Assemblée législative de l'Ontario

The House resumed at 8 o’clock p.m.

ESTIMATES, MINISTRY OF HEALTH (CONTINUED)

On vote 2801:

Mr. Chairman: The hon. member for High Park.

Mr. A. J. Roy (Ottawa East): Are you sure this is his turn?

Mr. M. Shulman (High Park): Are we in session with eight members present? I didn’t mind speaking to 10 members before but surely eight is a little ridiculous.

Mr. R. D. Kennedy (Peel South): The quality is here.

Hon. E. A. Winkler (Chairman, Management Board of Cabinet): You have the floor.

Mr. Shulman: I have the floor, but I have nobody to talk to. Come on, let’s ring the bells another four minutes.

Clerk of the House: Mr. Chairman, there is not a quorum present.

Mr. Chairman ordered the bells be rung for four minutes.

Mr. Chairman: Will the Clerk take the quorum count?

Hon. Mr. Winkler: Don’t forget the Chairman.

Clerk of the House: Mr. Chairman, I see a quorum.

Mr. Chairman: The member for High Park may proceed.

Mr. Shulman: You will recall before the break, Mr. Chairman, I was --

Mr. R. F. Ruston (Essex-Kent): Here comes the member for Riverdale (Mr. Renwick).

Hon. A. Grossman (Provincial Secretary for Resources Development): Now we have one NDP.

Mr. Shulman: The minister said he was going to save money in the Ministry of Health in two ways. The first way was by cutting down on the number of doctors; we have a number of pious hopes on that but nothing practical. The second way was by somehow cutting down on hospital expenses; and we understand the ceilings have vaporized, so I gather you are going to try and cut down on the number of open hospital beds or the number of hospitals. I am asking the minister is that correct. If so, which is correct; and if any hospitals are getting the axe, which ones?

Hon. F. S. Miller (Minister of Health): Well Mr. Chairman, I think the assumption that I was going to cut back on doctors is an incorrect one. I would cut back, but not on the doctors. I would like to keep the ratio roughly what the World Health Organization says we should have.

Mr. Shulman: We are below that already.

Hon. Mr. Miller: All right, but our population is growing at a pretty steady rate, doctors are retiring at a pretty steady rate, and we need a certain number just to replace them every year, some 650 or so per year. So that if I could simply have our total production of doctors at something like the total annual demand, I would be satisfied. And I would be very happy to have the distribution of doctors a little better across the province, both geographically and in terms of their specialization.

Now those are tall orders; they are not easy to solve, and I can only tell the member we have done a great deal of work with the medical schools and we have had a great deal of co-operation from them. They are increasing their output of family practitioners; and we are working on the creation of nurse practitioners, I believe the member is aware of that, at McMaster.

Contrary to your opinions that I have highest hopes, I think I have realistic hopes that the --

Mr. Shulman: Hopes anyway.

Hon. Mr. Miller: -- rather large oil tanker that I call the health care system can be slowed down and possibly its direction changed.

Mr. Shulman: It may sink.

Hon. Mr. Miller: Well no, oil is lighter than water, and even when one stops it will stay afloat.

Mr. Shulman: But the minister may bring it down.

Mr. Roy: You are the third minister who has said that. There is no evidence of it at all.

Hon. Mr. Miller: Well, that is the member’s interpretation.

Mr. Roy: Well look at Hansard.

Hon. Mr. Miller: I am quite aware.

I suggest to the member, though, that the Province of Ontario has done a better job constraining the growth of health costs than any other province in Canada. I think we can take the record and we can show that to him. I think he can look back over the last two or three years and I think for a change -- my deputy may correct me -- that our total increase in health care costs was running something close to the gross provincial product. In fact I am told it was a slight bit less in certain areas.

Mr. Roy: That is not what the minister says in his speech.

Mr. Chairman: Order.

Mr. J. A. Renwick (Riverdale): Let’s not go into that. We could argue all night about how you were better off than the other provinces. The minister can make a statement; but we don’t have the information as he doesn’t furnish it. So let’s not digress on that.

Hon. G. A. Kerr (Solicitor General): That is why we keep saying it.

Hon. Mr. Miller: I’m not sure I’m glad we rang those quorum bells.

Mr. Shulman: Anyway, get on with my question about hospitals.

Mr. Chairman: Order, order. I would point out to the member for High Park that the minister has the floor at the present time. Would you give the minister a chance to answer the question please?

Mr. Renwick: But the minister is so aggravating.

Hon. Mr. Miller: So what was that?

Mr. Renwick: I said it was extremely difficult to give the minister the floor.

Hon. Mr. Miller: I thought the member said erudite, and I was wondering.

Mr. Renwick: Aggravatingly erudite.

Hon. Mr. Miller: Thank you.

Now the question of the hospital issue, as I pointed out and the Star accurately reported today, is a much more difficult one, because the public does want its hospitals. The public is very attached to its hospitals, and certainly if one looks across the record of the province in the last 20 years I think we have only actually closed one hospital.

So that I am not as optimistic in that area as I might be in the question of the doctor issue. Yet I feel that as the health care plan evolves from the Mustard report we will be able to change some of the smaller hospitals from their present function into health clinics of some type, or health centres of some type. That to me is the most important move.

There are lots of places where emergency services should be rendered but not necessarily bed services given, because we have lots of places in Ontario where bed services are within a very few minutes of existing small hospitals. I think that is exactly what we are going to have to do over the next few years.

Now as to hospital beds, you know we closed about 1,600 or 1,700 over the last two years; with the cooperation of the Ontario Hospital Association which recognized that we did have realistic planning standards. In fact if I recall the figures last year, we set our target as closing somewhere around 1,500 or 1,600 beds and more were closed than we requested, which was rather surprising to almost everyone involved.

Mr. Shulman: Well to pursue this, it doesn’t make any sense to me, economically, to be closing a wing here and a wing there. For example, let’s take this city, where you have wings closed in St. Michael’s and wings closed in Mount Sinai. Why should they not be all combined into one? Or for these downtown hospitals why should they not combine their facilities into one? Why should St. Michael’s and Mount Sinai both be duplicating the work of each other?

Hon. Mr. Miller: Well I don’t like duplication; and we have lots of it, one would not try to deny that, across the province. We can go to many towns and cities where we would like to see a better rationalization of services within hospitals. We have been working our way out, and I think if the member looks at my statement again the member will see we are doing so with some success across the province this year.

Mr. Shulman: Not in Toronto.

Hon. Mr. Miller: No, not a great deal of success in Toronto.

Mr. Shulman: None.

Hon. Mr. Miller: Well, I wouldn’t be that specific.

Hon. Mr. Kerr: Pessimistic!

Hon. Mr. Miller: Certainly in other areas we have; and we’ve closed the beds in Toronto.

Mr. Shulman: Yes, a bed here and a bed there.

Hon. Mr. Miller: At the same time we’ll have to change the function of some hospitals. We do need some chronic-care facilities, as you know.

I think this is one of the issues we’ve got to look at too in the overall planning of hospital beds. Chronic care, for example, is not popular in the medical profession. I think you would agree with that, would you not? Yet it’s the coming thing.

Our population is aging. The demand for health care for those over 65, someone tells me, is four times that of the average person in the under-45 group. We are living longer and chronic demands are going to grow, so obviously we have to be looking at some of the current facilities and either putting chronic beds in or converting some of them from their present function.

Mr. Shulman: I would like to suggest to you that you’ve picked at it, but if you are really serious about cutting down the cost of hospitals, somewhere along the line you are going to have to bite the bullet and you are going to have to say “no” when people get up in this House and say “in my city” -- we’ve heard it so often -- “we want a heart unit, we want a kidney unit.” You are going to have to tell all of these various places they can’t have it.

Hon. Mr. Miller: With great respect, go back to the Windsor affair.

Mr. Shulman: Yes, I’m pleased that you had the guts to do it. But you haven’t yet had the guts to tell anyone they have to take these things out.

Before you came in, and before Dr. Potter came in, there was a tremendous proliferation and duplication, not just around the province but in this very city. I can think, in Toronto alone, of a number of units you could cut down. In fact I could think of a couple of hospitals you could shut down and nobody would notice the difference except the doctors on staff and the people on the boards.

Somewhere along the line, if you are really serious about cutting health costs, you are going to have to eliminate the duplication, eliminate the boards. I mean, it’s a great ego thing if you are on the board of a hospital or the staff of a hospital, but if economy is necessary -- and I agree with you, I think it is, I don’t disagree with that one iota -- you are going to have to do far more drastic things than you’ve done up to now.

The other thing I want to ask you, because to me it is an incredible dilemma, and I don’t know how you are going to handle it is: What are you going to do about the doctors’ pay? The doctors were conned into accepting a four per cent raise for 1975 a year and a half ago; and they just aren’t going to take it. You are going to give your civil servants 58 per cent when the smoke all settles. People are getting 60 per cent and 65 per cent raises over two years. The doctors accepted seven per cent for 1974; and they accepted, agreed to accept in advance, four per cent for 1975.

They are just not going to do it, because despite their high salaries -- and no one argues this -- they are slipping behind very rapidly because of the incredible rate of inflation. What are you going to do?

Hon. Mr. Miller: Again, one has to look at these problems. I addressed some doctors very frankly on this issue the other day and they asked the same question. They got 7.75 per cent this year for next. They made their settlements well before the other labour settlements were made in the hospital field. Of course they feel they have had the gap narrowed on them, but wasn’t that what you were telling me we had to do?

Mr. Shulman: Yes.

Hon. Mr. Miller: All right -- that’s the answer to the question.

Mr. Shulman: But what I’m worried about is that the doctors won’t accept it.

Hon. Mr. Miller: I find the doctor’s income today, or at least a year ago, has in a very short period of time gone from four times the average person’s salary in Ontario to 5 1/2 times the average person’s salary. So he was gaining on the rest of the people.

Hon. Mr. Kerr: From $100,000 to $125,000.

Hon. Mr. Miller: I have no compunction about helping the lower end of the health field catch up. This doesn’t automatically mean the higher end has to keep ahead.

Mr. Shulman: I’m not disagreeing with you. I don’t want the minister to misunderstand. What I’m worried about is the doctors opting out of OHIP, which is what is being bruited about at this moment. They are not prepared to accept the proposal. I’m asking the minister, is he going to stand firm?

Hon. Mr. Kerr: Say yes.

Hon. Mr. Miller: A doctor can opt out of OHIP.

Mr. J. E. Stokes (Thunder Bay): Pound your table.

Hon. Mr. Kerr: An agreement is an agreement.

Hon. Mr. Miller: That currently is one of his rights, and strangely enough I would defend his right to opt out of OHIP.

Mr. Shulman: Except that if you have too many opting out the costs will escalate.

Hon. Mr. Miller: The costs won’t escalate to me, except from a managerial point of view, because it certainly complicates life to pay more cheques. But there may be a salutary effect. As long as the client can make a decision that he or she will go to a doctor who opts in or a doctor who opts out and still can get the service either way, then the system is working as we want it to do. I think you’d agree with that.

Mr. Shulman: Yes.

Hon. Mr. Miller: But at the same time one of the big arguments is that at the current time the patients never know how much they are spending in the system. The moment you go to an opt-out doctor you know how much you are spending because you have to lay it on the line before you get the service.

Mr. Shulman: Agreed, but will the minister agree that your administrative costs are going to rise astronomically?

Hon. Mr. Miller: I am willing to say they are going to rise, but when one looks at the administrative costs of OHIP as a percentage of the total health care package, it isn’t that significant.

Mr. Shulman: Just one final point: The minister said in his public speech the other day that there were too many specialists -- and I hope I am not misquoting him. The thing that I find impossible to understand is that we can’t get appointments with specialists. If you want to see an eye doctor, it is February; if you want to see an allergist, it is next April. What has gone wrong?

Hon. Mr. Miller: I am willing to listen to advice from any source at this point in time. One comment that a GP made to me -- and I think you were concurring in this, if I recall correctly -- was that the spread between the GP and the specialist has been growing. The GP has been working harder and harder to make his living; the specialist has been able to work fewer and fewer hours to make his living. Is that a fair statement? And that is one of the roots of the problem.

I think that is why a lot of people have chosen specialization, because you can have regular office hours a lot easier and have fewer demands on your time when you want the time to be your own. I think that to some degree is a problem of the OMA in that the rate schedules that pay specialists’ fees of that order should be looked at very carefully.

Mr. Shulman: Well, are you looking at them?

Hon. Mr. Miller: I don’t have to look at them -- OMA does.

Mr. Shulman: Yes, but you have the problem. You are the Minister of Health and I, as a GP, can’t get an appointment with a specialist for my patients. Are we going to wait for the OMA? We have been waiting for them for 50 years; and we are going to wait another 50 years. Is there nothing you can do?

Hon. Mr. Miller: Do you have trouble getting an appointment with an ophthalmologist?

Mr. Shulman: Yes.

Mr. Renwick: I don’t.

Hon. Mr. Miller: I don’t. I was going to say ophthalmologists are now --

Mr. Renwick: I went to school with one.

