cost of $14 billion and has put the whole province into debt, must end. That's why we're doing it, and it's unfortunate that his government didn't do it itself.

HEALTH CARDS

Mr Jim Wilson (Simcoe West): I have a question for the Minister of Health. Minister, you'll know that on several occasions I have risen in this House and brought to your attention the numerous wounds that continue to plague Ontario's health card system.

Recently, I was contacted by a doctor who told me that he was aware that OHIP, in early 1992, sent 400 health cards to one address in Ontario. Last week, I contacted your OHIP officials in Kingston to make them aware of what this doctor had told me. I ask you, given that you have never been able to give me an exact dollar figure on the extent of fraud in the health card system, have you at least been able to determine whether or not 400 health cards were mailed to one individual at one address?

Hon Ruth Grier (Minister of Health): I'm shocked at that accusation. If the member in fact wrote to my office, I have not received any indication from the member. I would really hope that he would provide me with the name of the doctor and the address, and I can assure the House that I will look into that and make sure that that, if it happened, never happens again.

Mr Jim Wilson: As I indicated in my question to the minister, I did phone and speak to your OHIP officials last week in Kingston. I'm shocked that you're unable to manage the system, that you're unable to check out these allegations to discover whether or not 400 health cards had been mailed to one individual. I hope you'll get back and report to this House immediately, because that could spell millions of dollars of fraud to the health card system.

My supplementary refers to Saturday's Montreal Gazette, in which it was reported that health officials in Quebec have launched an investigation to determine whether members of the Akwesasne native reserve are eligible for health care benefits in Quebec.

As you know, this reserve borders Quebec, New York and Ontario, and the Quebec government is concerned that some residents of Akwesasne could be American citizens who are registered under Quebec's health plan; in fact, as many as 900 residents could be American citizens who are illegally registered in either Quebec or Ontario. A Quebec medicare board investigator was quoted as saying it is possible that some might be registered with both Quebec and Ontario.

Minister, are you carrying out a similar investigation to that which has been launched in Quebec and, if not, why not?

Hon Mrs Grier: Let me first of all make it clear that the majority of residents of Akwesasne are permanent residents of the province of Ontario and therefore are entitled to be covered by the Ontario health insurance plan. In those cases where there may be some questions as to their eligibility, then I can assure the member that, yes, an investigation is being done, and because of that, I really have no further comment to make.

Mr Jim Wilson: In my final supplementary, I want to point out to the minister that last Thursday's Toronto Sun reported that your ministry's bureaucrats have decided to change the health card system and bring in a new system featuring photo ID.

It's encouraging to see that at long last, at least someone in government has realized that the system that was brought in by the Liberals is completely flawed and needs to be overhauled. But what is not encouraging is that the decision to go forward with photo ID was apparently made in mid-June, yet your cabinet may not be approving the new photo ID system till at least the end of August.

You know I've raised this particular issue on seven different occasions in the House. Your own studies show a potential fraud of some $10 million per week in this province. Your foot-dragging could be costing the taxpayers of Ontario millions of precious health care dollars. I ask you, why aren't you proceeding immediately with the new photo ID system?

Hon Mrs Grier: First of all, the member has raised very exaggerated figures with respect to misuse of OHIP cards in the past. I have acknowledged that there is in fact misuse, and for that reason have instructed officials within the ministry to begin to examine an alternative to the current health card.

But when the member says a decision was made in June and the issue won't be before cabinet until August, I would remind him that this is a cabinet government, and if cabinet has not yet dealt with the issue, then no decision has been made. We are examining a number of ways of improving the health card system. A photo ID is certainly one that I want to take a very careful look at, but no final decision has yet been made.

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PRODUCE-YOUR-OWN BEER AND WINE

Mr Gary Carr (Oakville South): I don't know if the Premier knows what this is: It's an empty. It's what some people in Ontario use to fill at the you-brews in the stores across this province.

Unfortunately, this is as empty as the budget promise to create jobs in your introduction on page 1 of the budget. This weekend your tax grab in the spring budget will cost the you-brews jobs. This weekend your 26-cent-a-litre tax will go on the you-brews.

My question is this: Do you have any idea how many you-brews will close as a result of the tax grab that was introduced in the spring budget?

Hon Bob Rae (Premier): Mr Speaker, I'm just getting a late communiqué here that will help the Premier through a difficult moment.

This tax was brought in to create a sense of balance in the overall industry. The member will of course appreciate that to have one segment of the industry untaxed and to have other sectors of the industry paying a level of tax creates an unfairness. That's a fundamental reality of the situation we face.

With the expansion of the number of brew-onpremises and other places, obviously it was a feeling of many, including many in the industry, I would say to the honourable member, that some steps had to be taken to provide for a degree of fairness. I would say to the honourable member that the fact is that the tax on this kind of beer as opposed to other kinds of beer still gives a tax advantage to the people you mentioned.

Mr Carr: The problem is that in your budget this spring you said you were going to put people back to work. The Brew on Premise Association of Ontario says that your 26-cent-a-litre tax will kill 40% of the businesses; that 40% of the businesses will close as a direct result of this tax in your spring budget. And why? All so your Treasurer, Floyd, can get $5 million in new taxes; that is all the result will be.

Is it worth putting 40% of the industry out, closing, losing jobs? Is it worth losing 40% of an industry just so you can get $5 million in new tax revenue?

Hon Mr Rae: First of all, I would say to the honourable member that I certainly appreciate the fact that he comes armed with numbers and statistics provided by the group the Brew on Premise Association of Ontario. I would say to him that the assumption behind the numbers I think is something one would want to at least look at. I certainly wouldn't want to leap to the conclusion that the member is correct in the assertion that the tax will have the impact that is being described.

I would say to the honourable member that we have to look at a number of factors. First of all, we have to look at the relative fairness of a tax as it affects the entire brewing industry. We have to look at the entire wine and beer industry and look at all of those together. We have to recognize that the very efficient, effective and increasingly well-known and now world-exported wine industry in the province pays a tax. They pay a share of revenues to the province. Others pay a share of revenue to the province. Of course, when a tax has not been imposed in the past, when there are new taxes imposed, people don't initially take too kindly to it.

I think the lesson of experience would be that one should not overreact to what is, it seems to me, done in the interests of trying to create a sense of fairness in the industry and also recognize that, as I say, even with the tax that was contained in the Treasurer's budget, we're not looking at a huge imposition. We're looking at an imposition which is still going to be substantially less than would be the case, and than is the case, in the rest of the industry, and substantially less, for example, than we're charging the wineries.

Mr Carr: I'm sure the people who are in that industry will be very reassured by that, the people who will be losing their jobs. The problem is that small business has been the backbone in this province for many years. You-brews were one of the few growing businesses here in the province of Ontario.

There aren't many pleasures left in Bob Rae's Ontario, and you couldn't leave well enough alone. You have no regard for the jobs that are going to be lost. You don't even know how many jobs are going to be lost; you couldn't even give us an indication here today. There's no regard for small businesses. My question to the Premier is this: For the sake of the people who work in the you-brew industry, will you cancel the tax so that August 1 does not become last call for this industry in the province of Ontario?

Hon Mr Rae: I would say to the honourable member -- and I appreciate these very helpful notes provided by the taxation policy branch at the Ministry of Finance, and I express my appreciation publicly to it -- that a case of 24 at a regular beer store is now going for $26.40 and that a case of 24 at a you-brew, after the tax increase, will now be the grand total of $15.85, which means that August 1, 1993, it costs you 60% of the cost of regular beer. There's still a substantial consumer saving if that's what consumers choose to do, to produce their own. There's still a substantial saving there if that's what people choose to do, but it means that there's --

Interjections.

The Speaker (Hon David Warner): Order.

Hon Mr Rae: The member's quite right. There's no longer going to be a completely free ride and the cost will go up from being about 52% of the cost of a case of 24 to about 60% of the cost of 24, still a substantial saving to the consumer, if that's what the consumer chooses to do, but a guarantee of fairness across the board as it relates to the industry. I think we have an obligation to do that rather than simply parrot the numbers and arguments that are made by those who have an interest in seeing those arguments presented.

CHARITABLE GAMING

Mr Murray J. Elston (Bruce): I'd like to ask the Minister of Consumer and Commercial Relations if she would confirm, as all of the people who read the Hamilton Spectator, as I do, already know, that there are roving casinos that are available for play in the Hamilton-Wentworth area up to seven days a week at 10 different locations. I would like to know, on the very day that we begin our casino bill, whether or not she sees any need to continue with her casino bill, bearing in mind that people are operating these roving casinos for the benefit of local charities in several cities around the province.

Hon Marilyn Churley (Minister of Consumer and Commercial Relations): When I introduced the new Gaming Services Act last year, we introduced some new guidelines and regulations around charitable Monte Carlo nights. This was after consultation with many of the over 50,000 charities out there which raise money for their charities and churches through these kinds of events. We came up with some new guidelines.

It's quite true that there are still some wrinkles to be ironed out in terms of the huge growth in that charitable industry, and we're working on that. But these kinds of roving casinos he's talking about are not in fact full-blown casinos. They do not involve video lottery terminals, for instance. They are table games primarily. We are working with the industry to iron out some of the problems, but it in no way is the same thing as the kind of casino we're going to be building in Windsor.

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Mr Elston: I think that's precisely the point. The minister and the government have maintained that these casinos are to raise money particularly for public purposes. Already we know that charities are using the casino nights in various of our communities to do the fund-raising they need to do good local work. The wrinkles that this minister has pointed out need to be removed are the wrinkles that don't give the government of Ontario the major take on all the work that's done by volunteers around the province.

I want the minister to tell us today that she is not going to proceed with this casino legislation and put out of business the charitable casino operations which all our communities are sponsoring, put out of business the racing employees around the province; in fact, put everybody out of business but the government of this province so that it can take the money and do with it what the New Democrats want to do for their own political partisan purposes.

Hon Ms Churley: Once again, the member of the opposition is taking this whole thing out of perspective. The whole gaming industry in Ontario is a $4-billion industry at this time. That includes horse racing. That includes charitable gaming in church halls and for charities. That includes the lotteries. This is one pilot project we're talking about in Windsor. In fact, with the Windsor charities, we made a commitment that we would not hold bingos in the casino, in that most of the charities in Windsor hold bingos. We made that commitment. So this has to be kept in perspective.

Charitable gaming has blossomed considerably within the past couple of years, partly because of what we have done as a government to make it more accessible and easier for them to compete in the marketplace.

FREEDOM OF INFORMATION

Mr Charles Harnick (Willowdale): My question is to the Attorney General. Are you aware that the Freedom of Information and Protection of Privacy Act can be used by incarcerated criminals to obtain information from crown files?

Hon Marion Boyd (Attorney General): The act is intended for the use of any citizen who is attempting to gain the information to which he or she is entitled as a citizen.

Mr Harnick: The answer surprises me. The fact is that convicted criminals can gain access to crown prosecutors' files. They can gain access to the names and addresses of informants and of victims of crime. When the process comes to the crown attorney two or three or five years later, that crown attorney may not be there any longer. He or she may have moved on, or after prosecuting thousands of other cases, may not have any recollection of this particular case. How are you permitting this to go on, and go on in a way that is not protecting victims of crime?

Hon Mrs Boyd: Under the act, the ministry to which a request is directed must look at the file that's concerned. There has to be an assessment that is made as to the kind of information that is going to be released, to protect individuals who are named in those files. That happens in every kind of file that's looked at under freedom of information.

It may well be that the particular crown attorney has moved ahead, but there are supervising crown attorneys who would then do the task. I would suggest to the member, given his experience with knowing what legal case files are like, that it is very important for him to understand that the protection of privacy is just as much a part of this act as the freedom of information, and that the protection of privacy of those who might be harmed in these instances can be protected by the ministry. Obviously there are appeals to that, but that is in fact what does happen.

MENTAL HEALTH REFORM

Mr Peter North (Elgin): My question is for the Minister of Health. Over the past nine months there has been a considerable amount of concern in my riding, the riding of Elgin, and some of the other ridings that are around us such as Norfolk, Chatham-Kent and Essex-Kent, and I think across the province as a whole, as to the downsizing of psychiatric hospitals in Ontario. I am aware of the lengthy consultations which have been carried out by your ministry staff with regard to this matter. Madam Minister, could you inform the House today of the results of those consultations?

Hon Ruth Grier (Minister of Health): There have certainly been consultations and there has been a base budget review that was undertaken last year. Recommendations contained in that report on the St Thomas-London psychiatric hospital are still under consideration, so I can't give the member a definitive answer today, but I can assure him that those recommendations will be considered within the context of all mental health services in the region and the provincial mental health reform initiative.

Mr North: Madam Minister, you mentioned the word "consider." I hope that the people in the ministry and yourself will consider very strongly that Elgin county and the surrounding areas have not fared well in terms of economics during the recession. We have had great difficulties in keeping the unemployment numbers from increasing dramatically. The real numbers, I think, are somewhere in the 22% range. For us, that's very, very difficult.

There have been, as you know, a lot of rumours that either London or St Thomas or both, or something, is going to happen in the area. We have employment numbers around 800 at the St Thomas Psychiatric Hospital, so at this point it would probably, aside from the Ford plant, be considered our largest employer. I ask you very directly, Minister, on behalf of my constituents, will the St Thomas Psychiatric Hospital be closing, yes or no?

Hon Mrs Grier: I suspected, in my answer to the member's first question, that he might be thinking of just a definitive yes or no. I regret that I'm unable to give him a yes or no answer at this point.

But I am aware, let me assure him, of the important role this hospital plays in the region which he so ably represents. Let me assure him and his constituents that any future decisions about the hospital will be made in consultation with not only senior management at the hospital, but with all the people who work there, and will comply with the terms set out in the collective agreement which the ministry has and will be consistent with the restructuring of hospital services and the policies that cover those.

WATER QUALITY

Mr James J. Bradley (St Catharines): I have a question for the Minister of Environment and Energy. The Minister of Environment will recall that in the winter of 1987, after several months of extremely difficult negotiations and after Ontario stood alone to hold out against a very weak agreement, finally a good agreement was signed for the cleanup of the Niagara River. The Niagara River, he would recognize, flows into Lake Ontario, which is the source of drinking water and recreational water for millions of people from Ontario and from New York State.

Now, even today, high levels of PCBs, dioxins and other hazardous chemicals are continuing to show up in the flesh of mussels exposed to the Niagara River. I ask the Minister of Environment if we can tell the House whether he is satisfied with the degree of progress which has been forthcoming in fulfilling the agreement between the four parties, and if not, what specific action he is taking to ensure a speedup in the cleanup of the Niagara River.

Hon Bud Wildman (Minister of Environment and Energy): I'm sorry, I didn't hear the first part of the member's question. I just received a note regarding the question his colleague posed earlier to the effect that Ontario Hydro has cancelled the contract to which the member referred.

The member raises a very important question. I know that he is personally very interested and concerned about it, and I know that as Minister of the Environment he played a very important role in raising the concerns and taking action to clean up the Niagara River.

He will know that there has been some improvement. He asked me if I'm satisfied. No, I'm not satisfied until we have a clean bill of health for the Niagara River, but the member will know that largely due to the work of the ministry and the other officials on both sides of the river, Ontario industries and municipalities show a 95% reduction in persistent toxic chemicals known to be a problem in the river. We are not satisfied, but we are making some progress.

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Mr Bradley: The minister will know that American authorities have put forward a program which is designed to clean up, specifically, the dump sites which are the main source of pollution for the Niagara River. In fact Ontario and Canada have consistently had a better record than others in dealing with those issues in terms of the Niagara River.

In light of the fact that Dr Ian Brindle, a chemist at Brock University, a past chairman of the remedial action committee on the Canadian side governing the Niagara River, has said that the US plans are "a whitewash job" and "a bunch of rubbish," will the Minister of Environment and Energy undertake to endeavour to get a meeting immediately with the commissioner of the Department of Environmental Conservation of New York state and authorities of the US federal government under the Environmental Protection Agency to insist, on behalf of the people of Ontario and ultimately the people of Canada, that the United States take far more drastic action to clean up those dump sites and that it do it in an expeditious fashion?

Hon Mr Wildman: The member is correct in his comments that the monitoring studies by the Ministry of Environment and Energy in Ontario show that persistent toxic contaminants continue to enter the Niagara River, mostly from sources on the American side of the river.

The member also knows that the COA agreement expired at the end of March 1991 and was extended on an interim basis to the end of March 1993. On this side of the river, we must deal with the problem of the fact there is some concern between the provincial government and the federal authorities as to how we should properly share the cost of fulfilling the requirements.

It is very important if we enter into international agreements with the United States authorities, the federal and state authorities on the American side, that the federal government in Canada ensure that that government is making a proper contribution to the cost of the remedial action required on the Ontario side of the river.

We will be meeting later next month in August with the new federal minister and his officials to try to ensure there is a fair sharing of the cost. I'll take as notice and under advisement the member's suggestion that we should meet directly with the American authorities and I will report back to the House later.

CASINO GAMBLING

Mr Ernie L. Eves (Parry Sound): My question is to the Minister of Consumer and Commercial Relations with respect to the issue of casino gambling. Prior to September 1990 when the last provincial election was held, the Premier of the province was quoted as saying, "The casino plays on greed." On May 17 of this year my leader asked the Premier if your government would hold a referendum on whether or not casino gambling should be introduced into the province of Ontario. The Premier said no.

When a government turns its back on the very principles and reasons it was elected to power, should not that government give the public an opportunity to express its opinion?

Hon Marilyn Churley (Minister of Consumer and Commercial Relations): I believe the Premier has said, and I certainly have said, that no casino would go to any community which did not demonstrate its wishes for a casino to be in that community. Windsor has had many consultations with the people of Windsor, and in fact the city council has made it very clear to us its overwhelming interest in that community. However, we have said that we would move very slowly and cautiously to make sure that if and when casino gambling is extended, we will look at ways that communities can be sure the people of their community are interested in having a casino.

