L097 - Thu 23 Jan 1986 / Jeu 23 jan 1986

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

COURT RULING

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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. Morin-Strom: I have a few more remarks on Bill 94, the Health Care Accessibility Act. Fundamentally, the issue in extra billing is whether we are going to let our health system be subject to a discriminatory practice, where health care is based on economic wealth or ability to pay the fee a doctor charges. Are we going to have one level of health care for those who can afford extra payments and another for those who cannot? I believe health care is for patients and not for doctors. Everyone must be guaranteed equal access to the same quality health care, with no extra charges being possible.

Heaven knows, we already pay enough for health care in Ontario. There is no justification for supporting doctors who want to charge us a second time for health care. The whole point of universal health insurance is to spread the financial risks among all of us. In return, everyone must have the same access to quality health care, without being charged a second time through extra payments.

I cannot tolerate the idea of a person suffering from illness or serious injury having to pay hundreds or thousands of dollars because he or she is unfortunate enough to live in a community where most doctors are opted out, or to have contracted an ailment that requires a specialty in which most doctors have opted out.

I know of several cases of patients requiring eye surgery who can get it only at a cost of $800 to $1,200 over and above the Ontario health insurance plan fee schedule, because all the qualified ophthalmologists in the province who can perform the required surgery are opted out. This is an absolutely intolerable situation that we cannot allow to continue. I know some of the doctors have used the argument that they have some inalienable right

Mr. Guindon: On a point of order, Mr. Speaker: I would like to point out to the member that not all ophthalmologists have opted out. We have three in Cornwall who are not opted out.

The Acting Speaker (Mr. Morin): That is not a point of order.

Mr. Morin-Strom: The issue is whether they have the capability to provide the type of surgery required in this case.

Some doctors believe they have an inalienable right to extra bill. The best response to that is the remarks of Mr. Justice Emmett Hall in the report of the Royal Commission on Health Services, and I would like to read them into the record.

"The emphasis on the freedom to practise should not obscure the fact that a physician is not only a professional person, but also a citizen. He has moral and social obligations, as well as self-interest to do well in his profession. The notion held by some that the physician has an absolute right to fix his fees as he sees fit is incorrect and unrelated to the mores of our times. When the state grants a monopoly to an exclusive group to render an indispensable service, it automatically becomes involved in whether those services are available, and on what terms and under what conditions."

This legislation does take those considerations into account and as a result I strongly support this legislation. I trust that the vast majority of doctors also recognize that the fundamental issue here is putting an end to a discriminatory health care practice in Ontario. I trust that the doctors in our province will work together with other health care professionals and the Ministry of Health to ensure that Ontario has the best possible high-quality health care, a health care system that is universally available and accessible to everyone with no further arbitrary discriminatory billing of individual patients.

Mr. Dean: It is a privilege for me to join with my colleagues and to give some thought to the debate on Bill 94. I hope to say a few words with a great deal more thought in them than I have heard from some. The bill has a very fancy title, but that it is really only a way of dressing up another attempt by the present government to fix a problem with restrictive legislation.

It seems to have become a habit, and I might say a bad habit, of the present government to want to legislate everything. They have nothing except a heavy hand. The government says the Ontario drug benefit plan has a problem. How will they fix it? They will legislate pharmacists. The government perceives a problem with environmental cleanup costs, which has nothing directly to do with the environmental issue we discussed this afternoon. How will they fix that? They will proclaim the spills bill, which is very difficult legislation.

Here we have another example, a perception that there is something wrong with the health care system, so they want to legislate the doctors. I do not know whether the present government will come to realize that problems are solved better by building a consensus with which people can live and in which they can voluntarily participate rather than by beating them into submission. The carrot is always better than the stick.

I notice our Minister of Health (Mr. Elston) is not here, although his parliamentary assistant is. I am sure the member for Wentworth North (Mr. Ward) will report all this very dutifully to his boss. The minister says this new bill, whose main purpose is to ban extra billing by doctors, has solid support across the province. I know his parliamentary assistant spent a great deal of time in the last eight months going across the province and doing various things.

He might have a different report to make than I have on the issue of solid support, but then I am not sure if that is what he was gauging anyway. He was probably trying desperately to find a Liberal in the part of the province he went through. There are a few desperate Liberals there.

8:10 p.m.

This raises the question of whether the minister's method of ascertaining the merits of a new policy by means of going around the province is unique or whether it is all part of this new government's whole way of operating. It seems to me the very idea of establishing government policy, and especially a policy such as the one that lies behind this bill, aimed directly at curbing the rights of a minority group -- and let us not pretend otherwise; while the doctors are sometimes portrayed as a powerful, wealthy, influential group, and while, of course, they do have some of that influence because of the very nature of their occupation, they are still a minority group -- the idea that the government of Ontario would try to establish policy affecting a minority group by means of something it might call public forums, which have been orchestrated by the minister in some communities, reminds one more of some of the distasteful methods used during Hitler's Third Reich. This is how the Nazis undermined public morality in Germany.

Mr. Ward: The last speaker described it as anarchy.

Mr. Dean: Is that right? We are quite mixed. Maybe there is not much difference between the extreme left and the extreme right.

That is how the Nazis undermined public morality in Germany. They arbitrarily picked a minority -- any minority -- organized mass rallies to denounce the dreaded and chosen scapegoats and then congratulated themselves for doing what the people wanted. What the people wanted in those cases, of course, was what had been preplanned and almost subliminally induced into the thinking of the people.

I would not want anyone to think I am directly comparing the Minister of Health or his supporters to Hitler's Nazis, but the methods have a familiar ring. Surely it is the minister's job to consider the moral rights and wrongs of any policy the minister submits to the Legislature. For him to argue that his ban on extra billing was endorsed at public forums across Ontario is very much to change the picture, very much like arguing that it was okay to throw Christians to the lions in ancient Rome because the spectators always cheered. In other words, is the least common denominator the standard we use for judging what is to be public policy? I would like to think not, but it seems to have had too much influence on this minister in his current policies.

There really was no crisis; this is the point I am trying to make. The government has manufactured a crisis where there was none in order to appear decisive, a government of action: "We are going out. We will kill the bear."

Oh, there is the House leader.

Mr. Eves: Speaking of a bear.

Mr. Dean: The Treasurer (Mr. Nixon) has just come in. I am sure he has dollars on his mind.

Mr. Davis: Did the member say "dollars" or "dullards"?

Mr. Dean: If they are silver dollars, they are not duller.

To me this is not really statesmanship. This is a method of trying to appeal to a certain group of the public to get votes.

Let us review again some of the simple statistics. Of the doctors in the province, 87 per cent are operating within the Ontario health insurance plan. Maybe it is slightly more than that. Of the total number of claims submitted, only six per cent are for services performed on an opted-out basis. So we are really talking about six per cent of the services that are performed by physicians in Ontario when we are saying this is a bad thing.

Those members who have read the parody on British history called 1066 and All That will remember that the writers there come across every so often with something that is a "bad thing" or a "good thing." Somebody in the government, perhaps the Minister of Health or his staff -- that huge bureaucracy in the Ministry of Health -- may have read 1066 and All That and think this is a good thing and that people who opt out of OHIP are a bad thing. However, we are talking about around six per cent of the claims.

Most general practitioners, to separate them out from all the rest of the physicians, have not opted out. As a result, there is no identifiable problem with access to basic health care.

The members will notice that one of the words in the title of this act has a beautiful ring to it. Where were we? "Accessibility" is in here somewhere. It is not in the title, I am sorry. This is "rendering services." One of the catch words has been "accessibility." There is no problem of accessibility to general practitioners.

If we consider the group on its own, the vast majority of specialists who may have opted out are not just cruel, heartless monsters who say: "Tough bananas, Gord. You do not have the money, so you are not going to be able to get the hole in your head fixed." The vast majority of specialists have more heart to them than that.

Mr. Callahan: They do not have enough money to fix that hole.

Mr. Dean: It is a matter of bone rather than money. They do take into account the ability of patients to pay. We all know specialists who have said this and who do that. They are not simply in there to get their fee no matter what, regardless of the ability of a patient to pay, even if they are opted out of the system.

In reality, more doctors are opting in as time goes by, rather than opting out. For example, about seven years ago, in March 1979, about 18 per cent of the physicians were opted out. Only about 12 per cent are opted out at present. One can see that this is not a growing, cancerous or gangrenous problem, as the minister and his supporters tend to say sometimes. As a matter of fact, it is a problem that is diminishing as years go by.

There is no reason to believe the statement that there is a crisis in the health care system, not for this reason. There may be some other aspects of the health care system that are getting near a crisis, but not the matter of whether the physicians are opted in.

I have spoken to a number of physicians in my own area, as have most members of the Legislature. While we have not gone into all the details of the present system or of the proposed changes, there is one thing that has come out of my conversations with those physicians I know personally, and they feel they can be quite frank in speaking to me about this. Without exception, they all say that in this debate, this discussion, this disagreement between the physicians of the province and the present government, income is not a problem; it is not a factor.

[Laughter]

Mr. Dean: I hear laughter from some members of the government and also from the quasi government on my left. They may laugh if they like, if they find it amusing, but the point is the present government lets it be spread abroad, whether it actually does it itself or not, that the doctors are taking a stand because of a great personal desire for more income. This is not a motivating factor with the physicians I know.

8:20 p.m.

Money is not an issue. Income is not a problem. These physicians I speak of, and to whom I spoke, were not opted-out physicians. They are happy with the income they are making now. We all know of physicians who often gave, and still give, scads of their own time gratis for medical treatment if needed. They have given an equal amount of free time to many public activities. They are people like the rest of us. Let us not consider that they are particularly evil people. They have a particular dedication to the health care system that benefits all of us.

What is the reason the majority of them are still strongly opposed to the principles and terms of this legislation? They say it is offensive, and that is probably a good word for it. It is offensive, first, because there has been no consultation on the principles. There has been an invitation to the physicians, and the minister repeated it again this afternoon in the House, to consult on procedure. That is very much like saying to someone who has committed a misdemeanour: "You are condemned to be punished. Now let us talk. About whether you are condemned? No. Let us talk about whether you would like to be executed by firing squad or by slow death sitting in the Legislature."

