L093 - Mon 20 Jan 1986 / Lun 20 jan 1986

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

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The House resumed at 8 p.m.

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

Resuming the adjourned debate on the motion for second reading of Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act.

Mr. Bernier: I am most pleased to rise in my place and complete the remarks that I started on this bill Friday last. I did not have the opportunity to complete those remarks then, but I am pleased to be able to do so tonight.

I was well into my remarks and I was pointing out that there really is not the accessibility that is promised. The introduction of this legislation, the Health Care Accessibility Act, in my opinion threatens to decrease that level of accessibility which we all worked to attain. In my mind, this is because the Liberal-New Democrat accord has failed to realize some very basic facts.

Mr. Callahan: There are only seven people behind him.

Mr. Bernier: I think I see a quorum here.

Mr. Callahan: There are only seven on the Tory side.

Mr. Bernier: They will all be here to vote against this bill when the time comes. The member had better worry about the New Democrats. He is going to need them to get this bill through.

Interjections.

Mr. Speaker: Order. The member for Kenora (Mr. Bernier) said he had a few more remarks. Please let him make them.

Mr. Bernier: Sorry, Mr. Speaker. Before I was so rudely interrupted, I was pointing out that the Liberal-New Democrats have failed to realize, as have so many other people, that government is in the health care business to stay and they have failed to realize that doctors are also in the health care system to stay.

Prior to the Liberal-NDP ascent to power, a mood of co-operation existed between the government of Ontario and the medical profession. However, since this coalition took over, it has become obvious that this government has deliberately chosen the route of confrontation.

I believe they have been listening too closely to their former Liberal advisers from Ottawa, who as we all know perfected confrontation until the September 1984 federal election. As a colleague of mine has pointed out, the people of Ontario are too sophisticated for Trudeau-style confrontational politics.

None the less, in the past, when differences arose, the Progressive Conservative government always worked to address and resolve the outstanding problems to everyone's benefit. We looked for the win situation. Unfortunately, the only thing this government is looking for is a fight.

By way of example, let me point out that as of January 9, 1986, there was not a single opted-out physician in the city of Timmins. By the following evening, at least 42 of the 50 doctors in the Porcupine area had opted out of the Ontario health insurance plan system. That is an attack on accessibility and nothing less. There is no one to blame other than the present government.

The Premier (Mr. Peterson) pointed a cannon at the collective head of Ontario doctors and said, "Let us negotiate." The present government appears to have forgotten that doctors are people just like everyone else and deserve to be treated as such. Who among us, when threatened, would meekly submit without returning a blow?

We are all about to pay for the insensitivity and political incompetence of this government and the sacrificial lamb is to be our health care system.

We have all heard the argument that in all probability only a small percentage of our medical profession will leave the province as a result of this legislation. People point to the Quebec experience, where approximately 300 doctors decided to take their practices elsewhere, a significant number, some people might say. Most of the 268 doctors who came to Ontario at that time were specialists.

I agree the loss of a couple of hundred doctors in southern Ontario would not pose a real hardship for the citizens. However, the loss of just one doctor in many communities in northern Ontario would jeopardize the health and wellbeing of the community's residents. For a number of communities, there is only one doctor.

How the government can suggest this legislation would increase accessibility is beyond my understanding. Had the present government acted responsibly and entered into discussions with the medical community in good faith instead of governing by decree or, dare I say, by accord, the problems now surfacing could have been avoided. The fact remains they failed to do so and we, especially those of us in the north, are left to pay the price.

Given my concerns regarding the need to take positive and constructive steps to enhance access to health care, especially in northern Ontario, and the need to continue to build upon the solid foundation of health care that the present government inherited, I am afraid I cannot support this legislation. The development and the introduction of this bill have been mishandled and mismanaged from the beginning. This confrontational approach has proved to be and will continue to be more detrimental to the maintenance of our health care system than the legislation itself.

The penalty of $10,000 for extra billing is obscene. Doctors are not criminals, but this government is determined to make them into criminals. With this bill, the public has no choice, the patient has no choice and the doctor has no choice. The government wants to deprofessionalize doctors, to make them state employees.

We saw the health care system crumble when Britain made doctors state workers. Unions in Britain today are insisting that private care be part of their new contracts. The public system is just not good enough. Throughout Europe, where socialized medicine is the rule, strikes and under-the-table cash payments are commonplace.

In conclusion, I want to go back a few years. Some members may remember when the Attorney General in 1966 came into this Legislature and introduced a piece of legislation known as Bill 99. It gave sweeping powers to the police of this province. It gave them the right to search without a search warrant. There was a storm that blew. It started that very day.

The member from just east of here, the former Attorney General of this province who became the Solicitor General in the Clark government, the Honourable Allan Lawrence, took up the cause within our caucus. The opposition reared on to its hind legs and brought to the attention of this Legislature just how bad a piece of legislation it was. Attorney General Fred Cass recognized it was a bad piece of legislation and he said so publicly. The Premier of the day, the Honourable John Robarts, reflected on that legislation over a weekend and, for those of us who were here on that Monday afternoon when he returned, there was chaos in this Legislature because of Bill 99.

The Premier of the day did the right thing. After hearing the members of the opposition speak, he stood up and withdrew section 14 of Bill 99. He went on to say: "I personally would not tolerate any legislation which infringes upon or jeopardizes the basic, fundamental, personal rights and freedoms of the individuals of this province."

8:10 p.m.

The Premier of the day had the guts, the courage and backbone -- and behind it was the protection of the freedoms of the individuals of this province -- to withdraw that section. He withdrew the section and, we will all remember quite vividly, later that day he accepted the resignation of the Attorney General, the Honourable Fred Cass, who tendered his resignation because he had brought in such a terrible piece of legislation.

As to the legislation we are bringing in today, I am appealing to the Premier of this province to stand in his place, to reflect and to join with us in saying to the people of Ontario that this is bad legislation and should be withdrawn. He should withdraw the legislation immediately and the Minister of Health (Mr. Elston) will then do the right thing and tender his resignation.

I conclude my remarks by pointing out again that I cannot lend my support to this legislation.

Ms. Bryden: I welcome this bill and I am very pleased to participate in the debate on it because I think it is one of the most important bills that has come before this Legislature.

The bill is, in effect, putting the Ontario health insurance plan back on the rails after the former Progressive Conservative government, by permitting extra billing, let doctors erode accessibility, which is an integral part of our national medicare scheme. The 1966 federal bill that wrote the basic criteria for medicare in Canada included the term "reasonable access without financial barriers."

Another reason I am proud to speak on this bill is that the New Democratic Party can claim to be the innovators of universal publicly operated medicare in Canada. The first public hospital insurance plan was established in Saskatchewan in 1947. I was a civil servant in Saskatchewan at that time and shared in the work of organizing the information meetings around the province that preceded the introduction of the bill, an indication that we believed in consultation at that time as well. In 1962, Saskatchewan pioneered again in introducing the first provincial medicare plan.

The concept of medicare that was embodied in those bills was a sharing of risk, a protection against crippling hospital and medical bills. The criteria included universal coverage; a public, nonprofit comprehensive plan; portability and one-price medicare. These principles were written into the federal legislation when the federal government came in on a cost-sharing basis in 1966.

In Ontario, the NDP at its 1970 convention opposed extra billing; the Progressive Conservatives allowed it to grow and to continue to expand until very recently, so that it now has reached as high as 20 per cent of the bills. In addition, the Progressive Conservatives allowed the provincial taxpayers to lose more than $50 million a year from federal grants since the Canada Health Act, which was passed in April 1984, disallowed extra billing or required a penalty if a province allowed extra billing. In effect, it also allowed the sick to pay an equivalent $50 million more to the doctors in extra bills. It also allowed Ontario residents to pay the highest medicare premiums in Canada: almost $60 a month. The residents of Ontario expect full medicare for those fees, $714 per family per year.

The present leader of the Progressive Conservative opposition, the member for St. Andrew-St. Patrick (Mr. Grossman), said extra billing was not a problem; he said only the wealthy paid. That was in 1983.

The Liberals are late converts to the principle that there should be no extra billing. In a radio interview in 1983, the member for London Centre (Mr. Peterson), now the Premier, said, "We have not come out against extra billing at the present time." But in September 1984, he saw that extra billing was causing hardship and that a majority of the population was very much opposed to it, so he changed his position. I congratulate him on changing his position and admitting it was a change of position.

As a result of both the New Democrats and the Liberals opposing extra billing during the election campaign, the abolition of extra billing became part of the accord signed by the NDP and the Liberals before the change of government. In effect, it facilitated the change of government.

I am very glad the Liberals have implemented that part of the accord and that we have this bill before us. Canada's medicare program is far ahead of the partial medicare programs in the United States. According to an article in the Toronto Star of January 16, American residents pay 10.4 per cent of their gross national product for health care but only a small percentage are covered by publicly assisted medicare. Only the aged and the disabled are covered by public programs there.

I am shocked by the actions proposed by the Ontario Medical Association to oppose this bill. These proposals at its weekend meeting amount to petty harassment of the sick in order to make the point that they think the bill should be stopped. We might call this taxation without representation. In Timmins, they are planning to charge an extra dollar for the hospital fund. In other places, according to the press reports, they are going to charge 25 cents on bills or they are going to charge for authorizing the refilling of prescriptions over the phone or for signing documents -- all kinds of petty harassment.

I think the public should refuse to pay these charges until it is established whether or not they are allowed under the Ontario health insurance plan regulations. If they are allowed under the present regulations, they should be prohibited under the new act. In effect, they are nickel-and-diming extra billing.

The doctors assert they have a right to set their fees unilaterally, that other professions do this and why should they not do it as well. The article of January 16 in the Toronto Star made a very good point. In the field of health care there is not a free market. Health care is not a commodity we can shop for to find out where we can get the best deal.