Mr. Stokes: I waited three months in Thunder Bay for an appointment.

Mr. Shulman: I wouldn’t turn you down if you phoned my office, either; I would be a little nervous.

Hon. Mr. Miller: It is amazing. I use a pseudonym most days.

Mr. Shulman: I just want to refresh your memory about something. You will recall last year when the seven per cent raise was given. You got up here -- I am sure it was you -- and said the majority of that money is intended to go to the GPs. And when the smoke cleared, we didn’t get any of it.

Hon. Mr. Miller: Yes you did.

Mr. Shulman: Oh no we didn’t.

Hon. Mr. Miller: Your basic rate went up 10.2 per cent over last year.

Mr. Shulman: Let me just refresh your memory; or fill you in on the facts. For every office call, which was $6 at that time, it was raised to $6.70 -- so we got an extra 10 per cent there. And at the same time, for every annual health exam, which was $15, it was reduced to $10.

Hon. Mr. Miller: You have got it wrong. You had better go back and look at your OMA schedule properly.

Mr. Shulman: I have the OMA schedule right here in this building, so don’t challenge me on that.

Hon. Mr. Miller: It is just that you can’t read it.

Mr. Shulman: All right, Mr. Health Minister, don’t say that, because you are wrong. Prior to the increase in the fees --

Hon. Mr. Miller: You were wrong the day you brought that to me. I can’t explain it out of my head, but I had it checked for me and you are wrong.

Mr. Shulman: All right, you have a lot of experts. Ask one of them to explain this to you. Now I am going to give you two facts, and you challenge either one of them.

Hon. Mr. Miller: Just wait till I have my answer back.

Mr. Shulman: All right; here are the two facts, and I ask you to challenge either one of them. Prior to the raise in the fees, the GPs received $15 for an annual health exam. After you raised the fees we received $10.

Hon. Mr. Miller: I understand the question. I will have your answer in detail.

Mr. Shulman: All right. Point two, prior to the raise in the fees, we got $15 for every pre-school examination -- pre high school or pre public school. After you raised our fees, we got $10. It was the con job of con jobs. The Star headline was: “GPs To Get Most Of It.” And it wasn’t true.

Hon. Mr. Miller: Who made those decisions?

Mr. Shulman: The OMA.

Hon. Mr. Miller: All right.

Mr. Shulman: But you are supposed to be the Minister of Health overseeing it.

Hon. Mr. Miller: Look, I said how much money they could have, and I told them they could divvy it up the best way they wanted.

Mr. Shulman: But who do you think runs the OMA? It is not the GPs.

Hon. Mr. Miller: Why don’t you run for office?

Mr. Shulman: Well I am a little busy here worrying about you. You are supposed to be the Minister of Health; you are supposed to be watching them. You are the one who agreed to the fee schedule, That was the con job of con jobs.

You got up in this House before it was announced and said the GPs were going to get the bulk of it. I found afterwards that in an average day I would take in less than before. I could see the same number of patients, and end up with less money. And this applied to every GP, because we were getting 70 cents more on one side and losing $5 on the other. It was a great con job.

Do you know who got that extra money? The specialists got the extra money. And you were supposed to be changing the OMA schedule so that a greater percentage went to the GPs. It just didn’t happen.

Mr. R. G. Hodgson (Victoria-Haliburton): How did you do today?

Mr. Shulman: Pretty good.

Mr. Chairman: The hon. member for Hamilton Mountain.

Mr. J. H. Jessiman (Fort William): Inflation goes up another two per cent.

Mr. Shulman: The minister won’t accept the facts.

Mr. J. R. Smith (Hamilton Mountain): Mr. Chairman, listening to the various remarks about hospital services in Metropolitan Toronto, I indeed realize how fortunate we are in the municipality of Hamilton Wentworth to have such improved health services in the past five or six years. Indeed, perhaps I have been too harsh, to say the least, in publicly criticizing the Hamilton Health Council at recent meetings held by the minister at the invitation of the regional chairman at the Hamilton city hall.

In retrospect, I must confess, it is an evolving programme, an evolving council in embryol stage, and when one sits back and assesses what has been accomplished in Hamilton, it’s most notable. I am impressed that we have specialized facilities, not in all the existing hospitals in the community, but rather a system of specialization that has developed at certain key hospitals, such as the Henderson with their cancer clinic, the general hospital with their burns and industrial accident unit and their cardiac programme, and the Chedoke hospital with their rehabilitation services and so on. It’s most admirable.

One programme in our community that really is a pioneer in the field of medicine is the St. Peter Centre which is going to concentrate on an intensive programme for out-patient care for geriatric patients which will not only provide a needed service for senior citizens, and relief for families but will also allow them to live with their families or with a husband or wife that is well at home. I think this is far better than relegating many people prematurely to homes for the aged or into nursing homes.

St. Peter’s Centre, of course, is connected with assessment and placement of people requiring nursing home care. I think Dr. Bain, the head of that programme, has developed a very sophisticated assessment and placement programme, and despite the initial fees of many people in the community, it has evolved into a very admirable programme. I hope a similar assessment and placement programme can be provided in other centres across the province.

In conclusion, I hope we in Hamilton, with the operation of the McMaster Medical Centre and Medical School, have indeed become one of the finest medical centres in North America. Just last week one of the officials on the board of education informed me that this year they have noticed the number of schools has risen. Some people are now moving into Hamilton because of the specialized health care facilities that are available to people of that region. To me that’s just great and most admirable.

I would like to ask the minister one question. Regarding some of the isolated communities in northern Ontario and northwestern Ontario -- we discussed this before by correspondence -- particularly those served by the northern core, I wonder if there has been any progress in providing eye testing and hearing screening and so on in these communities and the follow up that is required for the prosthesis and so on.

Hon. Mr. Miller: Mr. Chairman, I think I can echo the member’s comments on Hamilton. In fact I had the privilege, just yesterday, of meeting with a delegation from Hamilton. Hamilton is one of those happy areas where there is virtually no duplication of services because the planning at the local level has worked. I think it’s an indication of the very things we are trying to say can happen if a group of people at the local level put their minds to solving their problems and determine there won’t be duplication; there will be teaching throughout the system rather than in the McMaster University Medical Centre core; and specialized services won’t be dragged into the university rather than left where they should be, in the hospitals.

I was most impressed to find representatives of several hospitals, the university, regional government, city government and the health unit, sitting down and making a concerted pitch for something they believed in. I think that’s a lesson I hope the other areas of the province will emulate and profit by.

As far as the north goes, I can’t give you much detail on the improvement. As you know, both the ophthalmologists and the optometrists have been doing their best to get eye vans, as they call them, into the north to test the eyes of children in areas that are otherwise under-serviced.

I know that when I was in Red Lake in late May or early June, they were still concerned about the inability to get a regular service. I have been in contact with the optometrists since then, and they have indicated some interest in trying to help us resolve the problem in areas like that on a more permanent basis than the present one. It is always the story of “having great difficulty.”

In going through the north I visited quite a few of the smaller communities this summer. Up the shore of James Bay, for example, in places like Fort Albany, Attawapiskat and Moosonee, one of the interesting things, of course, is that the medical schools are starting to send their students out to spend a period of time in these areas and provide services to remote communities like Attawapiskat.

The weakness in that system is there is not much continuity in that the patient often sees a different physician each time, but at least for a change they are seeing a physician. And they do have a continuity of nursing staff in most areas to look after their regular needs. I think, the nursing practitioners, do a very fine job in those areas.

I am encouraged to think that the service is so much better than it was not long ago, that with the present rate of improvement we can hope for even better conditions.

Mr. Chairman: The member for Ottawa East.

Mr. Roy: Mr. Chairman, before I get into a number of questions I have on this vote, I would like to ask if the minister intends to answer any of the comments made in the opening remarks or will he reply later on? I don’t want to repeat myself on these things.

Hon. Mr. Miller: I can wait until later if it suits the member. I have made notes of the things I thought he raised. I suspect also that a good many of the points will occur during discussions of the individual votes and the opportunity will come then. However, if they don’t come up, I have a list of the ones that have been mentioned and I can summarize at the end.

Mr. Roy: I want to talk about the question of the number of doctors. Before the House recessed, I made one point in relation to the number of foreign doctors -- I think we are in full agreement on that point -- about cutting down the number of places we have available in our medical schools. It is difficult to extend medical school placements, of course, if you keep accepting doctors from the outside, but we try to keep that balanced.

Mr. Renwick: Isn’t that an immigration problem and not our problem?

Mr. Roy: Well, I think the Province of Ontario, which is accepting the bulk of these doctors from outside, certainly should provide some input to the federal government as to the immigration problem.

Mr. Renwick: I will comment in a minute or two about that.

Mr. Roy: Mr. Chairman, the first question I want to ask the minister is, what does he expect to bring in as far as supplementary estimates are concerned, keeping in mind the fact we have given these increases to the hospital workers, the nurses, the technicians, and in light of the fact that the ceilings are now -- well they are gone according to the comment yesterday. They are gone and they are not gone, according to the minister’s comments. In any event, there is certainly a very serious question whether the ceilings are still there.

What does the minister expect we will have as far as supplementary estimates are concerned?

Hon. Mr. Miller: In dollars?

Mr. Roy: In dollars.

Hon. Mr. Miller: I really don’t want to estimate because I cannot give the member a sound figure at this time. I have a pretty good idea. I think to start guessing that it’s $100 million, $75 million or $150 million is a dangerous kind of game. I think I know what it is going to be, but until I have the papers put before me I am not going to give that figure.

Mr. Roy: Are we going to get the supplementary estimates prior to the Christmas recess?

Hon. Mr. Miller: I would hope so. We can be prepared for them.

Mr. Roy: That is all I want to know, because I expect the figure will be something over $200 million.

Hon. Mr. Miller: The member may be right.

Mr. Roy: But the minister can’t tell us now? As I mentioned in my opening remarks, these estimates are pretty late in the year anyway, and since we generally get supplementary estimates about this time in the fall session, I would have thought we should have had some idea of what they are.

Mr. Chairman, if I may, I would like to move to another point dealing with the doctors. You’ve admitted -- and this is something we’ve known now for over a period of a year -- that the doctor-patient ratio in this province is adequate. In fact, it’s lower than the standard as provided by the United Nations. We all know, though, that the problem is one of distribution of doctors. We all know that doctors generally gravitate towards the centres. In other words, the patient-doctor ratio for Toronto and Kingston, and probably Hamilton and Ottawa is very high, whereas the minute you get out of those areas, then the patient-doctor ratio goes down.

I know you have a programme about basic salary. You are encouraging doctors to go to remote areas. But what are you going to do with the OMA, which I see recently is quoted as saying the provincial government should not have any control over where a doctor sets up his practice, which patients he sees, and how he is paid. The Ontario Medical Association said this in a brief which I think came out last week. I see a sense of confrontation.

You, as the minister, and certainly we as an opposition, want to co-operate with what we consider to be some of the more important health professionals of the system. On the other hand, I find that some of the associations in the OMA have shown a lack of flexibility. Surely when the taxpayers of this province, and we as representatives of the taxpayers, are paying out moneys, when we are talking about a budget of $2.3 billion and when we are talking about the question of numbers and the question of distribution and the question of specialists and so on, I think it is a right and a duty of a Minister of Health and of this government to tell the doctors if there are too many doctors and if there are doctors needed in certain areas. I think the OMA, by taking this position, is going to tell you they don’t want you to have any control over where the doctor sets up his practice, which patient he sees or how he is paid. I think that is a bit much. I’d like to have your comments about how you are going to deal with the OMA.

Hon. Mr. Miller: First of all, I have to say my relationships with the OMA, which are pretty regular, as I see them at least once a month on a planned basis with an agenda that is agreed upon and discussed, have been excellent. That doesn’t mean there aren’t points on which I disagree with them.

I think their reaction to the Mustard report if it were compared to the Ontario Hospital Association reaction to the Mustard report, if it were compared to almost all other reactions, would fall into place because almost all groups that had a special interest in the health care field looked at the Mustard report, agreed with most of it and disagreed, as I have said before, with the parts that applied to them or threatened them.

I think that is a pretty normal reaction. This is their current position. We are digesting it, and all the other replies that have come in and hopefully we will have our own white paper to float before too long, although how long that will be I can’t say because it is by no means an easy task. It is a jigsaw that has very many pieces and some pieces seem to be missing some days.

Mr. R. S. Smith (Nipissing): Is the white paper a policy paper?

Hon. Mr. Miller: A policy paper, yes.

Mr. R. S. Smith: A definite and definitive policy paper.

Hon. Mr. Miller: Usually white papers are a definitive policy paper. It’s the closest thing to legislation. It usually precedes it.

It’s not the final form, I would like to say to the hon. member, because it gives you that final reaction the public will have or the groups will have to your position. The white paper after all is our position. Dr. Mustard’s was a green paper. It was not our position. I think that is the fundamental difference in the two points. Just as our position in the health disciplines bill was amended considerably through discussion, a white paper position would be subject to amendment through discussion. As long as one understood that, we would be on safe ground.