But I want to say that every day there are thousands of Ontarians travelling outside of this province and spending millions of dollars of money outside of this country. It's not a question any more of hiding our heads in the sand and pretending that casino gambling doesn't exist. It's starting to spread out all across Canada and in the United States, so we have to look very carefully at where we're going with this. But of course we will make sure that a community is fully supportive of having a casino.

Mr Eves: The minister steadfastly refuses to answer this question directly, because I suspect that she knows her government said one thing before the election and one thing after the election.

On three separate occasions the state of Michigan has provided the people of Detroit with a vote on whether or not to establish a casino. The people of Detroit have rejected it three times. In Mississippi there have been two referendums on the establishment of a casino; the first one failed, the second one was successful.

In Colorado, Connecticut, Indiana, Illinois, Florida, Missouri, New Jersey, North Dakota, Ohio and South Dakota referendums were held on the establishment of casino gambling. Some won; some lost. Why won't you give the people of Ontario and the people of Windsor the same democratic right that the people in these states have had?

Hon Ms Churley: The people of Windsor spoke through their city council loudly and clearly. We did a lot of work to make sure that the people of Windsor wanted a casino in that town. Referendums are part of the American system.

Interjections.

The Speaker (Hon David Warner): Order. Would the minister take her seat, please.

Interjections.

The Speaker: Minister.

Hon Ms Churley: Referendums, as we know, are part of the American system much more than here in Canada. You haven't said anything about Quebec, which is in the process of opening up casinos. You haven't said anything about Manitoba. You haven't said anything about Alberta. You haven't said anything about BC. You haven't said anything about the Yukon. All those jurisdictions within Canada have casinos and they didn't call referendums. We have a different kind of system than in the United States.

Mr Eves: You are part of the New Democratic Party, are you? What's new and what's democratic about it?

The Speaker: Order, the member for Parry Sound.

Hon Ms Churley: As I said before, we will be paying close attention and making sure that any community which, down the road, gets a casino -- that is, if we decide to expand -- will be thoroughly consulted.

ENVIRONMENTAL SENSITIVITY

Mr Donald Abel (Wentworth North): My question is for the Minister of Health. Recently it has been brought to my attention by a constituent in my riding of Wentworth North the terrible suffering that people with environmental sensitivities have to endure, not only as a result of their condition but also at the hands of uninformed health professionals. I would like to know what your ministry is doing to address this situation.

Hon Ruth Grier (Minister of Health): I appreciate an opportunity to speak on this issue, because I agree with the member that it is in fact suffering for a great many people. Environmental sensitivities encompass a number of conditions which have been difficult to address for many reasons, some of which have to do with a lack of understanding about the nature of the illnesses.

The ministry wishes to contribute to greater understanding of these and of the people affected by them. I have approved funding for the establishment of a joint clinical research program where individuals with sensitivities may come for complete assessment and appropriate referral and where research on diagnosis, treatment and prevention can take place.

We've also approved the establishment of a new provincial committee with a very broad representation, including consumer groups, which will develop and distribute information material for health care providers and consumers. This follows upon many previous initiatives in the Ministry of Health to promote more understanding of this condition.

Mr Abel: How do these initiatives help people who are suffering now as I speak? How will this help people who, in addition to their illness, are put through more pain as a result of inaccurate diagnosis?

Hon Mrs Grier: I appreciate the member's concern. He's right. There aren't any quick and easy solutions for the victims of these often extremely debilitating illnesses. However, we are attempting to increase awareness among the medical community, not only awareness of the condition and its serious effects, but also about the avenues that are now open to practitioners right now for more appropriate detection and treatment.

I hope that as awareness increases among doctors and others, these professionals could, where appropriate, begin to rule out environmental causes before moving to consider other diagnoses, for example.

AMBULANCE SERVICE

Mr Steven Offer (Mississauga North): I have a question for the Minister of Health. This question deals with the issue of ambulance service in my area. I think you should be aware that, though you have frozen the budget of an independent ambulance service, the only ambulance service in my area, you and your government have increased the cost of running that ambulance service.

You have increased the cost by virtue of increasing salaries of attendants, you have increased the cost through increases in premiums of the WCB, you have increased the cost through your new tax on auto insurance premiums and you have increased the cost through the new tax, the sales tax on health premiums.

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The impact of this is that the ambulance service can now no longer replace an attendant when that person happens to be on sick leave, on compensation or indeed on vacation. This has severe consequences, two in fact; the first is that if two attendants happen to be absent, then one ambulance is taken off the road. The area that I represent has but two ambulances, so one of two is taken off the road. The second consequence is that if one attendant is absent, then an ambulance is staffed by only one person. An ambulance with only a driver attends to the scene of any occurrence.

My question to the Minister of Health is, as the Minister of Health, is it adequate that an ambulance with only one person in it attends at the scene of an emergency?

Hon Ruth Grier (Minister of Health): I'm not going to give a categorical answer to that kind of question. But let me say to the member that as we constrain expenditures in every area of the public service, it is incumbent upon all of those involved to examine the way in which they operate and to examine the functions that they carry out and to reallocate funding to those that are most critical and certainly to those that meet emergencies.

I would suggest to the member that within that service there have to be ways of looking at what is most critical and how that service can be provided, because I would agree with him that the provision of emergency services is a basic responsibility of government at all levels.

Mr Offer: By way of supplementary, it's strange that the Minister of Health cannot give a categorical answer. The question is, is it appropriate that an ambulance attend at the scene with only one person? God forbid it should happen to any one of us with any of our loved ones. Is it appropriate that an ambulance come to our home or to the scene of an accident with only one person? What type of emergency service can be performed by only the driver?

Madam Minister, it does require a categorical answer from you. You must stand up and say that it is inappropriate that an ambulance has only one person in the car at any time and that you have mandated, through your ministry, that in my area and in all areas -- I'll use mine -- there are two cars that must be on the road.

Madam Minister, are you going to stand by your own ministry's mandate? The question is important to thousands and thousands of people who may require emergency ambulance services. An ambulance with one person in it will not provide that service. Madam Minister, stand up and tell us, is that appropriate?

Hon Mrs Grier: What I said in my first answer was that we all have to look at how we do things, and all levels of government have to find how in fact they can do better with less.

If in fact a fire engine and a police car are at an accident and it is as yet unknown that it is a serious accident, there may be occasions where one person from the ambulance is appropriate; there are many other occasions where it is inappropriate. If the ambulance is the only vehicle responding, I would agree with him there would have to be more than a driver in the ambulance. But I don't know the circumstances he is describing. I don't accept that what he is describing applies in every particular circumstance.

I agree with him that emergency services are critical components of our health and our safety systems and, as municipalities, private sector ambulances and the ministry look carefully at how they can constrain their costs, they have to take the critical nature of those services into consideration.

SOCIAL CONTRACT

Mr David Johnson (Don Mills): My question is again to the Minister of Health, and it concerns the health sector social contract and its impact, for example, on the homes for the aged.

The health sector agreement was approved by this government, was signed by the government and was signed by the union before the employers even had the opportunity to look at it and to comment on it, and of course it was rejected by the employers.

It indicated that the powers of the joint workplace committee should be expanded and that the powers of the union would therefore be expanded in terms of its influence on the running of our health care facilities, facilities such as homes for the aged. These additional union powers would impact on planning, on budgeting and on human resources planning, and they would in fact not only be temporary powers but would be permanent powers beyond the term of the social contract.

The municipalities have said they do not want the unions running our cities. Now the health care sector is saying it does not want the unions running our homes for the aged and our hospitals.

The Speaker (Hon David Warner): Could the member place a question, please.

Mr David Johnson: The question is, why is the government attempting to force these greater union powers on the health care system, such as the homes for the aged?

Hon Ruth Grier (Minister of Health): As the member knows, we are still discussing the terms of the social contract. The deadline is not until August 1, and I still believe an agreement can be reached in that entire sector.

But the principle of involving the employees and using the talents, the skills and the experience of the employees in any institution as we try to find ways of saving money and performing our services better is a principle that we completely support. I am surprised that he, as well as the employers in nursing homes, would want to disregard the ability of the people who work with them and not want to take advantage of every opportunity to work coherently in a coordinated way to achieve savings and better management.

Mr David Johnson: Of course the municipalities and the health sector use every opportunity to hear what the employees are saying. But they do not want greater mandated or legislated authorities to the unions. That was the issue with the municipalities -- they spoke loud and clear -- and this government backtracked.

The health sector is saying it wants an agreement based on the municipal model. The municipal model permits the government to obtain its prime objective, which is to reduce spending, but at the same time it does not restrict management abilities in our health care system.

Again, the homes for the aged do not want legislated union authority in terms of planning, budgeting, and human resources planning.

The Speaker: Could the member place a supplementary.

Mr David Johnson: Madam Minister, my question to you today is, will you permit the health sector to have an agreement based on the municipal model?

Hon Mrs Grier: This is not the social contract negotiating table. I'm sure the member is aware, as I said in response to his first question, that discussions with respect to the social contract are proceeding and will proceed until the end of this week. I still remain optimistic that it may be possible to gain an agreement in that sector.

I would point out to him that the municipal sector has signed an agreement. And when he says that municipalities and all institutions work with their employees, I would suggest to him that that is not perhaps as even across the entire sector as he might wish to believe, and that if it were working as effectively as he implied, then there would be no need to try to negotiate or to find a way of making sure that happens. But I would say to him that it is not my intention to do these negotiations either on the floor of this Legislature or in public.

ONTARIO DRUG BENEFIT PROGRAM

Mr Pat Hayes (Essex-Kent): My question is to the Minister of Health. I've been approached by a number of pharmacists in my area who have some real concerns about Bill 29.

This bill gives cabinet authority to set dispensing fees under the Ontario drug benefit program, and the minister has actually rejected a fact-finder's report that called for a 3% increase in fees retroactive to December 1991.

I understand that there is a need to exercise restraint, given the fiscal outlook for the province and the sacrifices that are being required in the broader public sector. None the less, the pharmacists feel they don't have enough input. Will the minister assure this House and the pharmacists in my area and across the province that their ideas and suggestions on controlling the cost of drugs and their dispensation would receive fair consideration and that they will be consulted fully before any changes are made to dispensing fees, the schedule?

Hon Ruth Grier (Minister of Health): Yes.

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PETITIONS

SOCIAL CONTRACT

Mr Hugh O'Neil (Quinte): I have a petition that has been handed to me by hundreds of people in my riding of Quinte, which is the Trenton-Belleville-Frankford area, and it reads:

"To the Honourable Lieutenant Governor, Legislative Assembly of Ontario, from the people of Ontario:

"We, the undersigned, beg leave to petition the Parliament of Ontario as follows:

"That free and open collective bargaining for public service employees be restored and be returned to its honourable position in Ontario;

"That the social contract in its present form be destroyed and that the valuable programs and services in the public sector be maintained for the betterment of all Ontarians; and

"That the government withdraw Bill 48, and in place of this bill the government work cooperatively with the public service unions to find an equitable solution rather than eliminating valuable public services."

HEALTH CARE

Mr Charles Harnick (Willowdale): I have a petition addressed to the Legislative Assembly of Ontario and it reads as follows:

"Whereas proposals made under the government's expenditure control plan and social contract initiatives regarding health care in the province of Ontario will have a devastating impact on access to and delivery of health care; and

"Whereas these proposals will result in severe reduction in the provision of quality health care services across the province,

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the 1991 Ontario Medical Association/government framework and economic agreement."

I have affixed my signature.

Mr Kimble Sutherland (Oxford): I have a petition on the letterhead of the Oxford County Medical Association. It has been sent to me by Dr Munnoch in my riding and has about 150 names on it. They want the government to withdraw proposed measures and reaffirm its commitment to rational reform under the 1991 Ontario Medical Association/government framework.

RETAIL STORE HOURS

Mr Alvin Curling (Scarborough North): I have a petition to the members of the provincial Parliament:

"I, the undersigned, hereby register my opposition to wide-open Sunday business.

"I believe in the need of keeping Sunday as a holiday for family time, quality of life and religious freedom. The elimination of such a day would be detrimental to the fabric of society in Ontario and cause increased hardship on retailers, retail employees and their families.

"The proposed amendments to the Retail Business Holidays Act, Bill 38, dated June 3, 1992, to delete all Sundays except Easter from the definition of legal holiday and reclassify them as working days should be defeated."

I affix my signature to this petition.

GO BUS SERVICE

Mr Gary Carr (Oakville South): On behalf of my colleague David Tilson, MPP for Dufferin-Peel, I'd like to table a petition signed by a number of his constituents which reads as follows:

"To the Legislative Assembly of Ontario:

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"To object to the recent cuts to GO Transit bus service to Woodbridge, Kleinburg, Nobleton, Bolton, Palgrave and Highway 9; and

"Whereas this will be a major inconvenience to non-drivers; and

"Whereas it will have a negative impact on the local economy; and

"Whereas the lack of transit services will increase traffic, thereby increasing air pollution levels at a time when all levels of government are making efforts to reduce pollution and encourage the public transportation system; and

"Whereas the cuts leave no alternative means of commuting in and out of Toronto during peak hours; and

"Whereas the lack of GO buses will force passengers, at one of the worst economic times in Ontario's history, to incur extra expenses, finding another form of transportation;

"We, the undersigned, respectfully petition the Legislative Assembly of Ontario to overturn GO Transit's decision and restore GO Transit service to Woodbridge, Kleinburg, Nobleton, Bolton and Highway 9."

GAMBLING

Mr Dennis Drainville (Victoria-Haliburton): Again, I read one of the many thousands of petitions I've brought to this House:

"To the Legislative Assembly of Ontario:

"Whereas the New Democratic Party government has not consulted the citizens of the province regarding the expansion of gambling; and

"Whereas families are made more emotionally and economically vulnerable by the operation of various gaming and gambling ventures; and

"Whereas creditable academic studies have shown that state-operated gambling is nothing more than a regressive tax on the poor; and

"Whereas the New Democratic Party has in the past vociferously opposed the raising of moneys for the state through gambling; and

"Whereas the government has not attempted to address the very serious concerns that have been raised by groups and individuals regarding the potential growth in crime;

"Therefore, we, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government immediately cease all moves to establish gambling casinos and refrain from introducing video lottery terminals in the province of Ontario."

It's my great pleasure to affix my name to this petition.

HEALTH CARE

Mr Mike Cooper (Kitchener-Wilmot): I have a petition to the Legislative Assembly of Ontario:

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

MENTAL HEALTH SERVICES

Mrs Barbara Sullivan (Halton Centre): I have a petition to the Legislative Assembly of Ontario which reads as follows:

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto. The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province as specified under the Ontario Medical Association/government framework agreement."

I concur with this petition and affix my name to it.

AUTOMOBILE INSURANCE

Mr Bob Huget (Sarnia): I have a petition to the Legislative Assembly of Ontario. This petition is signed by 235 members of my riding of Sarnia and surrounding area. The petition reads as follows:

"Whereas the people of Ontario are undergoing economic hardship, high unemployment and are faced with the prospect of imminent tax increases; and

"Whereas the Ontario motorist protection plan currently delivers cost-effective insurance benefits to Ontario drivers; and

"Whereas the passing of Bill 164 into law will result in higher automobile insurance premiums for Ontario drivers;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That Bill 164 be withdrawn."

HEALTH CARE

Mrs Joan M. Fawcett (Northumberland): I have a petition to the Legislative Assembly of Ontario:

"Whereas these proposals will result in a severe reduction in the provision of quality health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

I have signed the petition.

ONTARIO DRUG BENEFIT PROGRAM

Mr Leo Jordan (Lanark-Renfrew): I have a petition to the Legislative Assembly of Ontario:

"We, the undersigned, beg leave to petition the Legislative Assembly of Ontario as follows:

"The expenditure control plan announced in the Legislature by Treasurer Floyd Laughren on April 23, 1993, includes reductions in health care services by $4 billion. This means that the Ontario drug benefit program is in jeopardy. We quote:

"'The reform on the Ontario drug benefits program will result in a savings of $195 million.' To be reformed are pharmacy services, prescribing guidelines, management of nutritional products and over-the-counter products. There will also be price changes and cost-sharing.

"We therefore request that the House refrain from supporting this piece of legislation which will result in a serious burden to senior citizens in Ontario."

There are 165 signatures on this petition and I will sign it on their behalf.

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HEALTH CARE

Mr Kimble Sutherland (Oxford): I have another petition submitted by a member of the Oxford County Medical Association. It's sent to me by Dr M. Dowdee, and it's similar to the petition I read in earlier. It has about 40 names on it.

Mr Ron Eddy (Brant-Haldimand): I have a petition to the Legislative Assembly of Ontario:

"Whereas these proposals will result in a severe reduction in the provision of quality health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw these proposed measures and reaffirm its commitment to rational reform of Ontario's health care system through its obligations under the Ontario Medical Association-government framework and economic agreement."

It is signed by 230 residents of Brant county and the city of Brantford. I affix my signature.

MENTAL HEALTH SERVICES

Mr Jim Wilson (Simcoe West): I have a petition addressed to the Legislative Assembly of Ontario:

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"The government of Ontario move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto. The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province, as specified under the Ontario Medical Association/government framework agreement."

That's signed by a number of very concerned taxpayers in this province who are worried about Bill 50 and the unilateral decisions being taken by this government. Some of those residents are with us today in the gallery. I too have affixed my name to this petition.