Mr. Andrewes: How painful that would be.

Mr. Dean: The member for Lincoln would take the firing squad. Okay.

The point is that the matter is not up for debate, according to the Minister of Health, and this is what is found to be offensive. They say it is dictatorial and an encroachment on their freedom.

It did not need to be this way. The Ontario Medical Association offered the government a deal. I have heard some comments about this from members of the government. In simple terms, the deal was something like this: "If you want to talk about the health care system in Ontario, look at the whole health care delivery system, not just the relationship of the doctor to OHIP. Let us look at how you pay doctors by establishing a blue-ribbon committee of people with impeccable qualifications and we, the doctors, will guarantee that we will not extra bill people who are in special need during that period." Who are those people? They are people over 65 as a group, we will say, or those who are getting premium assistance.

That was a reasonable offer, it seems to me, on the part of the physicians to look at the whole health care system. Mr. Peterson, in his wisdom or lack of wisdom, turned it down.

Hon. Mr. Kerrio: The Premier, not "Mr. Peterson."

Mr. Dean: I am sorry; the Premier.

Hon. Mr. Kerrio: He is going to be here a long time. The member might as well get used to it.

Mr. Dean: The Minister of Natural Resources is pining for the north.

The Acting Speaker: Order.

Mr. Dean: The Minister of Natural Resources should go out in the lake somewhere, because he is a disturbing influence.

Hon. Mr. Kerrio: I am listening very attentively.

Mr. G. I. Miller: I thought the member was a Liberal at one time.

Hon. Mr. Kerrio: He says he was.

Mr. Dean: Oh, yes. I have even known some members of the government who were Liberal at one time, but they have become just as unyielding and uncompassionate as anybody else.

Interjections.

The Acting Speaker: Order.

Mr. Dean: The blue-ribbon committee I was just speaking about -- before some members on the Liberal benches seemed to think they needed to offer a little garbage to bring this down to their level -- will actually consider, along with all the other aspects of the health care system in Ontario, the most serious problem of all. The most serious problem of all is not extra billing, not whether physicians are opted in or opted out; the most serious problem of all is utilization. This is not something I dreamed up over a glass of Niagara grape juice; it is something I have been told by conscientious physicians.

Utilization, as members know, refers to the amount of billing that is put in by the physicians because of the number of patients they see or treat. There is the inclination on the part of all people, probably including us, if the service is "free," to use it. Sometimes we use it when we do not really need to; we overuse it. That kind of utilization adds up. If everyone sees his or her physician one time during the year when he or she does not need to, and there is a population of about nine million, we have $90 million or maybe $180 million extra just because of overutilization of the system.

I will grant that doctors have not been pressing very strongly for any kind of review of the utilization of the health care system, and I do not think the government -- either this government or the government of the past; we are both in the same boat on this one -- has been pressing strongly enough for that. If we are going to come to grips with the ever-mounting costs of the health care system -- and they are mounting on almost a geometrical factor each year -- we are going to have to, I will not say put a cap on, but somehow come to grips with the factor of utilization.

Perhaps the minister and the parliamentary assistant have some bright ideas on this subject. If so, I hope they toss them out in the course of the debate because I do not see them in this bill. It is not going to deal with that question at all; if anything, it is going to promote a further overutilization of the system for reasons that will become apparent as I continue.

In any case, this committee, which was proposed, recommended and offered by the OMA, would have dealt with that thorny and high-priority problem, as well as other things it could have been selected to deal with, but the Premier missed that golden opportunity.

The doctors are concerned about their freedom. I would like to read a little bit submitted by one doctor. I will skip over some of the less interesting details. He is not a newcomer; he has been practising in Ontario for 10 years, following six years of medical school and eight years of post-graduate training.

He says he has attempted to furnish his patients with the best care he can, and the accessibility of patients was limited only by the constraints of time. He could deal with only a certain number of people in a given period. It does not look to me as if he was a shirker, because he says:

"Accessibility to me in medically urgent situations when I have been on call, an average of 100 hours per week, 52 weeks per year, has been absolutely unrestricted. No patient has ever complained that I have been unavailable when needed or that I was too highly paid for my services. Indeed, not only have I always accepted the OHIP rate for my services as payment in full but also the terms of my appointment in the faculty of medicine, Queen's University, include a provision whereby all my professional income above a negotiated ceiling goes to the university.

"In my practice I attempt to establish a doctor-patient relationship based on mutual trust and confidence.... Without it, my only rewards for looking after a sick patient are the fee I receive and the intellectual satisfaction of solving a medical problem; that is, of treating a disease rather than a patient. That is not the climate in which I wish to practise medicine. I cannot believe that this is the climate in which the people of Ontario wish medicine to be practised."

8:30 p.m.

Here is the most significant part of his statement:

"As concerned as I am about the above issue, as a citizen of a free society I attach much more importance to the effect of the proposed legislation on my personal freedom. Heretofore I have always felt free to choose whether or not to accept the OHIP benefit as payment for my services. If working within OHIP is like being in prison, being able to opt out and extra bill is like possessing a key to the prison door. Freedom is available to me and, therefore, I am free. Without it, I am a slave.

"I find particularly galling your public pronouncements to the effect that most doctors, because they do not opt out of OHIP, do not care about the abolition of opting out. Nothing could be farther from the truth. Do you really believe that any doctor, or any other responsible citizen of our free society for that matter, could be apathetic to legislation which imposes a form of slavery upon him?"

Those are not my words, they are the words of F. James Brennan, MD, of the division of cardiology in the department of medicine at Queen's University.

All of us, as free women and men in this free country, one of the freest on earth, can understand how physicians can feel that way and how they would resent very much being enslaved by the kind of legislation we are considering here.

I have a few other expressions of opinion by a respected physician from my own community. I am quoting Dr. Michael Greenspan, a specialist in neurology in the city of Hamilton. He uses some words that had not occurred to me, but they fit the description of the legislation. This was originally addressed to the Minister of Health.

"I am sure you and your colleagues all realize this is an obscene piece of legislation. The name of the act and the issues with which it deals are totally irrelevant to the problems in the health care system in Ontario.

"This piece of legislation is merely being used as a political tool and, once again, the medical profession of this province is being used as a scapegoat for the government's deficiencies in delivering health care for the people. The statements which you and the Premier of this province have made...are being done for totally political reasons only."

This is the part I think the member for Niagara Falls (Mr. Kerrio) will be interested in hearing, since he is listening so carefully. Still quoting from Dr. Greenspan, "I have basically been a Liberal all of my life" -- there are not many like that, are there? -- "having been born in the Niagara Falls area, which was a Liberal stronghold at that time."

Hon. Mr. Kerrio: At that time? It has been for 10 years.

Mr. Dean: I am quoting. He is more than 10 years old or he would not be a doctor.

Hon. Mr. Kerrio: They lose their perspective and move away from Niagara.

Mr. Dean: The minister is slipping already. "However, I must say that your party's attitude to the medical profession, with special reference to this piece of legislation, has led me to change my political philosophy. I am positive that most of my colleagues have adopted these feelings as well."

Mr. Eves: What about the New Democratic Party?

Mr. Dean: It is coming; wait for it.

"The Liberal and New Democratic parties are acting like children who want immediate gratification by passing this piece of legislation and really do not realize the future consequences of health care should this be adopted. I am sure you are not that naive that you do not realize the truth of this last statement."

Mr. Sargent: On a point of order, Mr. Speaker: I am advised that there is a law against reading a speech in the Legislature.

The Acting Speaker: I will make that judgement.

Mr. Dean: I am glad the member for Grey-Bruce brought that to my attention. No one could ever accuse him of reading anything he says.

An hon. member: He cannot read.

Mr. Dean: My colleague says there is some question whether the member can read, but he can certainly speak.

I will continue to quote briefly from this excellent letter from the former constituent of the member for Niagara Falls. He is now in Hamilton. He saw the light.

"I think a response to this letter and a communication with every physician in this province directly would be in order from you." He is speaking to the minister. "However, people with nothing constructive to say, such as yourselves, usually do not respond in this way."

This is a short one. It is from Dr. J. De Maria, pediatrics, adult urology, McMaster University Medical Centre.

"I am a full-time physician at McMaster University Medical Centre. I do not bill directly and am paid a salary. I am outraged by the so-called Health Care Accessibility Act.

"Some of the health care problems in Ontario are inadequate facilities for the aged, insufficient operating room time due to underbudgeting of hospitals and lack of funds to obtain adequate treatment. Billing by less than 15 per cent of Ontario's physicians" -- I already mentioned it is about 12 per cent now -- "is not a critical health care issue, other than buying votes for a minority government."

To show this is shared by people in all kinds of medical service, here is one from a radiologist, Dr. Davidson, also from Hamilton:

"The method which you have introduced to end extra billing by physicians in Ontario would be acceptable in Soviet Russia or satellite communist countries or dictatorships." He makes a few unflattering comments such as that.

"You should know quite clearly from the press and correspondence, that few would object to the end of extra billing in hospitals so that emergency situations, anaesthesia and other services would be universally available to all patients in Canada without financial barriers.

"The medical profession will reject your concept that total control is necessary.... My prediction is that if you can get away with the type of bill you are considering, the next step will be to demand access to patient records for government purposes."

Here is a letter from a plastic surgeon, Dr. Moscrop, also from Hamilton.

Mr. Wildman: Does he extra bill?

Mr. Dean: Yes. I try to show all types of physicians in all situations.

"I am a physician who is opted in and I have been in practice for about 16 years. I am very disturbed that the government of Ontario is about to try to pass the Health Care Accessibility Act...it places all kinds of inequitable financial control on certain physicians.

"In any other profession, particularly in law, accounting and even politics" -- he has the grace to term politics a profession -- "allowances are made first for seniority, which often equates with experience, and with operating expenses."

Mr. Wildman: That is not true. Even new members are paid the same.

Mr. Dean: There are some who seem to be more senior than others.

"It is not reasonable in our society that a lawyer who is eminent in his field and who may have been involved in the practice of law for 25 or 30 years be paid the same amount as a lawyer who has been out of school for two days. Similarly, in medicine, it is not reasonable that the only payment a senior physician can receive should equal that of a very junior physician. Your government is proposing that there is no means by which a skilled physician can receive the additional payment his services are worth.