Mr. Roy: Let’s deal with the first aspect. Do you not feel, as Minister of Health, when you consider the distribution of doctors across this province, that, if for instance, we have too many doctors in Toronto or Hamilton or in Ottawa and not enough some place else you reach a point where you should say we need doctors there. As to how you go about saying it, you might need incentives. You might have to pay doctors who go to a particular area more -- a higher fee for service to go into that area.

But, nevertheless, don’t you feel as a matter of policy that you, as minister, as representative of the electorate in this province, should have a say, first of all as to where a doctor sets up his practice?

Hon. Mr. Miller: I think there’s logic in that basic statement, yes. When one is short of physicians, one cannot dictate the ground rules.

Mr. Roy: That’s right.

Hon. Mr. Miller: When one doesn’t pay physicians, one cannot dictate the ground rules. But when one has enough physicians and pays them, one can start discussing the issues.

Mr. Roy: Now we’re talking. The second point is which patients he sees, and that brings us to the question in your speech about too many specialists.

Mr. Stokes: The CMA would disagree with you on that. They say there are enough.

Mr. R. S. Smith: He agrees that there are enough.

Mr. Roy: I am saying to the minister, you’ve talked about the large increase of specialists over the last years as compared, let’s say, to family practitioners. We know, for instance, that you have too many specialists in some areas or too many people in one speciality.

Hon. Mr. Miller: And not enough in others.

Mr. Roy: And not enough in others. Now, there’s a question, as you know, in the Mustard report about how people get to see specialists. They do it on referrals or so on. As you know, the OMA is against that, and in fact it proposes an alternative solution. I see here, looking at the latest Ontario Medical Review, they state they’ve suggested to you that rather than have a system whereby a patient does not have the choice of going to his family doctor or directly to a specialist if he wants to, and rather than have a system, as Mustard suggests, where you have primary care and everybody goes through the system -- that way, if he needs a specialist he ends up on referral only -- that you have a system whereby you pay the specialist fee only on referral, and charge the difference to the patients who go to the specialists unreferred. That’s their suggestion and I’d like to have your comments on that.

Hon. Mr. Miller: That’s an interesting one. I think one of the editorial pages of one of the papers recently discussed this reaction and said it was even simpler, that you should only pay a specialist a specialist fee if he did a duty that required his special knowledge. I believe the Province of Quebec has been thinking about that, if it hasn’t already done it.

There are a number of ways of solving that problem, and I am not going to commit myself to one tonight, obviously.

Mr. Roy: No, no.

Hon. Mr. Miller: But the problem has to be resolved. It’s obvious that you’re going to have some kind of economic disincentive, isn’t it?

Mr. R. S. Smith: You have to have a definition of what a specialist does or does not do.

Mr. Roy: The point I’m trying to make to the minister is that the OMA has taken a pretty firm position as to where it stands, what your duties are, and what it is going to put up with. The first one was that you don’t have a say in where they practice, and I say that you should.

The second point, of course, was which patient he sees, and that brings us to the question of specialists and the primary care and this type of thing.

The third point is how he is paid. I find that a bit hard to take, and I just wanted your comments on that as well. Again as the representative of the public, and you as Minister of Health, in the light of the fact that it is the taxpayers’ money that goes to pay the doctors, do we not have a say in how the doctors are going to be paid?

Hon. Mr. Miller: We do now, Mr. Chairman. We have what we call the Clawson committee. It was set up after the Pickering study, which was paid for by the OMA, as I understand it.

It looked into all the attitudes of the public, the payment mechanisms, the role of the physician and so on. It came to the conclusion that in fact government had a justifiable interest in the payment mechanisms and the amounts paid and the negotiations to physicians. Out of that very quickly came the Clawson committee, which has three voting physicians, three government people and one neutral chairman.

This committee has functioned in those areas of monetary interest to the physicians, and at the last health ministers’ conference was held up to them and by them as a model of how to discuss these issues, a model that worked.

Mr. Roy: Mr. Chairman, I just have a couple of more questions on the first vote; and I intend to deal with the question of hospitals, I think, on a later vote, with your permission.

The other point I wanted to raise with you is, you’ve already discussed the Mustard report and I want to know when you’re going to bring in your white paper. You say shortly. What are we talking about, months?

Hon. Mr. Miller: Yes, certainly months.

Mr. R. S. Smith: That’s less than a year?

Mr. Roy: Less than a year?

Hon. Mr. Miller: Months are not necessarily less than a year.

Mr. R. S. Smith: Oh, oh; I see; I see.

Mr. W. Ferrier (Cochrane South): Maybe after the next election.

Mr. Roy: I suspect that you’ll not try to muddy the waters or create any waves before the election in 1975.

Mr. R. S. Smith: That’s the only thing we’re sure of.

Mr. Roy: I’m prepared to wager you that we’ll see very little of Mustard prior to the election in 1975.

Hon. Mr. Grossman: Who said there was going to be an election in 1975?

Mr. Roy: It’s obvious. Were you not in during the question period today? Your propaganda is going all over the schools.

Mr. Stokes: The Minister of Natural Resources said it.

Hon. Mr. Grossman: You said it last year and we didn’t have one.

Mr. Roy: Man, I should go and look at the bank account for your party. The money must be starting to roll in already.

An hon. member: That’s just a start.

Hon. Mr. Grossman: Oh, we have always done pretty well. People have faith in our party.

Mr. Roy: It’s full.

Mr. Chairman: Order. Let’s get back to the vote.

Mr. Ferrier: Kelly was a pretty good arm twister, you know.

Mr. Roy: Mr. Chairman, to the minister, I want to know when we can expect his second phase of the bill in the Health Disciplines Act? Does he plan to deal with some of these?

Hon. Mr. Miller: Yes, we’re making good progress there; but it won’t be in this session before Christmas -- I can assure the hon. member of that. I would hope that within our next session, yes, we would have more parts in the Act.

Mrs. M. Campbell (St. George): Before the what?

Hon. Mr. Miller: Prior to Christmas.

Mrs. Campbell: No, the question is, it won’t be before Christmas; but I hope that these boards have been looking into it.

Hon. Mr. Miller: I would think that we would have some more parts for the bill in the spring.

Mr. Renwick: Can the minister table it before then for examination at the end of the year?

Hon. Mr. Miller: I don’t know that it would be necessary. I don’t think it’s going to be ready for that stage, quite frankly. But our last system worked very well. I think that system should be maintained, whereby we work with the groups involved -- basically thrash out most of their differences -- and then put it into committee for open discussion and allow it to be discussed and amended to as we need to at that point.

Mr. Roy: It should continue to work very well as long as we retain your confidence, or that you have confidence in us. As I mentioned in my opening remarks, unless something substantial is done in certain areas, we are going to start wondering whether we’re really doing something or we’re just playing around with the denturists or the Health Disciplines Act.

My last question to the minister is this: I want to have his comments -- and it seems to me as a matter of policy -- whether he was correctly quoted at the ministers of health conference. I think it was here in Toronto a month or so ago. He stated at that time that the question of “dentacare,” or a universal dental care plan, was not a high priority action item. Are we going to have that sort of a plan in this province prior to 1975?

Hon. Mr. Miller: I couldn’t say I wasn’t accurately quoted. I feel I was accurately quoted in those words. I don’t know about the word “action” -- that doesn’t sound like me; but “a high priority item,” if the member will settle for that. I have made a commitment to be ready with a plan for dental care; in other words, to have the mechanics of it worked out.

Mr. Roy: The timing is going to be important.

Hon. Mr. Miller: I think it is important to have a number of options available, because there are a number of areas in the health care system that we could move into -- and sometimes at equal dollar cost. I think it’s only good sense for me, as minister, to have these costed in advance, to have the details worked out in advance, and to have discussed them with the people who will be involved with them.

And so, consciously, almost since the first day I was made minister, I have asked my staff to work with the Ontario Dental Association and, at times, with the college -- because the college is involved in this process, too -- to have a plan ready.

I can tell the members that as recently as two nights ago I talked to the ODA, and they’re totally satisfied that we have reached the point where all but monetary negotiations have taken place. They are fully aware that I did not ever tell them that, in carrying out these discussions, it was because a plan would occur; but in case we were able to afford it, or elected to do it.

Mr. R. S. Smith: What about the minister’s predecessor?

Mr. Roy: That’s a change of policy, because I recall the minister’s predecessor stating clearly there was going to be a plan brought. It appears clearly to be a change of policy.

I will be prepared to wager with the minister that, again, come the election in 1975, that’s going to be one of the goodies. We’re saying to him that, as far as priority is concerned, we on this side of the House consider it to be priority enough that it should be enacted as soon as possible. It’s not a thing to play games with. I don’t see anything more important.

Now, I quite appreciate that it’s hard to bring in new programmes when the government has a series of other programmes that it has not been able to control. At least, we have not seen much evidence with you or your two predecessors, that this ministry has been able to control the question of cost. But I say to the minister -- and by the way, while I’m on that topic, controlling the question of cost -- was he not quoted Oct. 1 in his speech when he said that the health budget was not increasing faster than the increase in the GNP?

Hon. Mr. Miller: I said for two years on the average.

Mr. Roy: The GNP is not rising at 16 per cent a year, is it, in this province?

Hon. Mr. Miller: No, it is not. I took averages over a period of time, the average escalation rate; not necessarily a given annual rate, because we constrained it for two years, I think, specifically. Is that correct?

Mr. Roy: Which two years?

Hon. Mr. Miller: 1972-1973.

Mr. Roy: There was a constraint, sir, because the minister is quoted here as saying the pace at which it turned toward escalation has been continuing, “even without special settlements there has been an increase of 16 per cent per year.” I would think that this year it is going to be more like 20 per cent.

Hon. Mr. Miller: That is why I am taking the average.

Mr. Roy: Because if we are going to follow the minister’s logic in that speech, the health budget has got to be increasing faster than gross national product, because he talks about disaster -- and if our gross national product is escalating at the same rate as his health --

Hon. Mr. Miller: It is good.

Mr. Roy: It is good, yes, but that is not what is happening. I just want to clear that point up.

Getting back to the question of dental care; the minister’s predecessor, if I recall correctly, had made a commitment that was something that was, if not a priority item, it was certainly something that was coming.

Mr. R. S. Smith: It was a policy that they were going to bring forward.

Mr. Roy: Yes, it was a matter of policy, and I would like to know what is the minister waiting for? Is he waiting for the election to be declared before he comes up with this type of plan?

Hon. Mr. Miller: I suppose there would be no real reason for changing ministers if a minister was bound to every policy decision that was announced in the past. We wouldn’t have changed my mind on dentu-therapy, would we?

Mr. Roy: No, but --

Hon. Mr. Miller: But the member told me to change my mind, didn’t you?

An hon. member: That’s why we are still here.

Hon. Mr. Miller: I have to, as minister, bear the responsibility for those things I do; and I feel, therefore, I have to have the right to look at the things I do and make up my own mind.

Mr. Chairman: The hon. member for Thunder Bay.

Mr. Stokes: Thank you. I want to chat with the minister about the statements he made that there were enough doctors in Canada and in Ontario today, and it was just a case of poor or mal-distribution.

How am I going to explain this to people who live 300 and 400 miles away from a doctor? How am I going to explain this to people who live, say, in Pickle Lake, which is 347 miles away from Thunder Bay? How am I going to explain this to people in Savant Lake, who live 240 miles away from the nearest doctor? What kind of information, what kind of data, did the CMA base that conclusion on, when they said that there really wasn’t a shortage of doctors in Canada generally and in the Province of Ontario?

I want to remind the minister that in my home town of Schreiber, the doctor we have now came from Czechoslovakia, he didn’t come from any place in Canada. The doctor before him came from Ireland and the town that I live in paid several hundred dollars just to advertise and recruit and bring a doctor out to serve the medical needs of my home town.

Now the doctors and the Minister of Health can do all the rationalizing they want. But there is no way he is going to convince the under-serviced and the non-serviced areas of northern Ontario that we have sufficient doctors. I think it is patently unfair for this ministry, through OHIP, to charge premiums for health service and for medical services in the Province of Ontario, and then expect the people who pay those premiums to travel the distances that I have just mentioned in order to avail themselves of the services. I think that it is unjust.

Can you imagine the great hue and cry if somebody wanted a specialist or some kind of medical attention in Metropolitan Toronto and they were told: “Oh, no, we can’t provide that service here -- you’ll have to go over to Sault Ste. Marie.”? Those are the kinds of distances that I have been talking about.

Mrs. Campbell: It does happen in Toronto right now.

Mr. Stokes: You’ve got patients from Toronto going as far away as Sudbury and Sault Ste. Marie for medical attention?

Mrs. Campbell: No, I am sorry -- Hamilton is the farthest I know of.

Mr. Stokes: Yes. Well, that is a hop, skip and a jump in terms of northern Ontario.

Mrs. Campbell: Yes, but we are not so well serviced here.

Mr. Stokes: Well, you may not be well serviced, but I want to say that we in the north are underserviced or lack services completely.