PUBLIC SERVICES

Mr Bob Huget (Sarnia): I have a petition signed by 29 constituents of mine in the riding of Sarnia. The petition reads as follows:

"We, the following undersigned citizens of Sarnia, beg leave to petition the Parliament of Ontario as follows:

"We, the undersigned, call on the Ontario government to maintain and improve our public services. Public services are vital to our communities and our way of life. We can't afford to lose them."

I've affixed my signature to the petition.

MENTAL HEALTH SERVICES

Mrs Barbara Sullivan (Halton Centre): I have an additional petition to the Legislative Assembly of Ontario which reads as follows:

"Whereas these proposals will enable government to unilaterally and arbitrarily restrict payments for psychotherapy; and

"Whereas these proposals will result in a severe reduction in the provision of quality mental health care services across the province;

"We, the undersigned, petition the Legislative Assembly of Ontario as follows:

"That the government move immediately to withdraw the proposal to restrict payments for psychotherapy and withdraw the proposal to allow the cabinet to make decisions with respect to the number of times patients may receive particular insured services and set maximums with respect thereto.

"The government of Ontario must reaffirm its commitment to the process of joint management and rational reform of the delivery of medical services in the province as specified under the Ontario Medical Association government/framework agreement."

Once again, hundreds of signatures are on this petition, and I concur with it and affix mine as well.

NATIVE HUNTING AND FISHING

Mr Leo Jordan (Lanark-Renfrew): I have a petition to the Legislative Assembly of Ontario:

"Whereas in 1923, seven Ontario bands signed the Williams Treaty, which guaranteed that native peoples would fish and hunt according to provincial and federal conservation laws, like everyone else; and

"Whereas the bands were paid the 1993 equivalent of $20 million; and

"Whereas that treaty was upheld by Ontario's highest court last year; and

"Whereas Bob Rae is not enforcing existing laws which prohibit native peoples from hunting and fishing out of season; and

"Whereas this will put at risk an already pressured part of Ontario's environment;

"We, the undersigned, adamantly demand that the government honour the principles of fish and wildlife conservation; to respect our native and non-native ancestors and to respect the Williams Treaty."

This is signed by 501 constituents, and I also affix my signature.

The Acting Speaker (Mr Noble Villeneuve): This terminates the time allotted for petitions.

WRITTEN QUESTIONS

Mrs Barbara Sullivan (Halton Centre): On a point of order, Mr Speaker: On June 16, I placed two Order and Notices paper questions, number 224 and number 226, to the Ministry of Health, the first with respect to documentation about impact studies, consultative meetings held with respect to reducing technical fees paid to facilities and hospitals; the second requesting cost-benefit studies, health outcomes analysis and studies undertaken, consultative meetings held, surveys conducted etc with respect to the delisting of psychotherapy.

I had an indication that while the material could not be available in the time required under standing order 97(d), a final answer would be available on or about July 14. That day has long passed, and I'm asking once again for the material that as a member I have the right to access.

The Acting Speaker (Mr Noble Villeneuve): Your request is on record on the order paper and indeed on a point of order here in the Legislature, and I'm quite sure officials at the Ministry of Health are looking into it.

REPORTS BY COMMITTEES

STANDING COMMITTEE ON GENERAL GOVERNMENT

Mr David Johnson from the standing committee on general government presented the following report and moved its adoption:

Your committee begs to report the following bill as amended:

Bill 7, An Act to amend certain Acts related to Municipalities concerning Waste Management / Loi modifiant certaines lois relatives aux municipalités en ce qui concerne la gestion des déchets.

The Acting Speaker (Mr Noble Villeneuve): Shall the report be received and adopted? Agreed.

Shall Bill 7 be ordered for third reading? Agreed.

The bill is therefore ordered for third reading.

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ORDERS OF THE DAY

EXPENDITURE CONTROL PLAN STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LE PLAN DE CONTRÔLE DES DÉPENSES

Mrs Grier moved second reading of the following bill:

Bill 50, An Act to implement the Government's expenditure control plan and, in that connection, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act / Loi visant à mettre en oeuvre le Plan de contrôle des dépenses du gouvernement et modifiant la Loi sur l'assurance-santé et la Loi sur l'arbitrage des conflits de travail dans les hôpitaux.

The Acting Speaker (Mr Noble Villeneuve): Does the minister have some opening remarks?

Hon Brian A. Charlton (Government House Leader): Mr Speaker, just before the minister commences her opening remarks, two things: I believe we have consent to sit till 8:30 this evening.

The Acting Speaker: Do we have agreement to sit until 8:30 this evening? Agreed.

Hon Mr Charlton: Secondly, I believe we have an agreement to adjourn the debate on this bill, Bill 50, and to move then to the debate on Bill 8, the casinos act, at 6 o'clock.

The Acting Speaker: Do we have agreement to cease debate on Bill 50 at 6 o'clock and begin the Bill 8 debate? We have agreement.

Hon Ruth Grier (Minister of Health): This motion is for second reading of Bill 50, the Expenditure Control Plan Statute Law Amendment Act, and this, as the title says, is an act to implement the government's expenditure control plan, and connected to that, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act.

Reforming our health care system is a critical part of our government's agenda. That reform has four central elements: first, to place a greater emphasis on health promotion and disease prevention; secondly, to manage the health care system so that it remains affordable and effective; thirdly, to improve accessibility and to meet the needs of special groups within our population; and fourthly, to strengthen partnerships with health providers as well as the community.

Bill 50 is consistent with that health reform strategy and will enable the government to meet its targeted expenditure reductions.

The first major challenge we faced as we moved to implement our health reform strategy was restructuring the hospital system, and this has also been our greatest success. When hospitals were forced to trim their budgets a couple of years ago, critics sounded the alarm bells, unnecessarily, as it turned out, and today we see more efficient hospitals offering better quality care. We've seen that because of great achievements from hospital administrators and hospital workers.

The average length of stay in a hospital has fallen from nine days in 1988 to seven days today. The number of people treated has increased by almost 8%, or about one million cases, with more cases being served on an outpatient basis. Day surgery, as a percentage of all surgeries, has risen from 53% to 70%, and we also have in place a five-year reform plan that includes reorganizing services on a regional basis to eliminate duplication, work that is being spearheaded by the district health councils across the province.

I believe our success in the hospital sector is due in large part to the constructive role of the Ontario Hospital Association through the joint policy and planning committee, the local and regional planning that, as I say, is being done by district health councils, and a much more open decision-making process at each hospital through the implementation of operating guidelines.

In the early life of this government a framework agreement was signed with the Ontario Medical Association, and that again was a very important step in our reform of the health care system. That agreement created two very important tools, tools that enable us and the Ontario Medical Association to manage the ministry in a way that improves effectiveness as well as controlling costs. One of those tools is the joint management committee, working very effectively, and another is the Institute for Clinical Evaluative Sciences, known as ICES. This institute, about which I believe not enough is yet known by the people of this province, provides us with technical information to help doctors to do their jobs better. Research conducted on issues such as small variations in coronary surgery rates and ultrasound examinations will help improve the quality and effectiveness of our medical services.

Earlier this year, again consistent with our reform agenda, I announced two major policy frameworks, that for long-term care as well as a strategy for mental health reform, and we recently released a discussion paper on reform of the Ontario drug benefit plan.

Work has also begun on development of a primary health services framework that will help us ensure that basic health care is effective and truly accessible. This policy is part of the ongoing work on a community health framework and will look at the role of physicians and other health care professionals such as nurses, pharmacists, chiropractors and midwives and what role they should play in primary health services.

We are very proud, and I think the people of Ontario can be proud, of the progress that has been made in the last two years, because only by reforming the health care system to manage it better can we continue to afford it and also provide every citizen with high-quality care.

The current fiscal situation forces us to face an inescapable truth: Our system is the most expensive publicly funded system in the world. Between 1982 and 1992, the Ministry of Health's budget increased annually by 10% and doubled to the $17.8 billion it stands at today. If we keep spending as though the sky were the limit, we will not have a universal health care system to pass on to our children and our children's children, because the system would become unsustainable.

Last year, we kept growth in spending to an increase of 1%. This year, with our expenditure control measures as well as savings in the public sector payroll achieved through the social contract, the budget will increase by just 0.1%, an amazing achievement.

However, I think it's important for everyone to understand that Ministry of Health spending in 1993-94 will still be more than $17 billion, or one third of the provincial budget. So our task is not only to keep health expenditures under control, but to bring costs down while at the same time reallocating money from one sector of health care to another.

We do that in order to be able to meet the needs of the aging population, of people with AIDS or for more community-based services, in order to fill the gaps that have for too many years been allowed to develop. I believe this presents us with an opportunity to deal with a situation that has been ignored for too long while at the same time advancing our health reform agenda.

For years Canada's provincial and federal governments have been hearing the warning calls from health economists and planners, as well as from doctors and other health professionals, that spending on health care was getting out of hand and that some of the money was not being spent as wisely as it could be.

One prominent health policy expert, Jonathan Lomas, who coordinates the Centre for Health Economics and Policy Analysis at McMaster University, has said that he would like to see ministries of health across Canada move from simply being insurers and payers to becoming managers. We believe the job of government is to invest in health, not merely to pay the bills, and that's what our reform agenda is all about.

One fact that ministries of health across Canada ignored as long ago as the mid-1970s was that the growth in the number of physicians was far outstripping the growth in the population. This imbalance came from health planning decisions made 30 years ago, when the planned growth of physicians was designed for 37 million people, not the 27 million we have in Canada today.

In Ontario the increase in physicians has been more tied to our capacity to train doctors than to our population needs. There has been a lack of planning and management resulting in shortages of specialists in some areas and an oversupply in others.

For example, there was a 46% increase in paediatricians between 1981 and 1989, but only a 4% increase in their young patients. Meanwhile, there's a growing need for health services in the areas of geriatrics and chronic diseases. We saw a 33% overall increase in doctors, but we still have communities that have no doctors: 24 years of incentive plans have not been able to get enough doctors to rural and northern communities.

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Even in the past three months, despite the publicity and controversy that there has been about our proposals to try to redistribute physicians to areas where they are needed, we have been forced to bring in doctors from other provinces, from Australia, Israel, the United Kingdom, South Africa and the United States: bring in doctors to work where our own doctors don't want to go. As well, Ontario has specific populations that remain chronically underserved, such as women, native people, AIDS sufferers and francophones.

Physician resource management has long been under discussion by every health ministry across the country. In 1991, professors Morris Barer and Greg Stoddart submitted a report to all of the provincial and the federal ministers of health. It was called Toward Integrated Medical Resource Policies for Canada, and the recommendations in that report have played a significant role in provincial strategies to deal with physician resource management.

Last February, Ontario's universities agreed to enrol 70 fewer medical students, starting this fall. The ministry also announced better ways to control entry into the health system of graduates of foreign medical schools who come to Canada as visa trainees.

But development of a policy to better manage our human resources has only just begun. There needs to be a broad discussion, and some of that is occurring through the recently created Provincial Coordinating Committee on Postgraduate Medical Education. That committee, chaired by Dr John Evans, includes people from district health councils, from academic health science centres, hospitals, as well as organizations representing physicians. The committee will look at the issues related to post-graduate medical education and the management of physician resources, and I want to say that so far I'm extremely encouraged by the work that committee has done.

The second thing we have to do is to encourage payment approaches or means of payment that give us much greater flexibility than the current fee-for-service system.

Thirdly, we need to ensure a much more effective match of needs and resources.

This brings us to Bill 50, legislation that is not for the purpose of allowing government to practise medicine, as I'm sure members will hear in the debate this afternoon, nor does it allow the government to stop paying for medically necessary services. In fact, the Canada Health Act ensures that we provide medically necessary services, along with reasonable access to them, for all our permanent residents.

The legislative amendments we have proposed clarify the authority required to proceed with the types of proposals that have been made under the expenditure control plan.

With respect to the changes to the Health Insurance Act, the amendments are the first major changes to the act since 1972. These changes will allow for better management of the health insurance plan, and some would argue that they are long overdue.

This legislation is a fail-safe mechanism to ensure that the government can meet its fiscal targets in the event that we cannot reach agreement through negotiations with the Ontario Medical Association. These negotiations with the OMA have been taking place for some time, very intensely, and indeed are occurring as I speak.

We have proposed a number of measures through the expenditure control plan, such as income thresholds, discounts and changes to the fee schedule. These, plus the social contract reductions, are designed to reduce the fee-for-service budget for physicians this year to approximately $3.6 billion, a decrease of 8.6% from last year, and we plan that they should continue to be at that level for the next two years. Expenditure control plan measures and a successful social contract will result in a decline of 7.5% from last year on payments for physicians, other fee-for-service health providers, out-of-country care and laboratories.

While I hope we can arrive at our savings through successful negotiations with the Ontario Medical Association, I want to make it clear that our target must be met. But I also want to make it very clear, once again, that with this bill the government has no intention of limiting medically necessary treatments.

I want to speak for a moment on some of the details of the three key sections of Bill 50.

First of all, there are amendments being proposed to the Health Insurance Act. Under the current act, the Minister of Health has the power to prescribe the amounts payable by the health insurance plan for insured services. We are expanding that already existing regulation-making authority to make it more precise. The expanded authority will allow us to pass regulations with respect to other matters that may be agreed upon between the government and the Ontario Medical Association.

There will be more specific authority with respect to payment, based on classes of physicians, practitioners or health facilities or where the service is rendered. We will have the authority to lower fees to new entrants, but also to pay 100% of fees to a new entrant in an underserviced area or specialty.

The changes will ensure that regulations under the Health Insurance Act can control government expenditures, encourage appropriate distribution of doctors in the province and discourage doctors, practitioners and health facilities in overserviced locations.

Other amendments in the Health Insurance Act will allow increases, through regulation, in the number of members of the Medical Review Committee and the practitioner review committees. The ratio of lay to professional members will be maintained.

The Medical Review Committee, at the request of the ministry, reviews cases of physicians who appear to be inappropriately submitting claims for insured services, an issue that I know all members of this House have raised and are concerned about. But I want to point out that there is currently a backlog of 49 cases at that committee and the response time is now averaging more than two years, up from seven and a half months in 1984 and 20 1/2 months three years ago.

The committee has only eight members. In 1990, the Provincial Auditor asked the previous government to expand the committee. We are acting on that recommendation through Bill 50. We need that expansion so that we can more quickly get back the money taxpayers have incorrectly paid to doctors who billed inappropriately.

This bill also includes amendments to the Hospital Labour Disputes Arbitration Act, amendments that require parties to share the cost of arbitrations in hospitals and nursing homes. At present the government pays the full amount of these costs, which on average has been nearly half a million dollars every year.

What we see in the health sector, where government picks up the full cost of arbitration, is 40% of negotiations going to arbitration. Contrast that with the fact that in police bargaining, where there is a sharing of costs, only 8% of cases go to arbitration.

Cost-sharing is already the norm for firefighters, teachers and community college employees. This amendment to the Hospital Labour Disputes Arbitration Act is also consistent with the policies of most other provinces where there is mandatory arbitration in the public sector.

Lastly, Bill 50 enables the government to override existing agreements where new agreements have not been reached to achieve fiscal targets. While it is not our wish to override any collective agreements, the alternative would mean a crisis for health care spending in the future, and that we cannot allow to happen.

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Let me close by re-emphasizing the fact that the Expenditure Control Plan Statute Law Amendment Act is a tool that will help the ministry to effectively manage the health care system. We intend to hold the line on spending for health services. We intend to preserve the best of what we have in Ontario's excellent health care system while reforming to meet new needs and new demands. Far from dismantling the system, we are making it better and making sure the taxpayers can continue to afford to pay for it.

In 1979, Tommy Douglas, whose New Democratic government in Saskatchewan introduced medicare to Canada, said that public health insurance was only the first step in the setting up of medicare. The second step, he said, would involve the reorganization of medical and health practice and an emphasis on health promotion and disease prevention. He predicted the second step would be even tougher than the first.

Our government has taken on that second step. It is not an easy task, but with discussion and participation by everyone involved in Ontario's health care system, we will succeed. This legislation is one step in that direction.

The Acting Speaker (Mr Dennis Drainville): I thank the honourable minister for her participation in the debate. Questions or comments? If there are no questions or comments, further debate?

Mrs Barbara Sullivan (Halton Centre): I listened to the comments of the Minister of Health with some interest and was quite taken with the fact that she described Bill 50 as being a fail-safe mechanism which will entitle the government to make targeted expenditures. I did not hear her, however, in the course of her discussion talking about the implications for health care delivery which is so very much a part of the Ontario medicare participation and so important to every single person in the province.

I believe that Bill 50 has extraordinary implications for the public, for physicians, for hospitals, for the health care system generally and indeed for our medicare system as a whole. It provides the Ontario government with draconian powers to impose massive cuts on medical services and, hence, patient care. Those cuts can be made without reference to the need for such services or to whether an individual or a group of people will be adversely affected.

Through this bill, the government is giving itself the sole power to determine the circumstances and the conditions under which doctors, other practitioners and patients will be reimbursed for medical services. It would allow the Minister of Health and the government of the province to determine behind closed doors that a person could only see a doctor for a specific treatment a certain number of times. It would allow the Minister of Health to say that a doctor will not be paid for services that he or she has provided to patients.

It does not require that limitations be put on the use of doctors' services only when such services aren't really necessary. In fact, the bill gives the minister and her bureaucrats in the Ministry of Health the unilateral power to ration insured and medically necessary services no matter what the effect that rationing will have on the person who needs to receive those services, and the bill says that those cuts can be made not because those services aren't needed but simply because the minister doesn't want to pay for them. That is what this bill is all about.

The bill gives the minister the power to say where and how a doctor can practise medicine. An older doctor may have different rules to follow than a younger doctor, and those rules could be imposed without any check on the minister or the government, without negotiations with the Ontario Medical Association nor any discussion required of the efficacy of that decision.

