L100 - Mon 27 Jan 1986 / Lun 27 jan 1986

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

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The House resumed at 8 p.m.

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

Resuming the 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. Guindon: I will carry on from where I left off. The Cornwall Standard-Freeholder is a member of the Ontario Press Council. The article I quoted from earlier was published on Wednesday, January 15, 1986.

I urge the Liberal government and its allies to listen to the concerns of the people of this province, rethink and try to find a method to restore the mood of co-operation between the government of Ontario and the medical profession it seeks to regulate.

Before I sit down, I want to read part of a letter sent to me on October 31, 1985. It is from Dr. Robert W. Harris, who is a specialist in plastic, cosmetic and reconstructive surgery and surgery of the hands. He is affiliated with both the Cornwall General Hospital and the Hotel Dieu Hospital. He is also the past president of the Canadian Society for Surgery of the Hand.

On page 2 of his letter, Dr. Harris writes: "Because of the restrictive qualities of the Régie de l'assurance-maladie du Québec and the contraction in patient care facilities, such as hospital beds, operating time, etc., I had the time to spend in community affairs. Here in Cornwall, as the only doctor in my two specialties, I barely have time to brush my teeth each day. An easy day is 12 hours long and many run 15 or more. There are many emergencies generated by alcohol, Highway 401, and the various industries around town. Hardly a week goes by that we do not have a roller injury of the hand from Domtar, for example.

"All the doctors here in Cornwall work very hard, and I am impressed not only by their energy but also by their competence and devotion to their patients. It is because of this that I am very distressed to see this same nonsense developing from the provincial government that began in Quebec in 1976. Interference in the profession's functioning has ruined health care in Quebec and the same tragedy appears to be commencing here in Ontario.

"When I made up my mind to leave Quebec at age 49 because the situation was intolerable -- having to wait 48 hours to get an accident case into the operating room -- I began the process of obtaining an American visa. I came to Cornwall in response to a need for a surgeon trained in reconstructive and hand surgery and was very pleased to find medicine being practised as it should be, with the attention of everyone -- administration of the hospitals, doctors, nurses, etc. -- directed at the patient's need.

"In two short years that situation has deteriorated. A few weeks ago I was told I could not operate after 6 p.m. on a patient with a fracture of the hand because it was too costly to bring back a nursing team for the operating room. I was offered time in the OR for the next day. In other words, budgetary considerations took precedent over professional standards.

"Is this the great health care system that the government likes to tout? It was because I was unable to practise to North American standards that I was forced to leave Quebec (une crise de conscience) and it will be for the same reason that I will leave Cornwall.

"I now have my `green card' and will not hesitate to move on if I see the situation becoming unacceptable here. Medicine is a great profession and I have no intention of betraying it by practising below the standard I have learned and tried to maintain over the years.

"If the Ontario government wants to cut costs by closing beds and restricting access to operating room facilities, the quality of care will obviously descend. The concern of the people's representatives should be to find new money to fund the system. The private sector should be brought back in to share the responsibility for the rapidly expanding health needs of the public. You cannot expect progress to be made by cutting back, but the public purse does not have to be exhausted either.

"The system has encouraged overutilization. Every week half the operations I perform are unnecessary, but people insist on having them since they are insured benefits: moles, cysts, etc.

"I like Cornwall and its people.

"I think the community likes having a specialist in plastic and hand surgery here. In all humility, I think Cornwall needs a reconstructive surgeon. Transfers to Ottawa and Kingston are often risky and dangerous, let alone inconvenient to the patients and families. I am certainly prepared to accept the responsibilities that go with this position, being the only one in a specific field, but I am not prepared to accept the doctor bashing that is becoming more and more audible. It may be political expediency but I do not have to put up with it. The human body is the same in the United States, and I have all my papers in order so the message should be clear: lay off or I am gone.

"Sincerely yours, R. W. Harris, MD."

I have here photocopies of documents Dr. Harris has obtained from the US authorities. He is registered as a resident alien and has a licence to practise medicine in the state of New York.

I said earlier this evening that doctors have no problem with extra billing. I have told members why the doctors in Cornwall are so angry over this bill, which would ban extra billing. Cornwall cannot afford to lose the expertise of Dr. Harris or any other specialist who may choose to leave us. We are fortunate to have the services of such men and women. It would be criminal if they are forced to leave because this bill will not permit them to stay.

Mr. McClellan: I welcome the opportunity to speak briefly in this debate. Many of my colleagues in the New Democratic Party have already spoken, and we all have an enormous degree of pride and satisfaction in the fact this legislation is before us. We hope that in a very short time, a matter of weeks or months, it will be passed into law and extra billing, which has been a threat to the universality of our medical care system, will be a thing of the past.

8:10 p.m.

For us, the issue is very simply a question of whether a universal medicare system continues to survive in Canada or is allowed to disintegrate as it did in Australia and New Zealand through the process of extra billing, privatization and the reintroduction of co-insurance. For the past eight or nine years, a gap of 30 per cent to 40 per cent has existed between the Ontario Medical Association fee schedule and what the Ontario health insurance plan is prepared to pay doctors. If that situation is allowed to continue and a significant minority of specialists --

An hon. member: A minority?

Mr. McClellan: Of course it is a minority. It has always been a minority and regional phenomenon, what health analysts have called a cluster phenomenon. In some parts of Metropolitan Toronto, obstetricians have opted out at a rate of 100 per cent. For example, one cannot find an opted-in obstetrician in North York. We are talking of a difference of $600 or $700 between what obstetricians charge and what the insurance plan will pay for births.

In our major hospitals in Metropolitan Toronto, all the anaesthetists are opted out. In this city, every single anaesthetist is opted out and they all extra bill. Unless one is prepared to undergo surgery without benefit of anaesthesia, a practice I recommend heartily to my Tory friends to prove their dedication to the principle of free enterprise medicine, one is faced with bills in the order of hundreds of dollars.

We are not talking about an insignificant problem confronting patients in our medical care system. It is a major threat to universal health care that has been with us in Ontario in a significant way for almost 10 years. If it is allowed to continue, it is simply a question of time before people insist that they be permitted to take private insurance to cover the gap between what medicare pays and what the doctor-specialist charges. It is as simple as that. Once that happens, medicare is a dead duck.

That is what killed medical insurance in Australia and New Zealand. The gap was permitted to widen between what the doctor charged and what the insurance plan was prepared to pay. The private insurance companies were allowed to come back into the field and provide private coverage on top of and in addition to medicare and medicare was dead and buried. If we think that could not happen here, we are deluding ourselves. We are crazy. It would simply be a matter of time before exactly that happened.

This is not just my peculiar view. It is the view of virtually every health planner and analyst outside the Ontario Medical Association who has looked at the question, including Mr. Justice Emmett Hall. He studied the matter in a royal commission and came to the conclusion that we must do what we are doing here in the Legislature right now and end extra billing.

It has been a long campaign. I was reviewing the Hansard of the Ontario legislative debates earlier today. It was initiated by the New Democratic Party in 1978. We have been asking first the Conservative government and now the new Liberal minority government to end extra billing for eight years. An interesting process of conversion has taken place during those eight years in response to the demand of public opinion. The public in this country has demanded that medicare be protected and that governments at all levels, federal and provincial, take action to ensure it is protected.

In 1982, the federal Liberal Party in Ottawa adopted the view that extra billing had to be outlawed. In the historic month of September 1983, the provincial Liberal Party changed its position that extra billing was an essential safety valve, repudiated that policy and took the position we had taken since 1971 that extra billing was a threat to medicare and could not be tolerated. In 1984, the parliamentary group of the federal Progressive Conservative Party in the House of Commons in Ottawa took the position that extra billing had to be outlawed. When the legislation was introduced by the Liberal government in Ottawa, it was supported by every Progressive Conservative in the House of Commons.

Hon. Mr. Kerrio: Are you sure?

Mr. McClellan: I am positive.

Hon. Mr. Kerrio: Is that on the record?

Mr. McClellan: Vince, for once I know exactly what I am talking about.

Mr. Cousens: The member should not call the minister by his first name.

Mr. McClellan: The member for Niagara Falls. The minister will know exactly whereof I speak.

We are enacting companion legislation to the legislation that was passed

Mr. Martel: Look at this. The handsome waiter just came in.

Mr. Rowe: Look at the Minister of Consumer and Commercial Relations (Mr. Kwinter). He has been out wine tasting.

The Deputy Speaker: Will the member for Bellwoods please carry on? That is not the Deputy Speaker coming in.

Mr. Martel: He is a handsome waiter.

Mr. McClellan: I am struck speechless by this apparition that has come into the House. I think the minister should dress like this all the time.