The minister made mention of the fact that he had visited places like Moosonee, Fort Albany and Attawapiskat. I know of a programme that was undertaken in concert with the federal authority, the Ministry of National Health and Welfare, to provide services to remote communities in the north. Well I want to tell you that with the specialists who go from Toronto Sick Children’s Hospital here under the auspices of the medical school associated with the University of Toronto, there are some areas in the far north where they get better treatment than many communities in the lower part of my riding.

Take a look at the town of Armstrong. Your colleague, the Provincial Secretary for Resources Development, lays claim to having talked with a lot of people -- and I don’t doubt this for a minute -- in the town of Armstrong. He knows what the social and economic problems are there. He just talked about an ambulance to take people 160 miles from Armstrong into Thunder Bay for medical services. How many people in Toronto and in southern Ontario would tolerate a condition where they had to hire an ambulance and go 160 miles to seek medical attention when they pay the same OHIP premiums up there as they pay down here?

When are you going to at least provide us with mobile clinics for both medical and dental services and for all of the things they pay for and don’t get? When are you going to make the health services much more mobile?

If you don’t provide a mobile service in areas that are serviced by road, and a flying clinic-flying doctor services, flying nurse services in remote areas, when are you going to make the cost of travel for those people who have to travel the 350 miles to get the services of a doctor, and to get medical treatment, a direct charge against the OHIP programme to see that justice is done in this province?

I’ll bet you that if you took a look at the number of visits those who pay OHIP premiums in the small communities of Pickle Lake and Central Patricia make to a doctor or a hospital in the course of a year and compare that with the same number of people any place else down here in Toronto, you would find that the health costs are at least 10 times as much per capita in Metropolitan Toronto to what they are up in Pickle Lake.

You are shaking your head in the negative. I happen to know that is true.

I know people who haven’t gone to a dentist in five years. The communities of Schreiber and Terrace Bay are nine miles apart. Schreiber has a population of 2,100. Terrace Bay has a population of 1,900; and in order to get dental treatment they have to go between 130 and 140 miles to the city of Thunder Bay. We have a concentration of 4,000 population and we haven’t had a dentist for the last six months.

These are the kinds of things that cause us a good deal of worry, a good deal of concern, when I hear the Minister of Health and representatives or spokesmen from the Canadian Medical Association stand up and say we have lots of doctors, we have lots of medical practitioners, there’s really no problem; all the Minister of Health has to do is sort out the problems of bad distribution.

I could tell you that you have had your incentives to doctors to settle in the north, and you know better than I do, and Dr. Young knows better than I do, what the shortages of doctors and dentists are in remote areas of this province.

I want a direct answer from the ministry. I don’t care how he resolves it or how he arranges it with those who are responsible for providing health services in the Province of Ontario, but I want a commitment that he will undertake to see that need is met; either by providing the necessary personnel and the necessary services, or making the cost for patient travel to the closest place where that service is available a direct charge against the OHIP programme.

Hon. Mr. Miller: I have never tried to imply that the north was well serviced with physicians. I said our total number of physicians. I automatically said our other problem is one of distribution.

It is; and there’s not a province in Canada that hasn’t got a distribution problem, unless it is Prince Edward Island. It’s as simple as that. Even the have-not provinces like Newfoundland have the distribution problem.

I have great sympathy with this problem in the north. I think Ontario is looked upon by all the other provinces as having had the only scheme that got people into those areas by any means. The under-serviced area programme has worked very well. You have a physician in Terrace Bay, have you not?

Mr. Stokes: Yes, we have two.

Hon. Mr. Miller: You have two in Schreiber?

Mr. Stokes: One.

Hon. Mr. Miller: One in Schreiber and two in Terrace Bay? You have two more going? Is that right?

Mr. Stokes: Two more going where?

Hon. Mr. Miller: To that area.

Mr. Stokes: I wish they wouldn’t. I wish they would go up to Armstrong, Savant Lake, Pickle Lake.

Hon. Mr. Miller: I have 46 doctors right now who have signed a roster to go to Armstrong. Did you know that? I have.

Mr. Stokes: When are they going to arrive?

Hon. Mr. Miller: There are 46 of them. That’s one of the commitments we got from the family practice people at their convention two weeks ago. Forty-six of them have signed up to make sure that place is staffed with physicians.

Mr. Stokes: Well, we would be satisfied with one.

Hon. Mr. Miller: You will have at least one all the time. In other words, I am going to guarantee that place has a physician and I think that’s a positive move.

Mr. Stokes: Well, that’s one community.

Hon. Mr. Miller: Well, you have named that community.

Mr. Stokes: Oh, I am happy that he is going, but one doctor doesn’t solve the problem of the north.

Hon. Mr. Miller: Well, sir, I solve them a doctor at a time, don’t I?

Now as far as the premium, you and I both know the premium is roughly 20 to 25 per cent of the cost of the programme. It is a method of payment. It is only extracted from those people who can pay because they have taxable income. I suggest my riding and your riding are very fortunate in one sense, and unfortunate in another sense. Unfortunate in that we have a lot of people with lower than average income. Those people, fortunately, are able to get their health coverage in many events free; or in other cases, at half cost.

Mr. Stokes: If they have the wherewithal to travel 347 miles or more.

Hon. Mr. Miller: I have never tried to discount that problem.

Mr. R. S. Smith: That is the difference between his riding and your riding.

Hon. Mr. Miller: Well, my riding still has problems of 75 or 60 miles at times. It’s not as bad, I quite admit. I recognize the tremendous problems of distance in the north. It is a fact of life of the north, is it not?

Mr. Stokes: All right. Why don’t you do something about it?

Hon. Mr. Miller: I think we are doing a lot about it. That’s what I was just trying to say. The very fact we move to allow the teaching --

Mr. Stokes: Why don’t you initiate a flying doctor service?

Hon. Mr. Miller: We have a flying doctor service in parts of the north.

Mr. Stokes: Not in the parts that I am talking about.

Hon. Mr. Miller: Again, we have it in parts of the north; and I am willing to keep on looking at these solutions. In other words, I am not turning a deaf ear to what you are saying.

Mr. Chairman: The hon. member for Peel South.

Mr. Kennedy: Mr. Speaker, I would like to ask the minister about the Mississauga Hospital facilities. As he is aware, representations have been made for a number of years to get going with an expansion there. The fact is there has been no expansion in hospital accommodation since 1968, I’m informed by the current chairman of the hospital board, Mr. Eades.

In 1968 we had a population, I believe, of perhaps 150,000 people and we had in the order of 500 beds. There is a need for a couple of hundred more beds, based on the criterion of four per thousand, since the population is now about 222,000.

I acknowledge that we have the Queensway General Hospital, Peel Manorial Hospital and the Mississauga Hospital; in fact, from the west side some patients are admitted to the Oakville Trafalgar Memorial Hospital. But in its total context the population has increased dramatically, and there is this need.

The board has also discussed the future need of a hospital in the Streetsville area, which seems to make sense geographically and according to development patterns. That’s on the drawing board, and I understand there is a site available for that.

Really, Mr. Minister, what I’m saying is that, recognizing the constraints we face, nevertheless we seem to be on a critical path and there is a need for some decision with respect to capital funding.

As I understand it, the last figures that were made available indicated a need for about $18 million for the Mississauga expansion alone. It seems to be in a hold position, pending the approval of some phasing-in and annual contributions to fund the project as it goes on.

The news story mentioned here this afternoon indicated that grants were to be sprung loose for this great need. That left us somewhat confused. I’m not sure about the accuracy of such news stories but, knowing our need, I could only take some optimism from it unless I heard differently.

Can you offer any encouragement, Mr. Minister, as to when this very real need might get on the rails and get under way?

Hon. Mr. Miller: Mr. Chairman, the part of my budget that has been most severely constrained, as you know, is the capital side. We have been very aware of the rapid growth in the Halton, Peel and Mississauga areas. I understand there are two proposals for expansion there: South Peel, Mississauga, 200 extra beds; Peel Memorial, Brampton, another 200 beds.

Mr. Stokes: Send them to Ottawa and Windsor. That’s what you do in the north; no problem.

Hon. Mr. Miller: To some degree that’s part of the solution in that area too, in the sense that Toronto has had a surplus of beds and many people do go into the city for their hospitalization. That has been one of the reasons we’ve been a little slower in these larger growth areas close to the city, than we have been in other areas of the province, in adding to the hospital bed numbers.

At the present time we’re planning, subject to the capital being available, to have those two hospitals I mentioned -- Peel at Brampton and South Peel at Mississauga -- ready to start construction in 1976. That’s our current estimation.

As far as Streetsville goes, we are well aware of that. There are discussions going on. A hospital will be required by the late 1970s. Discussions are going on with Housing, who are of course working in that area with their growth plans.

Mr. Kennedy: Would you comment on the accuracy or otherwise of those news stories, Mr. Minister? I think in your earlier comments the operative words were “as funds become available”.

Hon. Mr. Miller: I am sure my hon. friend on my side of the House realizes I’m constrained to one fiscal year at a time in my capital dollars. For me to predict a year --

Mr. E. W. Martel (Sudbury East): Your planning shows it too. You plan one year at a time.

Mr. Stokes: Ad hoc-ery.

Mrs. Campbell: I thought you had a multi-year plan.

Hon. Mr. Miller: One year is approved at a time. We have a multi-year plan, but at any time I only have the funds for one year. I always add those very careful words at the end, “If the funds that we think we’re going to get come, I’ll do it.” I think I gave you the facts. Peel and South Peel 1976 funds available.

Mr. Chairman: The hon. member for Riverdale.

Mr. Renwick: Mr. Chairman, I would just like to briefly comment on a couple of matters, and perhaps the minister would help me with it. I somehow have the sensation that the speeches which he has been making across the province, or the lectures he has been giving to the people of the Province of Ontario, about their life styles is designed really to cover up a very serious financial problem for the government which hasn’t been spoken about. I dare to speak to this minister about it because he and his colleague, the Minister of Education (Mr. Wells), between them account for, give or take a few dollars, about 50 per cent of the budget of the Province of Ontario.

I think the undisclosed fact, and maybe we’d better start talking about it, is the very point which was made by the Treasurer (Mr. White) in Ottawa in January and by the study which was made about the effect on available funds in the province of the indexing by the federal government of the income tax. I think the thrust basically of what those studies showed, that while there was not going to be a net reduction of revenue to the Province of Ontario, there was going to be a substantial diminution of the rate of growth of the provincial revenues over the period from now through until the Eighties, given an assumption of roughly a six per cent inflation factor for the next decade or whatever the year period was.

If you’re going of necessity to have that immense reduction in revenue through the income tax system because of the indexing, then it seems to me that the government of Ontario has to maintain the quality and the expansion of the health care system in one of two ways. You’ve either got to borrow money, which, of course, is anathema to my friends on the right who like the balanced budget conception of government operation, or you’ve got to raise taxes, which would be anathema to the government which prides itself that it really doesn’t levy any taxes on the people of the Province of Ontario at all, and particularly in an election year. Your other alternative is to do what you’re doing, and that is blame the people of the Province of Ontario for the demands made on the health care system. I don’t think you can do that. The reason I say you can’t do it is, I think, related to a science and a technology of medicine which are developing at a rate which produces demands on the system because of the very advances which are made in the field of medicine.

I think one need only use a very simple example -- I don’t even know if I can pronounce the words properly -- but the kidney dialysis machines which were invented are extremely expensive. Before there were those machines, people were prepared to die because there was no way of dealing with it. Once you invent an expensive piece of equipment, then you project an expectation in people who will make a demand for it, and that expense is going to be an ever-increasing part of the expanding health care system. There must be many many examples of it.

I don’t fault the minister with respect to being vigilant about the economic use of the dollars which are available for the health care system. I don’t fault the minister about that. But that avoids the problem. I think the best statement of the basic problem that I’ve seen was recently made by the late R. H. S. Crossman, who had a very substantial governmental experience in the Labour governments in England in the various portfolios dealing with the demands of the social service system, including health and housing and pensions and all the rest of it. He simply said what governments and people in our society have to understand is that for all practical purposes a civilized society is never going to be able to meet the demands made on it for the improvement in the quality of the social services, and particularly in the field of health care.

It seems to me that the government is being a little less than honest when it lectures the people of the province about their life styles and the resulting demands on the health care system, because of the inadequacies of their life styles. I don’t think that is the government’s job; it is not there to teach that kind of lesson to anyone. I just don’t happen to appreciate that kind of homily.

I think this is what you have to say to the people of the Province of Ontario: “If you want to have an increasing and expanding health care system, if you want to maintain the quality of the existing system, if you want to introduce new programmes, such as dental care, then you have got to be prepared to permit the government of Ontario to have the revenues, either through borrowing or through revenues raised by way of taxation, to provide that kind of health care.” You can’t talk about constraints on spending for health care purposes, there are too many gaps in it.

All right, I leave that for what it is worth. If I can lay my hands on the Fabian tract, the statement made by the late R. S. Crossman, I will send it across to the minister and he can read it some night. It will take about 10 minutes and it is a very fine statement of the essence of the problem of financing the rising costs of social services in its broad sense.