The article quotes from Dr. Arnold Relman, editor of the New England Journal of Medicine and a professor of medicine at Harvard Medical School. He says, "A free market won't work in health care because a free market assumes the consumer is able to discipline the suppliers by making discriminating judgements on what he needs. But the consumer in health care has to depend on the system, on the supplier, which in health care is the doctor, for information on what he needs."

8:20 p.m.

So the argument that they have the right to charge what they like in a free market does not apply to medicare. They should also recognize that they have a monopolistic position created by the state. Hospitals and the services in those hospitals are provided to them by the state. Their education is subsidized by the state. As a result, they have an obligation to the residents to supply the kind of medical services the residents decide they want through the legislative process. However, the doctors are saying: "This is a law we do not like and we will oppose it. We will even" -- presumably, according to the newspaper report -- "engage in civil disobedience because we think it is a bad law."

Civil disobedience is something that should be considered very carefully by a citizen in any situation. Generally, it is justified only if one can state that legislation is arbitrary and is passed without due process or without sufficient debate. We are having considerable debate in this House on this bill. Citizens may perhaps engage in civil disobedience if they think legislation denies natural justice. However, we have had medicare for the last 25 years and nobody seems to have really suffered a loss of natural justice. There have been no cases in the courts on that basis.

The other argument the Ontario Medical Association is putting up is that its views should prevail over the wishes of 83 per cent of the population, who told a Gallup poll in 1984 that they opposed extra billing. What it boils down to is that the OMA is putting forth the question that was put forth in 1962 in Saskatchewan by the then Premier, Woodrow LLoyd, who said the issue is "whether the people of Saskatchewan shall be governed by a democratically elected Legislature or a small, highly organized group." That is the crux of this debate.

I do not oppose increases on a regular basis for the medical profession. However, they should be arrived at not by the blackmail method of saying, "We have decided that you shall pay so much," but through negotiations with the representatives of the government, who have been entrusted with operating the scheme in the interests of all the people of the province. Suitable arrangements can be worked out for increases that take into account increases in costs. This has been done over the years in most provinces and in other jurisdictions that have medicare.

We can also make more money available for good health care if we improve the efficiency of the delivery of health care. This means we do not rely entirely on the fee-for-service basis but develop community-based clinics and centres where health care can be delivered by teams of doctors, perhaps by teams working on salary or a combination of doctors working on salary and doctors working on a fee-for-service basis. We should be looking at these methods of improving the efficiency of health care instead of looking solely at whether doctors should be allowed to charge what they please in the situation.

Basically, we cannot afford a two-price system for medicare, because it means discrimination in the delivery of services. It means those who are willing to pay the higher fees that doctors may wish to bill them will get preferred service, preferred time and preferred entry to hospitals. There will not just be a two-price system of medicare, but there will be a two-class system. This is what the original system was intended to end. There should be equal service and equal access to service.

I am very proud the New Democratic Party and Liberal accord made this issue a priority for the first session of the Legislature after the change of government. I hope that after sufficient and due debate, it will be passed and put into effect as soon as possible and that we will restore accessibility to our medicare system by this legislation.

Mr. Lane: I appreciate the opportunity to say a few words on this bill. When the minister introduced Bill 94 in this House on December 19, 1985, the gist of his remarks was that people were being denied access to medical care because of extra billing.

To suggest that extra billing presents a serious threat to our public health care system in this province is a gross distortion of reality. The fact is that only 12 per cent of some 17,000 doctors in Ontario extra bill, which means 88 per cent do not.

How can this government pretend to have a conscience when in one arbitrary blow it singles out our doctors and holds them to blame for all the current problems of access in the system? Is not the problem with access to the facilities rather than access to doctors and the fact that demand for health care is growing much faster than current resources can accommodate? Why have the doctors, who of all professionals we depend on the most and expect the most from, been singled out for this abuse?

Is it not true that they are easy scapegoats for the real problems and challenges that face us in maintaining and enhancing the health care system in this province to meet the demands of the future, the burden of which is already upon us? Is not the government's real motive to net the $50 million per year the federal government has been withholding because of extra billing?

It seems to me we should be looking at the real issues and, in an honest spirit of co-operation that includes our doctors, work out a solution together that is in the best interests of everyone, especially the citizens of this province who need and depend on the best possible care, and more, that our physicians can provide.

When we discourage and punish our doctors, it is the patients who really suffer in the long run, because in addition to his or her knowledge and skill, it is the doctor's ability and time to care that fulfils a powerful part of the coping, treatment and healing process.

Also, what about fairness? Surely what is fair for dentists, lawyers, engineers, teachers and other professionals and business people is fair for doctors also. They should be able to charge for their services according to their individual levels of skill and experience.

Our future in health care depends on pushing past all these obstacles to pioneer new knowledge and treatments. Surely such commitment to respond to and overcome challenge, and to the pursuit of excellence should have rewards beyond just the mental and emotional satisfaction of problem-solving and a job well done.

Who would get inspired by across-the-board fees set by the state? Surely the last thing we want in Ontario is an assembly-line style of medicine, when a doctor's main incentive becomes how many people he can process in a certain number of hours. Examples of what has happened to the quality of health care in other countries such as Britain show the sad results of submitting to that style of medicine. That would be the beginning of the end of our own high standards previously set in place.

Who in a free society wants or will accept being dictated to? Certainly I do not and I cannot imagine any doctor worth his or her salt would either. The atmosphere of freedom of personal choice is a fertile and productive one. However, doing one's job in an atmosphere of no options is deadly. Incentive withers on the vine. If a person is smart, he or she will leave and go to another environment that makes him happy in his work. What is more, in the process of preparing Bill 94, the current government made it clear from the start that the subject of extra billing itself was never up for negotiation or discussion; the discussion was on how to proceed to ban it.

8:30 p.m.

My main concern in these remarks today is that we do not mortgage the quality of the future health care system in this province for short-term, poorly thought-out, superficial gains. The people of this province enjoy the best health care system in the world. Why try to fix something that is not broken? We should be moving forward, building on our achievements towards the 21st century instead.

It is my guess that if Bill 94 is passed as currently written, untold havoc will have been created, with the result that we will no longer have the best health care system in the world. Our doctors will have been insulted to the point of having lost their professional freedom, and many will see no point in continuing to have a personal interest in their patients. They will see their work as treating a disease, not a person, so the patient will suffer greatly.

When all is said and done, the health care system in this province will cost more and produce less. It seems to me the best minds in Ontario can work together to do much better than that.

Mr. Philip: I want to start speaking about this in a very personal way. I want to talk about a constituent in my riding. She is a young widow who is taking care of her retarded, adult son. She confided in me last year that she did not have the money to pay for repairing her furnace.

She is a personal friend of my wife's and myself. When I started to question her, she admitted she had spent more than $2,000 in medical fees to several doctors that year for a series of operations on her son's eyes and other problems he had had. When I asked her why she had not come to me and told her she and I together could have gone to each of those doctors, she said, "I do not want to ask for welfare."

That is the issue. This woman, who fought so hard to keep her son out of an institution, who personally took care of him and is doing so now, did not want to suffer the indignity of begging for what she considered welfare.

I can tell another story that is very personal to me because it concerns my brother. He was born in a hospital in 1944. During the war years, he unfortunately underwent what perhaps might now be seen as medical malpractice or certainly malpractice by that hospital. In any case, his oesophagus was shrivelled up by giving him some overheated milk that not only burnt his mouth but also his oesophagus. It shrivelled it up.

My father had been a successful businessman during the 1930s, but unfortunately, like so many successful businessmen, he had the same problem those years brought others. By the time my brother was born -- indeed by the time I was born -- he was operating a very small business and working long hours to make ends meet.

I can recall he had spent some $3,000 at that time in hospital and doctors' fees. A social worker at the hospital, or some other authority figure, said to him: "You are just a working man. I can see that by your clothes. Is there not something I can do? Why are you paying all this? Other people are buying homes while you are paying out large amounts in medical bills." He said: "I will not take charity. I made my way through the 1930s. I was not on the dole. I will not take charity."

It is fine for other members and me to say that those who are in need can go into institutions and plead they do not have the money. It is fine for us in our $200 suits and with our fairly reasonable wages to say, "If I were in those peoples' shoes I would plead for my family." However, to many people, particularly those brought up through the 1930s, this is a major admission of failure. It is something that is deep within them and it is very difficult to do.

What is at the bottom of this is not the specific amount the doctors are overbilling. What is at the bottom of this bill is that it gives those people back their dignity so they no longer have to go and plead, bargain and bare their financial souls to a doctor who really has no business examining their wallets.

I am proud my party and its predecessor, the Co-operative Commonwealth Federation, have pioneered progressive medical care programs in this country. When I go to the United States with various parliamentary delegations and talk to some of the US congressmen and senators, they talk about Saskatchewan and the medicare program developed in Canada.

In 1960, when the Saskatchewan CCF promised to introduce a province-wide medicare program, the very same arguments were made against that program by the medical association, by the Liberal official opposition and by the chamber of commerce that the Conservative Party is making here today and has been making against this bill.

I have vivid memories of the battle. I was only a freshman in college at the time. I can recall the great threats that were reported in the media and the strike that followed. Invariably, the Liberals, who were in opposition, blamed the CCF government for deteriorating medical care in the province. "Our doctors will leave," they said. The doctors have not left.

The essence of that legislation was brought out by Tommy Douglas, Premier of Saskatchewan at the time. In a speech he gave, he said, "This means imposing a means test that you are asking for." The opposition Liberals were asking at the time that there be only partial coverage.

"This means imposing a means test. This means probing into people's affairs, and this is a pretty serious thing to do.

"The time has surely passed when people should have to depend on proving need in order to get services that should be an inalienable right to every citizen of a good society.