"I understand that your government feels it is important to pass this legislation quickly, but I predict that unless the problems I have mentioned are adequately addressed, your government will experience nothing but strife from the medical profession in the foreseeable future."

This is the last one about this sort of thing from a different kind of physician, a child psychiatrist, Dr. Martin Beck from Hamilton. It is interesting to see how he starts out. This was written to the Premier:

"Much as I welcomed the access to power of the Liberal Party of Ontario following the last provincial election, I am angered and dismayed by the legislation tabled by your Minister of Health on December 19....its content does not deal in any way with the substantial hindrances to accessibility which have been multiplying over the past years in the Ontario health care system."

He then lists what he thinks are the things that hinder accessibility.

"This bill suspends the civil rights of a physician in Ontario to conclude a contract with his patient as to the value of the services he provides that patient and as to the means of remuneration of the professional physician for those services. In effect, in one stroke, the medical profession in Ontario has been conscripted into being civil servants. Our profession has long had an honourable tradition of putting the interests of our patients before all other considerations." I alluded to that earlier in my reference to the number of physicians, of whom all of us are aware, who do much beyond the call of the letter of the law in and outside their practices.

8:40 p.m.

"What has engendered a profession such as the medical profession in Ontario with its high standards of performance and service? It is my belief it has been the efforts of gifted, spirited and independent-minded individuals, dedicated to serving their communities and their individual patients through teaching, research and clinical care that have given rise to the highly skilled group of physicians who service Ontario."

He concludes by saying, "I urge you, Mr. Premier, to withdraw this ill-considered legislation and to table legislation which actually addresses the issues of underfunding of the medical system, of the closure of hospital beds and of the lack of access to adequate outpatient services in the province. If Mr. Elston would channel his considerable energies and zeal in this direction, he will be remembered by patients and physicians alike as one who really served their purposes rather than his own political ends."

That is Dr. Martin Beck.

Mr. Wildman: Maybe we could apply for another $50 million for the province.

Mr. Davis: All they will do is pay the doctors more.

Mr. Dean: That is absolutely right.

Mr. McClellan: That is what Larry did. What a guy.

Mr. Dean: It is easy to see that people are not stretching it when we hear them say, and when we believe ourselves, that this could easily be an insidious first step into turning our first-class, conscientious, professional doctors into civil servants, running a state medical office from nine to five where patients would pick a number, stand in line and wait one's turn, just like shopping for groceries.

There is a threat that it would kill the personal relationship. That was referred to in one of the letters I read. Doctors value the relationships with their patients, just as most of us value our relationship with our personal family doctor. That relationship and trust has developed over a long time between an individual and his physician. It is not like going to the Ministry of Revenue to see about one's sales tax, where one is dealing with somebody who has a strictly nine-to-five job and deals with these impersonal events. Everything that happens between a physician and his patient is very personal. We must have that element of trust for it to work right.

As I said earlier, there was no need to have this development. The government had an opportunity for full consultation with the doctors, not only on the matter of fees, but on the whole system and how we can come to grips with and rationalize what is a very expensive, although a very excellent, system.

With this onerous legislation, the government will certainly find that the professional people who are our physicians are not the least bit content. One cannot help but wonder if the next step is going to be directed at some other professionals. Are the lawyers next? Who knows? If there is a problem with any profession, there will be a temptation for the government to go in with its heavy-handed legislation and slug them on the head.

Banning extra billing will not have a beneficial effect on the medical profession here. It has been said -- and I know most of us have read this somewhere -- that those who fail to study history are doomed to repeat its mistakes. Why can this government not see what complete state domination of health care has done in other countries of the world? I think most of us are acquainted with some other countries' health care systems. I am not speaking now of the country south of us, the United States, because they do not have a health care system there.

Mr. Wildman: What the member wants is free enterprise medicine.

Mr. Dean: No. I ignore the interjections, but I want to make it clear I am not advocating untrammelled free enterprise. That is the usual oversimplification and muddying of the issue one would expect from some of my colleagues on the left.

For example, the British have two systems. They have a state system of public health that was brought in and they now have one of private practitioners. We think ours is a lot better than that which prevails in Britain.

In theory, all the people in Britain are covered by the public health care system, but there has been a decline in its standards that has been attributed by people who have studied the system closely to the fact that the doctors there are civil servants, as the Liberal government and its NDP stooges would like to see introduced here. They now find that it was not the paradise, the egalitarian system they had hoped it would be.

Mr. Wildman: Even Mulroney and Jake Epp do not believe that.

Mr. Dean: I hear a certain din to the left. Has somebody let the dogs in? I am not sure. I cannot quite make it out.

The system did not work out that way because it turned into what one would expect from people who turn out to be bureaucrats or civil servants. They lose some of the incentive to do a private job.

Another system was established in parallel. The interesting thing is that public and private health care plans offer a choice. A considerable number of people in Britain now subscribe to the privately funded health care plans, even though it comes totally out of the pockets of the people who subscribe or do it for their employees.

I want to emphasize that the private health care plans have no state money. We are talking about the choices of people. We are not talking about physicians; we are talking about people who are patients or health consumers, to use a rather unpleasant and overworked phrase. It is the choice of those people to say, "I would rather put my extra money into a privately sponsored system, because there is something there that is missing in the public system since it became totally state-dominated."

There is a very interesting thing that many members know and which I discovered in my research. Even some trade unions in Britain now are insisting through their contracts that the service offered to their members when they are ill will be -- what; the great state system? Not on your life; it will be the private system. About 6.7 per cent of the British population is now enrolled in private plans, including people in trade unions, who perhaps feel there is some virtue in statism, but who say, "When you are treating me, I want the best there is and I am going to pay for it."

They turn to private care because, although treatment under the public system is reasonably good, it is not adequate to suit some people. It has gone full circle from a privately run system with hospital insurance, through the gradual approach to complete service as a state-run system with doctors as civil servants, until now a portion of it is being returned to the private system, so those who wish to can go that way.

What is wrong with that in a democracy? According to the government we are suffering from today, there seems to be a lot wrong with it because it is trying to legislate this out of existence.

8:50 p.m.

The reason this sort of system ends up the way it does and actually damages the health care system in the end is that it encourages what I will call assembly-line medicine. Perhaps it is a slight exaggeration to say assembly-line medicine, because we get a picture of somebody standing by a moving belt putting a nut on here, a roof on here, a rad in there or something else. However, it could appropriately be called assembly-line medicine that is encouraged by this sort of legislation, because some doctors, remembering that the doctors are probably a cross-section of our society and we should not expect them to be that different personally from anybody else --

Mr. Treleaven: The member says they are cross? I say they are very good-natured.

Mr. Dean: Oh, okay. A happy section of society?

Anyway, some doctors, under the kind of system that will evolve if this bill ever becomes law -- perish the thought -- will try to see as many patients as possible and cut down the time per patient -- zip them in, zip them out, put the bill down. They will rush through examinations to get to see more people. Why? Obviously, because they are working on a piecework basis. If there is no other incentive to shine, they will say: "I am a civil servant. Why do I not just get all I can out of it?" They may even encourage repeat visits for little or no reason. That is one drawback this bill would foster if it were ever to become law. It would encourage assembly-line medicine.

A second adverse effect of it would be to encourage mediocrity. Under the legislation we have here, there is no reason for anybody to do what the doctor whom I quoted previously did. He spent eight years beyond his doctoral studies in medicine to become a specialist. There will be no financial incentive for a person to do that. There may be some inner compulsion that might drive a person to want to learn more about that particular specialty, but there will be no reward, if I can use that word, for a person who spends an extra eight years of her or his life to learn a specialty when she or he could be out enjoying a normal life. I will not say as we do, because what we are enjoying here is hardly a normal life, but the kind of life we enjoyed before we came here.

There is no reason for such a person to become a specialist or to improve his skills from the standpoint of getting a greater recompense for it. He will be paid just the same as one of the other doctors. Whether he is out 10 years or two days, he gets the same amount of pay for viewing Mr. Dean's falling hair or whatever other malady is being treated.

Mr. Wildman: You would not have to extra bill for that.

Mr. Dean: You have to give something extra for the trip to find it.

The doctor would make the same on his first day as he would 25 years later with 25 years' experience. As one of the members on my left said a while ago, there is a sort of levelling factor in this chamber; but then we have to admit that nobody forces us to come to this chamber. If we do not like it, we do not have to stay here.

Mr. Davis: We should give equal pay for equal value of work to our colleagues across the House.

Mr. Dean: Maybe that will be in the green paper of our colleague.

Why would a doctor have to worry about keeping up to date with new procedures? Why improve his skills? There is no incentive --

Mr. Wildman: He does not do that for money. He does it to help his patients.

Mr. Dean: Maybe for incentive; I mentioned that earlier. The inner compulsion would still be there with some, but there is not the other, and it goes along with a lot of life. Something socialist countries have found is that socialism as a theory is tremendous; in practice it is lousy. That is the way this one would run out.

I am interested to note, however, that rather recently there have been a few more-or-less incoherent mumblings from the Premier about this particular issue the medical profession has been talking to him about. He has said, "Maybe we could negotiate something that would recognize skills; maybe we could negotiate this, that or the other thing," without really being clear. I do not think he and his Minister of Health talked that one out very much before those ruminations became public. However, there has been some hinting along the line that the government might be willing to do something -- if nothing else, perhaps raise the whole OHIP fee schedule.

Here we come to something: "To keep you quiet, kiddies, I tell you what: We will give you a few extra cookies." That is really what they are saying. They might even go as far as what happened with the government of Nova Scotia, which also banned extra billing a year ago and then granted fee increases averaging 12.8 per cent ending in April this year. That is not bad. Most of us, even those of us who decry the idea that there might be financial gain in any of these occupations, would probably not turn down a 12.8 per cent increase.

If that were to happen in Ontario, and this is only speculation, if the worst came to the worst and this bill did pass and extra billing was banned, then by the musings, mumblings and ruminations of the Premier, perhaps there is another secret agenda saying, "Okay, to keep the physicians from rebelling totally and making our name mud around the province, we must negotiate a new fee schedule with them."