If the minister doesn’t want to read it, he doesn’t have to read it. But I suggest it is an interesting contra-view to the view which the minister is taking around the province, and in the statements which he and his advisers are making in various areas related to health care.

Now, let me move to my second comment. I don’t happen to believe that one can talk about an adequate supply of doctors in the Province of Ontario unless the distribution is right. I think it is meaningless for me to be told by the minister that the ratio of doctors to persons in the Province of Ontario on a mathematical basis of simple arithmetic is adequate in World Health Organization standards, and then to say: “So it is not really a supply problem that we have, it’s a distribution problem.”

Well, it’s not; it’s a supply problem. The minister knows as well as I do, that apart from financial incentives, or apart from this weird scheme of sending 46 doctors week -- about up to Armstrong -- which is very much second best -- it is better than having no doctor. But people like to know the doctor they deal with, and to have confidence in his skills and abilities -- and all the rest of it.

I am extremely concerned about the intimation from my friends on the right and, indeed, from some of my own colleagues, on this question of the supply of doctors, and the implicit suggestion that the Province of Ontario must restrict the entrance of doctors from other countries into the Province of Ontario.

I am concerned about that for a number of reasons. I know the arguments about stealing qualified people from other countries. However, that doesn’t wash with this government, because in Ontario House in London, England, you have a man who is engaged in stealing highly skilled people -- very highly skilled -- and sending them to the Province of Ontario, and that is his job. That is the job in which he is engaged. And this province has never for one single moment been backward in stealing high skills from other countries; it has never been backward at all.

I recognize that is a problem. It may be a problem for the country from which the people come. It may be a problem in sense of international relations, but I am very much opposed to restrictions on the free movement of people.

I happened to listen -- I don’t know whether the minister listened -- to Cross Canada Check-up last Sunday afternoon. Robert Andras, the federal Minister of Manpower and Immigration, was on the programme and there were a number of questions coming in about immigration. One of them was with respect to doctors, and the Minister of Manpower and Immigration of the federal government categorically stated that the questions with respect to admission of doctors to practice was a provincial problem, not an immigration problem. It was an immigration problem only with respect to whether or not the prospective applicant could meet the point system.

Incidentally, they gave the minister the test and he couldn’t get enough points to get into Canada. He fortunately got here, as most of us did, either us or our forebears, before these silly point systems were introduced into the system.

The two keys to that point system -- this so-called non-discriminatory objective test standard system of immigration -- are very subjective. One is the opinion of the immigration officer about the capacity of the person to become used to living in Canada. That is very subjective and you get 15 points for that.

The other one is called occupational demand, and that is based on a series of statistical analyses for different parts of the country on the needs for various skills in those parts of the country. The very interesting thing is, of course, nobody ever sees those and nobody is ever told what those are. That is done in the mystery of the point system. Taking the case of doctors, you cannot go to the immigration office and say to the people there, “I am a doctor who wants to come to Canada. Will you tell me before I make my application where there is an occupational demand and in what region?”

It doesn’t help me if the Minister of Health says that he consults with his other colleagues, the Minister of Health at the federal level and the other provincial ministers, and they reach unanimity on this question, when in fact it is the immigration department which sets that point system and you can’t get the information. What I would like to know is -- forgetting for the moment this question of restricting the flow of people into Canada, and therefore into the Province of Ontario -- has your ministry worked out a distribution chart of occupational need for doctors and others in the health field related to the kind of areas that my colleague, the member for Thunder Bay, has been speaking about, and, indeed, other parts of the province? Have you devised a chart where you can say there is an occupational need and where you can say to the immigration people, “We are sending you here our study of occupational need for these professionals in the Province of Ontario so that if anybody applies, then provided the person is prepared to go to that area” -- and I recognize the problems of compulsion and making persons stay once they get into a particular area -- “we are prepared to have him come into the province”? I just happen to find it a little bit odd for us to suddenly be starting to talk about the protection of highly vested interests of the medical profession about the adequacy of the numbers. I think that is a lot of nonsense. I would have the same fear of it if they were talking about the adequacy of the number of lawyers.

I personally share everybody else’s view that it is shocking that there are any number of young people who want to become doctors in this province and can’t, because of the inadequacy of the medical school system based upon a restrictive quota operation. I think it was the Minister of Colleges and Universities (Mr. Auld) who gave the figures the other day. I thought I heard him say that there were 8,000 applicants and 500 places in the medical schools last year.

Mr. R. S. Smith: Right. Or 548 places.

Mr. Renwick: Incidentally, unless I am wrong, I don’t think there is any medical school in northern Ontario, at the Lakehead or at Laurentian or any of the other universities, and no effort, as I understand it, to establish one.

What I am trying to say to the minister is, don’t tell me about what you and the CMA think about the adequacy of the supply. There will never ever be, in the minds of most people in the Province of Ontario, in a province such as this, the adequate supply of doctors of the skills and abilities which this society will need, and I don’t think that you can start indirectly imposing benign quotas by sort of saying: “Oh, we all agree that this is the right ratio.” It isn’t the right ratio.

I would like the minister to give me, in any event, some assurance that he will consult with the Department of Manpower and Immigration, and that he will advise the Department of Manpower and Immigration of the specific occupational needs in various parts of the Province of Ontario for professionals in the health field in its broad scope. So that if a person who is a physiotherapist from Scotland applies to come to Canada, for example, that physiotherapist can be told: “Yes, there is an occupational need for you in some part of the Province of Ontario -- go there.”

I agree about the problem of mobility of people. You can’t guarantee he is going to stay, but you can at least get him there at the beginning. The chances are that a reasonable number of people will stay in such locations if that is made somewhat a condition of their admission to the country -- and I think at least for three years or four years -- until they obtain their citizenship, that likely would in an indirect way work as a method of correcting the maldistribution of the health service people across the province.

Those are basically the two things that bother me. I think the minister is being less than honest with the people in the province about the revenue squeeze of the provincial government, which is quite a legitimate point to make. You are being less than honest about the fact that you have got to expand and maintain the quality of your health service, and you have to get away from this conception that somehow or other the number of doctors is adequate. I think that in any society where there is the kind of discrepancy that you indicated tonight, such that in the last year or two years the doctors’ income is now five to 5 1/2 times greater than the average median income across the Province of Ontario, we are making the wrong decisions by allocating persons in accordance with what they are paid. The only way that a government such as yours can deal with it is to increase the supply of doctors, not curtail them. And you have to increase the supply of other persons in the professional health fields.

It seems to me that that makes only elementary common sense, and I would like the minister to comment on those aspects of it because it is so extremely difficult to ever put the contrary argument. The minister speaks on platform after platform after platform; the speeches come across our desks, and before long, because we are deluged with it, we think that there isn’t any other argument. There is another argument and that is that you have to face up to the fact that yes, our society will continue to demand an ever-increasing share of the provincial revenue for the social services, including health, housing, pensions and social welfare payments of all descriptions.

Mr. Chairman: Does the minister wish to respond?

Hon. Mr. Miller: Mr. Chairman, I have to say with great sincerity that I have listened to the hon. member since I became a member of this House, and I have always been impressed with his ability to clearly state his point of view and with his great breadth of reading and thought processes. I do respect them. At the same time I recall the thoughts that Lyndon Johnson expressed at the height of his anguish in the Vietnam war when people were against it, and he said: “If only they had the facts, they would agree with me.” Well, somebody else pointed out that two people can have the same set of facts and come up with opposite conclusions. Perhaps this is why you and I can agree on many of the things you stated and yet conclude different things.

Mr. Stokes: The fact is there is a shortage of doctors in many parts of Ontario. You can’t deny that.

Hon. Mr. Miller: I have never tried to deny that fact. I only point out that I can completely agree with the statements you have made about trying to tie the immigration of a doctor to Canada to a need in an area. That is exactly what I am trying to negotiate with the federal government. At this point in time they haven’t been listening to any of our arguments in that direction and we simply have to find the mechanisms. They have now admitted, at least to us, that this is the point we have to negotiate. So we don’t have any disagreement there.

The interesting thing, though, is that when we’ve gone around and made this inventory at the places where we’ve needed the doctors, and we have done that to the best of our ability -- whether it has been properly done or not can be argued, but we’ve done it better than most people -- we’ve found that 80 per cent, I am told, of the doctors who’ve been willing to take the positions in those areas have not been immigrants. They have been Canadian-born doctors who have filled the posts where we’ve needed them most. I think that’s rather reassuring rather than just the opposite. I think it’s rather reassuring that our own people have been willing.

I was at the University of Toronto a few months ago and I was discussing this issue of whether the government had the right, in their eyes, to tell a young student graduating in medicine where he should practise. I asked them two questions. The first was do we have the right to impose a limit on the doctors coming into Canada? The hands went up unanimously. I think one could predict that.

Mr. Renwick: Vested interest.

Hon. Mr. Miller: Sure. At the same time, I asked them whether they thought I had the right, once the state had basically paid for a great part of their education --

Mr. Stokes: Precisely. I’ll bet you it’s over $200,000.

Hon. Mr. Miller: Again, you and I would agree.

Mr. R. S. Smith: You have the right for a certain period of time to tell them where to go.

Hon. Mr. Miller: We’re not disagreeing here at all. I posed this question to them: Do you feel I have the right, or the state has the right, to tell you where you can practise for a period of time? To my shock, more than half the hands went up saying I did have that right. To me, that was a reassuring thought. These young students may change their minds. Their ideals may evaporate very quickly, but at that point in time they were willing to say that there was this right --

Mr. Martel: The first year.

Hon. Mr. Miller: -- that they did owe the province that educated them something in return.

Mr. R. S. Smith: Well, let’s impose that right.

Hon. Mr. Miller: I’m saying to you I have been trying, rightly or wrongly, to get an environment that would permit me to do some of these things. That is why I gave so many speeches this summer and why sometimes I got tired of saying the same things. The fact remains that I do not believe that you or I or any other government can do things which, in the final analysis, people do not accept as being necessary. Would you agree with that?

Mr. Roy: How long does the PR go on though? Lawrence said the same thing, Potter said the same thing and now you’re saying the same thing.

Hon. Mr. Miller: Okay, I think you can say that with some justification. I don’t know whether I’m going to win that battle or not. I’m quite honest with you. Strangely enough, I will need the opposition’s help just as much as I will need other help.

Mr. Roy: We have been saying the same thing, that you’re headed for bankruptcy. We’ve been saying that for a while.

Hon. Mr. Miller: I do think, with great respect, that I’m not trying to slough the blame off on the people by saying we’re out of shape. I’m pointing out to them that, if they look at world statistics and see who has the greatest incidence of premature death in the world, the United States and Canada lead the pack, that we are the worst in the so-called civilized countries. I think that if we went to some of the countries where elementary health control measures haven’t been enforced, this is not true. I’m talking about the so-called civilized countries. We lead the pack because we are in the worst shape.

Mr. Stokes: Because everybody doesn’t have a swimming pool like the minister.

Hon. Mr. Miller: Oh, that’s baloney! I don’t have a swimming pool, by the way. I use the YMCA for $75 a year, and you can come over there without a bathing suit any night with me, and we’ll share the wealth.

Mr. Stokes: Why don’t we have some exercise time?

Mr. Chairman: Order, please.

Mr. Renwick: You can’t say that we’re all dying off, and then tell us that our major problem is that everybody is aging in our society.

Hon. Mr. Miller: Some of us in this room have faced the edict of a physician who says you’ve got to do this or else. I think at least a couple of us can look at each other and say we’ve faced that. When that happens we do suddenly realize those things are important.

Mr. Renwick: Have you got your licence back yet?

Mr. Stokes: Is that why they revoked your flying licence?

Hon. Mr. Miller: That’s exactly it.

Mr. Renwick: Have you got it back?

Hon. Mr. Miller: No.

Mr. Renwick: Stop those abuses you’ve been practising.

Hon. Mr. Miller: Which ones do you think I’m practising.

Mr. R. S. Smith: Mr. Chairman, it’s ironical that I’m the next speaker after some of the comments that have just been made by the minister. I’m one of those who may have cost his system about $10,000 over the past 12 months.

Mr. Renwick: You were worth it, though.

Mr. R. S. Smith: Yes, I think the money was well spent.

Mr. Roy: Look at the shape he’s in. He’s been campaigning in Carleton East all day, and look at him.

Mr. R. S. Smith: I was down there in Carleton East today to look around, but that’s another question.

I would like to comment basically on two things. The first is in regard to the distribution and/or the availability of medical practitioners across the province. The fact of the matter, regardless of what the minister says, is that we have been over the last 20 or 25 years net importers of medical practitioners, that that’s where we’re wrong. We’re not wrong in having those people from other countries able to come in and practise medicine in this province. I agree with the hon. member for Riverdale on that. Where we are wrong is that we are not producing the required number of doctors to service the people of this province. Whether the people stay here or leave, whether we bring them in, whether we have the required number or whether we have the distribution is the question.