We are here to pass companion legislation to the enabling legislation that was passed by the House of Commons. It has imposed a dollar-for-dollar penalty on every province that permits extra billing. For every dollar doctors extra bill their patients, the federal government withholds a dollar of transfer payments.

That is what is happening here. We are following the lead set unanimously by the House of Commons. We are enacting enabling legislation that has already been enacted by Nova Scotia, Manitoba, Quebec, British Columbia and Saskatchewan.

To listen to the language of the Progressive Conservatives in this Legislature, one would think the War Measures Act was being reintroduced in a more draconian way, or at least that they supported the War Measures Act.

Mr. Martel: They supported the War Measures Act.

Mr. McClellan: I cannot believe they supported the War Measures Act.

The member for York Mills (Miss Stephenson), the former acting Minister of Health, the member of the Ontario Medical Association who was president of the OMA when medicare was introduced in 1971, who invented opting out as the first doctor to opt out of medicare in Ontario, described this legislation as an act of terrorism.

The leader of the official opposition, the member for St. Andrew-St. Patrick (Mr. Grossman), described it as a hand grenade lobbed into the health care system. If one can believe it, other members have been even more intemperate and inflammatory in their language. I wonder what mischief they intend by that inflammatory rhetoric, that confrontational language.

I know something about the use of hard rhetoric in this Legislature, but I would be embarrassed to use the language of terrorism and guerrilla warfare to describe legislation that safeguards and protects universal medicare. I wonder what mischief is in the minds of those who use this kind of rhetoric and what their purpose is.

I notice the Leader of the Opposition is travelling around the province. He has given up trying to make any impact here in question period. Instead, he has decided to go out on to the highways and byways and is reported to be giving tactical advice to various OMA chapters.

8:20 p.m.

Mr. Martel: I hope he continues it.

Mr. McClellan: I am not so sure. With the example he has set here in the Legislature of wretchedly excessive rhetoric, is it any surprise that shortly after his first seminar to the leaders of the OMA about the best way to approach this issue so the public will really understand what the Conservatives are saying, the president of the OMA is quoted in the Toronto Star as saying this legislation will make Ontario doctors worse off than doctors are in the USSR?

We are now going full circle. It is hard to understand how legislation that was eagerly supported by Brian Mulroney when he was in opposition, then eagerly supported by Brian Mulroney during the election campaign and now eagerly supported by Prime Minister Brian Mulroney now can be described as the very essence of Russification and communization, to say nothing of - -

Mr. Polsinelli: Maybe they are not Progressive Conservatives, just conservatives.

Mr. McClellan: I do not know. I am also amazed at the misanthropic view of doctors that is held by my Conservative colleague the member for Lincoln (Mr. Andrewes). It was not the member for Lincoln; he would never say that. It was the member for Durham-York (Mr. Stevenson).

The member for Durham-York, who is normally a very calm and almost placid spokesman in the Legislature, was heard ranting and raving on January 21 to the effect that in Quebec, because extra billing has been outlawed, "it is common knowledge that all sorts of cash is changing hands under the doctor's desk in Quebec." In other words, this usually quite sensible member is alleging that because extra billing is not permitted in Quebeç, the only way one can get specialist care is to bribe the doctor by payments of cash under the table.

He goes on to say, "The minister is putting the professional people in this province in a position to be crooks." The member for Durham-York, a minister of the previous government, expresses the view that it is necessary to bribe doctors in Quebec to get care if they do not extra bill and that if we pass the legislation we will have to bribe them here in Ontario to get service.

This is one of the most appalling pieces of nonsense. I have been here for 10 years and I have heard a lot of nonsense; I may even have contributed a lot of nonsense. However, I have never heard anything quite this stupid, and I say that with great respect and with a great deal of sincerity. I have never heard anything as bizarre as the proposition put forward by a previous cabinet minister that if extra billing is outlawed in Ontario, we are going to have to bribe our doctors to get medical care.

What is going on in the minds of my Conservative friends? Have they been so traumatized by their fall from office that their brains have been curdled?

Mr. Martel: Scrambled.

Mr. McClellan: Scrambled, whatever. They are certainly not making any sense. If they believe that somehow this kind of anti-doctor rhetoric is going to appeal to their local chapters of the OMA, I find it incomprehensible.

I do not know who is advising the Conservative caucus these days, but they are providing a gold mine of ammunition for their political opponents during the course of this debate that I assure them will be mined assiduously in the weeks and months to come.

The kind of irresponsible, wildly excessive and libellous anti-doctor rhetoric that has been used by the Tories during this debate ascribes to the medical profession the most venal and unprofessional motives I have ever heard ascribed to any professional group. I assure the members that these quotes will come back to haunt them because the people of this province are not interested in that kind of self-serving nonsense.

It may be the Conservatives are still sufficiently uncomfortable with the opposition role that they think if one is in opposition, one can get away with saying anything about anybody. I assure the members, from sometimes sorry experience, that is not so. A member of the opposition is just as accountable for what he says in here as is a member of the Treasury bench. I predict some members of the Conservative Party will be very sorry for some of the things they said during the course of this debate.

Mr. Jackson: We will have to go to the United States for an operation.

Mr. McClellan: One of the Tories said one would have to go to the United States. That is the kind of scare tactic the Tories are running during this debate: If one ends extra billing, one will have to follow one's doctor to Texas and pay $35,000.

The doctors are coming back from Texas because we have a better health care system in Ontario. Medicare has been a great boon to the medical profession. Doctors do not have to worry about unpaid bills and they have guaranteed annual incomes that average in excess of $80,000. They also do not have to hire collection agencies or bodyguards.

It is a strange tack the Conservative Party is on, as it sails into the far right, trying to appeal to what Dalton Camp respectfully calls the "cashew coalition." Perhaps the Conservatives have identified a new constituency out there, an orchard of cashew trees waiting to be harvested, and they intend somehow to try to appeal to every reactionary voice in our community.

There are lots of loud reactionary voices, but the people of this province are not interested in that kind of extremism; the previous Premier, William Davis, knew and understood that. The kind of extremist position the Conservative Party is taking in this debate will lead to some very interesting results whenever the runoff election takes place.

The issue is very simple: Will medicare survive or will we have a two-class health care system, with those who are rich enough able to buy the services they need on the private market and those who cannot afford to do so, subsidized by a welfare system as they are in the United States? That is the choice in front of us.

I am amazed when I listen to members of the Conservative front bench in question period and in this debate, especially the previous Health ministers, the member for St. Andrew-St. Patrick (Mr. Grossman), the member for Don Mills (Mr. Timbrell) and the member for Cochrane South (Mr. Pope). I listen to them criticize the government for taking a legislative approach and saying the solution should be negotiated with the OMA. Give me a break.

8:30 p.m.

The government of William Davis tried to negotiate a settlement with the OMA on extra billing each year from 1978 to 1985. I remember the member for Don Mills coming before this House on March 29, 1979, and proudly announcing his agreement with the OMA which was going to solve all the extra billing problems. He had negotiated an agreement, and no doctor would extra bill a patient unless they had given a previous consultation giving advance notice; if he did not give advance notice, the patient would not have to pay the bill.

The member for Don Mills proudly announced he had this agreement with the OMA. Four years later it turned out there was no agreement. The agreement was not worth the paper it was not written on; there was no agreement. The minister had a verbal understanding of sorts with the OMA such that his successor, the member for St. Andrew-St. Patrick, had to admit to the Legislature there was no agreement between the Ontario government and the OMA with respect to extra billing.

The minister of the day, the member for St. Andrew-St. Patrick, undertook to negotiate further with the OMA. He negotiated so successfully that we had a strike. In 1982, we had the first doctors' strike in the history of Ontario. That was the accomplishment of the successor to the member for Don Mills, the member for St. Andrew-St. Patrick, in using the negotiation route.

We had a strike. We had not even had a strike when medicare was introduced in 1971. It took the unique diplomatic and negotiating skills of the Leader of the Opposition (Mr. Grossman), his unique set of charming and sensitive human relations skills, to precipitate us into the first medical strike in our history.

How did he get out of that strike? Did he negotiate his way out of the strike? No, he bought his way out of the strike with $1 billion worth of the taxpayers' money. The settlement of the 1982 doctors' strike cost the Treasury $1 billion over the life of the agreement. I will not go into the lugubrious details of the terms of the agreement, except to say it is the most generous settlement in the history of collective bargaining in Ontario.

Mr. Martel: We should have him bargaining for us.

Mr. McClellan: Everybody should be lucky enough to be bargaining against the member for St. Andrew-St. Patrick. We would all be millionaires.

The fact remains that the health care budget of this province has increased by almost $1 billion since 1981, and all that money represents the $1-billion settlement extracted through the negotiating skills of the then Conservative Minister of Health.