If they granted the same increase as the government of Nova Scotia was led into doing, the 12.8 per cent, the cost to Ontario taxpayers would not be $52 million, not $100 million, not $200 million, but $270 million per year. That is a far cry from the $53 million that is supposed to be the driving force behind the government's introduction of this draconian legislation.

The word "draconian" is not normally on my lips, but it comes to mind because it was used by a member of the government party in expressing his own personal dissatisfaction, as a physician, with these draconian measures. Most of us will remember that Draco was an autocrat in Greece many thousands of years ago who ruled with an iron hand. We are referring to that Greek, long dead and gone, who was one of the first dictators.

Mr. Wildman: The member's colleague earlier today was talking about Plato and Socrates.

Mr. Dean: I do not think I will discuss that. It is very obvious if that were to be one of the consequences of passing this misguided legislation, not only would we have lost the services, interest and professional support of a great body of our fellow citizens, the physicians, but we would also have gone far beyond the kind of financial expenditures we would otherwise have had to make.

I am not suggesting $52 million is little, but by comparison with $270 million it is a very small part, as arithmetic will clearly show. It is only one fifth of the amount that could be needlessly spent by the government if it decides it has to sweeten the pot for the doctors.

It also means that extra money is not only coming from the so-called wealthy who are alleged to be the only beneficiaries of the present system; it is also going to come from everybody through the tax system of the province. If one buys gasoline, some of the money may go to pay the extra fee the doctors will require, instead of the privilege of extra billing for some of them. If one buys anything, the sales tax will apply and one will be contributing through that to this new expenditure. Most of all, we will be contributing through our income taxes, if and when this comes about.

I think it is coming as clearly as night follows day. If the one happens, the other will follow. All the people in the province, no matter what kind of income level they may be at, will be paying through their taxes for this alleged benefit. The Liberals and the New Democrats may think it is fair to make everybody pay, but the great majority of people in this province have many reasons to disagree, just for the sake of this draconian legislation.

9 p.m.

There is also the possibility that physicians who really value the freedom, and as I said earlier, all the ones whom I consulted have mentioned that as the only real reason they are objecting strongly to it, those who benefit from that freedom may decide that Ontario is not a good place to practise medicine and may go somewhere else where their talents will be more appreciated.

That will be a great pity. The Liberals and the New Democratic Party, and I hear them already mumbling, will scoff at this argument. Unfortunately, they both cling to their rather -- how shall we say it? -- levelling views, despite the hard evidence of the British example, which I just cited, which shows that it just does not work.

The exodus of a lot of Britain's talent to this continent, its brain drain of doctors, is a fact. Why would we expect Ontario to be immune to that same kind of dreadful situation? I do not think we could.

The number of people who leave who are specialists or are considering being specialists may be small. However, the whole issue we are talking about, as I mentioned earlier, concerns only a small percentage of doctors, something like 12 per cent of the total and only six per cent of the billing. The number may be small, but more will probably leave than the number who would otherwise extra bill without taking into account a patient's ability to pay.

Mr. Wildman: We have greater faith in the medical profession than that party does.

Mr. Davis: The member for Algoma (Mr. Wildman) certainly does not.

Mr. Dean: That was well said by my colleague here. The party on the left has no faith at all. It wants to legislate them all into a straitjacket, and it is to exactly that that the doctors are objecting.

It is not beyond the realm of possibility that this government, while it is still able to maintain an affordable and efficient health care system, can take into account the risk of the brain drain I have just been talking about. We do not want to lose those brightest, best and most forward-looking people in the profession. As I mentioned earlier in my remarks, we all know that the people who extra bill, the specialists, are not people with hearts of stone. They do take into account the ability of a person to pay in many cases.

This furor over extra billing cannot be regarded as just another labour dispute between employees and management. Fortunately, so far the physicians are not just employees of the government, and let us hope they do not become just that. They have the right to practise wherever they want.

Would lawyers accept a licensing on their fees? Would lawyers accept a ceiling on their fees?

Mr. Treleaven: No.

Mr. Davis: Would union leaders accept a ceiling on their fees -- the big bosses who make $300,000 a year?

Mr. Dean: Would plumbers accept a ceiling on their fees?

Mr. Mackenzie: They had no choice. The Tories forced them with restraint legislation.

The Acting Speaker: Order.

Mr. Dean: Would auto workers accept a ceiling on their fees? I do not think so.

Mr. Wildman: There was a large group of workers who had to accept a ceiling on their pay because that member's former government legislated it.

The Acting Speaker: Order.

Mr. Dean: Doctors who operate outside OHIP should have the same rights as everyone else. With this kind of measure, this government is trying to put itself in a position of discrimination against a certain class. It says it is not in favour of discrimination -- I hope none of us is -- but it is heading towards it with this legislation.

I am interested to hear the yapping from some of the people on the left, who do not like it to be brought to their attention that perhaps they are being very inconsistent.

Hon. Mr. Kerrio: What does the member call rent control, which his previous government put in?

Mr. Dean: It is not as bad as what the present government put in.

One of the features of what has been suggested by the Minister of Health, and I am glad to see he has finally put in an appearance, is binding arbitration in any kind of contract talks that doctors might have with the state-run doctors' service. Let us not kid ourselves. On whom is the arbitration binding? The government can change it the next day if it wants to. The government is not an employer like others; it can do what it pleases once this is in place.

Mr. Wildman: Yes. Just listen to him. On Bill 179, the Tory party did what it pleased.

Mr. Dean: I hear a broken record. I wonder whether somebody would turn off the power over there.

There could be other consequences of this bill. Doctors could even suffer, and we would suffer with them, from a government move to restrict the number of doctors who are billing just to keep manpower costs down. That is sensible if that is what it is going to do -- make everybody state employees. Then they will certainly have to watch how much money they are spending on it.

It could restrict the geographical location in which doctors can practise. It would be sensible for an all-wise state to say, "Okay, Tom, you go get it there; Gerry, you go there." If they were slaves of the state, what else could they do?

It could even cap the annual income regardless of work load; in other words, no more of this piecework stuff. No matter how many hours one spends, one is just going to get so much money.

It could limit the choice of prescription drugs for which the government will pay and could even replace medical manpower with paramedical manpower to cut costs.

Do members think that sounds farfetched? Do they think it could not happen? They should not think too long, because those measures are being carried out right now in some form in British Columbia and Quebec. They have been imposed, not with consultation but unilaterally by the governments of those provinces on the basis of political expediency, not really to improve the quality or availability of health care. I am sure they are all cloaked in the same grandiose and high-sounding phrases that we hear being spouted by the Minister of Health and some of his colleagues, notably the Premier, to give an excuse for this ill-conceived legislation.

The government should not say we did not tell it. It has happened in other places in Canada, and it is not good. It has happened very badly in Britain and in other countries of Europe. We do not want it to happen here.

We are not going to support this plan in its present form. At least, I am not going to support this legislation; I may not be able to speak for all my colleagues. I hope the minister and his parliamentary assistant will seriously consider this and will influence the other members of the government to --

Mr. Leluk: Come to their senses.

Mr. Dean: "Come to their senses" is exactly the phrase, as the member for York West has suggested, and back away from the repressive features of this bill.

Mr. Allen: I rise to join in this debate on Bill 94, the Health Care Accessibility Act. Those of my colleagues to my right who look to that title as though it were a euphemism of some kind seem quite clearly determined to underestimate the problem of accessibility that extra billing has created.

On the point of titles that are euphemisms, it seems to me that I recall a number of pieces of legislation that had rather fancy titles in another age of government in this province and that were equally misleading if one wanted to put the very worst light on it.

9:10 p.m.

I found the preceding speaker on the one hand attempting to be very thoughtful about this subject and on the other hand indulging in some rather remarkable contradictions -- and also, with respect to the history of medicare, some rather unusual comments. In addition, there was a fairly consistent strain of reasoning that struck me as being a rather severe, if not almost libellous, put-down of the medical profession.

To argue, for example, that the only reason, or even the principal reason, a student would spend eight years in university preparing himself for the medical profession is the monetary reward that would follow is a very severe reduction of the status, esteem and respect in which we all hold one of society's great profession and the traditions of healing and care it represents.

To suggest, on the other hand, that somehow there is something necessarily wrong about government when government legislates to regulate or to expand the accessibility of medicare, even if that happens to be at times in a somewhat unilateral fashion, is obviously to pay little regard to the proper role of government to legislate, and where necessary, to legislate from a rather tough frame of mind.

One wonders, for example, what kind of medical care we would have had in this country over the last 40 years if it had not been for certain unilateral action in Saskatchewan, first of all in developing a hospital plan, and then in expanding that into a full medicare system in 1960 and 1961. That had to be done, and I think, sad to say, the truth is that it had to be done unilaterally and without the co-operation of doctors in the province in question. It did take a lot of imitation by other provincial governments and the federal government, and then finally the necessity, even in Ontario in the middle of the 1960s, to press this province into some form of medicare system.

Now we are there, it is interesting to hear some of my colleagues describe the system we have as the best medicare system in the world. I am glad to hear that, because I happen to agree. I think it is probably the finest and, in many respects, the most cost-efficient medical system in the world.

About seven per cent of our gross provincial product in Ontario is devoted to the medical care system. Countries in Europe that have adopted a universal medical care system range upwards from that. The United States ranges upwards from that in the percentage of the gross national product devoted to medical care, even though the model there is often touted as being so much more efficient and based on a private medical care concept.

It would be interesting for all of us to drop into the small meetings, for example, in Swift Current, Saskatchewan, in the early years of this century. The people gathered together at the end of the first decade, shortly after their town was founded and began to discuss how they were going to provide medical services. It would be interesting to see how they developed the notion of community hospitals and projected the idea that perhaps somewhere down the road there would be a socially sponsored insurance system of medical care, which would hedge all of them against the unfortunate costs and the disastrous consequences that come when illness strikes.