But the first question is are we producing our share? Obviously, the answer to that over the past 25 years is that we have not, as one of the richer countries in the world and the richest province in Canada, produced our share of medical practitioners. Therefore, we have been robbing the less affluent areas of the world to provide services within this province. That’s where we are wrong.

I don’t say we should stop those people from coming in here to practise, because obviously we are getting people from the lower-income provinces in Canada itself who come here because of the higher payments in OHIP. You know that as well as I. But I believe that we should be producing in Ontario enough practitioners, whether it be in the general-practice field or in the specialties, to provide the services for all the people.

The question then comes down to whether or not we have them distributed across the province on a correct basis. There I agree with you, that if we are going to educate these people within the province, I believe the major costs fall upon all of us as taxpayers, because actually the tuition fees they pay and their personal costs through the six or seven or eight or nine years that they spend are only a portion of the total cost.

I think we should demand an agreement from those who enter medicine that for a period of time after graduation they wall practise in those areas of the province to which the government will designate them.

Mr. Martel: That’s the whole solution.

Mr. R. S. Smith: I think that’s the next step that has to be taken.

lf they are not going to do that, then they should be billed for the difference between the cost of their education and the costs they have actually paid through tuition.

So I think there are two different questions there. First, the question of distribution, which I think can be dealt with in that way with our own people. I’m glad to hear the minister say that our own people are those who are willing to go into the underserviced areas, because I feel that it’s necessary that we have our own people in those areas. But I would like him to comment on the fact that we do not produce enough practitioners in this province to meet our own needs, and that we are net importers. That is where the problem lies.

The other question I want to discuss is, naturally, the drug programme. Perhaps you would like to answer me now and let me go ahead with that after.

Hon. Mr. Miller: Do you want to discuss that under its own vote or do you want to discuss it now?

Mr. R. S. Smith: We have discussed medical services and hospital services, and everything under this vote. I bring up something else and you want to put it under its own vote.

Hon. Mr. Miller: All I can say is when we have finished we can say all the votes have been covered.

Mr. R. S. Smith: That’s fine, when we have finished tomorrow night, we will say that all the votes have been covered.

Hon. Mr. Miller: That’s fair enough by me.

Mr. R. S. Smith: Do you want to comment on my remarks?

Hon. Mr. Miller: Sure. I find very little to disagree with in what you are saying in terms of the fact that we haven’t produced enough physicians. The comment was made that we didn’t have a school in the north. We don’t; there is no intention of having a school in the north --

An hon. member: Why not?

Hon. Mr. Miller: -- and that isn’t a slur at the north.

An hon. member: It is.

Hon. Mr. Miller: No, it isn’t. The truth of the matter is that when we started looking at the problems of educating doctors in those areas we didn’t have the clinical facilities available to give them the experience they had to have. That’s why we’ve encouraged the reverse, though --

Mr. Stokes: You’ve got a forestry school at the U of T. Where the hell have you got any trees down here?

Mr. Martel: You have a mining school at Kingston and they haven’t even got a rock.

Hon. Mr. Miller: The rocks around here, sir, are in your head.

Interjections by hon. members.

Hon. Mr. Miller: The fact is that we can send the students in those other two courses to the areas where they need to go to study. But we cannot, too easily, in medicine.

Mr. Renwick: This is the Toronto-centred region with a vengeance.

Hon. Mr. Miller: We have tried the reverse and I think with some success. I don’t know how many of the teaching schools or the medical schools are doing it. Is it three that have programmes of sending their students into the north? McMaster University; Toronto certainly has some; I think Kingston has some, have they? But we want to encourage more students from the north. We want to give more contact to the north during the learning experience and we are encouraging universities to do just that. But it has not been feasible, from a technical point of view, to have the actual school of medicine in the north.

Mr. Stokes: May I just ask one question in relation to that?

Mr. R. S. Smith: Yes, and then I will come back.

Mr. Stokes: How can the minister justify his last answer when I had a bright young student from Nipigon who wanted admittance to a medical school but was turned down totally last year. He then got an honours course in science and applied to every medical school in the province this spring, but he was turned down by all of them again. Do you know why they refused his application at Ottawa? Because of his academic ability in relation to students from the Ottawa area who had applied.

The minister says we are trying to attract students from the north into our medical schools. How does he justify that answer?

Hon. Mr. Miller: I think I am getting out of my own area; I should stop right here. I can only tell you that I can only encourage them; I have nothing to do with the admission regulations; that is the responsibility of the Minister of Colleges and Universities.

Mr. Roy: Did you have a talk with the Minister of Colleges and Universities?

Mr. R. S. Smith: Granted, the minister has nothing to do with the admission regulations and they may well come under Colleges and Universities. But the minister does have something to do with the provision of medical practitioners -- and that is what he hasn’t done over the past 25 years. He hasn’t made sure that there have been enough practitioners provided to give the service required by the population growth in this province. The minister failed to answer that question; in fact, he avoided it by going off on to the northern Ontario question.

Hon. Mr. Miller: I agree with the member.

Mr. R. S. Smith: What is the minister doing about it then?

Hon. Mr. Miller: I explained all that earlier, sir, while the member was in Ottawa or wherever it was.

Mr. Roy: But the explanation was hardly satisfactory.

Mr. R. S. Smith: Okay. Maybe the minister will recall next week where I was. Since the minister has explained earlier how he is creating all these new places in the universities, I will expect next year that instead of 548, we will have at least a 20 per cent increase to 635 or something like that. Is that what he said?

Hon. Mr. Miller: The member has a great deal of faith.

Mr. R. S. Smith: Well, we have to live on faith. We can’t live on past records around here, I will tell you. We have got to look ahead. We can’t look back, that’s for sure.

Anyway, the other question I have is in regard to the drug plan. I realize it comes on the third vote, just as everything else we have been talking about comes under the second or third vote but not on the first vote, but basically I’d like to say to the minister that I agree with the plan as it is insofar as the provision of drugs to those on the GAINS programme, those on public welfare, those on family benefits and those receiving old age security and guaranteed income supplement.

However, there are two or three things in that programme that are wrong and that are going to be of real concern to this minister in the next few months if he doesn’t change them.

The first thing is the formulary that has been set up has been established without any type of variation possibilities. In other words, it is put there and it’s said, “That’s it until January; right, wrong or indifferent, that’s it.” No programme can be that intransigent, and basically, that is the way the programme has worked up until now.

Basically, I agree the major problems that you are having with the programme are in respect to compound drugs, and it is better practice if the physician is forced to prescribe the drug individually. I agree with that. But your people should make a difference between a compound drug combining two different substances in the one tablet or formulation, and the ones that are compound drugs formed by the combination of two ingredients in which a medical reaction produces another drug. That’s not a compound drug. There are some compound drugs not included in the formulary on that basis, and that is ridiculous. I realize those are mistakes that have been made and they will be corrected over the next few months, but they should be corrected now and not wait until January.

There is another thing that I feel is obviously ridiculous in this whole thing. You said in February that each prescription for all these people will have to be a signed prescription from the medical practitioner, and the pharmacist will not be able to fill that prescription unless he has that signed prescription. Now, you are really going to scupper the programme with that one. First of all, what you are saying to the pharmacists of the province is that you don’t trust them and that they have to have a signed prescription. That is just what you are saying to them. If they have any backbone at all, they will tell you where to get off.

Hon. Mr. Miller: May I just talk on that one point a second?

Mr. R. S. Smith: Okay.

Hon. Mr. Miller: First of all, the signatures in February are still negotiable. But let’s look at one of --

Mr. R. S. Smith: Are you making a statement?

Hon. Mr. Miller: I am just saying it is still negotiable.

Mr. R. S. Smith: Oh well, even the thought of doing that is an insult to them.

Hon. Mr. Miller: Oh no, it is not. Look, we have to have an audit trail, and you know it.

Mr. R. S. Smith: Do you think that every patient of every doctor in this province signed something that he got this morning?

Hon. Mr. Miller: We have an audit system. That is why I say we have to have an audit trail and that is why it is still negotiable. For about a year and a half we did not audit our OHIP payments, and we got great criticism from you people for not doing so.

Mr. R. S. Smith: There are other ways of auditing.

Hon. Mr. Miller: We audit on a sample basis now, as you know.

Mr. R. S. Smith: And you can do that on the phone.

Hon. Mr. Miller: All right, that is why I say this is still negotiable. My only desire is to find an acceptable means of auditing the actual delivery of those drugs that was acceptable to the Provincial Auditor. I am not questioning the integrity of the pharmacists in the way you imply it. But let us be honest, experience has shown with the plans that have been operated by the municipalities of Ontario that a great number of pretty dishonest things were done.

Mr. R. S. Smith: Would you like to specify what they were and who the people were?

Hon. Mr. Miller: I have had examples given in front of me by the pharmacists of this province.

Mr. R. S. Smith: Pardon?

Hon. Mr. Miller: I have had examples given to me. I stayed in Sault Ste. Marie one night -- I can’t name the individual druggist -- and a druggist there agreed that this was a problem. He said people came into drugstores who were on municipal welfare for drugs on the old system, and picked up things like toothpaste and other things and said, “Put it through.” And they were doing it. And they said --

Mr. Ferrier: Were they doing it?

Mr. R. S. Smith: Obviously you are going to have some abuses. Was it a major abuse of the system? What percentage of abuse was it? Was it higher than that which has taken place in OHIP?

Hon. Mr. Miller: It’s an abuse. I am just trying to say to you that because the abuse has occurred -- it’s not one that might occur -- we have to have an audit system. We are spending provincial money. You know why you don’t need a signed prescription right now.

Mr. R. S. Smith: Because your programme couldn’t work if you did, that’s why.

Hon. Mr. Miller: I mean in the free market. If I come in with a prescription from a doctor, I get the drugs. I give him the money. I’ve had my audit, haven’t I? I am paying for it in cash. But under this present --

Mr. R. S. Smith: There is Blue Cross and all those other plans.

Hon. Mr. Miller: Oh yes, but most of us pay for our own drugs. I still pay for mine. I am not quite eligible for GAINS yet. But the fact remains --

Mr. Roy: Keep it up.

Mr. B. Newman (Windsor-Walkerville): Put him on welfare.

Mr. R. S. Smith: Unemployable but not disabled.

Mr. Chairman: Order, order.

Hon. Mr. Miller: Yes, just not quite disabled. The fact remains we are looking for a mechanism that will satisfy the auditor and not cause undue hardship or imply undue disrespect for the pharmacists. That’s one of the reasons that a time delay has been put in. I am not saying that we won’t have to do it, but we are very anxious to find something that doesn’t make us do it.

Mr. R. S. Smith: I will say that, first of all, even implying that you were going to do it was a gratuitous insult to the profession, as far as I am concerned. And if they didn’t take it any other way then I think they are -- I haven’t been one in this House to protect them to any great extent. In fact, I have been one to be rather critical of them in the past. I think I have gone farther than you or your government in setting up the Parcost programme, for example. You are finally reaching the Parcost programme that I put forward five years ago. You may get there yet, if you just keep at it.

Mr. Roy: Fantastic health system.

Mr. R. S. Smith: The other side of this thing is: if you enforce it, what kind of a bill are you going to get from the medical practitioners of this province for having to write that prescription each time? Is he going to bill you $6.70 every time he writes a prescription for a person under these programmes? What will that cost be to the people in this province? That would be ridiculous, and that may well happen, because the general practitioners and the medical practitioners are not going to stand for that kind of a programme, where they have to sit down and write out each prescription.

Hon. Mr. Miller: The existing prescription is good for at least three months, I believe.

Mr. R. S. Smith: Yes, but are you saying that at the end of every three-month period, regardless of what is to be done by the practitioner, he has to call the patient in, see him again, write another prescription and bill him another $6.70?

Hon. Mr. Miller: Has he done that in the past?

Mr. R. S. Smith: No, he hasn’t done it.

Hon. Mr. Miller: Look, I take Aldomet. I take it every day of my life. I go and get a prescription about every three weeks.

Mr. R. S. Smith: He hasn’t done it and you know he hasn’t done it.

Hon. Mr. Miller: I don’t see my doctor. He just tells the pharmacist to give it to me.

Mr. Martel: You are a potential drug addict.

Hon. Mr. Miller: He’s had the right to charge $6.70 up to date any time I did it. Is he going to charge more just because the province is picking up the tab on the plan?

Mr. R. S. Smith: He is going to charge because he is going to be forced by your regulations to see the patient and do that.

Hon. Mr. Miller: No, he is not going to be.

Mr. R. S. Smith: How is he going to write the prescription otherwise? He can’t telephone it, because it has to be a written prescription, and that’s what your regulation enforces.

Hon. Mr. Miller: I just finished saying that’s not true.

Mr. R. S. Smith: I’m trying to tell you why you have to negotiate it in a proper way, or it’s going to cost you a lot of money and it’s going to make a farce out of the whole system, which is basically a good system right now.

Mr. Roy: Your best policy is to follow our suggestion and you know that.

Mr. R. S. Smith: The other question that I wanted to bring up in regard to this programme is the 30-day supply business. This is where I’m on the other side of the fence. I want to save you money through the $2.10 or $2.15 dispensing fee. I think there are some drugs on that formulary that you could mark with an asterisk or with some other --

Mr. B. Newman: Identifying mark.