In fact, Bill 50 overrides the framework and economic agreement which the government has with the OMA and says that whatever contractual arrangements exist for payments to doctors are of no value. They can be set aside by decree of the minister, and there is no recourse by the individual doctor nor by the association which represents all of the doctors in the province and is legally required and entitled to negotiate on their behalf.

Bill 50 doesn't end with the physicians. It also applies to chiropodists, dentists, chiropractors, optometrists, osteopaths and any other practitioner who is paid by OHIP for providing health care services.

Just before he was elected in 1990, Bob Rae, who was then the leader of the New Democratic Party -- he's now Premier of Ontario, much to some of our regret -- had this to say to the Ontario Medical Association, and this is a direct quote:

"There's no fairness in a system that allows the government to dictate unilaterally your level of pay. A monolithic system in which one insurer has all of the political cards can't work without checks and balances, professions free to speak out on the quality of care, a partnership in which planning decisions about the system emerge from a genuine dialogue and not from the cabinet room alone, and above all, a sense of fairness and pluralism when it comes to management of the system. These are all essential if the health care system is to maintain the confidence of everyone working in it, as well as the public it serves.

"Fair arbitration between the professions and the government is a critical element in creating a more open health care system. You have a right to it," Premier Rae told the doctors, "under international law and under every standard of natural justice."

I'm going to hold that quote aside because I may want to come back to it as we proceed through the debate on this bill, because this piece of legislation takes away the very checks and balances that Bob Rae spoke about when he was addressing the Ontario Medical Association.

It removes the partnership and it leaves the cabinet room in charge of how people are cared for and what medical services they can receive and when. It leaves everyone, patients and their families, physicians and other health professionals, and hospitals and health facilities at the whim of a government that is intent on slashing costs no matter what the effect.

The president of the Ontario Medical Association pointed out in a letter to all members of the Legislature on June 18 that this bill, and I just would like to quote from that letter, "gives government the power to say, for example, that if your child has an ear infection and needs more than the government-dictated number of visits, those medical services might not be covered by OHIP, or worse, might not be available at all."

He goes on to point out, "There are no limits on what services can be restricted by government under this legislation. The legislation is not specific to psychotherapy or eye examinations as originally proposed in the expenditure control plan for physician services; the power to ration insured and medically necessary services applies to everyone and everything. The number of medical services deemed appropriate can be decided unilaterally by some bureaucrat whose mandate extends no further than saving money."

That is precisely the crux of the problem with this bill.

Tom Walkom, who writes, as you know, for the Toronto Star, had a look at the bill and listened to what people were saying about it, and on July 3 he wrote a column about what's happening with Bill 50. In his column he said: "It's unclear what exactly the government hopes to win from all of this. Bill 50 would allow the cabinet to busy itself in the minutiae of deciding how many times patients can see their doctors."

He quotes Health ministry spokesman Layne Verbeek -- and I want to quote this from the column -- who says, "The government has little intention of using this blunt instrument."

If the government has no intention of using what is self-described as a blunt instrument, if the government has no intention of using the extensive and extraordinary powers which it is giving itself under this legislation, then why has this bill been drafted and why is the bill before the House? Why are we discussing this bill if the government does not intend to use the bill?

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My view is that indeed the government is not only committed to this law, but it intends to implement it with all its force, no matter what the consequences to any patient or to any practitioner anywhere in Ontario. Frankly, the Minister of Health made that very, very clear in her introductory remarks.

I want to ask some questions.

What about the patient? If a patient needs a medical treatment that the government has arbitrarily deemed to be not medically necessary, according to its own arbitrary standards or calculations based on cost, where will the patient be?

Will the patient have to reach into his or her own pocket to pay for medical care, perhaps because the doctor has provided that same treatment to too many others? Will the patient be refused treatment because the government has said that the treatment has been provided too many times in a geographic region and that the practitioner isn't allowed to provide that treatment again? Will the patient be forced to travel to another site to get the treatment from another care giver who perhaps hasn't met the quota, or isn't as young, or isn't as old? Or will the patient have to take out a loan to cover the costs of medical care if he or she doesn't have the resources?

What if the patient is to be admitted to a hospital for surgery but, too bad, the cabinet said that hospital's done too much of that same kind of surgery, too many of those operations? Can the patient have the operation if she pays for it? Well, then where is the commensurate right of the hospital to charge for that necessary surgery if that's the intention of the bill?

If hospitals and doctors and other practitioners must recoup their costs by charging patients for necessary medical care, what then is the place of medicare in Ontario? For it is clear this bill creates a two-tier system, where those who can pay for the care they need will receive it, and those who can't pay will have to take their lumps if the government deems that they have to take their lumps.

That is exactly what the federal-provincial medicare plan was designed precisely to avoid. Medicare's primary objective, as defined in the Canada Health Act, and I'm quoting directly from the act, is "to protect, promote and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

There are five principles and criteria for a medicare program: public administration, comprehensiveness, universality, portability and accessibility. As we look at Bill 50 today, I want to draw your attention specifically to two of those criteria: universality and accessibility.

The Canada Health Act says in section 10: "In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the ensured health services of the province provided for by the plan on uniform terms and conditions."

It doesn't say that an insured service can be an insured service in one place on one day but not an insured service in another place on the same day. It doesn't say that an insured service isn't an insured service if the patient has received it before. It doesn't say that an insured service isn't an insured service if a quota has been met.

But Bill 50 means that the government can determine unilaterally, without notice or consultation, what medical services persons can receive, where they can receive them, how often they can receive them, from whom they can receive them. The Minister of Health and her officials could determine whether a person in Toronto can receive treatment when a person in Cornwall cannot, although it's more likely in fact to be the very opposite case. The Minister of Health, under this legislation, could say that a doctor in Windsor must practise in a different way than a doctor in Renfrew. The Minister of Health and her bureaucrats can say that a person cannot receive medical care, even if that care is medically necessary, because the patient has received treatment before.

With this bill, I believe the principle of universality of our medicare program is threatened. Once again I want to read back to you that particular and very important section which says, "In order to satisfy the criterion respecting universality, the health care insurance plan of a province must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions."

The universality criterion is under attack here, but the accessibility criterion is also under attack.

I would like to move to that section of the Canada Health Act, which is section 12, and read directly from that very important piece of Canadian law:

"12(1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province

"(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;

"(b) must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province;

"(c) must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists; and

"(d) must provide for the payment of amounts to hospitals, including hospitals owned or operated by Canada, in respect of the cost of insured health services."

"(2) In respect of any province in which extra billing is not permitted, paragraph (1)(c)" -- that is with respect to the reasonable compensation for medical practitioners -- "shall be deemed to be complied with if the province has chosen to enter into, and has entered into, an agreement with the medical practitioners and dentists of the province that provides

"(a) for negotiations relating to compensation for insured health services between the province and the provincial organizations that represent practicing medical practitioners or dentists in the province;

"(b) for the settlement of disputes relating to compensation through, at the option of the appropriate provincial organizations referred to in paragraph (a), conciliation or binding arbitration by a panel that is equally representative of the provincial organizations and the province and that has an independent chairman; and

"(c) that a decision of the panel referred to in paragraph (b) may not be altered except by an act of the legislature of the province."

That section, in non-legalese, says, first of all, that the insurance plan for health care in the province must be provided to all insured persons on uniform terms and conditions, and it says that in a province such as Ontario, where extra billing is not allowed, that the government must negotiate with the organization representing its physicians in terms of compensation for services which are rendered under the plan.

That is what the Canada Health Act requires, and indeed Ontario does have an agreement with the Ontario Medical Association. We heard all about it on May 6, 1991, and we have watched the progress of that framework and economic agreement with enormous interest since that time.

When it was announced on May 6, 1991, Health Minister Frances Lankin called it a "landmark agreement." I'd just like to read a couple of quotes from the speech she gave at the time the agreement was signed:

"This agreement brings to the system a new cooperative approach to management that will allow for the kind of health care planning that this province has always needed.

"Physicians have agreed to help the government achieve more value for health care spending in Ontario," she said. "They have agreed to help achieve the appropriate number, mix and distribution of physicians, based upon Ontario's needs.

"A joint management committee, with representatives from the OMA and from government, will work to enhance the quality and effectiveness of medical care, including the pursuit of more value for existing spending."

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That's what the government said in 1991, and those were the exact words of the then Minister of Health, the Honourable Frances Lankin. But today, Bill 50 will mean that the provisions of the Ontario Medical Association/province of Ontario framework and economic agreement are -- I'm going to read some direct quotes from this act, because this is what the effect of this bill is. It says provisions of the agreement are "not enforceable." There is no obligation, if the government so designates, for the Minister of Health to "pay money in connection with the provision of health services and to engage in related negotiation, mediation or arbitration."

I remind you that the Canada Health Act requires that very negotiation, mediation or arbitration. It requires that physicians and practitioners be reasonably compensated and fairly compensated for the services they provide. This bill not only overrides the framework and economic agreement which the government has enacted with the Ontario Medical Association, but in those very circumstances overrides the Canada Health Act.

Bill 50 will allow the Minister of Health to decide that a physician can receive "a reduced amount or no amount" for treatment provided to patients. Furthermore, in case people missed this, the provisions are all retroactive to April 1, 1993. That means that the government can claw back payments that it has already made to physicians three months ago if it decides that the GP had treated too many patients for the same problem or because the GP didn't meet a regional quota that was also imposed retroactively.

Without negotiation or the clinical expertise that's so desperately needed, the Minister of Health can decide what is medically necessary or under what circumstances health care services are medically necessary.

Let's look at one, specifically, of the services which the government has arbitrarily decided is not medically necessary. The government has signalled its intent to prescribe the conditions for receiving service. The government's expenditure control plan singles out psychotherapy for particular treatment. I want to make it clear that whatever gobbledegook the Minister of Health puts before you, you should listen very carefully on this issue, because this was an idea that sprang out of somebody's head in the Ministry of Health. The proposal does not have and never has had the approval of the joint management committee or the Ontario Medical Association.

The Ministry of Health expenditure control plan for physicians' services explicitly states that the goal is to establish yearly per-patient maximums for psychotherapy. It says that Ontario spends more per capita on psychotherapy than any other province; that some patients see their physicians several hours a day every week and the medical benefits of such intensive therapy are questionable. The proposal is to restrict payments to 100 hours per year per patient, which equates to two hours per week per patient. This will result in 1993-94 savings of $26.5 million. I believe, in another document, those savings are projected to a much higher amount, in the area of some $40 million, but I will have that figure.

That is the target and that is the goal. The government has itself said that the value of intensive psychotherapy is questionable, but on June 16, I asked the minister -- and you will know that in the House today I stood up on a point of order, through an order paper question, to ask the minister to provide any kind of and all documentation relating to the ministry's proposal to restrict patient access to psychotherapy services to two hours per week per patient, including -- this was part of the information that I asked for -- cost-benefit studies prepared, health outcomes analysis and studies undertaken, minutes of consultative meetings that were held, surveys that were conducted or any other activities which were undertaken by the Ministry of Health to formulate this proposal.

As you know, Mr Speaker, under the rules of the House, I was entitled to a response on or about June 26. Instead, I received a notice stating that the answer could not be provided until July 14. Well, July 14 came and went and I do not to this day have an answer. I don't believe there will be one, or, if there is one, it won't be a complete response, because the health outcomes analysis, in my view, was not done. I would assume that if the minister wants to refute that statement, she will do so in questions and comments subsequent to my discussion.

I do not believe, given the expert opinion which has come in to all members of this Legislature, that the health outcomes analysis of this proposal, which has been put forward by the Ministry of Health, was done; I do not believe that the consultative meetings were held, and I will have some more discussion on that particular question later on; nor do I believe that the patient surveys were conducted. This proposal is an off-the-top-of-the-head proposal, and there's nothing to back it up.

On June 7, the Ministry of Health issued a backgrounder. It made some statements that have been characterized by the Ontario branches of the Canadian Psychoanalytic Society as, and I quote this, "misleading and inaccurate." The society presented some information to clarify the facts, and I would like to read some of that information into the record. The ministry statement, which the society says is false, reads as follows:

"In intensive, long-term psychotherapy, a patient may attend therapy many hours a day, several days a week, indefinitely. The intensity of treatment is seen by many experts in the field of psychiatry to be of questionable medical benefit."

What is true, according to the Canadian Psychoanalytic Society, is:

"Psychoanalysis is a proven, effective treatment for serious mental illness. Psychoanalysis treats severe and chronic mental disorders that prevent individuals from functioning as productive parents, employees and citizens. For this small group of patients, it is a treatment of last resort. Psychoanalysis takes place for one hour each day, four or five times per week. It is an intensive therapy designed to break through painful emotional barriers and heal deep-seated traumas.

"Every leading psychiatric association across Ontario has enthusiastically supported the retention of psychoanalysis as a fully insured medical procedure, including: the five chairs of the departments of psychiatry at Ontario medical schools, the Ontario Medical Association section of psychiatry, the Ontario Psychiatric Association, the Ontario branches of the Canadian Psychoanalytic Society, other psychiatric organizations and citizens' groups.

"Based on the extensive documentation which supports the efficacy and cost-effectiveness of psychoanalysis, even the ministry's own joint management committee recommended in 1992 that psychoanalysis remain an insured service."

The ministry statement, the backgrounder, says:

"The new proposal would limit psychotherapy to 100 hours a patient per year. Seven other provinces have set similar limits on psychotherapy. More than 100 hours per year per patient is deemed excessive by these provinces."

Well, I found out what happens in other provinces, and I'm going to move away from the psychoanalytic society's documentation and provide you with an analysis of what does occur in other provinces.

In Alberta, psychoanalysis is an insured service only if it is performed by a psychiatrist. There is no set limit on the number of hours a patient can receive psychoanalytic treatment.

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In Manitoba, psychoanalysis is an insured service if it is performed by a psychiatrist or if it is performed in a hospital by a psychologist. There is no set limit on the number of hours a patient can obtain psychoanalytic treatment.

In British Columbia, psychoanalysis is an insured service only if it is performed by a psychiatrist. Under the provincial medical insurance plan, there is no set limit on the number of hours a patient can obtain psychoanalytic treatment. According to Keith Sigmundson, the director of mental health services, British Columbia has a shortage of psychoanalytic services. In fact, this province has approximately five or six psychoanalytic centres.

In New Brunswick, psychoanalysis is an insured service only if it is performed by a psychiatrist. Under the provincial medical insurance plan, patients are allowed to visit a psychiatrist only once a day. If they exceed this limit, the medical insurance will not cover their expenses. If the patient visits a psychiatrist once a day, the patient can receive psychoanalytic treatment for as long as he or she desires without incurring any costs.

In Newfoundland, psychoanalysis is an insured service only if it is performed by a psychiatrist or a general practitioner. However, there is no limit on the number of hours a patient can receive psychoanalytic treatment.

In Nova Scotia, psychoanalysis is an insured service only if it is performed by a psychiatrist. There is no maximum number of hours that will be insured. The psychiatrist has full discretion to carry on sessions for as long as he or she feels they are medically necessary.

In Prince Edward Island, psychoanalysis is insured. The provincial medical insurance plan will only pay for an individual to undergo treatment for a maximum of six months. During this six-month period, the patient can receive daily treatment so long as this treatment does not exceed a certain number of hours. If a patient's treatment exceeds six months, a medical adviser will assess the case in order to determine if insurance should continue to pay for this service.

In Quebec, psychoanalysis is generally not insured unless it is rendered in a hospital that has been authorized by the Minister of Health. There is no set limit on the number of hours a patient can receive psychoanalytic treatment.

In Saskatchewan, psychoanalysis is an insured service. There is no maximum number of hours after which the insurance company will refuse to pay for a person's treatment.

Those are the facts.

As I move back to the society's analysis of the government's statements with respect to this particular issue, I want to move to its next point. I think that one stands alone and I hope that the minister will look at the kind of analysis that was prepared by her ministry officials and the kind of review that they made.

The backgrounder from the Ministry of Health says, "The patients not requiring hospitalization would rarely exceed the arbitrary limit," which the Minister of Health will be requiring under this new quota.

The society says: "Psychoanalysis saves the health care system direct costs by keeping patients out of psychiatric hospitals and in our communities as contributing members of society. Patients left untreated make serious demands on our health system in the form of increased medical utilization. Many end up on an endless 'merry-go-round' of ineffective treatments and suffer prolonged pain. A comparison study in Australia and New Zealand shows that unlimited psychotherapy benefits in Australia led to less overall mental health care expenditures. Germany reinstated psychoanalysis when research showed its absence was costing the health system more in hospitalizations and increased medical utilization."

The statement in the Ministry of Health backgrounder says, "Long-term, ongoing support services are available through community mental health services or self-help groups."

The society has this to say: "82% of patients currently in psychoanalysis have already tried briefer forms of treatment including self-help groups, and have not been successful in finding a satisfactory resolution of their illness. They have turned to psychoanalysis as the only workable solution to heal their wounds in a long-term permanent way."

The backgrounder then goes on to say, and this was the figure I was looking for, that the savings of the arbitrary yearly quotas on psychotherapy treatments for patients are estimated at $42.4 million annualized. The society points out that the government has never provided a clear, well-documented answer to the question of what, if any, savings will be realized by limiting psychotherapy. All of the numbers, the society says, which have been floated out as possible savings appear to be grossly inflated and completely out of proportion to the current level of psychoanalysis that is being practised.

I bring those issues to your attention because, of course, psychotherapy is one of the areas in the expenditure control plan that serves as the perfect example of the powers that the Minister of Health and the government, through cabinet, will have in determining what services should be provided, when they should be provided, how they should be provided and to whom they should be provided.