If one goes back to reports of some of the meetings early in the century of trade unions or independent labour party groups, when they were talking over the medical problems their own folk were having, trying somehow to survive the medical bills of their time, one can see how early they wrote into their platforms the need for comprehensive, universal, accessible, afford able medical care. One sets that longing and that long tradition and desire over the decades against the difficulty with which it has been accomplished in the face of a medical profession that was supposed to have their very interests at heart.

One is left to wonder and to ask why that difficulty lay there in the midst of that profession and what there was about the ethics and morale of that profession that somehow sat in the way of the realization of those dreams, and why it was necessary to go through an epic encounter such as occurred in Saskatchewan before we could finally break through to something that could properly and decently be called universal, accessible, affordable medical care.

When one takes additional steps, as we are attempting in this province today, following provinces such as Saskatchewan, Quebec, Nova Scotia and Manitoba -- where the doctors are not "enslaved," to use the adjective that was used in the last speech -- why is there a difficulty in following those examples when there is experience with the elimination or absence of extra billing, with that absence not having any disastrous social, professional or medical consequences?

Mr. Sheppard: I do not see a quorum in the House.

The Acting Speaker ordered the bells rung.

9:22 p.m.

Mr. Allen: Although we have had yet another quorum call, it appears I will be addressing about as many empty Tory seats as I was before the call. The emptiness of the seats is about in proportion to the emptiness of ideas in the speeches from that side.

In the light of the remarks I was making regarding the rather ironic relationship between the medical profession and the advance of medical care through government action by our legislatures in the latter half of the 20th century, it is with some sadness I rise in my place to respond to a great profession which once more, grim-faced, announces a campaign of civil disobedience.

There might have been concessions and reasons for engaging in such an action at some time by that profession -- I do not deny that -- but Ontario's doctors have surely adopted what must be one of the most implausible causes in contemporary history in staking so much on extra billing.

It has been said by members to my right that we could have avoided this impasse if there had been negotiation. Then we were told by the last speaker that negotiations would have entailed reviewing the whole range of medical problems that currently afflict us.

While the problems are there and are the result of many factors, when one is tackling discrete problems in a sensible way in a legislature, one does not negotiate the whole world at the same time. When the doctors insist that we not talk about extra billing when we negotiate the phasing-in of extra billing, then there is a reductio ad absurdum involved; it cannot be done.

For years, in the rising campaign to eliminate this one limitation to accessibility which still remains as a principal barrier in certain specialties, the profession has raised the level of its rhetoric. We have heard about the enslavement of physicians and the denial of basic civil liberties, about the undermining of doctor-patient relationships, ad infinitum about assembly-line medicine, and time and again about the inevitable flight of medical doctors from this country to some supposed green pasture existing south of the border, from which I understand those who have fled are now returning.

What all this parade of rhetoric tells us is that the profession has somehow succumbed to a bout of mass self-hypnosis. What is truly pathetic is that after all this time they have produced no evidence, no major studies to bear the burden of their claims; quite the contrary. It is precisely this heavy emotional attachment to an unproven and even a peripheral cause that provides the essential clue to what ails so many of our doctors.

To my mind, they are in the grip of an epidemic of symbolic or status politics. The pain is real and the symbolism and the status have to do with adjusting to the realities of the modern world. The pain is real indeed, but in their fever they should probably not be held accountable for all that they say.

Even in diagnosing their problem it is important to look at the reasons they give. They are some 15,000 strong in Ontario. We have been told time and again that 12 per cent of them extra bill and 88 per cent do not. About 800 of them have opted out into a separate and independent association under the Ontario Medical Association, and there is the small, 150-member Medical Reform Group of Ontario which believes its colleagues are doing themselves no service and the public some harm in insisting on their right to extra bill.

It has been said that there is no problem simply because only 12 per cent extra bill. However, the problem is not with the gross percentages. The problem is that in certain critical medical practices and specialties there is a phenomenally high rate of extra billing. For example, 58 per cent or more of anaesthetists are extra billing; in psychiatry, an absolutely critical medical profession, 27.6 per cent; in obstetrics, 33.9 per cent, and in other surgically related specialities, 31.1 per cent.

No one can tell me that opting out or extra billing in those proportions in that range of specialties so critical to medical practice and specialization does not create problems of real accessibility for people in real need. It just cannot be the case statistically.

There is an interesting geographical dimension and an interesting professional dimension to the extra billing phenomenon. The north and east do not have as much of it. Among general practitioners, paediatricians and internists, who are perhaps closer to general practice, opting out and extra billing are not very widespread. It is rather striking when one notes the professional distinction.

Hon. Mr. Elston: This is such a stirring speech that they are cheering in the streets of Toronto.

Mr. Allen: Yes. It is getting a remarkable response outside the chamber, if not inside it.

Mr. Davis: Did the Minister of Health write it for him? I want to know when they are going to freeze Bob White's salary and put restrictions on it. Maybe he should not make much more than the guys on the assembly line.

Mr. Wildman: The guys on the assembly line are not complaining about Bob White.

Mr. Mackenzie: I do not know what it has to do with it, but the member's comments are going to be well received. They will get around.

9:30 p.m.

Mr. Allen: Some interesting analogies are being made, and as they are heard in the community they will be responded to in some rather interesting ways, I am sure.

Recently a family in my constituency wrote me a very touching letter. They had received a communication from Dr. Eisenberg. Dr. Eisenberg concluded his arguments for extra billing, some of which I will look at shortly, with a petition to this family saying, "I pray for the sake of our future children that this has not been written in vain."

That was a very pathetic and emotional load to lay on that family. The family wrote to me and said: "Please look at these reasons. Are these disastrous consequences really going to follow? Please do not let all those bad things happen to our medical practice and to our prospects for health and health care in Ontario."

I read over the letter with a great deal of astonishment. I have read other doctors such as Dr. Kenneth Walker, the esteemed doctor who advises us all through his column in the Globe and Mail. I am struck by the utter and obvious lack of evidence, information and even elementary logic in the cases that are made. Let us look at the arguments that are given.

First of all, the government penalizes the doctors by allowing them to collect only 90 per cent, as it originally was, of the fees listed in the OMA fee schedule. There is not a word about the conditions under which that 90 per cent came into play; conditions which were well understood.

With the combination of assured collection of medical bills, that 90 per cent would inevitably provide the doctors with more income than they had received in the past, given the number of bills they had to forgive. There is not a single word of the estimate that, at a 90 per cent level, they received about a 30 per cent increase in their incomes overall.

The second argument is that extra billing is necessary because the OMA schedule of fees does not reward experience or skill. This is one I have heard time and time again in recent expositions by the medical fraternities, and yet it is totally illogical. If all doctors are able to extra bill, then the doctor who has just stepped out of medical school and set up his practice can extra bill in precisely the same way as someone who has practised for 30 years. The person who is a general practitioner can extra bill in precisely the same fashion as a specialist. There is simply no sense to the claim.

If one looks behind the reason for that arrangement, one discovers that ever since 1922 the OMA fee structure has itself never allowed for any differentiation on the basis of age or skill. All the government was doing in instituting that fee program was to copy exactly what the OMA had done. If they have an objection, it is with their own profession and not with the government. I would, however, urge the government to improve on the package and the subtlety with which the payments are made as quickly as possible.

Third, extra billing somehow improves medical practice by allowing more time with patients, etc. An exhaustive study was done on this subject in 1980 for the Ontario Economic Council by two doctors at the University of Toronto, Drs. Wolfson and Tuohy. Following a comprehensive and exhaustive study, they reported conclusively that, despite the claims, extra billers did not differ in their medical practice from non-extra billers in any measurable quantity whatsoever in any number of particulars that one would wish to examine.

Fourth, extra billing will promote assembly line medicine. If true, this is surely either one of the saddest confessions of the medical profession or one of the most libelous remarks about critics of extra billing. What it is essentially saying is that if the medical profession, which is devoted to the healing arts, does not get what it wants by way of extra billing it will go on a rampage of shekel gathering by turning medical offices into an assembly line process. It ignores the fact doctors consistently stand at the head of the professions with respect to compensation. It simply is not fair to doctors with respect to the ethics of their own profession.

Fifth, it is claimed that extra billing is a deterrent to abuse of the system by patients. But when one comes to study that question, one finds that doctors do not agree as to which practices of utilization they think are excessive, redundant or unnecessary. There is no agreement in the profession on that point, so in that respect the argument simply falls to pieces.

On the other hand, the patent implication of the argument is that for those who have the wealth to overcome the deterrent, the deterrent is apparently unimportant. What one has there is a clear acknowledgement of two-tier medicine, and that is what we cannot tolerate in this province. The only people who are deterred are the poor.

Sixth, extra billing causes no hardship because doctors can tell --

Mr. Davis: Mr. Speaker, there is not a quorum in the House.

The Acting Speaker ordered the bells rung.

9:40 p.m.

Mr. Allen: I understand students outside have constructed a monument about 40 feet high that we may all go out and admire after the end of the session this evening.

As I was saying when I was once more rudely interrupted, the sixth argument given by doctors is that extra billing causes no hardship because doctors can tell who can and who cannot afford it. They say they do not extra bill the latter.

It would be nice to think that were so and that doctors knew their patients that well. We all know that not only do they not have the bureaucratic capacity, but they also handle such a range of patients that they cannot know offhand who has what income, what resources and is suffering what financial hardship. With respect to the exterior dress and characteristics of the patients in question, those things are not identifiable.

When two of my McMaster University colleagues did a study of 275 poor families in Hamilton, they discovered that of 135 who had dealt with extra billing doctors, no fewer than 107 had been extra billed. In other words, the doctors could not or would not tell the difference. Therefore, what assurance does that argument give us? It does not give us any assurance at all. In any case, even if it were true, patients should not be subjected either to the doctor's charity or to his casual sense of who can afford to pay.

Finally, the other argument that appears frequently in the discussion is that extra billing makes patients aware of the costs of medicare. This assumes that patient restraint would somehow be the critical factor in reducing costs. That restraint would, in my estimation and in the estimation of any study that has been done on the subject, inevitably fall on the poor and not on the rich. It is obvious why that would be so. Some people can obviously cope with the deterrent and others cannot. It is as simple as that. It is an open-and-shut argument against the point that is made.