Mr. R. S. Smith: -- identifying mark that could be provided on a 90-day supply basis, where your dispensing fee would remain at $2.15 over the 90-day period instead of $6.45. I think this could save you, maybe not millions of dollars, but I think it could save you a few hundred thousand dollars when the programme really gets going and when you start to expand the programme to cover other people, like you and I; which eventually, obviously, you will do. That’s going to be the coming thing, whether it’s now or 10 years from now.

Hon. Mr. Miller: I’m pleased to think you believe it will be us who do it.

Mrs. Campbell: Oh, no; the government of Ontario thinks otherwise.

Mr. R. S. Smith: I want your comment on that suggestion, where you can save a considerable amount of money right now by designating some drugs that can be prescribed for 90 days. Turn and ask the doctor behind you if he hasn’t prescribed 90 days of drugs for many people over the years.

Mr. C. E. McIlveen (Oshawa): Such as what?

Mr. R. S. Smith: Such as lanoxin.

Mr. Roy: Yes, have you ever heard of it?

Mr. McIlveen: Yes.

Mr. R. S. Smith: Do you agree with that? I could name 20 or 30 without even thinking about it very strenuously.

Hon. Mr. Miller: Can I try to answer that one now?

Mr. R. S. Smith: I am sure Dr. Dyer in front of you can tell you a lot more.

Hon. Mr. Miller: Can I try to answer that now? On the present basis, I’m listening carefully, because first of all we do permit a pharmacist to give a 90-day supply or a 60-day supply at a time if he wishes to, and he can only bill a month at a time. That may seem a bit ridiculous, but he takes a bit of a gamble that the person will be eligible in the next month for the benefit programme. That is his gamble. At the current time the only --

Mr. R. S. Smith: That table at the back --

Hon. Mr. Miller: Just a second now, at the present time the only reason for the 30-day supply is not medical or technical, it is because the eligibility is a 30-day span of eligibility for the drug benefit programme.

Mr. Martel: GWA.

Hon. Mr. Miller: It is approximately a 10 per cent turnover per month. I’m weighing this one. I’m listening to your arguments because there is logic in what you’re saying, but I’m just saying this is the current reason for the 30-day eligibility. It’s not a question of which drug would fit the 30-day supply basis or which one wouldn’t.

Mr. R. S. Smith: Okay, that is fine, I can understand that.

Hon. Mr. Miller: Where you have the 30-day eligibility, but you don’t have that with the GAINS people or with those under old-age security. The only ones you have it with, really, are those on general welfare assistance, which aren’t covered the same way anyway. They are covered differently.

So I think it can be worked out. I’m just going to point out to you where you’re wasting some of the valuable health dollars that might be spent in educating a few more doctors.

Mr. Roy: Or having a dental programme or something.

Mr. Chairman: The hon. member for Kingston and the Islands.

Mr. C. J. S. Apps (Kingston and the Islands): I would just like to take a couple of minutes to enter into this debate for a short time and to comment first of all on the fact that we in Kingston are most fortunate in the numbers and the quality of the doctors that we have there. That is in large measure due to the Queen’s University medical school, which brings to our community a large number of very competent and qualified doctors who, I believe, are doing a good job in looking after the people in our community.

Mr. Roy: Is Dr. Haslett one of them?

Mr. Apps: Yes, he is. He is a very good doctor, along with many others. But that isn’t what I really want to comment on.

The minister has indicated a great many times over the past few weeks his concern for the costs of health care in the province, indicating that he really only has two ways in which he can control that cost: by the number of doctors who are practising and by the number of hospital beds that are available in the province.

I would like to submit, Mr. Chairman, that there is another way that he can control those costs, and that is by perhaps paying a little more attention to preventive health care. He can do that in four different ways, three of which he never had too much control over and one of which I think he has.

In the first place I think there has to be a much greater emphasis on physical education within our schools than there is at the present time.

Mr. B. Newman: Talk to the Minister of Education.

Mr. Apps: All right. Why I’m bringing this up is that this has a great bearing on the health of everybody as he grows up. I am going to urge the Minister of Health --

Mr. B. Newman: You have the right to convince your own colleagues.

Mr. Apps: -- if he would use his influence, bearing in mind the fact that --

Mr. Roy: You should be sitting over there.

Mr. Apps: -- the greater number of young people that he can get in good physical condition, the less he’s going to have being looked after by the doctors. I think the minister can play a very important part in convincing his colleagues that there should be -- as a matter of fact, there must be -- more emphasis on physical education within the schools.

Mr. Martel: Look at the shape he is in.

Mr. Roy: Right on, Syl.

Mr. Apps: Secondly, I think the minister will realize that a great many people are sick from lung cancer because, in many cases, people smoke too much. This is common knowledge.

Hon. Mr. Winkler: Right.

Mr. I. Deans (Wentworth): Oh, listen to the guy -- a chain smoker.

Mr. Apps: I feel the minister can do a great deal in trying to tell people the costs we have to pay because of excessive smoking.

Mr. Roy: Have you seen this photograph of Bill Davis?

Mr. Apps: That’s a very simple statement to make, but it’s a true statement to make.

Mr. B. Newman: He looks like physical fitness there.

Mr. Apps: If we’re really concerned about the costs of health care, this is one area on which we should be putting more emphasis.

Thirdly, the minister will realize, as his predecessor certainly realized, the fact that a great many people are sick because of excessive drinking. This is one area again where the minister, if he’s interested in reducing the costs of health care throughout this province, and I believe he is, must pay more attention to the health hazards created by excessive drinking.

Those are three ways that are sort of peripheral to him. He hasn’t got the complete control but in the same way I think he should be interested in it because it is one way in which health costs could be reduced.

Mr. Martel: Or the poor might eat properly.

Mr. Apps: Another point is that there are a great many people throughout the province working in district health units who are crying for more money to do the job that they want to do in preventive health care.

Mr. Roy: How did you like that picture, Syl?

Mr. B. Newman: He could stand some fitness there.

Mr. Apps: It looks like a harmless cigar to me.

Mr. R. S. Smith: But not the person.

Mr. Apps: I had the pleasure, Mr. Minister, this afternoon of attending the opening of the new administration building of the Kingston, Frontenac, Lennox and Addington health unit. I guess it is typical of health units throughout the province. They are trying their best to do a good job in preventive health care.

When we are talking about spending hundreds of millions of dollars to pay doctors or for hospital beds, please don’t forget that there is a group of very dedicated people throughout the province who are working very hard to try to keep people from getting sick. I hope that these people don’t get lost in the shuffle.

As I say, there are hundreds of million dollars being spent in primary health care. Something should be left over to increase the amount of money that is being given to the various health units throughout the province.

So, Mr. Chairman, there are four ways in which I think the minister can play a very important part in helping to reduce the costs of health care, over and above the two main ones that he has been discussing throughout the province. I think they are very important. I would urge you, and I am sure the member for Windsor-Walkerville will join me --

Mr. B. Newman: You are darn right.

Mr. Apps: -- in urging you to take an interest in the physical education of our young people in particular, and to try to make sure that at least they get a good start on the way and maybe as they get older they will continue on.

Mr. Ruston: Not only young people, all ages.

Mr. Apps: I would stress physical health education within the schools --

Mr. Ruston: Don’t forget the 40s and 50s.

Mr. Apps: -- and campaigns against the smoking and the drinking.

Mr. B. Newman: A little more jogging in our seats.

Mr. Apps: Finally, the district health units throughout the province are trying to do a big job for you but they need your help; they need the funds. If you give them those funds, then you are not going to have to spend nearly as much on the doctors and the hospitals as you are at the present time. Thank you, Mr. Chairman.

Mr. Martel: The member for Oshawa wouldn’t like that.

Mr. Chairman: Vote 1801. The member for Cochrane South. I think he spoke on it once.

Mr. Martel: That would hurt, wouldn’t it, Charlie?

Mr. Apps: Mr. Chairman, perhaps the minister would like to make just a short comment.

Hon. Mr. Miller: Yes, I was trying to get up before. I couldn’t help but agree with all four points. There are very few people in this House who can stand up and make the speech just made by the member for Kingston and the Islands without some degree of hypocrisy in what he said, but I think he is one person who can safely make those statements.

Mr. Roy: What’s wrong with the shape I’m in?

Hon. Mr. Miller: I will challenge you to jogging around the block, but I surely won’t challenge --

Mr. Roy: Okay, when?

Hon. Mr. Miller: Most certainly, within my own priorities and within the ministry’s priorities we put a very high accent on the very things you are talking about. Primary care, preventive care have to be improved. It is a small part of our budget. I don’t know if it’s six or seven per cent; that’s a figure that comes to my mind somehow. Yet I wouldn’t want to say that the method by which we deal with the preventive aspects will necessarily remain the same. That’s one of the big issues that is being discussed currently as a result of the Mustard study.

Most certainly we have to gear up our preventive health system. I agree completely that the best prevention lies in those first three areas you talked about. As a person who seldom, if ever, smokes, I just find it difficult to believe that people can see the statistics and ignore the cost it is to the system. I saw some figures on the cost to the health system alone of drinking in the province. I think it was $175 million or $180 million a year in direct costs that we can relate; some figure like that.

Mrs. Campbell: You are making a lot of money out of it.

Hon. Mr. Miller: Well, we are making $285 million to $300 million worth of sales. I don’t think one should even try to equate the two things. I am interested in what it costs from health rather than any other aspect.

Mr. Roy: How about the example where you said they were out?

Hon. Mr. Miller: Well, we are a private group.

Mr. Ferrier: I thought the minister was going to answer the speech by the member for Kingston and the Islands by one word and say, “Amen.”

Hon. Mr. Miller: That is your job.

Mr. Ferrier: That was a very good speech and I have to agree with what he said. We have had a wide-ranging debate tonight about the availability of doctors and whether we have now reached the adequate ratio of doctors to population and the distribution and so on. One thing, I hope the ministry has continued and where perhaps they have some ideas on, is that in some of the outlying areas there were pilot studies as to the role of the nurse practitioner. I think there was one around Geraldton as a result of a study through McMaster University. There was also some discussion at one point of the nurse practitioner doing some of the midwifery role and this kind of thing, and whether perhaps the health care system could be improved if there was a greater role given to the nurse practitioner.

The other point that was briefly alluded to in the speech by my colleague from Riverdale was about some of the other health personnel. I am thinking primarily of physiotherapists and optometrists, because I have had some occasion to have engaged in correspondence with the minister, and I must say I am pleased with the information he has given me.

I am wondering what kind of studies you are doing to determine the distribution of these two categories of health care personnel throughout the province and what efforts you are making to see that the people of the province are getting adequately served by optometrists and by physiotherapists. In my own community, until just recently we had three. Fortunately, this summer and fall we have now two more. I think we are probably being served okay, but people are waiting three, four and five months for an appointment with an optometrist. I can think of the whole northeastern region where this kind of wait is common and perhaps more acute than we have in the Timmins area.

I am wondering if perhaps you should engage in the same kind of programme for optometrists as you have for doctors and dentists and guarantee them a certain salary if they will go and practise in these areas. Perhaps you should engage in a bursary programme to enable the students at the optometry college, at the University of Waterloo, I believe, to get assistance through school and then direct them to the underserviced areas of the province, and similarly for the other health care personnel and physiotherapists.

In the letter that you sent to me, you say that some of the single girls wanting to leave the Metropolitan area want to go north to some of the adventure up there and then will eventually come back. One hopes that the romantic men of the north will latch on to them and keep them there.

Mr. Stokes: Up where the men are men --

Mr. Ferrier: Up where the men are men.

Mr. Stokes: -- and the women are glad of it.

Mr. Ferrier: The minister in his reply seemed to suggest that the men up north weren’t the kind of guys who were latching on to them and keeping them there.

The other thing is that the physiotherapist may move up into the north with her husband who was transferred up there for a year or two. Then he will be transferred to another community and the wife, of course, will follow the husband. So there is a great change-over in the city of Timmins. Sometimes we have one physiotherapist, sometimes two, and sometimes we don’t have any. In the other smaller areas of my riding there is usually no service at all.

I’m just wondering if you will look at the whole question of how these personnel are distributed in the province and if there is some way that it can be worked out where physiotherapists perhaps will be in private practice or something like this where they could visit the nursing homes, senior citizens’ homes and hospitals in an area on sort of a planned basis, whether they can even be attached to the health units. Is this something that has been considered? They could go and do some service in the home.

These are two categories -- optometrists and physiotherapists -- that have concerned me. People have brought problems to me and I am wondering what you are doing about their distribution. Have we got enough of them in the Province of Ontario? If we haven’t, what effort are you making to increase the supply, or how are you hoping to make sure that as far as is possible these kinds of services are provided to the people of the province in as practical and reasonable and realistic a manner as we can expect in Ontario today?