"It is very well for some people to say that there is no stigma or humiliation connected with having to prove need. This has always been said of people who know that they are in no danger of ever having to prove their need.

"I am very glad that the committee recommended and the government decided that there will be no such stigma and that there will be no means test."

We are essentially dealing with the same issue today -- the dignity of the patient. Douglas went on to say:

"This government believes that health is too important to be left to the chance that the average family will have the necessary money to buy health services.

"I believe that if we put this health plan into operation, it will have the same history as the hospital insurance plan, and I am convinced that inside of two or three years both the doctors who provide the service and the people who receive the service will be so completely satisfied that no government will dare to take it away."

8:40 p.m.

He proved prophetic in saying that the doctors would learn to live with it. To give members some idea of exactly how tense situations were at that time, I refer members to an interesting article that was contained in Weekend Magazine of July 15, 1978, about a doctor who, because of his sense of professionalism, opposed the doctors' strike in Saskatchewan and opposed the kind of rhetoric that the opposition, the chamber of commerce, the insurance companies and the medical association made. This was the kind of abuse he suffered at that time:

"Looking back, his wife Mildred can see the funny side of the war, the absurdity of adult doctors flinging signs at each other over the heads of their patients, but Hjertaas" -- and that is the doctor's name -- "still goes visibly upset when he talks about the long hot summer of 1962. It was a hectic and soul-searching experience. The boys" -- talking about his partners -- "were not speaking to me except to scream at me. People were offering to beat me up but it was hardest on the family. The kids were attacked at school and called communists. Every town had huge, keep-our-doctors committees whipping up the emotions of the people, organizations organizing cavalcades to Regina. Lawyers, bankers, shopkeepers all belonged. Their kids took it out on our kids and the damned telephone never stopped ringing with threatening calls."

If one went back to Prince Albert where this doctor had the harassment, even three years later, one would see that was forgotten. The doctors have given up that kind of fight. Those who were opposed and those who, for professional reasons, felt they wanted to go along with the government are part of the community and are delivering the same service.

The position of the Ontario Conservative Party and of the Ontario Medical Association is that those individuals who can afford to pay the extra bills should pay, and if they cannot afford to pay, the solution is to go to the doctor and bare their financial woes. In the New Democratic Party, we believe the professional relationship of a doctor and patient should not be interfered with and should not be in a banker-like capacity.

The arguments being made that by allowing the extra billing we are somehow improving medical care in this province is the most absurd argument I have ever heard. Fifty million dollars a year is being lost in federal subsidies because the previous Conservative government refused to have the guts to bring in this kind of legislation. Fifty million dollars is being paid in extra billing, $100 million taken from the taxpayers of Ontario that could have been spent in other ways to improve the medical care system.

The issue of the service of the hospital beds that I talked about last week and our concern with the lineups at the Etobicoke General Hospital and the number of people occupying active treatment beds when they should be in other institutions or assisted in other ways is not going to be removed by allowing doctors to charge extra. That argument is absolutely absurd.

In Ontario, we find many hospitals and many cities where 100 per cent of the anaesthetists are opted out. Mr. Speaker, if you were a working person, a senior citizen and you had an accident, would you lie on that stretcher and negotiate with the anaesthetist about whether he was opted in or whether he was going to extra bill?

I suggest there is no freedom. If one wants to go to a certain hospital in certain cities in the province to have an operation, there is no alternative but to deal with the anaesthetist who is extra billing. Thirty-six per cent of the ophthalmologists are opted out, 28 per cent of the gynaecologists and 25 per cent of the urologists.

The agreement signed by OHIP and the OMA with the former Minister of Health provided for an average take-home salary of $120,000 per year for doctors. I do not think they are terribly underpaid. To argue that to be more professional they deserve to charge on top of that is a most absurd situation.

My wife is a teacher in a college. If she and her colleagues negotiate a salary, a fee with the government, as indeed they do, they do not then have the right to say, "I am a superior teacher and therefore every student who comes into my room must pay an extra $2 a day to hear my lectures and participate in my classes." No other profession that negotiates with the government like that has that right. To argue that somehow the doctors should have that special treatment is absolute nonsense.

The Ontario Medical Association and the Conservatives argue that somehow we have to have free-enterprise medicine, and that it makes it better. Where is the free enterprise when the taxpayers pay the universities to train the doctors? Where is the free enterprise when those doctors, as well they should, come before members of the Legislature and say: "Our hospital beds are overcrowded. We need extra facilities to carry on our professional practice." Where is the free enterprise that builds those hospitals? Where is the free enterprise that collects their fees?

We can talk about free enterprise, but we do not have a free-enterprise system. Indeed, the doctors themselves would not want to operate in that kind of free-enterprise environment. They seem to want free enterprise only when it comes to their personal pocketbooks.

The argument is similarly made that somehow there is no system of rewarding doctors who are more competent and creative and expert, other than by allowing them to extra bill. By the Conservative's own admission, 88 per cent of the doctors do not extra bill. If we believe the argument that extra billing allows for the rewarding of more competent and expert doctors, then I suppose it means that the 88 per cent who do not extra bill must be less competent, less worthy of some kind of reward and less professional than those who extra bill.

Anyone who knows anything about the medical profession and who has worked with doctors in a professional capacity knows this is simply nonsense. One of the best authorities in plastic surgery in this province, indeed in the world, is an opted-in, no-extra-billing, doctor. She considers it would be unprofessional to extra bill. She is the president of the professional association.

To suggest there is no other way of rewarding competence, of rewarding extra studies and so forth, shows a certain lack of creativity by those who advocate that point of view. The minister himself went to the Ontario Medical Association with a series of proposals and said, "Let us look at ways we might be able to build into the fee system some reward for extra studies, extra professional progress and so forth." To my knowledge, the OMA refused to deal with that.

If we look at any of the other professions, there are ways of building in motivation and extra professionalism. It does not have to do necessarily with salary. If we look at any of the motivational studies and at the psychologists who deal in motivation, one finds that money is not always -- in fact, if one looks at Maslow's hierarchy of needs, it is not a prime motivating factor once one reaches a certain level of psychological needs.

To argue that somehow a doctor who is allowed to extra bill and who extra bills is more competent and more dedicated than those who do not makes absolutely no sense because there is no research to prove it. On the contrary, if one looks at key management studies that have been done in the United States, Canada and Britain, there is every evidence to the contrary that would negate it.

8:50 p.m.

I find interesting a letter written to Orland French of the Globe and Mail by a doctor.

"The issue of accessibility is nonsense. As far as our practice goes, I can assure you that any patient who has any financial difficulty with our fees is charged only the OHIP fee." Doctors who have long argued for their role as professionals want to detract from that by also playing bankers. I find that absurd. I find that completely unprofessional.

As someone who has worked and run seminars and professional workshops with people in various helping fields, when we get people from all disciplines together and ask, "What is it to be a professional?" on no occasion has any of them mentioned money. They mention dedication, self-motivation, the ability to make decisions, but they do not mention financial decisions. They mention the relationship between the client or clients, in the case of groups with which they may be working, and themselves.

We are faced with this bill, which says to the senior citizens at West Acres, Robert J. Smith Apartments, and Highway Terraces in my riding: "You are not going to have to go to your doctor and say, `I am on the guaranteed annual income system. I do not have a lot of money. I cannot afford to pay the extra amount.'" This bill says to those seniors: "You have worked hard all your life. You deserve some dignity. You will go to the doctor when you see fit, when you and the doctor decide it is appropriate, and the question of money will not enter into the interpersonal relationship that comes from being a professional and working with a professional." That is the issue. It is one of dignity.

Some of the seniors in my riding might be able to go without the luxury of some extra ice cream on the weekend or a bottle of wine with a meal once every second week to pay that extra fee to the doctor, but why should they? Why should a professional who is earning at the height of the financial ladder of any of the professions expect that? Why should the people who have worked hard to put these people through school have to do that? That is the issue.

I am sorry the Conservative members of this Legislature are no more enlightened today than the official opposition was in Saskatchewan when it made the same arguments.

Mr. Jackson: If they don't drink the wine, they don't need the doctor.

Mr. Philip: That is the kind of triviality and stupidity one would expect from one of the Conservative members: "If they do not drink, they do not have to go to the doctor." I happen to think some of the seniors in my riding have a right to a drink if they so choose. A few luxuries in life are their right. I am sorry the members are so insensitive to those simple pleasures they may have that, in their $300 suits, they do not want to consider that may be important to them.

Mr. Jackson: The member said before they were $200 suits.

Mr. Philip: In their $200 suits, then.

Mr. Eves: Nobody is talking about taking anything away from them.

Mr. Philip: The member is talking about taking away their dignity. That is what the issue is all about. The issue is dignity, the dignity of that widow I talked about earlier who did not want to go to her doctor and plead she did not have the money and therefore she paid the extra $2,000. The issue is the same dignity my father had in 1944 when he paid all those medical bills even though he could not afford it. The issue is the senior in my riding who said, "I know if I write to the doctor he will forgive me, but then I will be embarrassed when I go back to see him again and I will probably want to choose another doctor." That is what this issue is all about.

I ask that we deal with it. I ask that we pass this. I am proud to support this legislation. My constituents support this legislation, and in a few years we will see that what this bill provides will be taken for granted in the same way as the innovations introduced by T. C. Douglas and his government are now taken for granted and accepted in Saskatchewan.

Mr. Barlow: It is really with somewhat dubious honour that I rise to speak on this bill with regard to the banning of extra billing in our health care system --

Mr. Haggerty: The member should tell us how he is going to vote.

Mr. Barlow: I will get to that; I am just starting. Let me get warmed up here.

-- because it would appear that the public is generally in favour of not allowing doctors to bill beyond the regular Ontario health insurance plan fees.