Despite the payment of $1 billion in additional fees and a fee schedule under the Ontario health insurance plan that has kept doctors at the top of the economic pyramid in our society, a minority of doctors are still insisting on their right to squeeze even more money out of their patients and to put the medicare system at risk.

Quite frankly, despite the rhetoric that appears daily in the newspapers, I do not believe the majority of family practitioners in Ontario, almost none of whom extra bill, are prepared to punish their patients for the sake of a tiny minority of specialists who are intent on gouging their patients. I do not believe it.

I know it may disappoint my Conservative friends that the doctors may not storm the barricades, that there may not be another strike. I do not think there will be. I think once the law is passed, the medical doctors, like most people in this province, will obey the law and that will be that. Medicare will be safeguarded and we will be able to get on with the job of meeting the health care needs of the people of this province.

I say again, as many of my colleagues in the New Democratic Party have said during the course of this debate, we are proud of the role we have played in the campaign, both here in Ontario and in the House of Commons in Ottawa, to end extra billing. It has been a long haul, lasting more than eight years and involving many thousands of people. At one point, a petition with 250,000 signatures was gathered and presented to this Legislature.

It is a great day for the people of Ontario when their government has brought forward legislation that will end extra billing and keep medicare as something that is universal and protects every man, woman and child from the potential economic catastrophe of illness. We will not allow our Conservative friends to destroy medicare.

Mr. McFadden: The best thing one can say about this bill is that it is short. We often deal with long and sometimes convoluted pieces of legislation, and this bill is neither long nor convoluted. It is remarkable, however, how much damage and disruption such a small bill will cause to the delivery, range and quality of health care services in Ontario. It reminds me of a nuclear device that may be small in size but can cause a tremendous explosion and devastation over a broad area when detonated.

This bill has set in motion a chain reaction that could do widespread and permanent damage to relations between the government and the medical profession but, more important, widespread and permanent damage to the health services provided to the people of Ontario. In my opinion, this legislation is wrong from professional, practical and moral points of view.

The problem starts with its name, the Health Care Accessibility Act. It does not deal with accessibility to health care in any truly meaningful way. The title is misleading and mischievous. It is misleading to the public since it does not in reality make health care services more available to the people of Ontario and may well cause the reverse to occur in practice. It is mischievous because it is insulting to the thousands of fine doctors, dentists and optometrists who in a dedicated fashion provide services that are fully and readily accessible to every person seeking their help and advice.

When we get past the misrepresentation of the title of the bill and turn to its substance, it is clear this proposed legislation is an attack on the medical profession the government will come to regret because of the damage it will cause. If the damage were simply to the reputation and record of the government, I would not care; however, the damage will be far more serious than that. If this bill ever becomes law, in the end it will shatter the essential working relationship and trust between the government and the medical profession and could lead to a major deterioration in the quality of health care in Ontario.

Many people make the wrong assumption that the opposition of the Ontario Medical Association and its membership to this bill is based primarily on a concern about doctors' incomes. This is not the basis for the medical profession's opposition to the legislation. Anyone who assumes this is making a fundamental and dangerous mistake. As does anyone in society, doctors like to make a good living. This is only natural, and doctors deserve to make a good living in the light of their level of training and expertise and the vital, often life-or-death importance of their work.

8:40 p.m.

The real basis for the opposition of the medical profession to this bill is the attack it makes on the freedom and independence of the profession and the punitive and draconian sanctions set out in it. Doctors believe the right to bill above the OHIP fee schedule is a fundamental freedom which is absolutely essential for the maintenance of their status as a self-governing profession.

I know the desire of the doctors to maintain this right is repugnant to my friends to the left and their fellow travellers, the Premier (Mr. Peterson) and the Minister of Health (Mr. Elston). However, the proof of this can be seen in the fact that 88 per cent of physicians today in Ontario are fully opted in and of the remaining 12 per cent, a large majority follows the OHIP fee schedule.

Yet with the exception of a small, even infinitesimal, number of doctors, the profession is overwhelmingly opposed to the government's legislation, as the meeting of the Ontario Medical Association's provincial council proved on January 18.

The concerns of doctors about this loss of freedom was brought home to me recently by two family physicians who care for myself and members of my family. One is a man in his late 70s who served with distinction as a doctor in the front lines in the Second World War and has practised medicine in North Toronto with tremendous devotion for decades. Carrying out his practice in an office located in his residence, this doctor is always available at night and on weekends for his patients who need him. He will make house calls. Yet he is fully opted in and has never billed above the OHIP schedule at any time in his practice.

The second physician is a younger man, in his early 40s, who carries on a busy practice in partnership with another doctor. He is hardworking, with a thriving practice, and has an excellent reputation for first-class service for his patients. Like the first doctor, he is also fully opted in.

While these doctors are a generation apart, they also have another thing in common. They are completely and utterly opposed to this bill because they fervently believe it is a flagrant attack on their profession and on their personal freedom. Both have told me in no uncertain terms what they think of this legislation and how vehemently they are opposed to the policy direction of this government in the area of health care.

The vehemence felt by doctors about the government's legislation is reflected in a recent letter sent by a constituent of mine, Dr. Gordon Yanchyshyn, to the Premier, dated January 6, 1986, a copy of which was sent to both the Minister of Health and myself.

Dr. Yanchyshyn, who specializes in adolescent psychiatry, wrote as follows:

"I am writing to strongly protest your government's proposed legislation on physicians opting out. The scope of the proposed bill and the haste with which you are attempting to ram it through the Legislature are interesting indeed. The proposals are both intrusive and dictatorial, suggesting a strong anti-professional bias.

"Your Minister of Health has repeatedly demonstrated his ignorance about the root causes of the inadequacies and uneven distribution of health services in the province. In addition, he shows no understanding of the reasons that certain specialties in particular opt out of OHIP, nor does he care to understand.

"Targeting opting out as "bad" misses the mark. You have alienated the medical profession in the process and set a tone of confrontation rather than negotiation. I suspect this is just a hint of things to come."

Another physician who I think typifies the real nature of the doctors' opposition to this bill is Dr. Earl Myers, the president of the Ontario Medical Association. Dr Myers and his wife Ethel have been friends of myself and my family for a number of years. Dr. Myers is a quiet and warm individual who is a dedicated physician and a highly respected specialist in his field of medicine. He is also fully opted in.

Dr. Earl Myers has never charged above the OHIP schedule; he is a fully opted-in physician.

Yet he is diametrically opposed to Bill 94 because of the arbitrary way the government has acted in introducing this legislation and the threat it poses to the freedom of the profession. Dr. Myers is far from being a radical, but he is prepared, as he has stated repeatedly, to fight the government in every way possible to stop this legislation.

His concern about the Union of Soviet Socialist Republics, which was commented on by the member for Bellwoods (Mr. McClellan), is something Dr. Myers believes strongly and personally. It is not in character for him to make remarks such as that, but he is so upset about what he sees this government doing

Mr. Warner: Poor Mr. Myers.

Mr. McFadden: I would not say "Poor Mr. Myers." He is an excellent physician. He has provided excellent service to thousands of people for more than 40 years, and I do not think he deserves snide remarks from any member of this House.

The deep philosophical opposition of the medical profession to this bill should not be underestimated or sneered at. Doctors look on this legislation as a direct and vicious attack on themselves personally and professionally, an attack that will have a negative effect on health care in Ontario. Doctors, however, are not the only people who have seen the true character of Bill 94. I find it interesting that many newspapers have recognized the negative nature of this legislation.

The Ottawa Citizen editorial on December 21, 1985, entitled "Declaring War on the Doctors," said: "Is it legislation, or is it blackmail? It's a valid question in the wake of Ontario's harsh assault on extra billing by doctors. The editorial continues:

"That the Liberals banned extra billing is no surprise: they have been promising to do it ever since they wrested power from the Conservatives last June. But their uncompromising approach seems almost deliberately provocative, as if the government actively wants a confrontation with the doctors.

"The government either doesn't realize, or has wilfully ignored, that banning extra billing has complex psychological implications for many physicians. As long as they have the option to set their own fees, doctors can view themselves as independent professionals. Once their incomes are fully within the power of governments to determine, they become glorified civil servants, beholden to capricious and arbitrary politicians for their livelihoods -- and subject to even more controls and restrictions.

"This is a signal change in the profession's self-image. If the Liberals are determined to ban extra billing, (despite the suspicion they are motivated more by politics than policy), they should have the maturity to deal sensitively with those genuine fears.

"As a group, doctors are among the most skilled, dedicated and essential members of society. They don't deserve to be singled out as targets by self-serving politicians in a populist appeal for votes."

The Toronto Sun ran an editorial on January 8, 1986, under the heading "St. Nightmare." It stated: "While Elston hems and haws about the problem of cancer hospitals and offers amounts of two million here, a million and a half there, the estimates of how much is really needed are soaring -- from $110 million for cancer centres last June to $150 million yesterday, to a quarter of a billion in 10 years.