Although I am not an expert in this area, certainly experts have come to me with information, and we have been able to gather documentation on our own. The information we have that's been placed before us, through these interventions and through materials we have gathered, indicates that the homework has not been done here, that the background material which led the Ministry of Health to this kind of unilateral proposal is in fact not appropriate and does not benefit from the expertise and the guidance of those who work in the field, of those who do the analysis with respect to utilization, of those who are making the extensive analysis and study of what in fact is appropriate and needed in our medical care system.

For the government to march unilaterally ahead in the face of such overwhelming expert evidence, it seems to me, is problematic in this area. However, if the government can march unilaterally ahead in other areas, God help the people of Ontario.

I also want to read into the record, with respect to this issue, a portion of a letter which has been sent by Dr Norman Doidge, who is head of the assessment clinic at the Clarke Institute of Psychiatry. His letter was written to the Premier. I did, you may know, read part of this letter into the record of the estimates committee the other day because clearly I'm concerned about the arbitrary nature of this decision.

He writes to Premier Rae:

"I wish to respond to a recent Ministry of Health backgrounder dated June 7, 1993, entitled 'Proposed Limits on Psychotherapy.'

That backgrounder announces the government policy to limit the number of psychotherapy sessions per patient.

"It makes no more sense to legislate the number of psychotherapy sessions for all patients in the province than it does to legislate the dose of chemotherapy that every woman with breast cancer will receive or to mandate that every bridge in Ontario will be 250 feet long. This proposal seeks to fit all patients into the same mould and disparages and discards those who will not fit. When such a policy is based on inaccurate statements about psychotherapy, such statements must not go uncorrected."

Dr Doidge does an analysis of the Ministry of Health backgrounder in this area. He then goes on to say:

"Clearly, two groups are targeted by this decision. The first group is psychoanalytic patients, 82% of whom have tried briefer treatments without symptom resolution. These patients amount to only 4% of OHIP psychotherapy billings and less than 0.1% of the Ministry of Health budget. I have recently done a study on these patients in depth and they have frequently suffered childhood traumas (22% of them have had parents or siblings die in childhood, an equal number have been physically or sexually abused) and these patients have legitimate psychiatric diagnoses.

"The second targeted group are those with severe personality disorders or traumatic histories, many of whom require three-times-a-week treatment. The fifth bullet [in the backgrounder] states inaccurately that such patients 'may require two hours or twice-weekly sessions.' Sometimes this is the case, but as a generalization this is unsound and numerous checks on the subject of patients with personality disorders state that three and sometimes four times a week are necessary for these patients."

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I was quite taken with one particular paragraph in Dr Doidge's letter. He says:

"It is thoroughly legitimate for politicians and bureaucrats in the ministry to request that we document how we make our decisions. However, it is not legitimate for bureaucrats and politicians to make decisions on the patient's behalf. It is especially alarming when such decisions go against the advice of the most senior psychiatrists in the province, or world experts on the indications for psychotherapy and psychoanalysis."

I want to underline again the poignant case Dr Doidge has made. First, the government's conclusion that psychoanalysis and intensive psychotherapy is of questionable medical benefit is inaccurate, misleading and in contradiction of what the experts have stated or what is stated in the major psychiatric texts. Second, it is legitimate for politicians and bureaucrats to request that practitioners document how decisions are made, but it is not legitimate for bureaucrats and politicians to make decisions on the patient's behalf. Third, patients themselves have been made to suffer pain as a result of the government's threats to delist this treatment, then saying it would not be delisted, then again saying the treatment would no longer be insured.

I found it enormously puzzling, as the expenditure cut document was placed on the table earlier this year, to see that the limitations on psychotherapy were once again back on the table, because on January 29, 1993, Frances Lankin took this issue off the table. She said:

"A number of items that are not insured by some other provinces, including psychoanalysis, have been reviewed by a subcommittee of the JMC. This subcommittee has recommended to me that psychoanalysis be maintained within the fee schedule and that separate fee codes be developed to allow the ministry to more closely monitor the efficacy of and access to psychoanalytic services."

The recommendation to the minister and the action the minister indicated that she was taking at the time were conveyed to many patients across the province. In fact, the information that was conveyed allowed patients to believe that psychoanalysis and the removal of services were no longer on the table. None the less, when the expenditure control plan came down, we see that it's there again.

If the government is convinced that a disproportionate share of our medicare dollar is being directed at psychotherapy, then it should be prepared to explore ways, with the profession, that will ensure that those who need care are not cut off from care and do not receive an inappropriate form of care and that the care is provided by those with the skills and training to do so. Dr Doidge correctly points out that the government's proposal restricts the practice of psychotherapy by those who are most trained to do it on an equal basis to those who do not have extensive training.

Surely that is an avenue to explore with the profession, but as long as the government takes arbitrary problems and arbitrary solutions, it will not find the savings it wants, because costs will be transferred elsewhere into the system, and worst of all, patients will suffer.

The entire question of delisting some medical services or the decision not to add others is central to Bill 50. I've used psychotherapy as an example, and I could have used others. The issue is the basis on which services are delisted and to which people will have no access under medicare or what new services are added to medicare coverage and what expertise is involved in making those decisions. They are not for the Minister of Health alone and they are not for the Premier alone and they are not for the cabinet alone.

People feel much more comfortable knowing that excesses are taken out of the system, but they want to know that there is a medical and clinical rationale for determining what should be at the basis of our health care system. If medical expertise, combined with political will, judges that the removal of tattoos should not be covered by health insurance, then, with appropriate public information and notice, there will be an acceptance of that decision. If medical expertise, combined with political will, judges that the reversal of sterilization should not be covered by health insurance, then again, with appropriate public information and notice, there will be an acceptance of that decision.

But this bill provides so much one-sided power, and that side is where the expertise as to medical necessity does not rest. It is a serious onslaught on every person who needs medical care.

Now, let me give you what I know the minister will characterize as a wild example. With this bill the Minister of Health can indeed determine what is medically necessary. That has not been left out of the bill, has not been precluded from the bill. While the minister will say, "This is a wild proposal," just say that if the minister doesn't happen to like Caesarean sections, Caesarean sections could be taken out of OHIP coverage. If the minister doesn't think that certain kinds of addiction treatment work, those certain kinds of addiction treatment could be taken out of OHIP coverage. While those examples may be extreme, that is the kind of power that is transferred to the Minister of Health and the government with this bill.

I think we should look at those ramifications of this legislation. While the current minister may not act in that kind of rash way, who knows what another minister could do with the kind of power that ministry officials have themselves described as a blunt instrument?

I think we should look at some of the other practical ramifications of the legislation and we should understand that there are many implications to this bill. The Ontario Hospital Association has pointed some of them out in its letter to the Minister of Health which was written on July 6, and I would like to read that letter into the record. It says:

"The Ontario Hospital Association has now had the opportunity to review in detail Bill 50, the Expenditure Control Plan Statute Law Amendment Act, and I am writing today to convey the views of the association on this legislation.

"Although the major impact of the legislation will be on physicians and other professionals, it is clear that it will also extend into hospital diagnostic and therapeutic services that are directly paid by OHIP.

"The proposed legislation is designed to give to the government extraordinary power to determine the type of services to be provided and the circumstances under which these services will or will not be paid for. On top of this, the amount of the payment, if any, may also be determined by order in council, as well as the type of physician or facility that will be paid.

"We are not aware of any provincial legislation that gives to cabinet this type of all-inclusive power without the necessity for consultation. This is in stark contrast to the government's approach to social contract negotiations in Bill 48, the Social Contract Act, where the approach is unquestionably being linked to open consultation and consideration of the interests of all parties.

"The powers defined in the legislation go far beyond what is necessary to satisfy the stated objects of the act, to the extent that one could conclude that the government may have abandoned all intentions of joint management of the system by the parties.

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"The Ontario Hospital Association is of the opinion that this is an unacceptable precedent to be set in a health care system without major public debate. What is reported to be a device to manage a fiscal issue is now seen to be a statute to give management authority to the cabinet for all aspects of the operation of the medical care system. The management authority given to the government greatly exceeds the management rights provided for under any labour relations model.

"While the Ontario Hospital Association respects the right of the government to control its fiscal position and supports the effort to improve physician distribution in the province, there are many other ways in which these objects can be achieved without resorting to executive control of the detailed management of health care. Nor is the association convinced that this is what the government is seeking, as this is an entirely new intervention that hospitals and others affected cannot support.

"The Ontario Hospital Association urges you to reconsider the intent and the scope of the bill and either to withdraw it or to focus it more closely on the stated objects. At the very least, the bill should be subject to open public discussion, including committee hearings, prior to the conclusion of the legislative process."

I understand that indeed there will be committee hearings with respect to this bill as it moves along the legislative schedule, but I can tell you that the Ontario Hospital Association response will be mild compared to what most of the intervenors will say when those hearings begin.

The Ontario Hospital Association talks about executive control of the detailed management of health care and deplores the government's approach. It recommends, as I say, that the government either withdraw the bill or change its scope substantially. The OHA, like Layne Verbeek from the ministry, doesn't believe that the government has contemplated using such a blunt instrument. If not, once again, why do we have this dangerous bill? Is it to control physician resources? If so, it's not needed.

Let me go back to the government's own paper, presented as a supplement to the 1992 provincial budget, entitled Managing Health Care Resources. That paper was a signal of change that the government intended to see driven into the system, but in no way could it be seen as a precursor to this particular piece of legislation.

If I may, I'd like to quote from the section of the document relating to physician resource management, which is a fancy way of saying "making sure that we have the right number of doctors in the right places providing the right treatment at the right time to the right people."

Now this is going to be fairly lengthy, but I want it to be understood that the approach that was presented in this Managing Health Care Resources statement was one indeed that the government had been pursuing with the OMA through the joint management committee, and some progress had been made in the whole area. In fact, the approach that was put forward in this document was one that linked the physician resources problems in Ontario to those that were being faced throughout the country.

"The issue of physician resource management is important not only for Ontario but for every province. All ministers of health in Canada see this issue as key to strengthening the health care system and preserving the principles of the Canada Health Act.

"In January 1992, the Provincial/Territorial Conference of Ministers of Health held in Banff adopted a series of strategic directions for physician human resource management. At this meeting, representatives from six national medical organizations provided a consensus statement that recognized the need for a nationally coordinated physician resource strategy.

"The strategic directions adopted by the Provincial/Territorial Conference of Ministers of Health included:

" -- Reducing the number of doctors trained by Canadian medical schools.

" -- Establishing national clinical guidelines.

" -- Making medical care expenditures more predictable.

" -- Replacing fee for service with other methods of payment.

" -- Increasing the use of alternative service delivery models.

" -- Restructuring academic medical centres to meet the health care needs of the population.

" -- Improving access to clinical services in rural communities.

" -- Ensuring continuing competency of physicians.

" -- Promoting flexibility between professional groups."

That was the national approach. From that, the Ontario Ministry of Health moved into looking at what should be Ontario's approach to managing physician resources. The document goes on to say:

"The Ontario Ministry of Health recognizes the need to develop a physician human resources strategy that complements national directions. As an initial step, the Ontario and federal governments will co-host a national conference on physician issues in Ottawa in June [1992]. The conference will provide a discussion forum for federal, provincial and territorial governments, and various stakeholder groups."

This was the promise: "In consultation with stakeholders, the government will also develop a comprehensive physician management strategy to better manage the number, mix and distribution of physicians in Ontario. This strategy will be linked to the national plan and based on the documented health and cultural/ linguistic needs of the population. The government will work towards:

" -- Better aligning the educational supply of physicians to the health care needs of the province.

" -- Modifying the medical education experience to better prepare physicians for the settings in which they will eventually practise.

" -- Exploring ways to better distribute physician human resources geographically and by health care setting.

" -- Creating a system of linked, regional, multi-disciplinary referral networks to effect a mix and distribution of physicians that provides a more rational means of accessing health care providers."

Along with what was an apparently rational initial first step, coordinated with steps that were being taken on a national level, the government clearly made a commitment to proceed in consultation with stakeholders.

I have to ask if the government follows its own strategy. Does it work within the national parameters? No. Does it work in consultation with the stakeholders? No. The first announcement that we saw of any initiatives in this particular area of physician resource strategy was that all new graduating residents and interns will be penalized as they begin their working life; that they will only be paid a quarter of their legitimate fee unless they set up practice precisely where and under the precise conditions that the Minister of Health determines.

That is the physician resource strategy that is referenced in the expenditure control plan, and it's one that stands alone. It is not within the boundaries of all the other initiatives in the physician resources strategy, that I think we all agree are important.

Let me give you an example of this particular policy on a new, young paediatrician with whom I spoke. She had 10 years of specialized training beyond high school. She didn't come from a wealthy family and she had a load of school debts. She wanted to work with the cancer kids and she had made arrangements to buy, over time, a practice from a physician who had specialized in this area and who would gradually ease out of the practice as she took over.

In her first year, under normal circumstances, because of the way that she was easing into the practice, she expected to bill OHIP about $60,000 for her services and she anticipated that her costs would be approximately $30,000. So she would be left with an income of $30,000 to $32,000. That was her best guess.

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But one day she caught the Minister of Health's musings and learned that while she might bill OHIP $60,000, she would be paid only $15,000. Her costs would still be close to $30,000, so in her first year of practice, she would lose $15,000, and this would go on for another four years. So, modestly, at the end of the five-year period that the Minister of Health has designated, this highly trained young woman would have incurred a government-imposed debt of $75,000 plus all the costs of carrying that debt. Effectively, she was locked out of practice and her potential patients were deprived of her care.

The numbers and the circumstances change, and that may well be an extreme example, but I suspect that it's not an extreme example according to what I've heard from other residents and interns. None the less, the point is still the same. What kind of strategy was this except the way I've characterized it, as a stupid one? Was there any sense to it? Was there any kind of logic? Did it fit in any way into a physician resources plan that was thoughtful and workable? Did it mesh in any way with the national approach? Did it serve patients any better? Did any person benefit in any way? The answer is no on every one of those counts.

In my view, that announcement was a stupid, panic-driven, slash-and-burn policy. When the howls began, did the minister withdraw it? No, she left it on the table.

Then a new committee was formed, and we heard the minister speak about it in her introductory remarks today, with Dr John Evans at the head, and people from medical schools were part of that committee. They understood that the issue of physician resources planning was not one for which an immediate solution could be found. But in lickety-split time, they did come up with the first phase of another proposal, which included, among other things, paying new doctors 75% of the legitimate fee schedule unless they practised in designated regions or a specialized area.

Well, we know what happened to that. The minister said that she liked it. She told the media that she liked that plan and she'd take it to cabinet. But there's many a slip 'twixt cup and lip, and in the current OMA negotiations, guess what? There are two proposals on the table.

The minister has never clarified to the public, to the residents and interns, to this House, to the affected new doctors, to the existing profession precisely what her position is. Is it a 25% discount or is it a 75% discount? What other requirements are to be added for new doctors or for those who are about to retire? Those issues are clearly now being negotiated with the Ontario Medical Association.

But if the minister isn't happy with what comes out of the negotiations, I point out to you that under Bill 50 she can simply change it and choose her own additional requirements. She can say that night and evening practices are restricted by the compensation plan she elects, not only for new doctors but for all doctors. She can ensure that emergency departments will not be staffed in many hospitals in Ontario as a result of steps that she takes. That already is happening, and I'm going to refer to that shortly. Under Bill 50, all of those things are quite permissible and in fact, according to the government, desirable. If it's not desirable, then why do we have Bill 50?

Let me go back to some of the issues that were included in the national approach and some of the steps that Ontario indicated it was going to take as it looked at physician resources.

First of all, better aligning the educational supply of physicians to the health care needs of the province: One of the things that Ontario lacks, in my view, is a health status report. We don't know now precisely what the health status of our population is.

I recall when Marc Lalonde was Minister of National Health and Welfare that one of the major steps that was undertaken as the nation launched its review at that point in time of national medicare, it was important that the status review of the population be undertaken. It brought forward some startling facts, and I urge that you look at that report and see what it contains.

But in fact, as we're planning physician resources, we don't know what the health status of the population is. None the less, the government has adopted some ratios which were put in place several years ago and is using those as a guideline and, finally, we now have agreement of the medical schools that there is a decline in those who will be accepted in certain specialties and in medical school as a whole.

Modifying the medical education experience to better prepare physicians for the settings in which they will eventually practice, this proposal has started. In northern Ontario, there are young medical students who are attending school at Laurentian University in both Thunder Bay and in Sudbury, and indeed many of those young people were quite willing on their graduation to practise in the north. In those instances, they are general practitioners and they are having a very full view of what it means to practise in the north while they are receiving their training as well.

None the less, under the minister's proposals, they could well also have been shut out from the practice of medicine, with no notice and with no indication of any kind of a rational approach to ensuring that communities have adequate coverage.

We know that many hospitals are already pressed for physician staffing, on nights, on weekends, in their emergency departments, and I could you tell you many communities that have very serious problems. Geraldton is one; Barry's Bay -- I think the member for Renfrew has raised the issue of that hospital in this House; Mount Forest in Grey county; Tweed. All have a difficult time and many face times when there is no physician available at the hospital.

The impact of the unilateral decision-making that this bill will allow that can sweep aside any negotiated settlements, any negotiated agreements with the Ontario Medical Association to impose a practice pattern, to impose a fee, is highly problematic, because if you look at some of the issues that are included in the expenditure control plan, you see that it's not just a tiny range of items that are affected.

After-hours premiums for services which are paid to physicians on off-hours: The government proposes to eliminate the emergency department equivalent premium; it proposes to eliminate the evening and after-hours special visit premium; it proposes to extend the daytime premiums from 7 to 11 o'clock, and the night premiums would be extended from 11 o'clock till 7 in the morning.