Most people are very interested in any legislation that would affect their own personal pocketbooks, and certainly extra billing by some doctors -- and I emphasize "some doctors"; the figures have been used several times before, and I am going to reiterate them -- does hit the pocketbooks of some of the people of this province.

However, as we have heard time and time again -- and will be hearing again, I am sure, before this debate concludes -- only about 12 per cent of the doctors in the province are opted out of OHIP, and of that number I understand fewer than 50 per cent actually charge more than the OHIP fees.

I would like to remind the members on the opposite side -- and their little red rump to the left of us here -- that while they are sitting around congratulating each other for responding to what they believe is a public perception of doctors being unnecessarily rich and comfortable, many people are inclined to jump on a bandwagon for a short-term gain, which this legislation appears to have, without really analysing the long-term losses or the long-term pain.

The short-term gain in this instance will undoubtedly be that one will be able to go to the doctor of one's choice without having to pay any additional fees and one will not have to answer questions about whether one can afford medical attention if and when one decides to seek it.

The long-term pain, I am afraid, will be that all taxpayers will ultimately have to pay the price for the additional fees that doctors will undoubtedly try to negotiate in their new contracts with OHIP. They are going to have to negotiate and the bill allows for this negotiation. They are going to have to receive the extra funds that will be required to compensate the doctors who are older and have more years of experience, and that is going to fall on the heads of all taxpayers, rich or poor. We are all going to have to kick in to help that system along.

There will be even harder pain to bear if the government proceeds with the legislation currently before this assembly, in that it could send many of our specialists to other jurisdictions where they can determine their own destiny and where their right to govern themselves as a profession is respected. I am referring particularly to those who wish to head south of the border. We have heard stories of many doctors who have already gone to the United States, where they can practise and can charge what they feel their services are worth and where they are not dictated to by the government of the day.

9 p.m.

Who will replace these specialists if this should happen, if there is an exodus due to the imposition of this legislation? Who will be willing to dedicate the many hours of effort to becoming world-class in his chosen field only to be told by a government that he cannot charge what he feels is a fair fee in exchange for his expertise and his services?

Medicare was established in Ontario 18 years ago. At that time, the doctors of this province agreed to the plan because they were assured they could retain the right to opt out of the plan if they chose to. As I understand it, medicare was designed to ensure that everyone could afford adequate health care. I believe the system as it currently exists accomplishes that goal. The Liberals supported that.

Let me quote what my friend the member for Windsor-Riverside (Mr. D. S. Cooke) said the other night. "Until very recently, the position of the Premier, formerly the Leader of the Opposition, was that extra billing was a necessity, that it was a release valve or safety valve for the medical profession. It was only leading up to the last election that the Premier changed his mind."

The Liberals were on the other side of the fence at one time, as they have been on most issues that have come before this House. Now, of course, they are on the side of their chosen friends, their bed partners on our left.

Mr. Wildman: They have seen the light.

Mr. Barlow: Is that right? They have seen the light?

Mr. Villeneuve: Candlelight.

Mr. Barlow: Candlelight; that is right.

A questionnaire was circulated in my December newsletter. The results are still coming in on the question, "Is Ontario's existing health care system meeting your needs?" The good people of Cambridge said yes to this question in greater numbers than the provincial average.

Of the people who responded to my questionnaire, 88 per cent feel the present health care system is meeting their needs. Of the nine per cent who responded in the negative, many mentioned that such people as naturopaths, dentists, paramedics and so forth should be part of the system. That was where they had a problem. Of those who responded with a little note to that question, not one mentioned the problem of extra billing.

Another question on the health system asked that very question. "Should the province's doctors be allowed to bill beyond the OHIP schedule of fees?" To that, 69 per cent said no, they should not. That is not consistent with the provincial average. The provincial average seems to be higher than that.

As I said earlier, nobody wants to pay money out of his pocketbook if he can avoid it. They are going to look at the situation and say they want to save money if they possibly can. However, 88 per cent say the present system meets their needs, 26 per cent are not particularly concerned about paying beyond what the OHIP fees are, and 69 per cent would like to see extra billing prohibited.

From my own experience with specialists who have opted out of the OHIP system and charge extra fees, only once, and thank God for this, did I have to go to the extent of having to seek out a specialist who would be able to perform the service. Three years ago, when our daughter was 23, she had a bout with cancer. She had surgery in Cambridge. Fortunately, the surgeon was in the OHIP system.

Two weeks later we came down for the second operation to the Toronto General Hospital and had a consultation with the doctor. He did not know who I was from a hole in the ground. We sat down and had a consultation with him. He said, "My charges are not in the OHIP system. You are going to have to pay extra for this service." He gave us an approximate figure, but he said, "We will have to wait to determine this when it is completed."

Fortunately, I had no problem there, but I know the very same question would have been asked of anyone else who had sat in consultation with him. From talking to that doctor, whom I did not know prior to this, I know that if I had said, "Doctor, this is beyond my means; our daughter is sick and she has to have this operation, but it is beyond my means and I cannot afford it," he would have charged the OHIP fee. I know from talking to him, and he told us after, that he has performed many of his operations under the exact cost that OHIP would have paid.

This is the one and only experience I have had. I have talked to many people and many friends of mine in Cambridge and the same situation applies. I know that if they can afford to pay the physician the amount of money he is asking, they are going to pay it.

For people of lesser means, I do not know what is wrong with a means test. If one wants to call it a means test, call it a means test, but if they are going to perform the service at a cost that people can afford, then there is going to have to be a means test. Maybe that is the answer. I am not suggesting it at this time; it is not part of the debate. But I cannot see why we keep throwing it up here. That is a means test. So what? If it means getting people the proper medication and the proper services they require, so be it.

Mr. Wildman: Do you have a means test for the Canada pension or a means test for the old age pension?

Mr. Barlow: What is wrong with that?

Mr. Wildman: Is the honourable member threatening us with Mulroney?

Mr. Barlow: He and I have not talked about this yet.

Our newspapers are full of human-interest stories about people from all over Ontario or, for that matter, from all over the world, who are treated by our world-renowned specialists here in Ontario with the doctor agreeing to waive his usual fee and perform the service for what the people can afford, or, to use a business phrase, what the market will bear.

Mr. Wildman: That is right. Right on. He is right there.

Mr. Barlow: We have in place in Ontario a health care system of which we can be extremely proud. I fear the changes being proposed by the minister at the present time, with the support of -- again, I will use the phrase -- his little red rump. This system is in place, it is excellent, and we should not be tinkering with it. The physicians I know and the physicians to whom I have talked on this matter, some of whom are in and some of whom are out of the OHIP system, are concerned about one thing, and that is patient care. They do not want to take sanctions that could affect patient care.

I use Cambridge as an example of what I mean when I mention tinkering with the system we have in place. It is a good system. Let us not tinker with it. If we are going to spend money, and undoubtedly this whole system is going to cost us more money, let us put it back into the total health care system. This is an example of where money could be spent instead of tinkering around with what we are doing now.

Last week in Cambridge there were three elective surgeries that had to be cancelled because there were no beds available and there was not time available for the services to be performed. These are people who had psyched themselves up to have a certain operation performed at a given time, had made arrangements with their families at home and so forth, and these surgeries had to be cancelled. These are the things on which we should be spending money.

9:10 p.m.

I also know that in Cambridge, and I am sure this is true all over Ontario, because there are not the facilities available in many of the hospitals, referrals are being made to other hospitals, to the university hospitals. From Cambridge Memorial Hospital, patients are being referred to McMaster, to London, to Toronto, to all the university hospitals where the facilities are available. In many cases, they are not available in a hospital such as Cambridge. They do an excellent job, we have an excellent group of physicians in our town, but they can go only so far with the money that is available to allow the hospital to buy the necessary equipment to keep up with the times.

The doctors here are not opposing extra billing as much as they are the whole system. They want to maintain their right to be in the system or out of the system. They want to be treated as individuals, not as a total medical system or as a bunch of bureaucrats who are working for the government or for the state. They want to be treated as individuals who have the opportunity to bill for the services they perform, the services for which they are trained.

I feel this legislation will prevent many doctors who are highly skilled and more experienced in their profession from receiving due recognition. If this is not so, then the government must have another scheme in mind. I fear the Liberal government is about to enter into a very complicated multilevel fee system that could create a bureaucratic nightmare far beyond our wildest dreams. I fear a number of our best doctors will not appreciate being known as civil servants and will leave the province, hurting the quality of care that a family doctor is able to provide.

I have a very short letter from an individual that I would like to read. It is dated December 8 and it arrived in my office four days later. It came by Canada Post. The letter is from a Mr. Peter Worden of Cambridge. He says:

"Dear Mr. Barlow:

"I fully agree with the Association of Independent Physicians of Ontario in the request that there be a full public inquiry into health care in Ontario before any new legislation regarding extra billing is passed. I do not want my choice of physicians limited or my doctor to become a mere civil servant."

That is the extent of the letter sent by an individual in my riding who has a real concern for the health care system in our province.

Mr. Philip: How about the footnote? It says, "In case of medical emergency, see my son."

Mr. Barlow: Is that right? I did not notice that.

I have another letter here that was sent to me the other day because of the introduction of the bill. This is from an opted-out family physician in Cambridge. It is a rather lengthy letter, but I want to read a couple of paragraphs from it because what this physician says about the system is important.

"The entire opting-out issue is a sham set up for political purposes." I would not have used those words, but this physician chose to call it a sham. Perhaps I would have used those words; it is a sham.

"There are many other aspects of the health care scheme that represent a significant impediment to public accessibility such as increasingly longer waiting periods for elective surgery, a crisis in hospital funding and a shortage of facilities available for our ageing population. The proposed legislation will deprofessionalize the medical profession. It will force severe and bitter confrontations with the government at contract time.

"Recent provincial history contains many examples of this growing problem. The public that you and I both serve will not benefit from the possible outcome of the inevitable and continuing struggle that must ensue."