"These figures are just for cancer care. They don't include the needs of general hospitals. It's a nightmare in the making. It's past time to wake up and do something.

"Yet Elston and the Premier have surveyed the health scene and decided nothing is more important than to make war on the very men and women who have made our hospitals work through the good years and the lean years.

"So their priority is not cancer care or hospital funding but to turn doctors into white-collar criminals -- and their patients into squealers -- just because a comparatively few doctors charge more than the government wants.

"When these political lawyers operate, the patient is lucky to live."

8:50 p.m.

That is the Toronto Sun. I would like to move to London, the home town of the Premier. The London Free Press has published two editorials against the government's current legislation. Obviously, the Premier does not read his home town paper. The latest editorial, contained in the December 21 edition of the paper and entitled "Draconian Slap at Doctors," states:

"Notwithstanding Elston's claims, the transparent reasons for the extra billing ban are not medical but political. Provincial Liberals, in conjunction with the New Democratic Party, have decided that the contractual rights of doctors should be drastically curtailed in the public interest.

"Moreover, the draconian nature of Elston's bill suggests an element of vindictiveness against provincial doctors."

That is from the London Free Press.

Finally, the Kingston Whig-Standard had a lengthy editorial on this subject on January 14 under the heading "Prescription for Disaster." The editorial, which covers a large part of the editorial page, reads as follows:

"There is an old farm expression, `If it ain't broke, don't fix it.'

"Why are doctors in Ontario now facing a situation that many feared would come to pass when Canada first embraced medicare almost two decades ago? Was there a great groundswell among the population concerning medical treatment, opted-out doctors or exorbitant fees?

"The answer is no.

"Why, then, do we have legislation pending before the Ontario Legislature which for all intents and purposes will control doctors' incomes? The reason is political opportunism at both the federal and provincial levels....

"Politicians feel they are on safe ground. All the surveys, including one done by this newspaper, show that the public, having not had to worry about the financial ramifications of illness for the past 17 years, is quite used to having this perceived free service and doesn't want to pay any doctor bills. Since doctors have considerably more income than the average, the average response is that doctors have plenty of income. However, if we wish to continue to receive the level of service we are now receiving from our physicians, doctors must have a financial incentive to work long hours and provide their own benefits.

"It is much easier for a physician to work within OHIP than to opt out. But the opting-out provision has provided a safety valve. It is a sensible way for doctors to demonstrate their frustrations if the government sets unreasonable fee levels.

"The real crisis in health care costs is not doctors' incomes but the success of our medical treatment. The population is living longer, and the older we become, the more medical treatment we consume. An ageing population will continue to push up medical costs. We are going to have enough problems coming to grips with these increased costs without grinding down our physicians in the process.

"The proposed legislation should not be passed in its present form. If it is, there is no doubt in my mind that we will rue the day that we deliberately told our most important group of medical professionals that they can no longer function except as employees of the state."

That comes from the Kingston newspaper that endorsed the Liberal Party in the last provincial election.

These editorials have recognized the unfairness of the legislation and the draconian attack it represents on the medical profession. The minister perhaps lives under the illusion that he can bulldoze this legislation through the House, present the medical profession with a fait accompli and expect it to bow down and carry on just as before. This will not happen, because the doctors will not take this lying down; nor should they.

One has to ask why the government chose to set loose this whirlwind within such a vital area of service to the people of Ontario. It is based on politics pure and simple. It seems to be good politics, based on public opinion polls, to push around, intimidate and pillory the doctors of this province. The fact that it is bad for the health care system is of little consequence to this government.

The way in which the medical profession was treated in the period leading up to the introduction of the bill and then in the legislation itself proves that the whole concept of open, consultative government paraded around by the Premier and his minister is a complete and utter charade. The government's claim to be open and consultative is, to quote from Shakespeare's Macbeth, "a tale told by an idiot, full of sound and fury, signifying nothing."

While the lack of real consultation and dialogue points to the political agenda which is at the base of Bill 94, the most disturbing aspect of the bill is its failure to deal with the major substantive issues facing health care. One might be able to justify the tremendous acrimony and bitterness generated by this legislation if the bill addressed the mammoth challenges that we will face in the delivery of health care in the years ahead. The bill not only fails to address these challenges but also threatens our ability to meet the challenges in the future.

The government has failed to make a case for the public need for this kind of draconian legislation. Given current legislation and programs now in place, the vast percentage of opted-in physicians who are charging the OHIP fee schedule, and even those opted-out physicians who are charging the OHIP fee schedule, few, if any, Ontarians are being denied good medical care. Poll after poll has shown that the vast majority of Ontario residents are happy with the current health care system and believe it provides first-class service.

The very legitimate concern about the extra billing of senior citizens and others on limited income could have been satisfactorily negotiated with the Ontario Medical Association if the government had been prepared to sit down and talk with the doctors without arbitrary preconditions.

Mr. Warner: They refused to talk.

Mr. McFadden: They were prepared to talk about that.

Mr. Warner: The OMA refused to talk.

Mr. McFadden: As a precondition they were not prepared to negotiate extra billing, but they were prepared to sit down and talk about all these other things.

The Acting Speaker (Mr. Morin): Order.

Mr. Warner: Talk to the seniors about that.

Mr. McFadden: As a principle, senior citizens should not be billed above the OHIP fee schedule for any medical services. We should accept that as a principle. Senior citizens should never be billed above the OHIP fee schedule.

When viewed as a percentage of the total amount of doctors' services provided to senior citizens in Ontario, only a very small fraction results in any form of extra billing. I argue that even that fraction should not exist.

However, the OMA was and is now prepared to end all extra billing for senior citizens. The government could have talked to the doctors in good faith and negotiated this result. This matter was open to negotiation and could have been settled; but the government was not looking for a settlement in this case, it was trying to score a political point.

Mr. Warner: The OMA would not negotiate.

Mr. McFadden: We have a claim here that the OMA was not prepared to negotiate. That is not true. The member for Scarborough-Ellesmere might check with the OMA to clear up the fact.

The government has dressed up this draconian legislation under the guise of accessibility. If there is any real problem of accessibility, it relates to the availability of hospital and chronic care beds and the lack of various treatment facilities in a rapidly ageing society. The bill does not touch on those issues which are at the heart of accessibility, and yet it purports to be the Health Care Accessibility Act. It does not deal with these important availability issues.

9 p.m.

While accessibility is an absolute prerequisite for any health care delivery system, surely the most important priority must be the quality of the health care offered. Our goal should be to ensure that every Ontarian can secure the best medical treatment available anywhere in the world right here in this province. We have been able to achieve that goal in Ontario at present.

All one has to do is witness the large number of patients who come to Ontario from across Canada and around the world for medical attention. These people would not be coming to Ontario from the western provinces and the Maritimes, from the United States, the developing world, and even from Europe, were we to have a crummy medical profession, a bunch of scoundrels practising medicine or a medical profession we should kick around and pillory.

In Ontario we have a medical profession of which we can truly be proud and whose competence and accomplishments are recognized by patients and practitioners across Canada and around the world. We should be proud of our practitioners. We should be prepared to negotiate with them openly and in good faith. This bill gives no acknowledgement of that whatever. Fundamentally, this short, mean bill effectively denigrates the outstanding work of our physicians.

More than this, will this bill enhance the quality of future health care in Ontario? Will it encourage top-flight medical research to be done here? Will it influence the best specialists to practise in Ontario and to develop treatments and procedures that will lead the world in caring for the sick and in curing illness? Will this bill establish the essential foundation for a working relationship between physicians and the government based on mutual trust and respect? The answer to each of these questions is a resounding no.

This whole matter was brought into focus in a recent discussion I had with one of the top cancer researchers in Canada, indeed in the world. This researcher, who secured his doctorate in Europe, is a member of a number of major international research bodies and is frequently invited to address medical groups across Canada, in the United States and abroad. He personally attracts hundreds of thousands of dollars a year to this country for cancer treatment and research.

This researcher told me that experience throughout the world has clearly proven that legislation of this type over time -- not instantaneously but over time -- will cause the departure of many of the best medical specialists from Ontario and will discourage medical specialists from coming to this province from other countries.

The negative atmosphere surrounding this legislation creates the very real threat that Ontario will become a medical backwater. This creates the possibility that Ontarians may be forced to leave this province to secure sophisticated treatments that will not be developed or applied in our hospitals because they simply will not have the specialists to do them.

This is quite a bill. It has created a sense of hostility and betrayal within the medical profession that could sour relations between government and the medical profession for years to come. It represents an unjustified attack on the rights of a self-governing profession which has provided first-class medical attention and service for the people of Ontario.