The after-hours evening premium for surgical procedures will be reduced by 10%, including for surgical assistance and for anaesthetists; the evening special visit premium for surgical assistance and anaesthetists would be eliminated; and the after-midnight premium and special trips wouldn't be changed.

The ministry calculates that those initiatives together would save $26 million in this year and something like $40-plus million on a full-year basis. But the impact cannot be limited to examining how much money will be saved. The impact must also be examined in terms of what services will no longer be available to people in their own communities.

I guarantee you that if that analysis hasn't been done, if this change is implemented on a unilateral basis, as the minister will now have the power to do, there will be severe repercussions in many communities where there already are problems and this kind of initiative will certainly exacerbate those problems.

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On two occasions recently in the House we've seen very unusual interventions from the College of Physicians and Surgeons of Ontario in consideration of the consent to treatment, advocacy and substitute decision bills, because the government had there acted in a unilateral and ill-informed way. The college felt that it had to intervene and become involved in the debate on those bills to ensure that changes were made that will enable the law to be workable and to ensure that physicians would not be subject to disciplinary matters for making a choice between delivering care to their patients and following a law which was badly crafted and badly thought out.

The college, as you know, has been, I think, quite forward-looking in making its recommendations with respect to sexual abuse by practitioners of their patients known to the ministry and to have those recommendations come for evaluation. We know that the bill the ministry introduced was not what will be a workable document, but we are anticipating, and the Minister of Health has promised, that there will be substantial amendments to that bill. But as I say, it is unusual for the College of Physicians and Surgeons to intervene and to become involved and embroiled in a debate with respect to particular legislation. However, once again, because of the draconian nature of this legislation, the college has found it necessary to become involved in the particular debate with respect to Bill 50.

I have received a letter from them which reads as follows, dated July 26, 1993:

"Dear Mrs Sullivan:

"The College of Physicians and Surgeons of Ontario hopes that the introduction for second reading of Bill 50 will give members of the Legislature the opportunity to reflect on some of the fundamental changes to Ontario's health care system that could result from the passage of this bill.

"While the government has an obligation to control costs, it cannot, even with the best information and intentions, practise medicine by setting out in regulation what the limits of particular services should be under different clinical circumstances. Yet this is the apparent effect of one of the suggested amendments to the Health Insurance Act contained in Bill 50.

"This amendment interposes the government both between the patient and the health care provider and between the patient and the actual place he or she may receive a particular medical service. It also opens the door to a two-tier, US-style health care system by introducing the notion that the patient must pay in certain circumstances for services which have previously been considered medically necessary and have thus been fully insured.

"Deeming certain kinds of services, or a specific number of occasions of a particular service, to be uninsured will simply transfer the costs to either the patient or a third party. As in the United States, this will inevitably lead to third parties, ie, insurance companies, deciding and defining the medical needs of the patient.

"A more sensible and sensitive alternative would be to allow the providers to work together with patients to provide necessary medical services within a predetermined global budget.

"As it stands, Bill 50 provides for limits to be imposed by regulation on a patient's legitimate need for essential medical services and on a provider's moral duty to render those services. It precludes professional judgement and denies legitimate essential services to those who need to receive more than the arbitrarily imposed number of said services. For example, taking only the area of cancer care, it raises questions such as:

"Who should determine how many treatments and of what kind could be rendered by a particular doctor in a particular institution to a particular patient? What would happen to that doctor or institution if the approved number of treatments were exceeded? What would happen to the patient if he or she reached the government-prescribed limit and was either refused further treatment or could not afford to buy the services required above the government limits?

"Cost controls are a fact of life. The issue, however, is where to put the controls so that essential medical and health care judgements are made by the most informed and responsible people within the financial limits defined.

"Health care decisions are individual decisions. Individuals have different health care needs and professionals must have the flexibility to exercise their professional judgement in the best interests of their patients. If costs are to be controlled in a humane manner, those controls must be based on front-line, clinical judgements, not based on government decree.

"Yours truly, Michael E. Dixon, MD, MSc, FRCPC, Registrar of the College of Physicians and Surgeons of Ontario."

That letter is a poignant one and it speaks for itself.

My view is that the current Health Insurance Act provides the government of Ontario with all the power it needs to make appropriate decisions about the shape of our health insurance system and provides the scope for ensuring that the services that people require are considered and are, through the system, provided.

Let me just acquaint you with section 45 of the Health Insurance Act, through which the Lieutenant Governor in Council may make regulations with respect to the delivery of health services through the health insurance plan in Ontario.

The cabinet, by order in council, may make regulations "prescribing the services rendered in or by hospitals and health facilities and by practitioners that are insured services." The cabinet may make regulations "prescribing constituent elements that are a part of insured services rendered by physicians or by practitioners." The cabinet may make regulations "prescribing constituent elements that shall be deemed not to be part of insured services rendered by physicians or by practitioners."

The cabinet may make regulations "prescribing the amounts payable by the plan for insured services rendered in or outside of Ontario...by hospitals and health facilities and by physicians and practitioners and the conditions for their performance and for payment, but no schedule of payment shall be prescribed under this clause that would disqualify the province of Ontario, under the Canada Health Act, for contribution by the government of Canada because the plan would no longer satisfy the criteria under that Act."

The cabinet may make regulations "prescribing services that shall be deemed not to be insured services for the purposes of this act and the conditions under which the costs of any class of insured services are payable and limiting the payment commensurate with the circumstances of the performance of the services."

The cabinet may make regulations "prescribing services that, despite any provision of this act, shall be deemed not to be insured services in respect of prescribed age groups of insured persons, or to be insured services only in respect of prescribed age groups of insured persons, but no service or age group shall be prescribed under this clause that would disqualify the province of Ontario, under the Canada Health Act, for contribution by the government of Canada because the plan would no longer satisfy the criteria under that act."

Mr Speaker, I point out to you that power is an extensive power. It has worked well in the past and, frankly, I think I've said on several occasions in committee and in this House that I was happily surprised to see that the framework agreement with the Ontario Medical Association in fact did bear some fruit. Unfortunately, I believe that framework agreement is jeopardized by this bill.

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The minister spoke about Bill 50 as being a fail-safe mechanism. I believe that this fail-safe mechanism is a gun to the head of the OMA. The minister is saying with Bill 50, "Do what we want in whatever area we want, whether it's the delisting of medical services, whether it is in the planning of physician resource supply, whether it is saying what medical treatments can be provided in what facilities at what time, whether it's with respect to compensation for various kinds of services that are provided." The government is saying, "We'll see what kind of agreement we come to at the negotiating table, but if we don't like it, we will use Bill 50 to throw that agreement out and we will impose what we wanted in the first place."

The minister calls Bill 50 a tool. She doesn't need this tool. The Ontario Health Insurance Act and the Canada Health Act provide all the tools that are required and necessary for the delivery of a competent and complete medicare system in Canada.

I know I have 10 minutes left; I know my colleagues want to participate in this bill. I can't tell you how strongly I feel that this bill is an outrage. It should be withdrawn. There is no need for it. If the government doesn't intend to use it, as a ministry spokesman has indicated, then it shouldn't be on the table.

As the hospital association, the medical association, the college of physicians and surgeons and individual consumers have indicated, this bill goes far beyond what's necessary. It's the wrong bill, it's at the wrong time, and I guarantee that when we go out on the road with this bill in committee, there will be outrage expressed by anyone who has a need for medical care and who wants to know that the determination of the necessity and the clinical value of the medical care that's being provided is being determined by someone with the expertise to make those recommendations and to come up with those policies, and not solely in the back room of the NDP government at Queen's Park.

I think that on no other matter so much as medicare are people's live entwined with the emotional issues. As Canadians, we define ourselves by the pride we have in our health care system and the fact that we care for other people who are perhaps in a less healthy state and there is no threat to their financial stability as a result of being sick. We have a system where you don't have to be rich to be cared for and to receive medical treatment.

This bill, in my view, goes a long way in throwing that out the window, and along with it the entire principle of medicare in the province of Ontario. My party will fight this bill every step of the way. We will not be supporting it; I think that's clear. We think it's a dangerous precedent, one that cannot be tolerated. As I conclude my remarks, it will be with one plea: that the Minister of Health withdraw Bill 50.

The Acting Speaker: I thank the honourable member for her participation in the debate. Questions and/or comments? If there are none, further debate?

Mr Jim Wilson (Simcoe West): I appreciate the opportunity to speak for the next hour and to continue my remarks tomorrow with respect to Bill 50. The title of the bill is An Act to implement the Government's expenditure control plan and, in that connection, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act.

I want to say to all members of the House and to the public that this is one of the most very serious pieces of legislation this House could possibly debate during the mandate of an NDP government, and it is one of the most ironic pieces of legislation. I recall well that in the last election campaign and for many, many years -- in fact, decades -- prior to the 1990 election, the NDP told the people of Ontario that it had a corner on compassion, that only it understood the needs of the people of this province. When I went to doors in the last election, people were telling me that Bob Rae understood their concerns, that the Tories didn't understand their concerns, that the Liberals had spent too much and still not provided the services that were needed for the people of this province.

Bill 50, this bill, allows the government to take unto itself unprecedented powers. If I were the Tory Minister of Health, if we had won the last election and I were the Conservative Minister of Health for this province, if I or any of my colleagues in the Ontario PC Party or in fact the Liberal Party tried to bring in legislation that's this draconian, the NDP would be hanging from those chandeliers. They would absolutely want all of our heads on a serving plate. They would be screaming. There would be headlines in the Toronto Star, in the Globe and Mail and the local papers throughout the province. Bob Rae would be on his sanctimonious horse telling us what a bunch of idiots we are that we don't understand the people of this province, that we're ending medicare as we know it in this province. I tell you, it's ironic, it's sad and it's shameful that the NDP is doing exactly that.

I heard no mention of the fact that they were going to pretend to be the physicians of this province in the last election. Dr Ruth has decided to be just that: Dr Ruth. She, along with Bob Rae and all of the NDP caucus, who sit there like a bunch of bumpkins, are going to tell the physicians and health care professionals in this province how to do their jobs. Let alone that they can't run a government, let alone the fact that they're the worst bunch of managers this province has ever seen, now they're going to meddle head first into the health care system. They're going to tell every physician exactly what services can be rendered, what services will be paid for and how often those services will be available to the people of this province.

The fundamental question here is, do you trust Bob Rae, do you trust Dr Ruth Grier, to run your health care system, when we know that, on every other issue they've tried to deal with in this province, they've absolutely, totally messed it up? They're the worst bunch of managers you could possibly elect to this chamber. It's unfortunate for the people of the province that, the way the cards fell in the last election, we end up with this government which is bringing in absolutely draconian measures.

The minister in her remarks this afternoon said, "This is fail-safe legislation." She tells the members of her caucus, "Like Bill 48, the social contract, we won't implement this legislation, but we want the power to tell every physician how to treat and communicate with his patients and how often." As I say, the NDP would be hanging from the chandeliers if we ever attempted to do something like this.

What I also found ironic in the minister's own remarks this afternoon is her saying, "Well, we may not ever use these wide-sweeping powers we're taking unto ourselves, the ability to make decisions behind closed cabinet doors, the ability to bypass any negotiation process with the union, the Ontario Medical Association."

The Treasurer a couple of weeks ago finally said what we've been saying since 1991, when the OMA and the government signed an agreement: that the OMA and the physicians in this province now do belong to a union. The party that sits across from us in the Legislature here, the New Democratic Party, claimed to be friends of unions. We've seen them totally mess that up in social contract discussions. Now with Bill 50, they want to go even further and bypass any discussions, which they're mandated to have under their agreement with the OMA. They take authority unto themselves to bypass those discussions on Bill 50, to totally ignore the OMA-government memorandum of understanding, the union agreement. In fact, in section 1 of the bill, they have the audacity to exempt themselves from any legal action that may stem from their gutting of the OMA-government agreement.

They're going to go ahead and just ignore all the good things the OMA and other people in the health care system have helped to bring about in the last couple of years. The government admits that the medical profession in this province over the last couple of years has probably saved the government upwards of $2 billion in savings. They've done that through a system of negotiations, through the joint management committee, through this memorandum of understanding, through lengthy and legalistic processes that are set out therein. They've done that, and now this government says, "That's not enough. We've got an expenditure control plan that was introduced in April and we've got a social contract. We need another $1.6 billion out of health care. We can't wait for full public discussion. We don't want to talk to the public," and frankly the public probably doesn't want to talk to the NDP. I saw the poll today; they're at 16%. They're about as popular as Brian Mulroney was in his most unpopular days in office. That's ironic.

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But to bypass their union friends in the OMA I think is shameful. I don't know how any of these NDPers can go back to their ridings and talk to physicians. That's if they do talk to physicians. To hit on the medical profession, the medical services, is to hit on the people of this province. It's to hit on exactly what we used to pride ourselves in in Ontario, and that is that we were different from Americans, that we were different from other nations, because we had a medicare system which, regardless of your income, regardless of your ability to pay, you had access to that system. It was a system that had quality, it had universal accessibility and it was there when people needed it.

For 42 years, under my party's rule in this province, the polling showed that Ontarians consistently didn't worry all that much about their medicare system, because they trusted that there were managers in office who wouldn't bring in Bill 50s, who wouldn't bring in draconian legislation, who wouldn't take powers unto themselves to manage a health care system.

We know they'll make a complete mess of it. They already have. And what are we seeing? What have we seen since the NDP came in? We've seen the NDP try and convince the public that the only issue in this province is user fees. Well, let's dispel that myth for a while.

This government, several times announcing, and the Liberal government before it, had committed to $647 million of new money into long-term care over the next four or five years. What the government and the Liberals before it didn't make clear is that $150 million of that will come out of the pockets of seniors and residents of long-term care facilities in new user fees.

I don't want to hear that debate any more in this House. I think it's dishonest to go around saying there aren't user fees in the system, and I think it's dishonest to try and direct public debate to only a user-fee issue. What Bill 50 does is not only end medicare as we know it but gives the future management of medicare into the hands of the NDP government, and frankly I don't trust the NDP to do a good job. They've not done a good job on anything else they've ever tried to do, and I don't think the people of this province trust the NDP government to do a good job.

I want to read a couple of letters from the people of this province. The first one is an editorial, a comment by Mr Bruce Haire, which appeared in the June 30, 1993, edition of the Record Sentinel and the Times, which we know locally as the Beeton-Tottenham-New Tecumseth papers, published out of Beeton.

The headline is "Government by Indecision." It says:

"The Bob Rae horror story goes on and on and on. One week the big news story is panic in one sector of the public service. The next week it is of panic in another sector.

"This week it is the medical health care sector that is grabbing our headlines.

"We have an aging population -- one which will be in need of additional health care.

"Studies done by local hospitals have determined the obvious -- the area is growing and the population is aging -- more hospital beds will be needed.

"Indeed, the province had approved the concept of hospital expansion and even the funding involved.

"Suddenly, Ministry of Health officials were showing up at meetings announcing: to heck with the studies, the province had changed its mind and wanted more bed closings, perhaps even hospital closings.

"Our worst Environment minister ever (you remember Ruth Grier -- queen of the megadumps) is now making a name for herself as our worst Health minister ever. She is criss-crossing the province announcing hospital closings -- 10 in Toronto, one or two in Windsor....

"These are based on nothing but panic. The NDP give us over two years of denying recession and big spending and then panic in their pursuit of cutting soaring deficits.

"What is happening is almost beyond belief but the people of Ontario are coming to believe almost anything from Bob Rae, Ruth Grier and the crew of clowns.

"Here are the thoughts of Stevenson Memorial Hospital chief of staff Dr N.D. Gripper:

"'Within the hospital building program we have seen constant changes of government personnel with whom we work. In the last few days our whole building program has been revamped with new ground rules and requirements. Even the funding has been changed.

"'This type of uncertainty and lack of decision by government administrators in the health system creates a lack of faith in their decisions and ability for us to pursue a reliable and fulfillable agenda. From my observations in the past few weeks, they have thoroughly undermined the morale of those of us who have been struggling to function within this mess.

"'We are further concerned that the actual patient care is of secondary importance. What seems to be important is the bureaucracy. While there are further major economies and closures going on within the hospital system, the much publicized improvements in the home care and the long-term care programs are not yet in place but from what I understand the Ministry of Health seems to be unaware of this. I also have no doubt that funding for these programs will be cut in the near future.'"

That's from Dr Gripper, Stevenson Memorial Hospital in Alliston, somebody on the front line, someone who's extremely concerned about the draconian power grab of Bill 50 and someone who would agree with me that this is the end of medicare as we know it. Let us be unequivocal about that.

The NDP have decided that they, behind cabinet doors, will end medicare. They'll delist psychoanalysis, in spite of all of the good arguments made throughout this world with respect to the efficiency and effectiveness and need for that particular service. They'll delist eye exams. They'll delist anything else they take a fancy to delist, and the public won't know a thing about it. We'll all have to read about it in the Ontario Gazette, I guess, when the regulations are passed.

They're introducing Bill 50 in the hazy, lazy days of summer here, so that the people of Ontario won't notice. Well, I'll tell you, there are a number of good people here who have noticed, who are fighting to retain the psychoanalysis treatment that they're in now. They've brought forward studies, world-class studies, some of those authored by people in our own province who are recognized in this field.

I recall very well, particularly Ruth Grier, back in the early 1980s when they were closing down the Lakeshore Psychiatric Hospital. This was her issue. This was the NDP's issue, the provision of mental health services in this province. I tell you, with Bill 50 and the social contract legislation and just about every other decision this government has taken in the health care field, it's the end of your credibility on these issues.

We'll take no more lectures about mental health services. We'll take no more lectures about long-term care, because the senior citizens of this province know that you're a bunch of bunk over there, that you'll say anything to get elected, absolutely anything to get elected. In the hazy days of summer, you bring forward Bill 50 to gut medicare as we know it. We're not going to put up with it --

Mr George Mammoliti (Yorkview): Hey, it's Bart Simpson.