That really sums up the feelings of many members of the medical profession as they listen to our debate on this particularly important subject.

As a member of the opposition, I see it as our fundamental responsibility to ensure that the government addresses this issue fairly and squarely and attacks the real issue here. The issue, I repeat, is the health care system, not the issue of opting out, extra billing or whatever term one wants to attach to it.

As one very wise man recently said, "The biggest health need in Ontario today," and consequently the biggest responsibility of the government when dealing with the health care system and any changes to it, "is to protect the health care system from big government."

On that note, I would like to conclude my remarks on this legislation, hoping against all hope that this measure to ban all extra billing and to treat all doctors alike, regardless of whether they have performed 10,000 procedures or they are fresh out of medical school and have just completed their residency, will not create a society of patients who wander from doctor to doctor for trivial problems, having the same tests done again and again because they like the attention it affords them or because they want time off work or they are never convinced that what the doctor is telling them is correct.

People want to have faith in their doctors. Any one of us here, I am sure, would rather sit down and talk to his doctor, listen to him and discuss his problems with him than he would with almost anybody else, least of all our fellow politicians.

The proposed legislation seems to be based on the mistaken thought that everybody is equal in sensibility, that all doctors are equal in skill and that the Health Care Accessibility Act will miraculously correct any accessibility problems we might have in our health care system. None of these assumptions is correct.

I was asked earlier where I stood on this matter. Unless I can be convinced otherwise, at the present time and with the information I have, I cannot support this bill. It is not in a form that is going to be of benefit to all Ontarians.

9:20 p.m.

Mr. Wildman: I listened very carefully to my friend the member for Cambridge (Mr. Barlow), who I think spoke with great sincerity and expressed his point of view in defence of free-enterprise medicine, in defence of a medical system that I think he said should be allowed to charge what the market will bear and in defence of a system that he thinks is operating well and does not experience any problems.

I want to make clear at the outset that the member seems to have confused two issues. He seems to think that opting out and extra billing are one and the same, and it is important for us in this debate to recognize that they are two different things. They are related, perhaps, but they are two different things, and the legislation that is before the Legislature deals with one, not with both. This legislation would deal with extra billing. It would prohibit extra billing, but it does not prohibit opting out.

I am participating in this debate because I am very proud of the medicare system we have developed in this country and in this province. As a New Democrat, I am very proud of the role our political party played in developing the medicare system in this country.

Some people in this debate have harked back to the fact that when the fight was won in Saskatchewan and when the federal government subsequently moved to expand medicare across the country, the then Conservative Premier of Ontario reacted against it and called it a machiavellian plot. I think the attitude expressed in this debate by the Conservative members harks back to that view of medicare, the view that somehow by having a public medicare system at all, we are interfering in the free market and with the freedom of medical practitioners to operate as they would and charge what they would.

I am glad we do not have that system in this country. I look at our neighbours to the south and realize that if someone in that great country is unfortunate enough to sustain a serious illness or has someone in his family contract a serious illness, he faces bankruptcy unless he carries substantial and expensive medical insurance. A significant part of the population cannot afford to carry that kind of medical coverage.

There is a system in that country that some in this House would like us to believe is preferred by many of the medical profession in this province. If that is the case, I regret it very much. I think we all -- medical practitioners and laymen in this country -- should be proud of the medical system we have developed in Canada, which saves our population from the horrendous costs that face some with serious illnesses in the United States.

I am steadfastly and profoundly opposed to extra billing. For that reason, I am prepared to support the legislation on second reading and to have the matter go forward to committee for amendment and discussion of improvements, so it meets the needs of all concerned in this province.

I am not opposed to extra billing only for some of the reasons that have been expounded during this debate. I am not in favour of this legislation only because it will help us as a province to recover the $50 million we lose every year as a result of the Canada Health Act, legislation that was supported by all three political parties in Parliament -- not just the Liberals and not just the New Democrats, but also the Conservative Party at the federal level. That legislation was supported by the now Prime Minister when he was the leader of the official opposition in Ottawa. That legislation has continued under the present Conservative government in Ottawa.

I wonder how the federal Minister of National Health and Welfare, the Honourable Jake Epp, will feel if he ever has the unfortunate opportunity to read the Hansard of this debate and to read the comments made by his Conservative colleagues in this Legislature. He must feel very embarrassed and unhappy that he has Conservative colleagues in this province who are attacking the medical system and the legislation that he is responsible for in this country.

I am in favour of this legislation because to oppose it, as my colleagues on the right do, would mean I am in favour of two-price medicine or perhaps more than two-price medicine. To be in favour of it would mean to favour a class system in medical coverage and medical care in Ontario.

I am not in favour of entrenching in legislation a system that says: "If you can afford to pay for it, you will get one type of coverage. If you cannot afford to pay for it, you will not get it, or you might get it if the medical practitioner is willing and prepared to forgo his fee if you can prove you cannot afford to pay it." That is not a system I want and I do not think it is a system most thinking people in this province would advocate.

It is interesting that my colleague, who was just speaking for the Conservative Party, pointed out that even in his riding, according in his own questionnaire, 69 per cent of the constituents who responded are opposed to extra billing, not only because they think it would be a way to save themselves some money, but also because they believe it is inequitable, unfair and inappropriate to have a system that says: "If you can afford to pay for it, you will get better coverage and care than someone who cannot afford it, unless that person is willing to throw himself or herself on to the charity of the medical practitioner involved."

I am also opposed to the concept of extra billing because of a minor incident that affected me personally three years ago. Those who have been members of this Legislature for a while will know that I had a rather serious accident a few years ago. The hockey sweaters that are being passed out this evening to certain members of the Legislature remind me vividly of that accident.

I was hospitalized and had a couple of serious operations on my leg as a result of that accident. I had an unfortunate experience with what might occur more and more if we do not eliminate extra billing in this province. The doctor was a very capable and understanding orthopaedic surgeon who gave me tremendous service. I was very pleased with the care I received in the hospital from the nursing staff and all the support staff as well as from the medical team that was involved.

I had a hip-to-toe cast on my leg and I was to have a second operation. My surgeon indicated that because he had come to the conclusion that he would have a hard time keeping me still and in one place --

Mr. Haggerty: The member's leg or his mouth?

Mr. Wildman: Perhaps my mouth; I do not know. He wanted to put a special, lightweight plastic cast on my leg after the operation that would make it easier for me to move around. I said it was fine with me. The date was set for the operation. It was to take place around 11:45 a.m. The orderly and nurses came in to prepare me for the operation. The nurse sedated me and the orderly broke the plaster cast I had on my leg.

As the medication took effect and I was drifting off, the head nurse came rushing into my room somewhere around 11:15 or 11:30. It is hard to remember as I was a little hazy. She said, "Mr. Wildman, have you been notified that the cast the doctor wants to apply is not covered by OHIP?" I said, "No, I have not been." She said, "We are supposed to notify you ahead of time so you can determine whether you want to proceed."

9:30 p.m.

As members can imagine, it was a little difficult for me to think clearly as the sedative took effect. I did not know what to do, so I said, "I suppose you should proceed." I asked her if she knew how much the cast would cost. She said no, she did not, but she would check.

I had a telephone beside my bed.

The Acting Speaker (Mr. Morin): It is all very hazy.

Mr. Wildman: It relates directly to the bill, Mr. Speaker. I had a telephone beside my bed and the Ontario government directory, because I had been doing case work in the hospital. I phoned OHIP in Kingston. I am afraid the person who was on the other end of the line thought I was drunk. I realize it was the sedative. I said I was calling because of a problem with extra billing for a cast and I wanted to know how much it would cost, who would be responsible, who was supposed to notify the patient and when.

This person said, "The man you should talk to is in a meeting." That happens to us as members on occasion. "Can he call you back?" I said, "No, I do not think he can call me back because I am afraid I will be asleep." She said, "Who are you calling on behalf of?" I said, "I am calling on behalf of myself and I am about to enter the operating room."

The upshot of the whole thing was that there had been a mixup. It is normally the responsibility of the surgeon to notify a patient in advance, obviously before he has been sedated, that the procedure is not covered by OHIP. It is normally his responsibility, but in Sault Ste. Marie, apparently, an approach has been worked out whereby the hospital is responsible for notifying the patient if he is in the hospital. Someone had not done what he was supposed to do and the head nurse suddenly realized I had not been notified, or thought I might not have been.

The upshot of the whole thing was that I had to pay. It was not a substantial amount, but I had to pay for this cast. It was a very good cast. It helped me and I am glad I recovered.

Mr. Haggerty: Did the member get a refund for it?

Mr. Wildman: OHIP covered part of it but not all of it.

I am trying to make two points. First, I wonder how often this happens because the staff are busy and hurried in a hospital. How often is it that a patient is not notified when he should be and finds that he ends up having to pay?

I would also like to know what would have happened if I had been someone who could not afford this extra charge. In this case, the hospital would have had to pay, because it was its responsibility to notify me and it did not. However, I suspect that normally another person would simply have had the plaster cast supplied and not the special plastic one.

The point is that this is in essence what I call a class system of medicine. I could afford to pay for this plastic cast, which was very good and helped me to recover. I could get it, but if I had been a person who could not afford it, I would not have got it.

That is what the people in this Legislature who are arguing against this bill are saying should be the kind of medicine we will have throughout the system -- not just with a minor charge for a cast but for major operations such as the one mentioned by the member for Cambridge. We are going to be setting up and entrenching a system wherein the physician will be put in the invidious position of having to decide whether he should charge an extra amount to this person and having to judge whether he believes this person can afford it. The patient is put in the humiliating position of having to beg and say: "I am sorry, Doctor. I need this but I cannot afford your charge. Will you forgo it in this case?" I do not think any of us wants to have that kind of system in Ontario.