Hon. Mr. Miller: Mr. Chairman, the nurse practitioner, of course, is something we’ve talked a lot about and we have been doing quite a bit about. There is still some argument about the definition of, and the right to practise and do certain functions that are currently the duty of a medical practitioner only. But I think progress has been made in those areas. The fact that we have courses working now and people being produced is, I think, going to give us a growing number. The Hamilton area has led in this particular part of our training. I think one and possibly two other universities -- I’m not sure -- Toronto and is it Western too?

An hon. member: And Western.

Hon. Mr. Miller: They are both working in that area. I have real hope that we will have a greater supply of nurse practitioners and that some of the areas where we are experimenting with other forms of health-care delivery -- the community health centre concept -- permit the nurse practitioner to practise more freely than she can in a fee-for-service office.

One of the problems, of course, that has constrained the total use of a nurse practitioner has been that the federal rule for payment on a fee-for-service basis required that the service be done by a licensed practitioner -- the physician who was in fact doing the billing. It’s either made some people break the law or bend the law if they wanted to make full use of allied health-care personnel. This seems to me a ridiculous impediment and one that needs to be worked upon to iron out the problems of health-care delivery. We’ve gone around it by the other route, trying to encourage the creation of community health centres that could work on a global budget or some other form of payment.

We are told that the overall supply of optometrists coming out of the new university facilities will at least meet our requirements. So I’m optimistic on that. I have to say I have had tremendous co-operation from that group whenever I have had to ask them for some assistance.

We are dealing with the physiotherapists and are studying their problems right now. I believe we are making considerable progress here. We have a number of problems in that area, and yet I am encouraged to think that we are making progress.

The Ontario Council of Health has done a lot of study for us on our total medical manpower needs and continues to advise us in that direction.

Mr. Chairman: The member for St. George.

Mrs. Campbell: I am sorry, Windsor-Walkerville was next on the list.

Mr. Chairman: I am only going by the list here. Are you yielding to Windsor-Walkerville?

Mrs. Campbell: Yes, but I’d like to keep my place right after him, which is what the list said.

Mr. B. Newman: Thank you, Mr. Chairman. I wanted to discuss the problem of the distribution of medical practitioners throughout the province. When the minister says there are sufficient medical practitioners because the ratio is higher than in most jurisdictions, you can probably say exactly that same thing concerning money. There is enough money in the province but it is not distributed properly either. Were you to distribute it properly then you might not have a lot of the social problems that you do have. So you can’t come along and say the distribution is really the only problem there.

Now, the member for Kingston and the Islands did mention something concerning physical education and physical fitness, and so forth, as being one of the methods of reducing the total medical health bill. Mr. Chairman, I readily concur with him, because the member chaired the select committee on youth back some eight or 10 years ago which did come down with a lot of constructive suggestions. One of them, to the Minister of Education, was to make physical education compulsory in Grade 13. And what happened? Instead of making it compulsory in 13, they have eliminated it in the school system. It isn’t compulsory at all any longer. So you can see how you in the ministry are working at cross purposes with one another. The Minister of Education didn’t follow his suggestion. Likewise, you couldn’t make recommendations to your cabinet colleague, the Minister of Education, to implement some of his suggestions.

At the same time, you have the Minister of Community and Social Services (Mr. Brunelle) who still permits amateur boxers to engage in their activity without wearing headgear. You would think that you, as a minister, would strongly recommend the compulsory use of headgear when it comes to boxing. The Minister of Community and Social Services has that as his responsibility, yet, he doesn’t act on that.

I don’t know how many health dollars you could save if that were compulsory, but at least you might save some type of brain damage to our younger folk so that later on in life they might not be confronted with additional medical expenses.

As you can see, Mr. Minister, right in your own cabinet you have colleagues who do not agree with the idea of good health for all of the people of Ontario. You are working at cross purposes with one another.

Mr. Roy: That is why they have policy secretaries, remember, to get all this fused together. It really works well.

Mr. B. Newman: Yes, it did work very well.

Hon. Mr. Grossman: I am glad you were paying attention then.

Mr. B. Newman: Mr. Chairman, I hope that the minister, after listening to the words of his colleague, the member for Kingston and the Islands, does a little more with his suggestions than your cabinet colleague, the Minister of Education, did with the recommendations of the youth committee. Some of them were implemented, but the ones that would have a direct bearing concerning health costs, were not implemented. They were discarded. They weren’t considered good enough. I hope, Mr. Minister, that you seriously consider the recommendations of the member for Kingston and the Islands.

The member was a hockey player. You have hockey violence taking place. Younger folk in this sport are learning from their adults to engage in violence rather than play the good game of hockey. You can see that the Minister of Community and Social Services doesn’t attempt to police that -- or hasn’t attempted to do so in the past. Unless they come along and co-operate with you, you are not going to have the total medical bill reduced at all. I don’t think some of these recommendations would reduce it to any great degree, but a penny saved is a penny earned.

I wanted to give to the minister a suggestion that might, and in the eyes of many could, substantially reduce the health costs of the province. The idea is to computerize medical data. I noticed in one of your publications -- I think it was the October, 1974 issue of “Pulse” -- that you are looking at a scheme for computerizing medical data of the young folk. You call it the CASH programme in your ministry -- the computer-assisted school health programme. If it is as valuable as your ministry can foresee, why don’t you attempt to implement it? I have introduced a bill on a medical data bank that would make it voluntary. I think if you were to implement some of this, there could be some substantial savings.

Back several years ago a Dr. E. R. Gabriel, who was the director of clinical information centre at the Myer Memorial Hospital, predicted that a computer system is a vital necessity and if not implemented the alternative would be rapid bankruptcy and that it would mean increasing medical and welfare costs. Even medical men see the value of computerizing medical data. You have to start some time and you might as well start now.

I know there is always the problem that you are confronted with, and that is the confidentiality of medical records. This government isn’t interested in confidentiality really because it sells -- not your ministry, but one of the ministries, the Ministry of Transportation and Communications -- all of its data concerning licences to different organizations. If you can come along and sell that, you are divulging information that maybe the individual who owns the vehicle doesn’t want divulged.

I don’t think you have to worry so much about the confidentiality of this. If you are going to use a number and if you put it on a voluntary basis, then only those who are willing to have their medical records computerized would have it so. But, at least, computerizing would be a substantial savings as far as health costs are concerned.

I would like the minister’s comments on this and, likewise, if he has intentions of expanding or really implementing his CASH programme, as signified in the publication of his own ministry of October, 1974.

Hon. Mr. Miller: Yes, Mr. Chairman, we do have intentions of expanding the total data collection system within the ministry. In fact, we have very real progress in that direction.

I studied with a great deal of interest, a year and a half ago the change to personal identification numbers for health-care delivery and Chargex-type plates and so on when I was parliamentary assistant. They are part of the kind of system you are talking about too. As for data recovery, we feel we are coming along very well within the ministry. Again last month when the health ministers of Canada got together they talked about the need for a Canada-wide application.

Mr. D. M. Deacon (York Centre): Using the social insurance number?

Hon. Mr. Miller: We came to the conclusion that the only valid number would be the social insurance number. The problems that each province would face in having to implement it in the beginning were related to the availability of those numbers. There was the fact that the federal government controlled them and wasn’t willing, in effect, to make deposits of unused numbers available for the province when they needed them on birth and so on and so forth. Certainly progress is being made, apart from that, within the system and we are going to continue toward our computerization.

Mr. B. Newman: Have you set a goal as to when you expect to be computerized?

Hon. Mr. Miller: By some time in 1975 we should be well on our way.

Mr. Chairman: The hon. member for St. George.

Mrs. Campbell: Mr. Chairman, I am not quite sure what our procedures are tonight, because we seem to have been hitting most of the budget. I would be delighted if I could make all of my remarks now and then you wouldn’t have to --

Mr. Chairman: I don’t think you will be able to tonight.

Mrs. Campbell: Well, I don’t know that I will because I really feel that much has been said on various aspects which I am concerned with. I have followed the debate in the matter of the provision of doctors through our educational programmes in Ontario. I must say this, that I would hate to see us chopping off students who might be the very brilliant students of the future simply because we had to maintain a quota system. I don’t really believe that we can look at the numbers game in the medical profession as it is related to health services in this province.

I was saying to one of my friends from the NDP, from Thunder Bay, that I can quite understand his concern. I would also point out that when you look at a place such as Metropolitan Toronto, which is supposed to be so very well served by the medical profession, in some areas we still have a most inadequate delivery of health care.

Talking about doctors who don’t make house calls any more, it is interesting that we are looking at our health councils, health centres and all these other means of trying to bring some kind of service to people in this area. But, quite frankly, you cannot find doctors, in many parts of downtown Toronto at least, who are prepared to make calls. Very often the way the person gets attention is to get an ambulance and go to hospital. I think there must be something in this that would indicate that perhaps we’re suffering a cost that we shouldn’t be having to suffer.

I can remember hearing many years ago that China probably had the best approach to the whole health-care field, in that her doctors were paid while the patients were well and then they paid when the patients were ill.

I notice with interest the experiments in the United States at the present time -- I am referring to the Kaiser project and the one in Washington, and I regret that in my material I cannot bring forward the quotes at this time that I would like to have brought forward -- and that these two, interestingly enough, are operating on the same general principle.

If we want to cut our costs, it seems to me that perhaps we have to look at the total system and not just at a sort of patchwork system which has been functioning, but perhaps not to the overall benefit of the community to the extent to which the funds allocated to it would indicate it ought to be.

Something has been said already tonight about the drug programme. Not being a doctor or a pharmacist, I am not in a position to comment on the expertise relating to the discussion about compounds. But I’ll tell you something: Sometimes in my life I feel that these matters have to have a little bit of common sense someplace in the area of the human needs. For instance, a doctor might say: “This is what I want for my patient. My patient is 80-odd years of age and I would like to be sure that she took the various things that she needs to protect her health.” When I go in and see that patient, who has five bottles of pills and is having great difficulty remembering which one she took, which one she ought to take and when she ought to take them, it strikes me that perhaps if she’s lived to 85 with a doctor’s form of prescription, she might be allowed to live out the rest of her days, in that we probably couldn’t think that we were making too much of an indent into her health situation by letting her have the comfort of something which her doctor feels is good for her and which she herself understands.

Once more I would like to renew my invitation, Mr. Minister, because I’d love to have you meet some of these people who are sitting there trying to find out, over the course of a day, what pills they should be taking. It’s ridiculous, in my view. Since she has survived to the age of 85, I really think we ought to let it go on.

Then I want to know why it is that those medications which are necessary to keep migraine sufferers going have been deleted from the formulary. According to my information this is so; if it is not so, I would like to be able to correct the record. At the very time when people are beginning to recognize the importance of looking at the whole migraine situation, it is a pity if in fact this ministry has overlooked, or lacks concern for, the problems of these people.

I have already asked for clarification in one particular area; I have not received the clarification yet. That is on the matter of the use of phenylbutazone, not as in a compound form. In view of some of the serious problems which I had brought to the attention of the ministry, I would like some comment on that.

It is interesting to me, too, that the member for Thunder Bay was talking about --

Hon. Mr. Miller: We need some clarification on your problem with phenylbutazone.

Mrs. Campbell: I wrote to the member of your ministry who deals with this matter of the formulary concerning this matter and the fact that we had had problems with it without the use in its compound form, that the matter had been drawn to the attention of the college, and we had asked the college to please make the information available both to your ministry and to anyone else researching the matter. I have not as yet had a reply from your ministry. I hope that I shall. I will be glad to clarify it further if the doctor has not located my letter.

I don’t know whether you wish me to launch into the rest of it at this point, as we are approaching the adjournment period, but one of the things that the member for Thunder Bay pointed out was the great distances people had to travel in order to obtain assistance. As I pointed out to you, Mr. Minister, until it was rather tiresome to all of us, with the nine hospitals in my riding it is amazing to me that in one instance, for example, one patient with a broken leg was told to wait five days until they could get somebody to look after her. She went to Hamilton to get the leg set. I am just wondering if the minister will comment on the whole matter of hospital admission policies as he goes through these estimates, because it is very much a matter of concern in my riding.

I would like to say that I have heard the minister say that of course hospital boards are autonomous boards and therefore set policy. It is interesting today that I was in the Toronto Western Hospital, and took a look again at that document which is in that hospital, and of which one of my uncles was a signing member, where the doctors got together to form a hospital. I believe they were paying the sum of $10 down and $5 a month for the operation of the Toronto Western Hospital. I would like to point out that that day has gone; as we can obviously see, and that perhaps we had better look at the question of the so-called autonomy of the boards in connection with admission policies, when so much of the tax dollar is paid for the service on admissions to hospitals.

Mr. Chairman: Would this be a convenient time for the member to suggest the adjournment?

Mrs. Campbell: I would be delighted, sir.

Hon. Mr. Winkler moves the committee rise and report progress and ask for leave to sit again.

Motion agreed to.

The House resumed, Mr. Speaker in the chair.

Mr. Chairman: Mr. Speaker, the committee of supply begs to report progress and asks for leave to sit again.

Report agreed to.

Hon. Mr. Winkler moves the adjournment of the House.

Motion agreed to.

The House adjourned at 10:30 o’clock, p.m.