This bill fails to deal with the real issues of accessibility or to address the quality of health care. In fact, it stands to put in jeopardy the excellent health care system we have developed over the decades in Ontario. I would urge the government to suspend further action on this legislation and to sit down with the medical profession without preconditions to develop in a co-operative manner a strategy and a program to deal with the real health care issues in Ontario.

Mr. Cousens: I would begin by offering my compliments to the member for Eglinton (Mr. McFadden) on an outstanding presentation of the facts. It was a fine discourse in the tradition of the riding of Eglinton, following on from the former member, the Honourable Mr. McMurtry. I am sure his constituents will be proud of what he said. I for one learned from his outstanding contribution this evening.

We are talking about a very important bill, Bill 94, An Act regulating the Amounts that Persons may charge for rendering Services that are Insured Services under the Health Insurance Act.

Hon. Mr. Bradley: Is the member for Sunday shopping?

Mr. Cousens: Take a powder. The minister likes his own voice, but there are times when we really get tired of hearing his interjections, which have nothing to do with this important legislation before us.

Mr. McClellan: I remember the member heckling me 10 minutes ago.

Mr. Cousens: That is different.

Mr. Speaker: I wonder if I could get the discussion back on track and forget the verbal spills.

Mr. Cousens: The Minister of the Environment (Mr. Bradley) is full of it and we appreciate the fact he is in the House, even if his brain is not. I am speaking to this bill on behalf of all the constituents of my riding of York Centre, a large riding to the north and east of Metropolitan Toronto, including the communities of Markham, Unionville, Thornhill and Richmond Hill, a community of close to 180,000 people, bustling with industry and growing at 250 to 300 people a day who require the kind of services we are talking about in this bill.

We are talking about a community that already has two hospitals and a third on the way. We have one of the finest institutions in York Central Hospital in Richmond Hill, which represents the best of what health care is all about. Although it is tight to provide all the services that are needed because of the growth in the region, none the less, the spirit that the staff, the doctors and the administration of that hospital give to its patients is a credit to the health care system in this province.

The second hospital is the Shouldice Hospital in Thornhill, where people come from around the world to receive treatment, a very excellent form of treatment the Shouldice family has instituted for hernia. I am proud of the fact it has been able to do so much for so many people. Some in this House have benefited from its services.

We are also building a third hospital, the Markham-Stouffville hospital, which is in progress now and will be built within the next couple of years.

In speaking to this bill, I speak on behalf of my constituents, who need and require quality health services. They have come to expect it. They are able to receive it within our own community, and if not they have been able to travel just a little south of the border of Steeles Avenue to Scarborough Centenary Hospital, Scarborough General Hospital or North York General Hospital. There our province has been able to provide this basic fundamental service which until now people have taken for granted.

I know the accusations the third party likes to throw out that one is a spokesman on behalf of the doctors. That party's members can speak for themselves. None the less, I have a great admiration for doctors. As one who has occasionally had to use them, without exception I have found exemplary the care, concern and compassion the medical profession has been able to show.

We should not for a moment forget that the medical profession is a called profession. It is a dedicated one. In taking their oath, doctors have taken it seriously. Despite the fact there have been some statements in the media and by some physicians, deep down there is a genuine and true concern for the people of this province on the part of our medical profession.

In this debate, we have to respect that general practitioners, specialists and doctors of all kinds in our province are now feeling they are like prisoners condemned to death. It is now a matter of choosing the means of execution. There are people who feel threatened by the changes that are being recommended by the government in this bill. Unless the government changes its point of view and its mind, there is going to be a great let-down within that profession.

I believe that can have a serious, deleterious effect on the future of health care in this province. Why is the new government creating an atmosphere of confrontation and hostility to the point of being tyrannical, to the point where doctors are feeling quite hurt by the outrage the government seems to be throwing at them? What we are seeing is a new atmosphere, one of confrontation, and it is going to affect the ongoing quality of our health care system.

9:10 p.m.

I genuinely believe there is a need for consensus and for consultation and that through dialogue and sitting down together there will be a new spirit that can continue in the tradition that existed in the past. It is not always an easy relationship, but it is one in which discussion takes place, one in which people sit around the table and come with a common desire to continue to promote quality health care.

I resent, and many people in this province resent, the fact that there is now a questioning fear of what has happened to our health care system. If we see the continuation of this bill, as we did with the arbitrary action of removing QCs and the arbitrary action through the spills bill, which is now having a serious effect on insurance companies, farmers and truckers, we will move into a new age in the health care system in this province; and that makes me and many others very unhappy.

We have to broaden the context and look at the entire health care system in the whole context in which we live as Ontarians and as Canadians. We have to look at the total cost of health care. It is one of the largest expenditures for the province. We have come to expect that it is going to be an excellent system.

The sum of $50 million in transfer payments that we are losing from the federal government can be compared with the many millions of dollars that are going to be spent by the government in trying to woo the doctors back into a negotiating stance. The cost is going to go up in spite of the fact that we will get the $50 million that will be owing to us for the three years. The increase will far exceed that dollar value in the kind of tradeoff the government will have to make to negotiate and win back any goodwill.

We are imposing a system that in the long term will have very serious, detrimental effects. We run the risk of losing many specialists, many qualified medical practitioners who will move from our country. They have been morally bound to provide a service to their patients. Now we will hear them say instead, "If we are treated this way, if this is the way the government really thinks of us, then why stick around?"

That is going to be a problem in Ontario as it was in Quebec. If I have time in this speech, I would like to draw on some of the experiences Quebec has had.

There are two fundamental premises to the health care service that our province has come to take for granted. I will get to Nova Scotia and to the other provinces as well. I would be pleased to do so, because what we are seeing in this province is not a useful approach by the government to the physicians; it is going to be nothing but harmful in its future effects.

Like all of us in this House, I believe in accessibility. All we have to do is to look to the United States and to Britain to realize that we have accessibility and that there are ways in which we can meet and address the concerns brought up in the Canada Health Act.

I further believe that the issue in health care goes far beyond extra billing. It has to do with meeting the needs of our whole community. There are new concerns about acquired immune deficiency syndrome; we have not solved that one. There are new concerns about cancer; we do not know what to do about that. Though we are putting more money in, it is still not sufficient to meet all the needs. We have chronic care needs and we have nursing home needs.

Our province has an ongoing need for more and more health services. It requires a commitment by legislators, by the government, to sit down and talk and in that conversation to come up with the kinds of compromises and the kind of consensus that allow us to continue to work together.

Why is the Liberal government pushing this legislation through? It is a rhetorical question, and I have a number of answers that I think begin to address just why it is doing this.

Is it because of the accord? The accord certainly is a part of it. I have a copy of it here with me. It is the Agenda for Reform: Proposals for Minority Parliament. In reading through the accord, document 2, Proposals for Action in First Session From Common Campaign Proposals, to Be Implemented Within a Framework of Fiscal Responsibility, the third item down says, "Ban extra billing by medical doctors."

Therefore, the accord has had a certain part to play in why the government has brought this bill forward. It is to the credit of the New Democratic Party's diligence on this issue.

Mr. Warner: Does the member want us to take a bow?

Mr. Cousens: To the member's own integrity, I respect the fact that he has fought against extra billing for a long time. It now is on the government's agenda largely because of the persuasion of the NDP. It was one way of getting the government in. That has to be seen as one of the reasons the government is doing it, but I do not think it is the only reason.

Another reason has to do with the Canada Health Act. If the provinces of this great country have not instituted a health care system that will eliminate extra billing by July 1, 1988, under a program that is different according to each province, then our province alone can lose in the order of $50 million a year.

That $50 million becomes $150 million in three years and continues in perpetuity as long as the act stands, unless some compromise is made. Why is the government doing this? Is it truly because of the Canada Health Act? It has to be done by July 1, 1988, and there is time between now and July 1, 1988; there is the rest of 1986, all of 1987 and the first half of 1988. There is a long time to go during which the government could continue to negotiate with the Ontario Medical Association to come up with a satisfactory solution.

Although the Canada Health Act is part of the reason, it is not the whole reason. There is time and opportunity to work out an arrangement, if the government wanted to do that.

A third reason the Liberal government is pushing this through may have to do with campaign promises. It does with the NDP. The third party has been consistent in its desire to eliminate extra billing. To what extent was it really a promise?

Mr. Philip: Why is the member opposing it? Does it have something to do with campaign finances?

Mr. Cousens: Let me get to the point; I have a number of them. I am trying to figure out the rationale for the Liberal government proceeding with this bill. Most of the other promises are only promises the NDP made. The NDP is actually the strength and backbone of the government. The ideas for change and advancement have come from Elie Martel.

Mr. Speaker: The member for Sudbury East.