Some of the arguments that have been raised against this legislation relate to who controls the health care system. Some doctors have been saying the politicians are imposing their will on the medical system in this province, that they are taking away from the professional responsibility of the medical practitioner, that somehow politicians are interfering in health care.

In my view, health care is everybody's business. It does not come only within the purview of the medical profession. Most, if not all, of the public services provided to the people of this province are everybody's business, not just that of the professional who is directly responsible for delivering the service.

Just as education is everybody's business, so is health care. We do not leave the education of our children solely to teachers and we should not leave the care of patients solely to physicians. Our medical system is paid for by the public and it serves the public. As public servants in this Legislature, we have the responsibility to ensure that we have the best system possible.

In this province, 83 per cent of the people are opposed to extra billing in principle.

Mr. Villeneuve: Ninety per cent like the health care going now.

Mr. Wildman: Exactly. They want to preserve it and they do not want to have more extra billing. If that kind of majority, 83 per cent of the population, believes we should eliminate extra billing, then those of us who believe in democracy, in representative and responsible government, surely should consider very carefully and follow the wishes of the people. I am also in support of this legislation because we must protect access to medical care for everyone in this province.

It has been suggested by the opponents of this legislation that a fee schedule is being imposed on the medical profession without proper negotiation. All of us in this House recognize there have been problems in reaching agreement between the Ontario Medical Association and the government in the past. We have a system now in which the OMA schedule is substantially higher -- about 30 per cent -- than the recognized OHIP fee schedule.

We have a situation in which a small number of doctors are charging the higher fees. I do not think this is a healthy situation. It is not one we should perpetuate. In the health care system we have, we should have free and open bargaining between the medical profession and the government to reach an agreement on an equitable fee schedule and then both sides should live with that. Frankly, I believe in free and open collective bargaining.

9:40 p.m.

One of the problems we have today in this province is that many doctors, despite their high level of education and expertise, seem to have a basic misunderstanding of the principles of collective bargaining. They seem to think their professional organizations can negotiate with the government and when an agreement is reached they can say, "Okay. Thank you very much. We now have an agreement," but then individual members of their organization can say, "You have that agreement but I, personally, am going to charge more."

What other group that engages in bargaining to set its income believes that individual members of that group should subsequently be able to charge more than the agreed schedule?

It was suggested that we are imposing something on this profession that is not imposed on other professions, such as lawyers. My friend the member for Algoma-Manitoulin (Mr. Lane) mentioned teachers. Teachers cannot extra bill.

Mr. Jackson: They are asking for merit pay.

Mr. Wildman: That is something I wanted to get to. Some teachers have said they want merit pay. It is true their organization does not want merit pay, but I am willing to get to merit pay if members want to deal with it.

If this whole problem were approached with cooler heads and moderation, the medical profession and the government could work out a system acceptable to both sides. If they could not reach an agreement, both sides could discuss things such as arbitration so that a schedule, binding on both sides, could be reached, agreed to and set. That is one option. Frankly, if the Ontario Medical Association believes in merit pay and believes it has a proposal that could reward certain doctors for a high level of expertise and training, it should propose that idea to the government and negotiate the possibility of a tiered level of fees, such as that of the teachers.

Mr. Villeneuve: The member is having second thoughts about it.

Mr. Wildman: These are not second thoughts. Why are they second thoughts? I am opposed to extra billing; I am not opposed to a negotiated schedule of fees that is lived with by both sides.

Mr. Runciman: Why did they not do that in conjunction with this legislation?

Mr. Wildman: I do not know. I did not set the legislation. I am saying that if both sides would approach this with moderation, those things could be considered. I do not think, though, that we are likely to get that kind of agreement if we continue with the extreme statements that are being made by some doctors. Thank goodness it is a minority of doctors.

I have heard the minister say in this House -- and I have to believe him, as one honourable member listening to another -- that he is prepared to discuss whatever proposals the Ontario Medical Association may have, but I have also heard in the news media the comments made by some members of the medical profession about a dictatorial approach by the government, about this being one of the worst laws if not the worst law in the history of man and how this law is worse than any law passed in Nazi Germany or behind the Iron Curtain.

Those comments have been made by leading members of the medical profession. I wonder what kind of dream world they are living in. Those kinds of comments will not develop or produce the kind of atmosphere that will make it possible for an equitable system to be worked out between both sides.

I am happy those kinds of comments are being made by only a small minority. I am confident in the professionalism of the medical profession. I am sure the doctors of this province will respond to this situation, keeping in mind the needs of their patients, and that they will work through this situation to ensure that we protect the health care system, that we have a one-class, one-price system of medicine in this province that will be of the highest level of competence of all the medical professions in the world.

I do not believe some of the scare comments that have been made in this House that if we bring in this system outlawing extra billing, as other provinces have, in accordance with the Canada Health Act and what is desired by the federal Conservative government --

Mr. Lane: It was Monique who brought in that legislation.

Mr. Wildman: That is right. It was supported by all three parties in the House.

An hon. member: Jake Epp brought it in.

Mr. Wildman: It was supported by all three parties in the House. Jake Epp now supports it, defends it and operates it.

Mr. Lane: He inherited it.

Mr. Wildman: I am not aware that Jake Epp has tried to change it. Does the member know something I do not? Is he going to repeal the act?

Mr. Runciman: Does the member agree with everything Ed Broadbent says?

Mr. Wildman: I certainly agree with Ed Broadbent's position on this. Does the member agree with Jake Epp?

Mr. Runciman: No.

Mr. Wildman: We can work through this. If we have cooler heads, we will work through this and we will have a system that we will all be proud of and can continue to be proud of.

I am opposed to extra billing. It is a system that is abhorrent to equity and fairness. I hope all members of this House will think carefully about this and will support the principle of eliminating extra billing, just as all members of the Parliament of Canada -- Liberal, Conservative and New Democrat -- supported the principle of eliminating extra billing in medicare in this country.

For those reasons, I urge the members of the House to support this legislation on second reading so we can move to committee and work through the amendments that will be necessary to improve the legislation so it benefits not only the patients and the people but also the doctors of this province.

Mr. Villeneuve: It is indeed interesting to rise in my place and participate in the debate on the so-called Health Care Accessibility Act, 1985. First, in my humble opinion, "Health Care Accessibility Act" is a misnomer. My good wife Elaine and I have five children. We have been in the doctor's office from time to time, and accessibility has never been a problem.

In the riding of Stormont, Dundas and Glengarry, which includes the city of Cornwall, and in probably a good part of the riding of my colleague opposite, the member for Prescott-Russell (Mr. Poirier), we have numerous doctors. In the riding of Stormont, Dundas and Glengarry, which includes the city of Cornwall, there are no doctors who have opted out or who extra bill. We will set that straight right off the bat.

Interjections.

Mr. Villeneuve: I see that my sanctimonious friends on the left have all kinds of things to say about this. When they find out what the medical profession of the eastern part of Ontario intends to do because of the Health Care Accessibility Act, 1985, I think we should rename this bill the conscription of the medical profession and regimentation of the patients act.

Mr. Barlow: That is the short title. Wait until we hear the long title.

Hon. Mr. Riddell: Wait till we see how they vote over there.

9:50 p.m.

Mr. Villeneuve: The Minister of Agriculture and Food (Mr. Riddell) is interested in how we will vote. It is rather obvious how we will vote. If the Minister of Agriculture and Food will just be here in due course, when we are done addressing this subject, he will see how we vote. We will stand up and be counted.

This bill stands in the way of the medical profession reaching its apex of excellence. It is a situation that tells the medical profession: "We will paint you with one brush, dark grey. Thank you very much. If you feel like leaving this country, that is fine. We will probably install midwives and what have you later and we will replace you."

In my humble opinion, that is not quite what this party and what I, as a member of this party, are looking for. I will quote a few instances of what has occurred in other countries, including Great Britain and Sweden, those so-called great examples of socialism. At one certain and particular time, Mr. Speaker will agree with me that indeed, if we were to work with the medical profession instead of against it, if we had communication and consultation instead of confrontation, we could resolve this problem without the many situations that are most likely to occur in the not-too-distant future. All of us, as residents of this great province, and our families, will suffer because of it.

The government and its sanctimonious friends on the left here are telling some of our very best medical practitioners: "You may be great doctors but you will have to be dictated to and live within the confines of whatever this coalition government decides for you. We will cast your fate and dictate to your profession."

It has been mentioned that Ontario is one of three provinces that have allowed extra billing. I wonder why most of the heart transplants and the highly sophisticated operations are happening here in Ontario. In Ottawa, we have Dr. Keon, a world-famous heart specialist. He is a native of Quebec but practises in Ontario. Have members ever wondered why? Let them ask themselves that. I wonder why.

Mr. Haggerty: It is money.

Mr. Villeneuve: I ask the member for Erie (Mr. Haggerty), is that a bad word? It seems money is a bad word in his dictionary.

Mr. Haggerty: No, it is not. Money talks.

Mr. G. I. Miller: The member should ask the farmers down his way.

Ms. E. J. Smith: The member is not paid by OHIP. He is on salary.

Mr. Villeneuve: It is most interesting to hear the comments from across the House. Quite obviously, being bed partners is influencing them.

Again, I must address the Health Care Accessibility Act. I have four daughters, but I also have one son who happens to play hockey. He was in a tournament one week ago yesterday. I was interested to hear the member for Algoma reporting on some of his experiences as a late-blooming hockey player, I gather. I had a few hockey injuries myself, even a few football injuries.

Mr. Haggerty: Do they extra bill in Quebec?

Mr. Villeneuve: There are doctors who come from Quebec when their quota has been filled on the Quebec plan. They practise in Ontario, would members believe, and that is just as bad as extra billing. They are taking money out of our Ontario health insurance plan.

Mr. Haggerty: Oh, come on, now.