At the same time, it has to be noted that the very people who are making the argument at this time, the doctors and those who defend them, appear to ignore that so much of the cost of the system hinges on the overall control by doctors of medical resources, their styles of practice and their manners of billing. All those elements lie closer to the nub of the question of cost than the question of utilization by patients. Any argument that utilization must somehow be restricted is a deterrent to the seeking of health by people who need the care of the doctors in question.

Most of the arguments used by the doctors and the defenders of extra billing point to one or another real problem, but extra billing is so irrelevant, one might even say so irrational, in answer to the problems that are cited, that none of the arguments can be taken seriously.

If compensation for age and skill are necessary, let us follow the British plan of having a peer-adjudicated merit system built in. The minister has said he is prepared to talk about those things. If cost is the question, let us get on with the rest of the studies of cost in the system, as to where cost generation comes from, and do something about it on a realistic, pragmatic basis, solving a problem instead of pointing the finger at ill persons in the community for trying to secure their own healthy niche in life by patronizing a doctor.

When I look at the implausibility of all that line of argument on the one hand and how easily it falls to pieces, and at the strength of the arguments made on the other hand, I return to my central argument that something else is being defended, and that something is being defended in a symbolic fashion.

The arguments are hastily constructed walls around the sacred, so-called, tower of professional freedom, which the doctors believe to be threatened by the modern world of universal medicine. In a sense, they are right. Certain manners and styles of practising medicine are threatened. One cannot provide equally accessible medical care on the basis of the almost medieval fiefdom of medical practice that some doctors appear to prefer.

It is also inconsistent with the private-enterprise model of medicine so many of them keep throwing up to the public in self-defence. One simply has to insist that health is not a commodity. It is a primary need and a condition of everything else in life, and all human beings have a right to the services to maintain it. By the same token, health care is not a commodity that one can buy or not buy as one pleases. Either one needs it or one does not; one needs it in a hurry or one does not need it at all. That is usually the case.

Does an ill person decide who is the best doctor to perform an appendectomy when an attack of appendicitis strikes? Does an ill person who has been subject to a badly botched triple bypass have any alternatives in the market to compensate for what happened to him? To use the language of private-enterprise medicine really comes down to an exercise in the grotesque.

In discussing the question of the freedom of doctors, the previous speaker asked, "Who will be next to be struck by the state in this enslavement of a profession?" What is the implication of that kind of remark for other professionals who are on salary, including doctors who are on salary?

Is it, for example, that social workers, professors, city engineers, urban planners, doctors or dentists on salary with corporations or elsewhere, are necessarily unfree and enslaved? Can they not practise or pursue their specialties in those contexts? I would have to say surely they can and surely they do, because many of us have lived our professional lives in the context of salaried employment.

We were not bound by that fact to dispense assembly-line education, for example, or assembly-line social work. We were obligated by the ethics of our profession to treat people as individuals and as persons who deserve respect and to honour the canons and ethics that an educator or a social worker had to perform in order to live with himself.

The whole question of professional freedom around this issue is a package of stuff and nonsense. Extra billing confers no freedom of any consequence for the medical practice of any doctor; nor does the failure of the ability to extra bill limit the freedom of any doctor's professional service to his fellows in the pursuit of his medical practice and commitment.

On the other hand, surely it is time for the medical profession to acknowledge wholeheartedly the vast expansion of its freedom to serve people's health as a result of universal medicare. In fact, that freedom will be expanded by the removal of the last vestiges of the obstruction to accessibility and affordability of medical care.

9:50 p.m.

There is no other freedom that is more critical to the existence of the medical profession than the opportunity to dispense medical care in adequate facilities, with adequate equipment, in adequate conditions for the people who need that kind of health care. There is no question, in essence, of civil rights involved, although Dr. Eisenberg keeps using that language.

What I submit the medical profession should be about when it discusses the question of rights today is applying itself to developing a bill of rights for both doctors and patients which is appropriate to the new circumstances in which doctors and patients find themselves in the context of a developed, universal, affordable, accessible medical care system.

The problem doctors face, which is reflected in the very dispute over extra billing, is how to square their own freedom and their own rights with respect to a whole new context of the practice of medicine that has overtaken them. That is what I mean by status politics and symbolic politics; that problem of professionally squaring their goals, images and objectives with the realities of the circumstances in which they find themselves in the latter years of the 20th century.

They should have a right to substantial assistance with the cost of medical education -- and they do to the tune of 90 per cent -- in recognition of the service they will provide to the community in later years. They have a right to medical care as a system. They have a right to medical facilities that are equivalent to the skills they have.

They have a right to the expenditure of sufficient research dollars and sufficient research facilities in the universities and elsewhere so that their very skills can be utilized to the maximum on behalf of the people of this province. They have a right to have their patients have access to drugs at a reasonable cost so that they when they prescribe they do not put the incomes of their patients in jeopardy in any respect, and so that their treatment and diagnosis may be fulfilled in the fact of what follows.

They have a right as a profession to some form of allocation in our society, which we have still not satisfactorily resolved, of medical practitioners in all regions of the province so the public will be well served and no doctor in any region will necessarily be overworked simply by the limits and shortages of medical practitioners in that part of the province.

In other words, there are many things our doctors should be addressing themselves to, and in some respects are beginning to, in developing that bill of rights they and their patients require for satisfactory health care in this province.

It is in the light of that -- I come back to my opening remarks -- that one finds oneself rising to speak in this debate with more than a touch of sadness that a great profession should be hinging so much upon a so badly researched and so badly argued case. It does not do justice to the great traditions they bring to the health of the community.

I would not want to submit any individual doctor to substantial criticism with respect to his subscription to extra billing, given the anxieties that this conflict between medical practices and ethics of the past and the new realities of medical practice requires. Extra billing is not, however, the last refuge of scoundrels. It is simply the misguided and irrelevant defence of outmoded styles of professional practice which get in the way of universal, accessible, affordable medical care for every person in Ontario.

Mr. Gillies: On a point of order, Mr. Speaker: A large group of architecture students from the University of Toronto is building an obelisk in front of the building to protest the announcement today that its faculty is going to be closed because of underfunding of the universities by this government.

Mr. Speaker: What is your point of order?

Mr. Gillies: The point of order is that because the students are putting so much work into this and they are most anxious that as many members as possible see it before it is taken down tomorrow morning, I suggest to all members that before they leave tonight they take the opportunity to go and have a look and talk to the students.

Mr. Speaker: That really has nothing to do with what is taking place in the chamber. It is a great point of information. Thank you for the information. We will carry on.

Mr. Callahan: I could stay silent for about 20 minutes, and it would be equivalent to what has been said by the official opposition during this entire debate. I find it interesting that in this important debate, to which I came anticipating spending my time in a useful project, that when there are three, four or five members of the opposition present and they are debating what they espouse

Mr. Davis: Do not forget the debate on francophone education.

Mr. Callahan: There is the member for Scarborough Centre. We are going to get rid of the member too. He should come out and run in my riding and I will beat him.

Mr. Davis: Do not bet on it.

Mr. Leluk: The pharmacists will take care of him.

Mr. Callahan: I am glad to hear that. I do not know the riding of Mr. Leluk --

Mr. Davis: Pride goes before a fall. My friend should be careful.

Mr. Callahan: I had anticipated being very low key, but the member, whose riding I do not know, seemed to think it was very important that I made a comment about some of the pharmacists in my riding selling peanuts. I have already addressed the record in that regard.

Going back to my original opening, I came here to do things, to speak on behalf of the residents of my riding and of Ontario. I am rather dismayed by the approach this Legislature takes in espousing the cause of the pharmacists to begin with. To address my good friend the member for Scarborough Centre, as the Minister of Education (Mr. Conway) would say, they have been so concerned and caring about the people of this province they seem to forget that for a number of years, perhaps 10 or 12, the people of this province were ripped off. They seem to forget they are speaking on behalf of the people of this province, not just the rich, not just the middle class, but the poor as well.

Mr. Davis: I think we will put lawyers on a government fee schedule next.

Mr. Callahan: I would vote for that. With all due respect, if the member would listen rather than just spouting out occasionally he might learn something.

I want to say, and I do not seem to be getting to that point, that I came here as a freshman MPP, and other people came here as freshmen MPPs, and saw that what was happening was a reshaping of this province. It is a question, after 42 years, of starting to look towards the interests of those people who are not here with lobbyists and are not here with the ability to be able to speak out. They ask us as their advocates to speak for them, to speak for all sections of Ontario, north, south, east and west.

The official opposition is interested in one thing. It is interested in satisfying a group that might contribute to their coffers in the next election.

10 p.m.

Mr. Callahan: I looked at the Sun today and I watched Joe Clark standing there with Mickey Mouse. One can tell that they are equally Mickey Mouse. They are not here for serious issues. They are not here to speak on behalf of the average Canadian or the average Ontarian. I would like to get my hands on an Instamatic camera so I can record those people in the official opposition who will vote against this bill when it comes before the Legislature for a vote, who now consider themselves -- s

Mr. Andrewes: On a point of privilege, Mr. Speaker: I am sure the member for Brampton (Mr. Callahan) has understood from his legal training the meaning of impugning motives. Without varying too much from the discussion at hand, I would suggest that you call him to order.

Mr. Speaker: I was listening very carefully, and the honourable member does not have a point of privilege. He was, I suppose, trying to make a point of order.

The member for Brampton on Bill 94.

Mr. Callahan: It is too bad Hansard cannot record the frivolity with which the official opposition seems to address this issue.

Mr. Davis: Too bad Hansard cannot point out how many members of the Liberal Party are not here for important events.

Mr. Callahan: The member for Scarborough Centre always has a bright comment. I always listen to him, because I think his comments are important.

All members of this Legislature and the things they say are important; every member of the Legislature is a sincere, caring individual. However, I have to rise with reference to Bill 94 and the question of the pharmacists bill and say I have been disappointed by the attendance of the official opposition. Very often we have a spattering that looks as if the member for St. Andrew-St. Patrick (Mr. Grossman) had just taken the football and gone home, because they would have three of them in here.

I notice in looking up in the galleries around -- I cannot see in that gallery there, but I can certainly see in the galleries there -- the massive number of people who are concerned about this issue. The people who are concerned about this issue are the people of Ontario -- not the doctors, not a special group but the people of Ontario.