Mr. Cousens: They come from the honourable members in the third party, who are moving this country to a socialist state, which is most contemptible in my view.

The campaign promises are now becoming a reality. The people of Ontario did not know that the promises of the third party, which until now have not been worth a bit of dust and which people could ignore and not pay any attention to, would lead to this. The people of this province have not given their confidence to the third party to run anything, but now it has the opportunity to make the agenda for government. The people will have a chance to reckon with that at some future opportunity I look forward to and will enjoy.

The Liberal government is fulfilling the campaign promises of the third party. In so doing, it is going to have an unsettling effect on many people in Ontario. They did not elect the members of the third party to run the government. In this case, through the accord, that is what is happening.

One wonders whether a fourth reason the government is instituting Bill 94 has to do with media support. I see there is one outstanding news reporter in the gallery and there are a few others who will have the opportunity to read Hansard. May I suggest to the members that in Russia and the Soviet Union the government controls the media. In Ontario, do the media control the government?

Mr. Martel: You sound like Brian Mulroney.

Mr. Cousens: I want to give them their share.

Mr. Martel: Poor Brian.

9:20 p.m.

Mr. Cousens: Poor Brian. The people of Canada will see through the kind of press he is getting and will know that behind him there is a government that is giving us the highest standard of living and an improvement in our gross national product.

The media for a long time have had on their agenda the elimination of extra billing. I look at the Toronto Star --

Mr. Philip: I thought the member said we controlled the government. Now he is saying the press controls the government.

Mr. Cousens: I am just asking the question. I am asking why the Liberal government is doing it. One of the reasons is the accord, another is the campaign promises and yet another is the Canada Health Act. Could another reason be the media? The member just has to listen and then maybe he will understand.

I have some excerpts from various media that are strongly supportive of the government's stand, the Minister of Health (Mr. Elston) and the whole gang across there. The media are saying, as did the Toronto Star in January 1986 under the headline "Being Fair to Doctors:

"By ending physicians' extra billing, the Ontario government is being fair to patients, conforming to the Canada Health Act. In keeping faith with the electorate, it remains for the government to devise a system to be fair to the doctors as well."

Do they listen to the media or do they listen to their hearts and consciences and try to do things right?

One of the things the media have desired for some time is to end extra billing. Orland French, in one of his fine columns in January 1986, said, "If it were to display a spark of interest in the plums, then it would automatically appear to be interested in accepting a ban on extra billing and it wants no part of that."

It is hard to get the context of what he is saying. He too is saying doctors just go after the plums. He makes the point that they are saying to get rid of extra billing.

In Toronto there is the Medical Reform Group of Ontario, which is pushing its desire to end extra billing through all the Toronto papers, including the columns of Lorrie Goldstein in the Toronto Sun. I also agree the Liberals are using the issue as a smokescreen to cover up the issue of the real problems affecting our health care system, such as chronic underfunding and misallocation of resources.

I find it incredible that the Ontario Medical Association refused to negotiate with the Minister of Health while this bill was being prepared. It is not true, as the member for Eglinton (Mr. McFadden) said. There was a willingness to negotiate, but that did not happen.

Then Lorrie Goldstein goes on to say:

"Aside from the fact that they played right into Elston's hands, did the OMA really think the Grits, backed by 80 per cent of their public, according to opinion polls, were not serious about banning extra billing? The OMA has now put itself in the position of appearing to be motivated solely by arrogance and greed. Stupid, stupid, stupid."

The media go on giving their support to the government's plan to ban extra billing. There is this comfortable feeling, and I wonder whether that is one of the reasons the government has decided to ban extra billing. One truly wonders.

I wonder whether another reason might be the breakfast club that gets together at the Sutton Place Hotel for the weekly little breakfast. Does the Attorney General (Mr. Scott) come in with his gas problem and suddenly have a burp or two and indicate that maybe there is a problem with his health that he has not been able to solve? The Treasurer (Mr. Nixon) has been causing all kinds of blood pressure problems for other people through his poor budget; is he starting to have a little bit of high blood pressure himself? The Minister of Education (Mr. Conway), who also joins them, is suffering from warts all over because of the way he is doing things; as a single man, he is worried about his warts and perhaps he cannot find a doctor to solve his problem either.

Then we have the member for Bellwoods (Mr. McClellan), who may be manic-depressive and having trouble getting the right kind of psychiatric care. We also have the member for Oshawa (Mr. Breaugh), who has his own problems with his heart; maybe it is no heart, or maybe it is simply palpitations of some kind.

They all get together and talk about their health problems, suddenly realize they as a group cannot get doctors to make them well and decide to get back at the doctors. I wonder whether it happened that way. I wonder whether it was because they thought, "We have our problem; let us give it to them." I hope not. I happen to believe it is something as fickle as that because it has not come from a base of understanding of what the health care system is all about.

It seems to me the members who are pushing this bill through have ulterior motives, but I cannot figure out what they are. Is it because of the polls? So many people talk about polls and the effect they have on the decisions of governments. I deplore the fact that polls are attributed to having such an impact on the decisions governments make. In the past, the government in this province has tried to do the right thing for the right reasons for all the people of this province.

Let me give an example of one of the polls taken by the previous Conservative government. It was tabled recently in this House by the Treasurer. It was released by the Liberals. The people across the province were asked if there were any aspects of health care in Ontario that needed to be changed, fixed or given special attention. About 41 per cent of the people said there were no changes they would like to make. Seven per cent said they would ban extra billing and/or opting out. The other 52 per cent named things such as more hospital beds and equipment, better preventive medicine and more extensive pollution control.

What this indicates, beyond a generally high degree of satisfaction with the provincial health care system, is that a relatively small number of people will, off the top of their heads, name extra billing as the most urgent problem facing our health care system. On the other hand, if and when one asks people whether extra billing should be outlawed, the vast majority respond in the affirmative.

If I can offer an analogy that puts public opinion on this issue in context, I do not believe the price of bread would rank very high on the list if we were to ask the people of Kitchener or Markham to name the most serious problem facing them. If we followed that up a few minutes later with the question, "How many people would be in favour of lower bread prices?" a large number, the vast majority, would respond in the affirmative.

I am not here to defend doctors or the incomes they earn. They are quite capable of defending themselves. If they were to choose a nonmember of their profession to defend them, it would almost certainly not be me. What I am defending is the integrity of our health care system and the partnership that has developed over the years among the government, the people, the doctors, the hospitals and the other health care professionals. The people of this province have been satisfied with health care. They have been satisfied with the quality and the accessibility of doctors, and they did not, en masse, see a need to make this change.

Why is the Liberal government proceeding with this? Is it because the polls say generally that the public is in favour? The public, however, is not in favour of seeing its health care system deteriorate or suffer. It does not want to become anxious that the health care system is going to go downhill.

Why are the Liberals doing it? Is it the belief of some people that government can do things better than the free enterprise system? Is it true they think the government can always do things better? I sense there is an increasing spirit in Canada, especially in Ontario, where people are saying with too much confidence, "Let the government do it." They may have that confidence built in because the Tories did such a good job for so long

[Applause]

Mr. Cousens: The applause is thundering. As a member, I would never want to put trust in politicians or governments to do things better than the free enterprise system. There are three areas in which government must be involved: defence, education and health. In those three primary areas, government never does it completely by itself.

In our defence posture for this country, in the preparation of arms and our defence systems, the government involves different companies to assist it in building armaments and resources through its tendering process. Government sets the policy, but it works in co-operation with industry to succeed.

9:30 p.m.

In our education system, there is still a two-tiered system. There is the public and separate school system, and there is the private school system which is allowed to operate. We are not banning private schools by having the public education system, but if one goes to a private school, such as St. Andrew's College, Upper Canada College, Havergal College or Holy Trinity School, one pays the price.

We allow people to have an option when it comes to the education system. Why then do we have it so that in health in Ontario, unlike many of the other provinces

Mr. McLean: Mr. Speaker, on a point of order: I do not see a quorum in the House.

Mr. Speaker ordered the bells rung.

9:34 p.m.

Mr. Ward: On a point of order, Mr. Speaker: Is it appropriate for the official opposition to have a quorum call when only seven of their members are present and 45 are absent?

Mr. Speaker: That is not a point of order, but I am pleased to inform the member for Simcoe East (Mr. McLean) that there is a quorum.

Mr. Cousens: I do not need to have a quorum, because the New Democrats are not listeners anyway when it comes to this. As for the Liberals, I know there are many things they should be doing. I would rather see the Solicitor General (Mr. Keyes) get out there, press a few charges and get on with his work. The Minister of Energy has more that he should be doing.

If I may continue, I was talking about the trend in feeling. People in this province believe the government can do things better. It spells the end of the free enterprise system when one starts seeing it as I have described in so many other areas where government involves other people. Here we are seeing an example where the government is going to have its way only. Health care will be in a unique situation as one of the key services in this province in that it will be only a government-sponsored program. I see that as a very serious problem.