Mr. Villeneuve: I live in a border town. Ask my friend the member for Prescott-Russell. He will tell the member for Erie a few things about what happens there. We can talk about that a little further, but I must tell members about my son, Brian.

He was at an eight o'clock hockey game in the Osie Villeneuve Arena, right in downtown Maxville, on Sunday morning, playing against the town of Russell. My friend over there would be pleased to hear that. They are two very good hockey teams.

The tournament was going on. Halfway through the second period, my son had the misfortune of suffering an injury, a separated shoulder.

Mr. Jackson: What was the score?

Mr. Villeneuve: The score was okay for our team in the first game. It was not so good in the second but we will get to that later.

The town of Maxville is situated about half an hour from Cornwall, where the Hotel Dieu Hospital is located, which is where I took him. It is not too often his dad accompanies him to a hockey game, but that Sunday morning I was there. The injury occurred at about 8:30 a. m. By the time we got to the Hotel Dieu Hospital, the emergency ward was pretty well filled. There were little kids, big kids, old kids, young people, old people; there was a real shemozzle going on there.

We walked in, registered, gave the Ontario health insurance plan number, sat down and read a magazine for a few minutes. Brian's turn came up. We were told: "Yes; a separated shoulder, a pretty bad tear. We will take some X-rays and I think we should have our orthopaedic specialist come and have a look at him." This was only eight days ago; it is very fresh in my memory.

The X-rays were taken, hung on the wall with the lights and within 20 minutes the orthopaedic specialist in Cornwall was at the Hotel Dieu Hospital. He gave me the different alternatives we had. There could be an immediate operation. However, at 15 years old one tends to heal quickly, so we had alternatives. We had 10 minutes to think about it.

We decided that if surgery had to occur, it would not occur then. The orthopaedic specialist strapped him up. We left the Hotel Dieu Hospital. It took half an hour to drive home. We had a bite of lunch and went to his hockey team's next game in that tournament at the Osie Villeneuve Arena at one o'clock. If that is not good accessibility to a health system, I do not know what is. Tomorrow, he is going to the same specialist to have the Band-Aids and whatever taken off. He feels pretty good and thank goodness for that. That is the kind of situation that occurs.

When the orthopaedic specialist recognized this kid's dad, he had a few things to tell me. "I do not particularly like what is happening at Queen's Park these days with a certain bill called Bill 94, the Health Care Accessibility Act." This orthopaedic specialist has a sponsor in the United States of America and it is likely this orthopaedic specialist in Cornwall will no longer be a resident of Ontario if Bill 94 goes through.

If Bill 94 goes through, and I or any member takes his son or grandson to a hospital on a Sunday morning, I wonder whether he might be told: "The civil servant doctor will not be available until nine o'clock tomorrow morning. In the interim, you can do the best you can with whatever staff is available at the hospital today."

This government and its socialist friends are using the medical profession's code of ethics to better and further what they think should happen. They are using the medical profession's code of ethics to dictate to them. Medical practitioners, being the professionals they are, will not let anyone suffer. However, I wonder whether they will leave their home on a Sunday morning, travel to a hospital, perform surgery or whatever under the system that currently is being presented under the auspices of Bill 94.

When this orthopaedic specialist told me he already has a sponsor in the United States, I was very concerned. If this doctor has a sponsor in the United States, I wonder how many others in the top 10, 15 or 20 per cent of our medical practitioners have sponsors in countries such as the US, and are ready to fly away from Ontario should this legislation occur.

Mr. Grande: They would have gone long before this, my friend, long before this.

Mr. Villeneuve: There is a bit of demagoguery going on on this side of the House.

Mr. Wildman: There sure is.

10 p.m.

Mr. Villeneuve: I am glad they admit it. There is demagoguery going on on the government side, but in particular by our friends on the left. If this is allowed to be brought to fruition by bringing Bill 94 to full fruition, we will all suffer the consequences.

The pretence of an additional $50 million coming to this province from the feds will be a negative $100 million before 36 months have elapsed. There is no doubt of that.

I will read to the members a couple of excerpts of what my friends in the medical profession in the eastern part of this province -- none of whom extra bill and none of whom has opted out -- intend to do:

"Cornwall doctors have decided to begin charging for a variety of services they normally provide free to protest proposed Ontario legislation that would ban doctors from extra billing their patients.

"Most doctors spend about 20 per cent to 25 per cent of their time performing jobs that they do not charge for. Beginning next Wednesday" -- the day after tomorrow -- "they will be charging for all these services, and this will cost considerable dollars.

"We have decided to refuse to fill or refill any prescription orders over the phone. We used to do that for free. Now the patients will have to come to their doctors' office or to the hospital, and there will be a charge for that visit or any other one, for filling out any prescription.

"There will be a half-hour charge for missed appointments. These charges will run between $35 and $60 to our OHIP plan. Doctors will be charging for every phone call they make on a patient's behalf, or for every form they fill out and, heaven forbid, forms are second nature to the medical profession. It is going to get considerably worse.

"In addition, no patients will be given appointments after 5:30 in the evening on weekdays or at any time during weekends. The doctors feel that the legislation is heavy-handed and the kind of act which is inappropriate, particularly for $10,000 fines for not adhering to Bill 94."

I have a copy here of a short bit of correspondence that was sent to the Premier (Mr. Peterson). Many of my colleagues have referred to it. It is signed by A. G. Khan, MD, from Cornwall. It reads in part:

"On behalf of the members of the Cornwall Academy of Medicine, I very strongly object to the introduction of the Health Care Accessibility Act, 1985 -- in other words, the conscription of the medical profession and the regimentation of its patients."

This doctor represents the medical faculty in eastern Ontario. He goes on to say: "The citizens of the united counties have appreciated the service rendered by the medical profession by awarding many of our practitioners citizen of the year awards, bicentennial awards and heritage awards. They have organized banquets and dinners to honour members of our profession. This made us proud to be members of the community. It gave us extra strength and incentive to do more for the community and the citizens that reside therein. The introduction of this obscene piece of legislation" -- We have heard that before so I will not dwell on that.

"Now that this bill has declared the medical profession criminals, thugs, greedy and irresponsible people" -- I am simply quoting -- "there is nothing left but for us to fight back with every possible means."

Mr. Philip: Does the member agree with it?

Mr. Villeneuve: I will let the member for Etobicoke (Mr. Philip) draw his own conclusions. "Thank God, we are not the helpless Jews of Germany or the oppressed blacks of South Africa. We still believe that this province of Ontario is a democratic society and that physicians also have the right to practise their profession freely like any other professional."

We are talking about people who have graduated after lengthy studies. They were not at the bottom of their class in primary and secondary schools. I guarantee that or they would not be the highly respected surgeons and medical practitioners that they are today.

"We urge the government to withdraw this bill immediately and sit down with the profession to consider the total health care system, the inequality and disparity of the system, the lack of facilities for the aged, the children, the mentally ill, the overcrowding, the emergency departments," etc.

The letter goes on to speak of the cancer treatment centre, the heart surgery centre, etc.

These are probably some of the things that this particular legislation is camouflaging. People are concerned about when the doctor will see them if they have a certain problem. The elderly in our society are very concerned. When the medical profession, those people who look after our health care as individuals, start giving us the message that the government is not listening and is not negotiating, it is of grave concern to all citizens, particularly senior citizens.

The Premier was asked in this very Legislature to guarantee that doctors' fees would not be increased. He refused to give that guarantee. In other words, no one really knows what will happen or what sort of deal will be made just to keep the profession quiet and under the thumb of the government. If it feels that doctors can be bought with dollars, that just may come to pass.

Just think of this: If doctors' fees were to go up by only 2.7 per cent over and above last year, it would cost this province $50 million. We can guarantee that doctors who will now lose from 10 to 30 per cent of their income as a result of the ban on extra billing will be looking for a great deal more than a very small 2.7 per cent.

I leave to members' imagination what this government might do if the heat gets to the point where it feels it has to move, and move quickly, so the delivery of health care to which the residents of this province have become accustomed does continue. I believe that dollars will talk. Once those dollars begin to speak, the $50-million excuse that the government and our friends on the left use as one of the reasons to bring in this legislation will be long gone, and we will be well into the $100-million, over-and-above cost, that will be borne by us, the taxpayers of this province.

I have here a reference from June 16, 1981, in that great newspaper the Toronto Star to some of the health care systems in other countries. I may have to quote a little from this, but I think members will find it most interesting. It is the direction in which this government is orienting the medical profession and the patients of Ontario:

"Britain: There is not much doubt our medicare system is in better shape than the British 33-year-old National Health Service," and we speak of OHIP here in Ontario.

"In the UK, theoretically the 56 million people are entitled to full, free health care, but Robert McDonald in London reports a serious decline in standards. There is a waiting list of 641,000 people for the 364,000 beds available in British hospitals."

There are two people waiting for every one bed available, more or less.

Mr. Wildman: Because of Margaret Thatcher.

10:10 p.m.

Mr. Villeneuve: Does the member not recall a Labour government there not long ago? I distinctly recall a Labour government that sowed the seeds of exactly what is happening over there today.

"Because those who pay out of their own pockets for beds and treatment go to the head of the line, the number of subscribers to private health schemes has soared in the past two years by almost 25 per cent, and by 23 per cent in the first quarter of this year." Dollars are still speaking regardless, and I think we have a prime example in private plans.

"Unlike Canada, where health insurance parallelling the medicare plan is forbidden. Britain allows private insurance and permits doctors to practise outside the national health system and to be paid directly by their patients. Even some trade unions, traditionally vehemently opposed to private medicine, now enrol their members in private plans." That is interesting.

Mr. Pollock: Will the member read that again, please?

Mr. Villeneuve: "Even some trade unions, traditionally vehemently opposed to private medicine, now enrol their members in private plans. Currently, 3.7 million, or 6.7 per cent of the population, have private insurance and their numbers are expected to rise by 10 million by 1985. Typically, a private insurance plan costs about $800 a year."