It is not addressed by the official opposition. The official opposition, according to every speech I have listened to thus far, would like to look after the special interest groups.

Mr. Davis: Are lawyers a special interest group?

Mr. Callahan: If I were a former cabinet minister in the official opposition who had to go to bed at night recognizing the fact I had allowed Ontario -- the majority of the people in this province are not lawyers, doctors or rich people; they are average individuals who work hard for every dollar they take home and are concerned about those dollars, whether they be out of their pocket or out of the pocket of the public purse, in terms of moneys that are being spent on the Ontario drug benefit plan, which was allowed to be ripped off by this official opposition, who did nothing about it.

I would like to return --

Mr. Speaker: To Bill 94, I hope.

Mr. Callahan: -- to Bill 94. I happen to feel I am a very privileged individual to have the opportunity to be a professional in this province. The schools I attended were paid for by the taxpayers of this province. The university, the law school, my right to practise and the courts in which I have to this point experienced great delight in practising and where I also made my professional income were paid for by the taxpayers of this province. It bothers me and creates great --

Mr. Laughren: Was the member a Queen's counsel?

Mr. Callahan: I was a QC. I am no longer, and I am proud of that fact.

Mr. Davis: Did the member earn it or was it a patronage gift?

Mr. Callahan: Try to get a QC in Brampton when it was under William Davis and tell me how I got it, okay? I happen to be proud to have had the opportunity, to have had the God-given intelligence -- and I worked hard for it -- to have received a first-rate education in this province which allowed me to become a professional.

To relate it to Bill 94, and there is a relation, in some respects it has always embarrassed me that members of my profession who get a little hoi polloi and make a few bucks are not prepared to represent a person on a legal aid certificate.

In my view, the attitude of taking legal aid is fixed to the fact that those institutions I make my professional income from are paid for by the taxpayers of this province. I feel a commitment, and every member of my profession should feel a commitment, to deal with each issue which deserves justification for the totality and the largest portion of this society.

I will bring the topic back to Bill 94. I have heard speeches in this House that would embarrass me absolutely and totally if I were a doctor.

Mr. McClellan: Completely embarrassed.

Mr. Leluk: Totally embarrassed.

Mr. Callahan: The doctors of this province had equal opportunities and the God-given gift of some intelligence to be able to get into medical school. They obviously went through a university which was paid for by the taxpayers of this province, and they went into the practice of medicine. One would hope, and I sincerely believe, 90 or 95 per cent of the doctors in Ontario went into medicine because of the high principles of the Hippocratic oath, because they were concerned about people and knew what they were getting into. Unlike politicians who vote themselves a 45 per cent increase when they get in, doctors went into it because they wanted to heal people.

As I said before, if I were a member of the medical profession, listening to the garbage --

An hon. member: If you were a member of the medical profession I would leave the province.

Mr. Andrewes: Garbage is a big problem in Brampton.

An hon. member: If you were a doctor I would stop defending the system.

Mr. Callahan: That is probably unparliamentary. I withdraw that statement. If I went into the profession and I had to sit on those benches --

Mr. Speaker: The member for Brantford (Mr. Gillies) is not in his own seat. Would he refrain from interjecting.

Mr. Davis: You are coming back.

Mr. Callahan: That is right, the member for Brantford is not allowed to speak, so do not speak. If the Speaker could keep the member for Scarborough Centre quiet, I would appreciate that too.

To get back on track, if I were a member of the medical profession I would be embarrassed. What we are talking about is the same thing which embarrassed me as a municipal politician: setting one's own salary. I would be willing to bet -- I have a lot of doctor friends --

Mr. Leluk: You won't have many doctor friends after they hear this speech.

Mr. Callahan: I am sure the member for York West (Mr. Leluk) will send a copy of Hansard to the doctors just as he did to the pharmacists, and I hope he does, because I am telling it the way I feel and I am representing my constituents. I hope the official opposition will represent their constituents; those who are not the select groups, but the people of Ontario who are not quite as favoured as they are.

Having been given these opportunities, an education and medical degree which cost a significant amount, they took that degree for the reasons I have stated. Those members in the official opposition may figure they are advancing the cause of the professionals in the medical profession. They do not know the doctors I know, who would be embarrassed by the shenanigans they are carrying on and by the absolute and totally dishonest way they are dealing with it in this respect.

10:10 p.m.

Mr. Davis: Mr. Speaker, on a point of privilege.

Mr. Callahan: I have not finished yet. Let me tell the members how this dishonesty

Mr. Speaker: Order. There is a point of privilege, and I hope it is a point of privilege.

Mr. Davis: I believe it is a point of privilege. l believe the member who is speaking has impugned the integrity of the members of this House who are defending what they believe is important in the argument. He said they were dishonest. I think that is out of order and unparliamentary for a member of this House.

Mr. Speaker: I am sorry, but I was doing something else and I did not hear it. However, I would like to inform the member it is definitely not a point of privilege.

Mr. O'Connor: Point of order.

Mr. Speaker: Okay.

Mr. McClellan: It is abusive and insulting language of a nature likely to create --

Mr. Speaker: That is right. I am sorry I did not hear it. If the member for Brampton did say that, I am sure he will want to withdraw it and continue with his other remarks.

Mr. Callahan: Actually, I will replace that word with "unsatisfying" and "unsavory."

Mr. Speaker: Are you willing to withdraw?

Mr. Callahan: Yes, I will withdraw the word "dishonest."

The point I am trying to make is that I participate in these debates as much as anyone and the only member thus far who has been prepared to admit how he is voting is the member for Oakville (Mr. O'Connor). He said he was going to vote against it on second reading. That does not necessarily mean anything either. With all the eloquent speeches that have been made by the official opposition, I have not heard from one other member in favour of it. It sounds like the guy who is in the canoe who wants to assist himself with some problem he has internally. He tries to put one foot on one side of the canoe and one foot on the other side and have the benefit of both sides.

That is exactly what those guys are trying to do, with all due respect. They are not addressing the fact that this Minister of Health had the guts, after probably 10 years of waffling by previous ministers, to call a spade a spade and to say that in Ontario we are going to uphold the principle that we have the finest, and I underline that, the finest medical system in the province of Ontario, in the country of Canada and probably in the world.

Some members may have had an opportunity to review the comments of Kennedy in the United States Senate. They came up here and viewed our system because they consider it to be absolutely fantastic.

This system was introduced initially by the federal Liberal government. I also have to give accolades to Tommy Douglas. When Tommy Douglas was interviewed by Patrick Watson he was asked, "What do you ever expect to do, Tommy?" and Tommy said, "We are the conscience of the people." Perhaps that is one of the advantages. They can call it a court if they like -- I do not care if they call it a court -- but they are in some respects the conscience of the people and they do keep the two free enterprise parties in line. They make certain we care about the people of this province and this country. For that, I thank them. I would not join their party because I happen to be a free enterpriser. I do not subscribe to what they say, but I do say they are the conscience of the people.

Mr. Andrewes: The member should look at his free enterprisers. If that is free enterprise we are destined --

Mr. Callahan: Let us get back to free enterprise. One of the first tenets I was taught as a professional was that I was lucky to be a professional. They did not have to tell me I was lucky to be a professional. The member for Oakville will share with me the fact that in representing people as he and I do in courtrooms, one deals with people of all types, normally the downtrodden, and one begins to realize those people do not receive the same benefits as the privileged in this province.

This province is not for the privileged, the middle class or the poor; it is for everybody. I remember the old slogan from the 42 years of Conservative government, "A place to stand." That place to stand is not for any privileged group, for any one of those three I have addressed; it is for everybody who cares to be an Ontarian.

I exhort members, as caring legislators on all sides, to go out tonight and try to determine whether there are senior citizens, poor people or disabled people who are not able to receive adequate health care through the medical system as it exists without going cap in hand to a doctor. Whether or not we like it, there are such people in this province.

That is not to put the doctors down at all. The medical profession in this province is par excellence. It includes people who care and who will sit with their patients and review the questions of alcoholism, marital or psychiatric problems. They do care. I do not want anything I say to be construed as meaning they do not. Suddenly, however, we have a group that wants to get a little extra money.

An hon. member: Twelve per cent.

Mr. Callahan: Twelve per cent, and probably as low as about 10 per cent, according to the figures I have.

Let us look at why. What is the gist? Why do they want extra billing? They want it because within the framework of the previous government, now the official opposition, it was determined that the Ontario Medical Association, which was given the money by the government, should have the right to determine how it would be allocated to doctors under the Ontario health insurance plan legislation. That is the reason they have to extra bill; if some guy has been out of medical school for 10, 15 or 20 years or he is an expert or a specialist, he should be entitled to receive a greater benefit than the guy who is wet behind the ears and just out of medical school.

The member for Oakville will know it was in the legal aid plan, which is probably the closest parallel to OHIP with the exception that lawyers give 25 per cent of their fund back to the province -- I do not see that happening with OHIP.

Interjection.

Mr. Callahan: We give 25 per cent back to the province, but I get more than does the guy just out of law school, and the member for Oakville knows that.

I want to give others the opportunity to speak, but I am going to refer to two items. The first one is a passage from the Toronto Star, dated January 22, 1986, which I would like to read into the record. I would like to put one other item on the record and then I will sit down and take my place.

"A 70-year-old diabetic with one eye has used her grocery money to pay doctors' bills for five major operations." This is her quote; sleep with this, guys and gals: "`I had to do without clothes, too, and any other extras,' she says. `Friends and relatives helped me through every time. But it's tough, I'm telling you.'

"She cheered when the provincial government introduced Bill 94 to prevent doctors from charging more than their patients can recover through the Ontario health insurance plan.

"The Ontario Medical Association says people can always choose doctors who work within the plan, and even those who withdraw from it don't `extra bill' patients unless they can afford to pay.

Here is another quote from this 70-year-old diabetic, who could be your mother or mine:

" `But I had no real choice....I was very sick. It wasn't like I could shop around. I paid without question every time I went to the hospital. It bothers me very much not to pay my bills, and I needed their help or I was going to die.'"