I am trying to figure out why the Liberal government is pushing Bill 94 through. Here is another possible reason: Is it so everyone will come to the same level; so there will be one common denominator for this whole province? If we did not have the free enterprise system, everyone would be driving the same model of car. The Minister of Energy (Mr. Kerrio) would not have his big limo. We would not see the Mercedes the Minister of Consumer and Commercial Relations (Mr. Kwinter) or the Chevette the Minister of the Environment (Mr. Bradley) drive about in.

The fact is, different people will always want to do things in their own ways. Are we now saying health care is only one way? We would move to a system such as we see in nations behind the Iron Curtain where there is one form of housing, one kind of restaurant, only one kind of everything. Will we bring the legal system down so the legal aid plan is extended and there is only one kind of lawyer, not allowing the freedom that now exists?

Very simply, the baseline would be that in our province we would have a solid grey mass of meaninglessness, with everyone homogeneous, which would be built in without the freedom for people to excel and do what they want, without that opportunity for excellence.

The problem one has when one takes everything to the same level is, where is the incentive for people to become more, better and as capable as they could possibly be? I venture to say this becomes another reason there is a group of people, either in the government at hand or in the third party, who would like to lower everyone to the same common baseline, the same common denominator.

Hon. Mr. Kerrio: Or it could raise everyone.

Mr. Cousens: Why are they doing it? That is a nice question. I ask it because of the quality of health care. Is that one of the concerns the government has? The member for Niagara Falls (Mr. Kerrio) would indicate that it is, but as I said earlier, recent polls show that 80 per cent of Ontario's citizens are already happy with the quality of health care in this province. They look to those who are opting out and say it is primarily specialists who are extra billing.

That quality could become a problem with this bill, especially if, because of its introduction, specialists and others decide to leave this province. This will be a detriment to quality and will undermine the quality we have come to take for granted. If the government is suggesting it wants quality, there are other ways to go about achieving it than to alienate, antagonize and start a war with the medical profession.

If it is talking about accessibility as another factor, if it still thinks accessibility is our concern, that is also going to interrupt the whole health care process in this province. What will stop doctors from leaving the regional centres, and especially northern Ontario, in search of alternative places? Instead of increasing accessibility, it will take it away from those people in northern Ontario communities and it will eventually be a matter of affordability and the law of supply and demand. People will not be able to get the quality of care they are getting now. We are striving to improve it, but when this kind of legislation comes in, it will take away that freedom.

9:40 p.m.

To reiterate, why is the Liberal government pushing this through? I do not think it is just because of the accord, or just because of the Canada Health Act, or just because of the campaign promises. It is not just because the media are supportive of it or because all the people promoting it are sick themselves. It is not just because of the polls or because they believe government can do it better. It is not just because everyone wants to bring us down to the same level or that people want to have health care that is quality-oriented or more accessible. It is a touch of all those, and the fact that it is not one, single, good reason makes this legislation bad. There has to be some overpowering reason that is going to motivate the government do it.

Those are all just a pile of reasons when one is looking for an excuse. If one wants to do something, one gives about eight, nine or 10 reasons and they become a pile of excuses. We need more than excuses; we need a rationale. We need a sense of total understanding of health care for our province and that is missing in this legislation.

I am worried about what is going to happen in the long term to the health care service in this province. What is it going to bring? The first thing it is going to bring is a new deterioration in service. I am convinced that the bed shortages we already have in many of our hospitals, the staff shortages that have already caused --

Mr. Philip: l wonder what brought that about.

Mr. Cousens: We know that in my riding, where there is such significant growth, the York Central Hospital is bursting at the seams. I am talking specifically of that one because we need more beds in that growing community. We need more services. We almost had to lay off 40 people

Mr. Philip: Maybe some of the several million dollars a year that we lost could be used for hospitals.

The Deputy Speaker: Order. Perhaps the member would address the chair.

Mr. Cousens: The honourable member has such an ugly voice that it is hard to disregard him.

The Deputy Speaker: If you address the chair, I am sure you will be able to disregard him.

Mr. Cousens: If we do anything, we do not want to cause service to deteriorate; we want it to improve. When we have the climate that is developing in the medical association, its doctors and the government, one can soon see them as civil servants wanting to have the right to strike and to withdraw their services for whatever reason. We have not had that kind of thing for a long time in this province. That is a deterioration in service and it is the kind of thing that will unsettle the people of this province.

I wonder what the future will bring when it comes to medical education. When one starts having government involvement and regulation in one area, will it start doing the same thing to medical students who decide they want to become doctors?

Members should think about it. Right now it is very difficult for anyone to become a student in medicine at any of the universities in this great province of ours. Not only does it take excellence in one's academic record and character, it also takes a sacrifice by those students and their families to help finance their education.

We are now seeing a whole new ethos develop. By virtue of making health care a social system in this province, are we going to take it further, go back a step and say that anyone who comes to study medicine at the University of Toronto will now be subject to a new set of regulations and rules that will be instituted by the government?

Will the government go a step further, since it is going to regulate the total income that doctors make, and start paying their fees, their registration, their tuition, their books? Will the government give them a salary or a stipend as they go through school, as they do in the Soviet Union and some other countries? Are we going to take it the one natural step further back to the very beginning --

Mr. Philip: If they do it with every other profession, why should they not do it with doctors?

Mr. Cousens: It is true, though, with lawyers and every other profession. It is not any different when one looks at the length of time they have to study, the kind of work they have to do to

Mr. Philip: That is balderdash. I have as much education as most doctors.

Mr. Cousens: The member does not use it very well.

The Deputy Speaker: Order.

Mr. Cousens: I am offended at the way the member's mouth rattles and his brain does not work. Maybe he is brain dead.

The Deputy Speaker: Order. Would you please keep referring to the chair?

Mr. Cousens: I wish the member would either pay attention or do something that is a little bit more constructive than rattle around the way he is doing right now.

The Deputy Speaker: Order. We do not need a debate within a debate between two members.

Mr. Cousens: I would suggest that the member go to a doctor or a veterinarian. Probably after they opt out, there will not be anyone who will see him. A vet just would not qualify. The member is too good a person when he behaves himself, such as right now.

The Deputy Speaker: Order.

Mr. Cousens: As I look at the whole business of education for doctors, I see this as perhaps the next step. An understanding should be made on what happens with those who go through medical school. Are we going to change the rules there as well? Perhaps we should and perhaps it is coming. If we are going to have 100 per cent control after they graduate, the government may want more control before they graduate and even as to how they are allowed to enter. At that point, it might even become a political thing with only Liberals or New Democrats being allowed in; they probably would not qualify for other reasons.

Will the future bring a difficult time for people to choose a doctor? What will happen? How will one be able to separate one physician from another? Will it be a matter of putting names in a hat? Will we lose the opportunity for referral and the opportunity for people to choose from whom who they want to receive their health care? Since we are dealing with all civil servants, all receiving the same salary and all supposedly at the same level, what is going to distinguish one from another on a qualitative level?

Mr. Philip: How do you choose a doctor in a one-doctor town?

Mr. Cousens: I am offended by the member's continual interruptions. I ask the Speaker to remove him or have him be quiet.

The Deputy Speaker: That is quite an order. Will the member for Etobicoke please stop interrupting the member for York Centre. Will the member for York Centre also not recognize --

Mr. Cousens: If he had something good to say, I would be glad to listen to him, but all I hear is garbage.

I also believe the future could bring Ontario to the system now seen in Britain. What has happened in Britain with its health care system? There are nine points I would like to make -- perhaps even 10, and if the members keep talking I will increase them -- about where the British health care system has gone downhill.

We are moving to something even worse than the British health care system, because people are not going to have the option of using a health care alternative as is provided for in the British health care system. There is a totally controlled health care system in Britain. We are moving to that with this bill and I do not like it.

The first thing one sees in Britain is a universal health service that was expected to shrink as better health care reduced the incidence of illness. Probably no one imagined it would mushroom into a huge civilian employer with a million people on its payroll, and would dispense in the order of billions of dollars in drugs annually, with doctors in England and Wales writing hundred of thousands and millions of prescriptions. It mushroomed. Something went wrong.

Second, 75 per cent of the acute care hospitals in Britain are technologically obsolete, while health standards between regions remain savagely unequal. That could happen in Ontario and we could end up having Metropolitan Toronto with the best and northern Ontario deprived -- I do not think we owe it that -- or Niagara, Peel or some other area deprived.

Third, hospital building schemes in Britain are often scrapped. They are victims of the prolonged planning stages and inflation in that country. Right now we have inflation under control, but with this government increasing its deficit and with spending on a rampage, are we going to see inflation start again? When that happens, are we going to be able to maintain the priority that health care deserves? I venture to say that is going to be a victim as well, once the euphoria of this great spending spree ends.