The Acting Speaker: Order, please. The member for Yorkview will come to order. The member for Downsview will return to his seat. Order. The honourable member for Durham East on a point of order.

Mr Gordon Mills (Durham East): Mr Speaker, on a point of order: I don't believe as a member of this Legislature that the Legislature rules call for another member to call me a bum, and I would ask that he withdraw that, Mr Speaker. I think that's entirely out of order, entirely uncalled for, entirely unparliamentary and not worthy of comment in this House.

The Acting Speaker: I don't believe the honourable member said that in terms of my own hearing.

Mr Mammoliti: He said "bunk." Is "bunk" parliamentary?

The Acting Speaker: Order, please. I don't believe the honourable member said that. I will say, though, that the honourable member is continuing with quite inflammatory comments, and if he expects the order of the House to be at least reasonable, I would ask him to take that into consideration. But the honourable member for Simcoe West does have the floor.

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Mr Jim Wilson: I guess the truth hurts when you present it to the NDP. They like to believe that they can still go out and present the public with the fact that they claim they're managing the health care system and that they're reforming the health care system. I apologize to the member for Durham East if he finds that the truth is offensive.

But the member for Durham East didn't run in the last election as a Conservative or a Liberal, where we know very well you people would have thrown us off the all-candidates meeting stages. You would have continued to try to convince the public of Ontario that you have the corner on compassion. Now you bring in Bill 50, the expenditure control plan, in such a draconian way that it is unbelievable to me and my colleagues that you're getting away with this. It is unbelievable to me that the unions are not out front screaming bloody murder at you. It is unbelievable to me that the public of Ontario have not yet awoken to this issue.

I intend, during the time I have, to ensure that the public who are watching this, the several hundred thousand people who watch this every day, understand the seriousness of Bill 50, understand that this government doesn't consult with so-called stakeholders, that in 1991 it can make an agreement with the 23,000 physicians in this province and then in the summertime of 1993 introduce Bill 50, which guts any progress, and admittedly there's been some over the last couple of years in terms of trying to bring health care expenditures under control.

We've heard the government claim great credit for some initiatives. The cornerstone of that credit was the OMA-government memorandum of understanding framework agreement-joint management committee, and Bill 50 guts all of that.

The minister in her remarks this afternoon says: "It's a fail-safe bill. We won't use it. It's simply a gun to the head of the physicians and other health care practitioners out there who bill OHIP. It's a gun to their head to negotiate with us at the table. They're powers we think we need to bring health care expenditures under control."

I find that ironic, because you're at the table with the physicians. You don't know what agreement you're going to come up with, but you seem to know what draconian, closed-door cabinet powers you need, and you're ramming this bill through the Legislature.

I guess if the members over there find the truth difficult as I present it, perhaps they'll listen to Michael Dixon, the registrar of the College of Physicians and Surgeons of Ontario, who wrote to me on July 26, 1993. He says:

"Dear Mr Wilson:

"While the government has an obligation" -- and I'll say this is a very reasonable letter from the College of Physicians and Surgeons -- "to control costs, it cannot, even with the best information and intentions, practise medicine by setting out in regulation what the limits of particular services should be under different clinical circumstances. Yet this is the apparent effect of one of the suggested amendments to the Health Insurance Act contained in Bill 50.

"This amendment interposes the government, both between the patient and the health care provider, and between the patient and the actual place he or she must receive a particular medical service."

Dr Ruth and Dr Bob Rae have planted themselves between physician and patient, and they're going to sit there in their cabinet office and they're going to tell you how often you can have psychoanalysis. Maybe if a person has two heart attacks and has a little problem quitting smoking and has a third heart attack and needs medical services, you'll just decide that he or she doesn't deserve medical services. Maybe you'll cut them off. That has been suggested to me in letters from physicians.

Interjections.

The Acting Speaker: Order. The member for Simcoe West has the floor. Interjections are out of order. Other members will have the opportunity to debate when the time comes.

Interjections.

The Acting Speaker: Order, please. The member for Simcoe East, please address your remarks through the Chair.

Mr Jim Wilson: You're such a good guy, Mr Speaker, I know you're not part of the problem. But I will, as parliamentary decorum requires, address my remarks through you.

Michael Dixon, the registrar of the College of Physicians and Surgeons, goes on to state in his July 26 letter to me regarding Bill 50, "It also opens the door to a two-tier US-style health care system by introducing the notion that the patient must pay in certain circumstances for services which have previously been considered medically necessary."

Interjections.

The Acting Speaker: Order.

Mr Allan K. McLean (Simcoe East): On a point of order, Mr Speaker: I can't believe what I'm hearing here in this Legislature. The members are continually interjecting. There's no order here. If there isn't, I move adjournment of the debate, if that's what you want.

The Acting Speaker: The honourable member did not have the floor. I again want to remind members, if indeed you want to participate, the opportunity will be there. The member for Simcoe West has the floor.

Mr Jim Wilson: I appreciate the comments of the member for Simcoe East. It is a little difficult in here but I'm prepared to forge ahead on behalf of the people of this province. I'm prepared to forge ahead, as my colleagues are, on behalf of those currently in psychoanalysis, who are going to have their treatment gutted by this government, gutted by a government that had a corner on compassion, by a government in particular which carried mental health issues in this Legislature time and time again ad nauseam.

It's their opportunity to put forth what they believe are important services in this province. It's their big opportunity to do that, and what do they do? They gut those services. They fall back against everything they ever told us they stood for. I hope that the people of Ontario understand the widespread powers that the cabinet, Bob Rae, Ruth Grier -- Dr Ruth -- and their cohorts in the NDP -- I hope people understand the massive power grab they are doing.

It is no coincidence -- and I gave my button away today -- that the Ontario Medical Association has put out big three-inch diameter buttons saying that Bob Rae's government is dangerous to your health, and full-page newspaper ads: unprecedented in this province. The Liberals picked on the physicians in 1986 and they had a fight and that was great, but this is unprecedented in terms of the OMA's determination to fight this legislation, not on behalf of doctors or their paycheques as the NDP believe, but because physicians go through a number of years of service training.

In fact, we spend $2 million per doctor training them. What we find is so many of them going to the United States, and tomorrow in my remarks I want to bring forward some local examples from the village of Beeton in my riding and from New Tecumseth and Alliston and Tottenham and Tecumseth, where we have a shortage of physicians because of the NDP health care policy.

Dr Dixon, in his July 26 letter to me, continues, and I'll repeat because I don't think the NDP members are listening, even though I am trying, at the top of my lungs, as forcefully as possible, to drive some points home, some fundamental points that even they should be able to understand.

Dr Dixon says, "It also opens the door," referring to Bill 50, "to a two-tier US-style health care system by introducing the notion that the patient must pay in certain circumstances for services which had previously been considered medically necessary and have thus been fully insured." We've already seen the delisting and the introduction of user fees for people who require physical examinations. The unemployed truck driver who has to, by law, have a physical examination to renew his truck licence each year now has to pay $50, $75, $150 out of his or her own pocket for that service.

We've seen a delisting of many other previously medically insured services by this government, a government that I say would be climbing the walls around here if any other party in this Legislature or anywhere else in this country, including the federal government, had ever brought in legislation like Bill 50.

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Here the college of physicians and surgeons, the governing body -- not a political body and I hope the government understands that -- of all physicians, and physicians are NDPers too; they're Liberals, they're Tories, they're other parties. They're good people. They're trying to do a job and they're being driven out of this province. We're subsidizing Bill and Hillary Clinton's health care system at $2 million per physician that Bob Rae and Dr Ruth drive out of this province. Shame on you, NDP. Shame on you.

Dr Dixon goes on. He says, "Deeming certain kinds of services (or a specific number of occasions of a particular service) to be uninsured will simply transfer the cost to either the patient or a third party."

Mr Gary Malkowski (York East): On a point of privilege, Mr Speaker: As a matter of fact, the federal Tory government has been beating up the province of Ontario and that's why we're fighting to maintain our health services.

The Acting Speaker (Mr Noble Villeneuve): That is not a point of order, nor a point of privilege either. The member for Simcoe West.

Mr Jim Wilson: I may never get through Dr Dixon's page-and-a-half letter, but I'm going to forge ahead. I want to respond to what the member has just said, because it's totally untrue. How you people believe the stuff that your cabinet ministers tell you -- do you not do any independent thinking over there?

Why don't you phone the federal treasury and ask how much money was transferred to the provinces and to the province of Ontario this year over last year? You will see that for education and health care there is an increase in transfers. The federal government has capped those transfers at about 3% to 5% per year. It's up year-over-year.

You go ahead and unilaterally expand welfare programs. You don't spend the money you're given for health care and education on health care and education. You won't let the federal auditor come in and audit your books on the envelope of money that's sent, so that the people of Canada, the taxpayers of Canada, can actually trust that you spend the billions of dollars you receive from Ottawa each year. You won't allow that to happen. You won't allow committees of this Legislature to examine in detail those estimates.

Mr Anthony Perruzza (Downsview): The truth.

Mr Jim Wilson: They don't want to know the truth. They want to just believe in the mythology they've been spreading for 20 years. I say, enough is enough; we've had it with you. And Bill 50 is the last straw: Bill 50 finally brings out what this government and the NDP are all about, and what they're all about is a slash-and-burn approach to health care.

Mr Mammoliti: On a point of order, Mr Speaker: Are you going to let this go on?

The Acting Speaker: That is not a point of order. We will have the opportunity to have questions or comments when the member who has the floor is done. I highly recommend that you --

Mr Mammoliti: He's going to hurt himself.

Mr Jim Wilson: I wouldn't worry about my health, sir.

The Acting Speaker: Order. I highly recommend that members do participate when questions or comments come up. The member for Simcoe West.

Mr Jim Wilson: The truth hurts, and the truth about Parliament is that it's a substitute for war in our democracy. I am allowed to stand here --

Interjections.

Mr Jim Wilson: Seventy-five per cent of the world doesn't live in a democracy, doesn't have the opportunity to elect a member to speak out forcefully on their behalf. When the government refuses to listen to the people of Ontario, we have no choice in opposition but to get up and, as forcefully as every fibre in my body can muster, bring forward the points, the issues, the concerns we're hearing from the people of Ontario.

If you don't like it, why did you run for Parliament? If you can't stand the heat, get out of the kitchen. They should just resign and call an election. We'll look after all of you if you don't like it here. At 16% in the polls, there are very few of you coming back, very few of you.

Mr Chris Stockwell (Etobicoke West): It's 13%. They're at 13%.

Mr Jim Wilson: They're at 13%. My God, news breaking. They've just plummeted. As a result of my speech, they've gone down another three points since this morning.

Dr Dixon writes, "As it stands, Bill 50 provides for limits imposed by regulation on a patient's legitimate need for essential medical services" --

The Acting Speaker: Order. The member for Ottawa Rideau.

Mrs Yvonne O'Neill (Ottawa-Rideau): Mr Speaker, I don't believe there is a quorum present in the chamber.

The Acting Speaker: Could the Clerk check if there's a quorum present.

A quorum is present. The member for Simcoe West may continue.

Mr Jim Wilson: "As it stands, Bill 50 provides for limits to be imposed by regulation on a patient's legitimate need for essential medical services and on a provider's moral duty to render those services" -- that's a physician's, a health care professional's, moral duty to render those services. There is such a thing as the Hippocratic oath taken by physicians; Bill 50 is going to make it very difficult, if not impossible, for physicians to ensure that they don't break the Hippocratic oath.

I think cabinet ministers should take such an oath to the people of this province, such an oath that what they say in a campaign they won't go against when they get into government; such an oath that would require cabinet ministers, Bob Rae, Dr Ruth, the NDP cohorts, its party, its members, to go to the public when they want to make major changes, such as contained in Bill 50, when they want to make a draconian power grab unto themselves, to tell every patient in this province: what services he or she will be entitled to under medicare; how often that treatment will be provided; who will provide that treatment; where that treatment will be provided. There are many towns and villages now that don't have any physicians at all, and the few who are in some of those villages and towns like Beaton are moving, and I intend to talk about that tomorrow.

Dr Dixon goes on to say, "It precludes professional judgement and denies legitimate essential services to those who need to receive more than the arbitrarily imposed number of said services. For example, taking only the area of cancer care, it raises questions such as" --

Interjections.

Mr Jim Wilson: Mr Speaker, I'm talking about cancer patients and I would appreciate some courtesy from members of the government about the thousands of cancer patients in this province. Perhaps if they're not interested in my views, they'll be interested in the views of cancer patients in this province, something that all of us could be inflicted with at some time, may need a physician, may need treatment, may need it often. Bill 50 will deny that.

In the case of cancer patients, Dr Dixon says Bill 50 raises the following questions:

"Who would determine how many treatments and of what kind could be rendered by a particular doctor in a particular institution to a particular patient?

"What would happen to that doctor or institution if the approved number of treatments were exceeded?

"What would happen to the patient if he or she reached the government-prescribed 'limit' and was either refused further treatment or could not afford to buy the services required above the government limits?"

There have been other cases. I raised the one of the person who has had three heart attacks and may have a problem quitting smoking, and the government will say: "Well, since you don't look after yourself, if you have a fourth heart attack, you're out of luck. You're out of luck, buddy."

Or what we've already seen in this province: the rationing of services with respect to lungs. We remember very well Mr Decter, a couple of years ago, the Deputy Minister of Health, along with Frances Lankin, being quoted in the Globe and Mail saying, "Yes, we might not let 70-year-olds get new lungs, because that's not cost-effective." Well, that's sad. It's sad if it's your mom or dad, brother or sister, sibling, friend, who needs a new set of lungs, who needs a heart transplant, who needs all kinds of medically insured services. We're not just talking about --

Mr Mammoliti: Bill 50.

Mr Jim Wilson: This is Bill 50. We're not talking about electrolysis. We all let that be delisted a couple of years ago, because we felt it was more for cosmetic reasons, so we let it go without saying much. We knew it was the tip of the iceberg.

Bill 50 doesn't talk about frivolous medical services that perhaps never should have been insured under OHIP in the first place. It speaks to medically necessary treatment, medically necessary services. You have to get that through your heads, folks. I guess that's impossible. I feel sorry for the patients of this province.

The Acting Speaker: Please address the Chair.

Mr Jim Wilson: Michael Dixon concludes by saying:

"Health care decisions are individual decisions: Individuals have different health care needs, and professionals must have the flexibility to exercise their professional judgement in the best interests of their patients. If costs are to be controlled in a humane manner, those controls must be based on front-line, clinical judgements, not based on government decree."

1730

I couldn't have said it better myself. The college of physicians and surgeons, a non-political, non-partisan body, is trying desperately to get a message across to this government that Bill 50 should be withdrawn, that it is draconian, that it is unprecedented and that it is absolutely unfair to the patients in this province.

Bill 50 also, in addition to limiting necessary medical services, has already had the effect, in conjunction with Bill 48, the social contract legislation that the NDP already passed in this Legislature -- the NDP and the Liberals rejected our amendments that would have made it more fair and workable to physicians, to hospital workers, to nurses, to teachers, to a number of other groups.

I want to read to you from the Ontario Medicine magazine of July 12, 1993. It says, "Disillusioned Doc Throwing Farewell Bash: Going South With a Bang." It refers to Dr George Wong, a Windsor doctor, an area represented by the NDP, an area represented in cabinet by the NDP.

"Dr George Wong, probably Windsor's longest-serving cardiologist, will head for the brighter medical and political pastures of Phoenix, Arizona, this fall. But before he goes, he'll do something many of his forerunners, others who have bolted the Canadian medical system for the US, haven't. He's throwing a party for all the patients he served over the past 17 years.

"Dr Wong says he's going to the US because he's fed up with both the way medicine is administered in Canada and the general political situation. For physicians, he says, the 'freedom of practice and the freedom of movement are slowly eroding away.'

"'Every time there is a budget problem and every time the government would not balance the budget, it's always the physician or the medical caretaker who gets blamed for doing wrong,' says Dr Wong.

"'Basically,' he goes on to say, 'the number one reason for leaving is that we don't want to sit back and fight with the government any more.'"

You win, folks. You've driven Dr Wong out of Windsor, you've driven hundreds of physicians out of this province to other provinces, to the United States. There was a health care fair about a month and a half ago in Toronto; 500 physicians showed up and all wanted to go to the United States.

Mr Perruzza: Yeah, to the United States. Oh yeah, because they've got a better health care system there.

Mr Mammoliti: They can't change their minds and come back later on. If they want to go, let them stay there.

The Acting Speaker: Order. The member for Yorkview, the member for Downsview, please come to order. We are attempting to debate a bill in second reading and you are not giving the member who has the floor an opportunity. Please.

Mr Perruzza: On a point of order, Mr Speaker --

The Acting Speaker: There is no point of order. Please take your seat. Take your seat. There is no point of order.

Mr Perruzza: How do you know I don't have a point of order?

The Acting Speaker: Because I happen to be standing here attempting to get the House to order. That's the problem we have. The member for Simcoe West, please continue, address the Chair, and would other members please respect the orders of the House. It's that simple.

Mr Jim Wilson: Thank you, Mr Speaker. It was interesting, one of the reasons you had to rise from your chair, of course, was that I was talking about the mass exodus of physicians to the United States, physicians that we, as Ontario taxpayers, have paid at least $2 million each to educate.

When they graduate or when they've even been in service here, like Dr Wong, for 17 years, they now find the political climate so bad, so distasteful, so unprofessional, so threatening to their very livelihoods and their families' wellbeing and to their patients' wellbeing, so distasteful that they're leaving their province.