Did the Star set that up, or is that really a pensioner talking? If there is one pensioner in this province who is going to be affected by the approach the Tories are taking to extra billing, it is an absolute shame.

10:20 p.m.

Interjections.

Mr. Callahan: I will go on if I may. I want to give them a little bedtime music.

Mr. Davis: We will sleep after listening to the member.

Mr. Callahan: Why does the member for Scarborough Centre not listen for a second? Let him think with his head instead of his mouth.

She says only one doctor in a battery of specialists asked if she could afford his bill. Then he reduced his $300 fee to $100 for her sixth operation. Apparently, he spoke to the others too, because they did not bill her that time. Her name is withheld -- get this -- because she is afraid. Do members know why she is afraid? I will quote from her. "I have to go back to the hospital and I am scared of getting in trouble with the specialists. I have to trust my life to them."

If there is one comment that sums it up, that is it. We all have parents who are about the same age, and by God, I do not want my mother to have to be worried about the specialists.

I will give members one final item. I opened my presentations with my first speech in this House, for which I got hell from the press gallery for talking about a young child. I used the words -- I say them again and I stand by those words -- "He made the Elephant Man look like Clark Gable." This was a young lad who had been born with a great deformity. I have lived with that young man, in terms of knowing his grandfather and I respect those people totally.

Do members want to know how they are dealing with the issue? They went to a specialist, an expert, in one of our fine medical institutions. He performed operations on this two-year-old child to try to correct some of his deformities. As I recollect, the bill was three times the amount it would have been under OHIP. His mother and father, who are kind, caring, respectable, hardworking people, had to go to a service club to institute a charity to try to fund the extra costs.

If the people in the official opposition and the doctors of this great province can sleep comfortably with that fact, then I pray to God that their children and loved ones are never faced with that problem. I hope no one on the side of the official opposition ever has to face that situation.

I will be watching very closely, as I hope the province will be watching with its seniors, its disabled, its disfigured, its poor and its middle class, when the Conservatives vote on the issue that they have now espoused in this Legislature.

Mrs. Marland: In rising to speak this evening in total opposition to Bill 94, I must first comment on the title of the Health Care Accessibility Act. In my opinion, that is an absolute contradiction with respect to meaning and intent.

The real issue before us, as responsible representatives of the people of Ontario, is not an issue of physicians opting in or out. It has nothing to do with billing, extra billing or otherwise. It has to do with the subject of freedom, not only the freedom of physicians to choose but, equally important, the freedom of patients to choose.

I am not suggesting that everything is perfect in the present system. In this world, obviously, nothing is perfect, least of all anything to do with government. There is always room to improve everything, but that is never done by throwing out the baby with the bath water. It is done by making sure the next bath the baby has is in an improved bathtub with clean water. In the meantime, the baby is alive and healthy and surviving.

If we want to kill the main good thing that we Ontarians have going for us in this province in health care, if we want to destroy that one aspect of health care which is good, we can support Bill 94. Along with the rest of my Progressive Conservative caucus, I have very grave concerns about Bill 94. We have those concerns because we are informed and bright enough to see and understand the real problems with the health care system in Ontario.

We recognize that the issue can hardly be the 12 per cent of the province's physicians who are opted out, especially when only 20 per cent of them extra bill. It may be that the majority of the public does not know or realize those figures and, therefore, I do not expect the public to understand the issue of extra billing.

With the amount and the angle of information the media has fed the public on this subject, it is no wonder the public says, "Of course, we are opposed to extra billing." It is rather like asking them whether they prefer to pay for their groceries or have them free. It makes about the same amount of logic and sense.

The public has not been told by the media what the long-term costs of banning extra billing really are. We can hear the Premier say that the Canada Health Act is costing the province about $50 million per year in penalties against the extra-billed dollar amount. What the Premier does not tell the public is that if Bill 94 were to become law in this province, the increased doctor's fees for all to be opted out under OHIP and paid the OMA schedule of fees could cost additional hundreds of millions of dollars.

I have to ask the question, has a patient ever died from extra billing? I have an example I would like to quote from an incident that took place in North Bay.

Mr. Speaker: The member has one minute. I do not know how long that will take.

On motion by Mrs. Marland, the debate was adjourned.

10:30 p.m.

Mr. Speaker: The acting House leader has some information for members.

Hon. Mr. Elston: I do have some information for the members. I want to advise the House that the real House leaders have agreed to designate the standing committee on social development as the committee to which Bill 71 is referred, in accordance with arrangements made earlier.

COURT RULING

Mr. Speaker: Pursuant to standing order 28, the question that this House do now adjourn is deemed to have been made. The member for Brantford (Mr. Gillies) gave notice of his dissatisfaction with the answer to his question given by the Attorney General (Mr. Scott), as announced earlier. The member for Brantford has up to five minutes to debate and the minister has up to five minutes to reply.

Mr. Gillies: This is the second occasion on which the Attorney General and I have had an opportunity to debate this issue. I will say at the outset that I very much appreciate the attention and the arguments that were made by the Attorney General when we last spoke on this issue on Tuesday evening. For the record, I appreciate that he is treating this with a sincere interest as I have brought to his attention the concern that surrounds this issue in my riding.

This evening I want to address my comments to the question I asked today and to the response from the Attorney General, not about the specific case I raised in the House last week but rather about the sentencing procedures surrounding cases of the sexual assault of people generally, frankly, not just of children and minors.

My question to the minister was whether the duration of the assault was a prime and an appropriate determination in the sentencing. The reason I asked that question was twofold. In the letter the Attorney General very promptly addressed to me on the subject of the specific case I raised last week, with regard to a sexual offender on his third offence being given a sentence of two years' probation, he said:

"The sentence in question was regarded as appropriate by the crown counsel in question because the sexual assault, while wrongful, was very brief in duration and in the specific circumstances of the incident not within the category of extreme misconduct."

This led me to make some inquiries of the ministry about exactly what were the prime determinants of the severity of such an assault and the severity with which it was treated by the court. The minister's office told me that the age of the victim was a factor, as well as the duration of the assault, the nature of the assault, whether it was repeated and the prior record of the offender.

I also talked to two crown attorneys, one here in Toronto and another in my home constituency of Brantford, and I was told that many factors were taken into account: the brutality, again the duration of the attack, and whether the act was repeated.

What I would like to get by way of response from the Attorney General is whether the duration of such an act is a prime determinant and whether it is appropriate that it should be so viewed by the crown. I would submit that a sexual assault on a young child can be extremely damaging regardless of its brevity, while an extremely prolonged and brutal attack is going to leave terrible scars on a young child.

However, we have had evidence. Members of the standing committee on social development of this House especially have had much evidence brought before them in the past that would indicate that even a brief encounter can scar a young child and lead to problems in later life.

I would ask the Attorney General to review this whole process. I want him to assure me and to assure my constituents and others interested in this matter that when the crown is looking at the duration of an assault and at the age of the victim, we are not attaching some kind of meat-chart mentality to this kind of crime: that a 15-minute attack is by its nature less damaging than a 30-minute attack; that an attack on an eight-year-old child by its nature is not necessarily less damaging than an attack on a 10-year-old child or a 15-year-old or a 20-year-old.

It may well be that some of the comments made by the learned judge in this case, and the quote from the Attorney General's letter, are subject to misinterpretation. However, I would submit that the anger in the public which, quite frankly, surprises me, the breadth of that anger and the depth of that anger, may be cleared up by a clear and unequivocal statement by the Attorney General as to how these cases should be dealt with.

He should not leave the impression abroad in our province that the duration is an overwhelming factor or that the nature of the assault, the repetition of the assault and so on were overwhelming factors. I believe this should be cleared up. I feel the Attorney General perhaps did not understand what I was asking or did not have enough information this afternoon. That is why I filed my dissatisfaction with the answer to the question.

Hon. Mr. Scott: The other night, in the earlier version of night court, my friend and I debated the question of whether an appeal was appropriate in this case. I take it we have now passed on from that issue, which is problematic and difficult, to the question of sentencing principles.

My learned friend, who is naturally concerned about this case and about principles in general, in my respectful view misunderstands the jurisdictional responsibilities in this case. It is for the Parliament of Canada under the Criminal Code to establish the parameters within which a sentence in each case must lie.

The Parliament of Canada has decided that for sexual assault, depending on the way the case proceeds, the penalties may lie between an absolute discharge and a penalty of 10 years. That is a decision made by the Parliament of Canada, and this Legislature has no right to alter those outside parameters. Within those parameters, it is the exclusive jurisdiction of the court to decide which of the various possible penalties should be selected for each individual case.

In this case, the judge selected a penalty, and my learned friend thinks the penalty was inapt. He may be right, but it matters not what he thinks or what I think. The reality is that the parameters having been set by the Parliament of Canada, subject always to appeal, the issue he wants to put behind us, which was debated the other night, the decision about what is the appropriate penalty, having regard to the relation of the offence to the public welfare, is a matter subject to appeal exclusively for the trial judge.

If my learned friend thinks the trial judge has misconducted himself or has applied a principle recognized by the common law, which is not appropriate, his remedy again is to ask the Parliament of Canada to pass an amendment to the criminal law to exclude the kind of consideration that the learned trial judge in this case applied.

When determining the punishment appropriate for an offence, the cases in the court, which I cannot alter, nor can he, nor can this Legislature, are quite clear. They establish a number of factors and a number of criteria.

Among those criteria, in cases of sexual assault, are the following: the presence of physical injury in the commission of the offence; the presence of psychological injury in the commission of the offence; the duration of the offence; the presence of violence and the threat of violence. When the judges are deciding where on this scale between absolute discharge and 10 years the penalty should be fixed, they are allowed to consider those factors.

My friend may be entirely right that those are not the appropriate factors. Of course, if they are not the appropriate factors, or if the parameters between discharge and 10 years are wrong, his remedy is to petition the Parliament of Canada, which has exclusive jurisdiction to deal with these matters and to make the appropriate changes.

Even if I agreed with him, even if I could persuade my cabinet and caucus that he was right, which would be easy to do because he is so persuasive, we could do nothing about it in this Legislature. It is a matter for the Parliament of Canada, and the next late show should take place in Ottawa.

The House adjourned at 10:40 p.m.