That is after carrying the cost of a public plan. If dollars are the reason why this government is trying to limit what doctors can charge, I think it should take a hard second look at what it is doing.

"Hospitals are allowed a limited number of patient-pay beds and some have entire wings. In addition, there are 5,600 acute treatment beds in private hospitals. The British turned to private care because, while treatment under the National Health Service is excellent, waiting to get it can take months and in some cases years."

That is what will likely happen in good old Ontario if the government is allowed, with its associates on the left, to go ahead with Bill 94 under the pretence of calling it the Health Care Accessibility Act. It is unbelievable.

"Funds for the United Kingdom National Health Service, $32.5 billion a year, come from national insurance contributions and general revenue," much the same as Ontario funds come to OHIP. "Salaried workers in Britain pay 7.75 per cent of their gross earnings in social security insurance contributions, of which about half goes to health.

"For example, a wage earner paid $325 per week would have $25 deducted from his pay automatically for insurance and $12 of it would go to health. His employer matches all of it. In Ontario, such a worker would pay about $6 per week for OHIP premiums or $23 a month. In Ontario, premiums supply almost 29 per cent of the health care budget. Britain allows local health authorities to conduct lotteries to raise extra funds." It goes on.

Another interesting area to explore is Sweden. The members should listen carefully. "Stockholm reports that the Swedish health care system covers everything from free dental care for children to free homemaker visits and cab rides for the elderly." It sounds good. "Medical care is provided almost entirely through hospitals, including care for minor illnesses, or company health centres many large Swedish firms operate for their employees.

"More than 90 per cent of Swedish doctors are employed by the state so that getting a doctor to treat one privately is almost impossible." It sounds like what we are going to have here. "Few take new patients and waiting lists are long. With high taxes on big earners, it is not worth a doctor's time to work long hours." Does that sound a little like what might happen in Ontario? I am afraid it does.

"An American journalist working in Sweden went home to the United States to get treatment for a minor ailment plaguing him for a year. He said: `Sweden has well-trained doctors, beautifully equipped hospitals and all modern medical conveniences. The only problem is that you can never get to use them.'

"The Swedes pay user fees." The members on the left should listen to this; this is a socialist country.

Mr. Philip: Why do they live so long?

Interjections.

Mr. Villeneuve: Mr. Speaker, I am having problems getting their attention because they do not particularly like what they hear.

The Deputy Speaker: Would you please address the chair? That will cut down on it.

Mr. Villeneuve: Yes, Mr. Speaker, I am sorry, I did not mean to forget about you.

"The Swedes pay user fees, $5 for each visit to the doctor and $6 for each day in hospital. They pay a maximum of $10 per prescription for drugs. As of July 1, there will be a ceiling on direct costs to consumers. New health regulations will guarantee that nobody spends more than $125 a year total for medical expenses and drug costs." That is not all that bad. I can go along with that, but it is what follows that concerns me.

"The Canadian Medical Association would like similar charges and a cost ceiling in Canada. It argues that patients should pay a little to doctors and hospitals to act as a brake on overuse of health services. Dental care is free for those under 19 years of age, while adults pay half the dental charges. All government costs are paid directly by taxes." No fund-raising drives or even hospital volunteers like our candy-stripers here in Ontario.

"With a population of eight million, almost the same as Ontario, Sweden's health bill is about $10 billion to $12 billion a year, or double that of our provincial spending. Swedes spend nine per cent of gross national product on health. Ontario spends about five per cent of its gross national product on health. Swedes pay out directly three per cent of total health costs compared with 25 per cent for Canadian private insurance which is allowed primarily to pay supplementary and long-term benefits.

"At hospital clinics where most people get their care, doctors work from nine in the morning until five at night and are on call at overtime pay in the evenings and on weekends." This is the clincher. "Because of high taxes, they tend to take their overtime in time off and not in cash, with the result that most doctors take from three to five months' holiday a year."

That is the socialist system in Sweden. Do I need to tell members more? Here we have West Germany. In West Germany, and I will not quote directly, but I have a statement that was made many years ago, about the time when Our Lord was born, and it says very plainly and simply, "Whom the gods wish to destroy, they first make mad." If the gods indeed are intending to destroy -- and the gods are across this chamber and over to our left, or at least they think they are -- they are going along the right track to destroying one of the best medical systems anywhere, bar none.

"In West Germany," reports a certain columnist, "92 per cent of the population is covered by a public health care system. The exceptions are white-collar employees and executives who earn more than $1,600 a month." Quite obviously, in West Germany the figure of $1,600 or more is where one begins to become rich, according to this. "Virtually all those exempt have coverage with private health care plans that are equal to the public health scheme. The privately insured eight per cent pay, in proportion to income, less than the mass covered by public agencies: typically five per cent of the gross income compared with 11 per cent paid by the majority."

10:20 p.m.

Again, we have to a degree a socialist system. "To pay for national health insurance, a wage earner making $1,000 a month would have approximately $110 deducted from his salary for family health insurance, which would cover his health care costs for himself, his wife and his family.

"Each worker is entitled to up to six weeks of sick leave annually with full pay, but his employer must bear the cost. After six weeks, the public health care plan takes over, paying him 85 per cent of his gross salary for a further 78 weeks if required. Doctors' fees are negotiated by the national medical profession, hospital management groups and the public insurance agencies," much like collective bargaining, to which my friend the member for Algoma (Mr. Wildman) was referring.

However, he was talking of collective bargaining without having in it any of the extras for the likes of specialists, those who have many years of experience and have achieved or are achieving the excellence required, which many of our medical practitioners have. If this were built into the system, it might be a little more palatable, but at one fell swoop, one grey coat of paint covers everyone.

Mr. Wildman: There is nothing to prevent that from being built into the system. Teachers get extra pay for experience.

Mr. Villeneuve: The teachers have extra pay for all the additional courses they follow, if they follow these things. It is my understanding that under Bill 94 there will be one fee for services rendered. Just as the member takes his car to a mechanic --

Mr. Allen: That was the Ontario Medical Association's invention, not this bill's, and the member knows it. Since 1922 the OMA has had that kind of fee structure.

The Deputy Speaker: Order.

Mr. Villeneuve: It is my understanding the Quebec plan will be followed. The minister has not told us where he is going on this one. If the Quebec plan is followed, that is not built into it.

"The whole system," writes this reporter, "has led to extensive abuses by everyone, largely because the majority of West Germans live under the delusion that the health care system is free."

As long as we in Ontario have this delusion, we will never solve the problem and will continue to pay through the nose. If Bill 94 is implemented, we will have deteriorating quality in the health care system. I hope I am wrong. I am simply bringing forth those concerns I have as a lay person who sits on the back benches of the Progressive Conservative Party.

"There are more doctors, 21 per 10,000, compared with almost 18 in Canada. On a per capita basis, in West Germany they have more medical practitioners. There are 117 hospital beds per 10,000 of population, compared with Canada at 54 per 1,000. The annual hospital bill is $11 billion for a population of 61 million. Hospitals operated by municipalities, universities and churches are almost all self-supporting from payments from the insurance agencies for patients, but some get subsidies from their local government or university owners. Fund-raising campaigns are unknown."

I realize the evening is moving on. I have quite a number of other quotations I feel I must get on the record for the simple reason, to go back to my riding again, we have a large percentage of senior citizens who are very concerned.

It is very easy for the government or its friends on the left to say, "We do not want extra billing." Extra billing is only a small area within Bill 94, even if they call it the Health Care Accessibility Act and everyone seems to want to call it the extra billing act. I go back to what I said initially, this act is the conscription of the medical profession and the regimentation of patients, and that includes all nine million residents of this province, and we will live to regret this bill if it goes through as planned, without allowing for the highly trained specialists we have.

Again, I emphasize that the reason Ontario draws many patients with those very sophisticated illnesses -- I do not know whether that is a good word -- with those illnesses that seem unable to be treated in other areas of Canada, is that they have confidence in the medical profession that works in this province and in the health care system in its overall environment.

Some of the doctors are concerned that they seem to have some problem communicating with the minister, with his staff and with the government. On the weekend, the Minister of Health suggested he was not ready to make a move on anything because he would not react to something that had not already happened. The minister -- and I notice him listening very carefully -- had better be prepared to act because the medical profession is going to be standing on its hind legs to be counted, and the residents of Ontario will be the people who suffer.

I quote here from a representative of the medical profession. This is Dr. Howard Eisenberg. He requested a meeting with the minister on October 30, but the minister answered a month later that he could not meet Dr. Eisenberg until January. Was there a problem? Was the minister reluctant to accept this doctor's input regarding Bill 94 prior to its formulation as we now have it before us?

If the minister had met this doctor, it is possible that we would not have to call it the conscription of the medical profession and the regimentation of its patients; we could probably call it what it should be called, the Health Care Accessibility Act. Things might have gone more smoothly and he would not now be sitting on a bunch of fairly hot burners, getting hotter.

It says here that the doctors are not prepared to surrender. They are not prepared to throw in the towel and say: "Okay. With dollars you can buy our services. We are ready to throw in the sponge. Go ahead with Bill 94, the conscription of the medical profession and the regimentation of the patients."

They are not prepared to surrender and the minister and I, as residents of this province, will suffer the consequences. We will not have the medical services we are accustomed to after 5:30 p.m. or on the weekends. I am speaking from statements made by the medical profession. These people have credibility. They do not jump on both sides of the fence as some political parties have been known to do.

I notice by the large clock in this great chamber that we have reached 10:30 p.m. I would like to resume this debate at the next sitting.

The Deputy Speaker: Perhaps the member would like to move the adjournment of the debate.

On motion by Mr. Villeneuve, the debate was adjourned.

The House adjourned at 10:30 p.m.