They're leaving a province where they paid taxes. They helped build the roads and the bridges and the sewer plants and all the infrastructure. Their taxes helped pay for our education system, but it's so bad now, because of the introduction of Bill 50 and because of this government's mismanagement of health care, that they feel compelled to go to the US --

Mr Perruzza: On a point of order, Mr Speaker: I know for a fact that all the doctors that I've spoken to like the health care system and like to practise medicine here. That's absolutely untrue and false.

The Acting Speaker: Order. That is unparliamentary. All members here are honourable members. Would you please withdraw what you have just said.

Mr Perruzza: If anything that I've said has offended --

The Acting Speaker: I ask the member to withdraw.

Mr Perruzza: I have no problem withdrawing. The fact that there's a lot of doctors who like to practise in this country --

The Acting Speaker: Thank you and please take your seat.

Mr Jim Wilson: As I was saying, when I was referring to the mass exodus of physicians, many of them are top names in North America. We happen to have had many of the best specialists in the world located primarily here in Toronto, which is a regional clearing house for Ontario.

Those people have already gone, and I've raised it many times in this Legislature during question period and during debate. I've read into the record the names of dozens of physicians, top household names in their specialities in North America and the world who have gone to the US, and we no longer have the use of their services.

In fact, the ironic thing is we send many patients down to the US. They have to follow the specialists to the US. We pay high fees in the US to have those patients treated in certain specialties because the NDP drove them out of Ontario. Where are the cost savings to government? Where is the compassion they claim to have once had?

The member for Yorkview said about physicians that were going to the US during his interjection a couple of minutes ago, "If they want to go, let them go there and stay there." That is a disgusting attitude for a member of provincial Parliament to have, or any member of any Legislature in this country to have, that when we spend at least $2 million training physicians, the NDP have an attitude, "If they want to go to the US, let them go and let them stay there." That's what the member for Yorkview clearly said. I know Hansard picked it up and it is the crux of the problem that I'm trying to address here.

I am trying to get that mentality out of the NDP's head. Physicians, nurses, health care professionals, chiropractors, all of our specialists, all of the 24 regulated health professions, including midwives, are not bad people. They're good people trying to provide services to the patients of this province. They are willing to talk about cost controls. They have saved this province close to $2 billion over the last two years through a negotiated process with this government, and they are trying to work with this government. But this government brings in Bill 50, hits them over the head and the result is they're leaving this province. They are leaving in droves.

Dr Wong is one of many. I hope the member for Yorkview and his other cohorts over there who don't normally participate in a constructive way in debate -- their only way of getting by in life is to heckle the opposition -- I hope the member for Yorkview will take it upon himself to do the decent thing and send Dr Wong a letter of apology. Dr Wong deserves no less from this government.

Tom Dickson, president of the Ontario Medical Association, feels that Bill 50 is part of a sinister plot being hatched by the NDP government. That's not Jim Wilson, the member for Simcoe West; that's Tom Dickson, the president of the Ontario Medical Association. He says:

"There is a much larger, more sinister agenda at play here, a plan by the Ministry of Health to override almost all of the OMA's agreements with the government and impose massive cuts on medical services and patient care. The government is using its current fiscal situation as an opportunity to pass this very dangerous legislation. There are no limits on what services can be restricted by the government under Bill 50.

"It's not just psychotherapy or eye examinations, as originally proposed. The power to ration insured and medically necessary services applies to everyone and everything. The number of medical services deemed appropriate can just be decided unilaterally by some bureaucrat saving money, some unaccountable bureaucrat who has no agenda but the government's agenda."

1740

It's a sad day in Ontario when the president of the Ontario Medical Association, who represents physicians of all different political stripes, must feel compelled to come out with such strong language.

Tom Dickson, I think, is completely accurate in his remarks. We know he's accurate because when we look at Bill 50, the government says, in section 1, that section 1 will allow the Ministry of Health to carry out the initiatives identified in the expenditure control plan of April 23, 1993, without putting the government, a minister of the crown, an employer in the health sector or a health care provider at risk of facing legal action.

That is an absolute admission by Dr Ruth and company and Bob Rae that they know they're breaking a legally signed agreement with the Ontario Medical Association, and other agreements with health care professionals. They know they are going back on their word, that they're bypassing any legitimate process to come to terms with cost controls. They're simply taking a draconian power grab unto themselves. The legislation speaks to that. It gives the government immunity from any court challenges that may come.

It also means that patients in this province will have no ability in court to challenge the government should they be denied a medically necessary service. If you don't get the set of lungs you need and you die, your family can't go to the government; Bill 50 gives it immunity for that. It's a sad day in Ontario. It's a very sad day.

If the government wants to get up and say the legislation doesn't do that, then why is the legislation so broad in its power grab? It is unspecific.

All of the letters I've read to you, the comments I've put forth from other people, professionals in the medical community, very clearly indicate that the legislation will restrict medical services by regulation, which means the public will not have the opportunity to know what's coming at them until mom or dad dies. You'll wonder why the physician couldn't help. Then you'll want to sue the physician who is forced by this government to break the Hippocratic oath. The physician will have to say: "It was the NDP government that did it. I couldn't do any more. We were limited in the number of procedures we could give."

Take the issue of psychoanalysis. I have tons of paperwork on this, tons. I want to commend many, many people in this province who took the initiative for the first time in their lives to come forward and to take on the NDP government and to point out to the public the need for psychoanalysis.

Psychoanalysis, in many of the studies I have read over the past few weeks, can be a life or death issue. It's not just a quality-of-life issue, although it is primarily a quality-of-life issue. But it can also end in suicide. It can also end in people inflicting pain upon themselves both mentally and physically, to the point where they die. We're not just talking about cardiac surgery or lung surgery or all kinds of services that I think everybody in Ontario would agree are medically necessary; we're also talking about mental health services. Psychoanalysis is a prime example of that.

I want to read, as soon as I find it, from an absolutely superb letter that was sent to me by Ms Marnie Judge. It says, "Concerns to be raised regarding delisting psychoanalysis."

I only bring psychoanalysis to the House's attention, as Mrs Sullivan, the Liberal Health critic, did as one example. It's an example that the public has latched on to because of the good work done by Marnie Judge and a number of other people to raise this issue.

The public is responding in terms of hundreds of letters and petitions that we've read in this House because that issue's been made public. But I'm here to tell the public here today that psychoanalysis is just one issue. With all medically necessary services, all those people on waiting lists right now can't be assured that medicare will be there to help them. They can't be assured there will be a physician around to get them off the waiting lists. We know the waiting lists for a number of absolutely essential services have been growing and growing, because what Bill 50 speaks to is not just delisting a specific service, but it drives the physician who may provide that service out of this province.

I don't know how the government could ignore the fact of that. A world-class lung transplant team might not even be around to help you if you're in that situation. World-class cardiac teams might not be around to help you because they would have left the province because, for instance, of Dr Wong's quote about the political situation, that it's just so unbearable, he had to go.

But back to Marnie Judge and psychoanalysis. I just want to read some of the comments. She says:

"It seems that few if any of the officials that I have communicated with have any understanding of what is involved in psychoanalysis. Many general physicians are also unclear of the process.

"It is not the same as supportive psychotherapy, only more often. Supportive therapy serves to strengthen the patient's resources for the moment by 'leaning' on the therapist. Analysis has as its goal to help the patient create a strong, healthy personality system, with insight, that can ultimately function independently. This is achieved through the regressions that take place within the analytic sessions. If sessions were spaced far apart (as in twice a week)" -- Bill 50 has the potential to limit sessions to twice a week or once a week or never at all, depending on what mood the government's in that week -- "it would not be safe for the patient to allow the necessary ego regressions to occur. The analytic work could not be done.

"The goal of analysis is its eventual conclusion." That's important because the government has argued that these sessions go on far too long, and there seems to be an argument put forth that they are unproductive because of the number of years that may be required for a cure or at least a control of the illness.

"The patient is not just an isolated individual. The patient also interacts and impacts on the lives of those around them: parents, spouses, coworkers, and importantly, their children. Optimum mental health will affect not only the patients in treatment but everyone around them.

"Community mental health centres staffed by nurses, social workers, psychologists and psychiatrists are necessary and will reach a broader base of patients. However, there still remains the group of patients who need and require a more intensive analytical treatment. That should remain a medical not a government decision.

"Those in psychoanalysis want a resolution to their illnesses, not to be supported indefinitely in twice weekly therapy or by self-help groups, which once again are mostly supportive in nature.

"Increased needs for costly in-patient treatment will result from delisting analysis. Psychoanalysts as a rule do not hospitalize or use medications, allowing patients to be more productive at work and at home.

"Psychoanalysis is frequently the treatment of last resort for patients who have tried supportive or once- or twice-weekly therapy, medications and costly hospitalizations. To remove their treatment now would be devastating on a major financial and human scale.

"By delisting analysis the government won't be saving any money. Analysts will just increase their patient load and fill their schedules with patients for supportive psychotherapy. More people will have access to treatment, but for many it is ineffective treatment. That seems to be a waste of taxpayers' money.

"Many government officials have called patients in analysis 'the walking wounded.' It is the efficacy of analysis that allows the wounded to be walking, instead of taking up costly hospital beds and being a further drain on community and social services. Analysis allows the 'walking wounded' to be walking, to hold down jobs and to be consumers and productive members of society.

"Health care dollars are being spent on many lifestyle-related illnesses. Smoking, alcohol consumption, lack of exercise and drug abuse all cost the taxpayer large sums of money. Those with mental illness did not choose their illnesses. They are largely an invisible population by the nature of their illness. Perhaps it is because they are invisible that the government feels it can dispense with them."

1750

Marnie Judge has really, I think, in an emotional way put forward a tremendous argument of the need for psychoanalysis, the need for the government to withdraw Bill 50. We also know from a number of experts in the field that Marnie -- and that's her pseudonym -- is a person who knows at first hand the need for psychoanalysis, the need for frequent treatment. As she very clearly said, and as the hundreds of letters we've had -- and I think all members must have received these letters and petitions -- have clearly pointed out to legislators, these patients want a cure, they want to come to an end of their analysis sessions, and they're not wasting the taxpayer dollar because they are using medically necessary services. The frequency of those services is as necessary as the services themselves. I hope the government will understand that.

From the Clarke Institute of Psychiatry, now really just referred to as the Clarke, we've had some excellent research provided to us by Dr Norman Doidge. In this particular letter, he goes forward in his argument to contradict every point the government made in a backgrounder that was provided to the medical profession, in which the government argued a number of points in favour of delisting or limiting the number of times a patient may undergo psychoanalysis.

I want to point out, because I do not have time, just a couple of things. Dr Doidge refutes what he calls bullet point number 5 in the backgrounder by the ministry. He says, "The fifth bullet states that one hour a week is 'the coverage provided by most US insurance companies.'" This is the government's rationale. They're using US insurance companies as a basis for Canadian medicare services. Shame, NDP, shame. You used to hate the US. What happened? Now you're borrowing their analytical approach to rationing health care services.

"Where once-a-week limits have been imposed there have been no net savings and it has been seen as disastrous for patients, because treatments are not determined by medical necessity. The Clinton administration Mental Health Task Force recommended against these arbitrary limits."

In fact, the US is trying to go in the opposite direction now. Having seen the wisdom of the arguments put forth by psychiatrists and people in the medical community and patients with respect to psychoanalysis, the US is now supposedly going to try and go in the opposite direction.

I don't have time to read all this, but it goes on to talk about a very important precedent set in the world; that is, that a decade ago Germany delisted psychoanalysis. It limited the number of times a patient may see his or her physician for the purposes of psychoanalysis. More recently, the German government had to reinstate the original psychoanalysis program and the frequency of the availability of those services because hospital admissions went up dramatically over that decade. It wasn't a political decision so much as it was based on analytical data which clearly showed that mental health patients who could not receive services from their own physicians simply ended up in the emergency wards.

We shouldn't even have to look at the German example, because we have examples at home ourselves. When we had deinstitutionalization in this province -- it's still continuing and, granted, all three parties share blame in this, so we should all acknowledge what went wrong and not repeat the mistakes of the past -- a number of people were thrown out of institutions. They went on the street and they ended up in our hospitals. We don't know what happened to thousands of them.

The NDP used to love to give the Tory party full blame for that. Then, when the Liberals got in, they spent five years giving them full blame for that. Now we see that they want to go beyond that. They've closed 5,400 hospital beds in the past 18 months. In my area of the province and many areas I tour as Health critic, there simply isn't a bed to be found. You sit around in the emergency room -- that's if you can sit -- you bleed on a stretcher for a few hours and you're sent back home. There simply aren't the services there used to be in this province.

We know that in the mental health area, psychoanalysis is necessary. We know its frequency is high but necessary. I call upon the government to withdraw this legislation.

I repeat to the public that psychoanalysis is one particular issue with respect to Bill 50 that's captured a large segment of the population in terms of their lobbying efforts. But beware, public, everything is under threat with this government. Be aware that Bob Rae and Dr Ruth Grier have decided that they're going to tell you how often, what type of service, from which physician and where that service may be available.

They're going to drive more physicians out of the province. They're capping physicians in a unilateral way. We all agree on cost control, but what's happening in many of our communities -- it's happening in eastern Ontario where Mr Jordan, the member for Lanark-Renfrew, is from; it's happening in Simcoe county, the area Mr McLean, the member for Simcoe East, and I represent; it's happening anywhere I go in this province -- is that general practitioners are reaching their cap simply by doing office hours. They're reaching their government-imposed cap on gross billings and they're not covering the small-town hospitals. There's no incentive for them to go and cover the emergency room after hours because they've already reached their cap.

I think what the government doesn't realize about physicians is that they're in business too. They're not simply there to fulfil the whims of whatever political party happens to be in office. They are not tools of politicians. They are independent practitioners, as are so many other people in those 24 regulated health professions which this government took such pride in regulating and reregulating through the Regulated Health Professions Act legislation of a couple of years ago. This government took such pride in bringing some reform into the system and to strengthening the role of colleges.

We're going to see a bill come up perhaps later this week called Bill 100 which deals with sexual abuse of patients by health care professionals, something the government has taken very seriously. It's taken very seriously by all three parties. But the government seems to think that physicians and health care professionals -- because it doesn't like professionals and it sure as heck doesn't like physicians -- are little pawns in this chess game it sees as Ontario's health care system. On that grid, they're going to move pawns wherever they like. Well, the pawns are moving south. They're all going off the south end of the board. They're going down to support Bill and Hillary Clinton's health care reform. They're leaving Simcoe county, they're leaving Renfrew, they're leaving all areas of the province. We always had a shortage in northern Ontario, and that shortage is acute now as a result of the NDP's moves.

I have many more letters, many more briefs, many more analytical arguments that have been presented, but the agreement of the House leaders was that I would end in about three minutes and resume the debate tomorrow.

I want to repeat, because perhaps some taxpayers have joined us over the last hour and didn't hear how I started, that the fact is that this government has brought in the most hypocritical, draconian legislation in the form of Bill 50. No other party at any point in our history in this province to date brought forward a bill like Bill 50, which allows the cabinet behind closed doors to dictate how many medical services you'll receive, how often, where and who will provide them -- it will limit your ability to get those medical services.

Don't believe the rhetoric of the government. We know on so many other issues that what they've told us is simply not factual; in fact, untrue. I don't believe they know what they're doing with respect to Bill 50. Had any other party brought forward this legislation at any point in our history, the NDP would be hanging from the chandeliers. There is no doubt about it. I repeat that. They'd have gone nuts. They'd have gone absolutely crazy. They'd have accused those Tories of gutting medicare. They would have accused the Liberals of ending OHIP.

They do it in the hazy days of summer, hoping no one will pay attention, hoping no one will bother to pick up the phone and phone Bob Rae's office, phone Ruth Grier's office, Dr Ruth. Phone your NDP MPPs and tell them you don't want Bill 50. Join with your physicians, who have spent a great deal of their own money now trying to fight this government, with the message that Bob Rae's government is bad. I don't know any other way to put it. "Bob Rae's government could be bad for your health," I think the button reads.

Mr McLean: Just ask the seniors.

Mr Jim Wilson: Ask the seniors, as the member for Simcoe East points out, about the $150 million in new user fees. Don't take any more crap from politicians, particularly NDP politicians, about user fees. They exist in the hundreds of millions of dollars, and I say to Jane Leitch and the Senior Citizens' Consumer Alliance for Long-Term Care Reform and all those other people who keep telling me they don't exist: They exist. They were brought in by the Liberals, and they've been increased. Take an ambulance ride; it's right through the roof now. Rich or poor, a rubbie on the street, you get sent a bill for ambulance services. Try and get mom or dad or grandma or grandpa into a long-term care facility nursing home: Whack, you're hit with hundreds of dollars of user fees. Try and get some medically necessary services in your own hospital and you need a Visa card up front.

That's what the NDP's done to health care in this province. We have a US-style, two-tier system. Don't take any more crap from politicians, people of Ontario. The NDP is destroying medicare. Bill 50 destroys medicare. Let's not be wishy-washy about it. User fees exist to the tune of hundreds of millions of dollars in this province. We have to discuss where they should be appropriately placed. No: They just unilaterally, behind closed cabinet doors, increase them.

We have a two-tier system. If you want a medically necessary service in this province -- I'm just about to wind up -- and you can't get it within a reasonable period of time and you have money, you go to the US. There are many US cities that are now clearinghouses for Ontario taxpayers because they can't get the service here. We have private medicine in this country. There's a CAT scan out in Calgary where we send Ontario residents and we pay cash up front to a private sector operator because our own government can't provide that medically necessary service. I ask the people of Ontario to join us to fight Bill 50.

The Acting Speaker: Thank you. By unanimous agreement of the Legislature earlier today, we now move on. It is 6 o'clock. We now move on to orders of the day.

Report continues in volume B.