Fourth, in Britain, bureaucracy continues to plague the national health scheme. The most commonly cited reason the national health scheme has grown is the increase in secretaries and administrators. Thousands of extra staff have been hired to handle all the processing and paperwork. At this point in its development, the national health scheme is an elaborate network of committees and authorities. No one really knows what anyone else is doing, but they are all meeting in committees and the efficiency has gone out of the system.

9:50 p.m.

Hon. Mr. Kerrio: Is that a Tory government over there?

Mr. Cousens: It was not brought in by a Tory government. That is the problem; the minister cannot unscramble an egg. That government is scrambling the thing up so it will be next to impossible to bring it back into a whole, clean, united, quality system, but we will. Give us a chance -- the people of Ontario will give us that chance -- and we will come back and do our best. I would not back away from a challenge.

Mr. Epp: Is the member calling Margaret Thatcher an egg?

The Deputy Speaker: Order.

Mr. Cousens: The fifth point is, until 1974 a nonteaching hospital administration had two layers of management from the Ministry of Health. Now a hospital can have two, three or four layers of administration above it. This kind of a duplication of people to run things costs money, which comes from the taxpayers. That means health costs go up and it does not necessarily mean patient care is improved.

It has been years since the national health care system in Britain was inaugurated. It still has not won the respect of its doctors. When one does not have the respect of the doctors in the program in which they are involved, then the system has a weakness right at the core. Here in Ontario, with this action of Bill 94 proceeding through the House, the government is not going to win the doctors. We will be in a state of confrontation for a long time to come. That is not the way to build trust, goodwill and a quality system.

Sixth, also coming out of the British experience -- which I do not want to see here -- are the industrial disputes, the labour turnover and poor-quality patient care. They will continue unless remedies are implemented and an arbitration service is instituted.

The bill before us does not include any way of negotiating with the doctors. There is no method for the doctors and the Ministry of Health to be able to sit down with any kind of trust right now. One of the reasons Britain's health care system is so unstable and people are so unhappy with it is the ongoing problems that exist among the medical profession, the hospitals and the government. They continue to exacerbate the problems. They do not solve them, so the service goes down, down and down.

Seventh, patients are also put at risk by desperate shortages of trained nursing staff at some hospitals. By changing priorities, the money will not be there for other support services in the hospitals, for physiotherapy, for extra services, for nursing or for orderly services. Money is already tight in most of the hospitals. If we have to pump more money into the doctors' payments, which we will once this bill is completed, then we will see cutbacks in other areas and those, in turn, will have an impact on the quality of health care.

Eighth, another point that comes out of the British system is the two-tiered system: the public system and the private system, the state system and the private. In that system, one ends up having a duplication of services. We had the opportunity in this province if, with some negotiations, we could have worked out a system that accepted the opportunity for different opinions.

Ninth, we could also see where the system incorporates points of view that limit the accessibility of services down the line. In the British system, I was surprised to learn that anyone over 52 years of age cannot have a renal analysis. There are other examples that I do not have.

I am proud to be the chairman of the Kidney Foundation of Canada for my area. I am trying to raise money for it. I know the importance of kidney disease. If a renal examination were limited for someone in this province, we would have an outcry. In Britain, they have already instituted that kind of accessibility. Where is accessibility when one starts instituting that kind of limitation?

Tenth, if our system becomes similar to that of Britain, are we going to have a pick-a-number system? It will be similar to a butcher shop. There will be no priorities. It will be just a matter of first come, first served. The seriousness of someone's illness will not have an impact on what happens.

I am concerned that the day will come when we in this province will have a model very similar to the British model. That is not where we, as Tories, want it to be. I do not want socialized medicine as it is in Britain. I do not want to have socialized medicine of any kind. If we could, we would work out a balance that makes the future promising for all people who need health care in our great province.

We need a perspective here that puts the doctors in the light in which they deserve to be placed. The light is good and it is bad; there are two sides to the story. I can go back to the many doctors I have known through the years, many of whom have served in this House. One is an honourable member with Liberals now, the member for Humber (Mr. Henderson), and we have the member for York Mills (Miss Stephenson). Both have made marvellous contributions to their patients and to our society. I go back to a man I knew from my early days in Port McNicholl, Dr. McPhee, who was an MPP in this House representing our party. One could not have asked for a better or more gentle person. He gave his life for the wellbeing of society.

I see this in the character of family practitioners who served people in the early days, when they went on horseback and in wagons, and in the gentlemen and ladies now who take patients into their offices and consider their needs. They have done so from the beginning of time.

It was through this kind of dedication that the medical profession bonded together and found a cure for tuberculosis at the turn of the century. There was a sense of moral obligation to society and to the people around them that has been inherent in the whole philosophy of being a medical practitioner. It is this kind of dedication that I do not want to see insulted, destroyed or hurt in any way. Deep down there has been a level of respect that has allowed them, through negotiations in the past, to maintain a level of respect for their worthy contribution.

The perspective of doctors has to be that they are an angry group now. I heard recently that four obstetricians in Peterborough have stated they will no longer go on call on weekends if this bill is passed. We are going to see more like those, who will begin to withdraw their voluntary services. They will diminish and may eventually disappear. Why should they not do so? They will be civil servants; they will be able to work a limited day, and we will be faced with that extra cost, the extra service to be implemented.

I do not believe that doctors should have it their own way. They have to find a balance because today, unlike years ago, through the Ontario health insurance plan they are able to have their salaries guaranteed unless they go out on their own, as they do in some other provinces. It is up to the doctors as well to want to work together with the government to find a compromise. I believe this is the kind of thing that Dr. Myers and representatives of the Ontario Medical Association are saying.

They are angry, and that anger is now being vented and interpreted by society in a way that sees doctors not in a light in which I truly want them to be seen or in the way in which I have known them in the past.

Doctors also have a responsibility to continue to present their case in an intelligent, unemotional way so that the society we are trying to represent in this House of parliament is able to give them the recognition they truly deserve.

Doctors cannot have it all ways. There has to be some working out, and I sense it when they say they are prepared now -- and this would have come out in their negotiating stance -- not to levy any extra charges for senior citizens. This is the kind of spirit that could have been incorporated in this bill had there been an opportunity to discuss it beforehand. There are many other aspects to it that could have allowed doctors to participate. Instead, however, arbitrarily and without discussion, the government has come along and shut them off and has made a move in this bill that denigrates the excellent service that doctors have contributed in the past.

10 p.m.

The perspective on doctors is changing. If this bill is introduced as it is, what will happen to the freedom of thought and the freedom of opportunity that doctors have had to criticize and come up with new ideas? As soon as one has a state-controlled system, one takes away some of the genius that comes out of the freedom we have had in our society up until now. An individual may feel constrained not to speak out because if he did so, he could in some way be cut back, hurt, punished or regulated against by a government authority, a police state, an inspector or by some medium the government might institute.

Could this kind of bill take away the opportunity for professionalism that has been one of the hallmarks of this great profession?

I am impressed when I go back and see some of the speeches and comments made by previous members of this House, such as the Honourable John Robarts. On April 23, 1963, he described something of the evolution of the health care system. He said, "There are seven points which I think are salient in regard to the legislation." That was legislation before the House way back in 1963.

"First, it is not a compulsory medical insurance plan.

"Second, it will not disturb the 70 per cent of our people who are now covered by one form or another of medical insurance.

"Third, it will not disturb the traditional doctor-patient relationship."

May I say, that is something that has been sacred in this province. There has been a doctor-patient relationship that may now be disrupted for ever.

"Fourth, it will ensure that every resident of the province, regardless of age, physical condition or financial position, can obtain full medical coverage.

"Fifth, as a government, we will assume the responsibility of providing this coverage to those who are considered unable for any one of a number of reasons to provide it for themselves.

"Sixth, the coverage provided will be noncancellable. That is to say, once it is taken out, it can be cancelled only by the person insured and not by the insurer.

"Seventh, there will be a maximum premium chargeable for the basic coverage. This maximum premium will be established by the government."

In those early days he was setting forth some of the various fundamental principles of a good, strong health care system.

Let us go on and look at some of the other comments. I was very impressed with what Mr. Robarts said on February 25, 1969, in response to a question from Mr. T. P. Reid of Rainy River. He said: "...I am not opposed to national medicare, nor am I opposed to the fullest possible health care that we can give our people. But I must say I am violently opposed to the way in which the federal government is trying to ram this down our throats."

There were some interjections by honourable members.

"The province of Ontario has traditionally had the opportunity of running its own health care system. When the Liberal government here before us today is blaming the federal government, giving the federal health plan as its reason, it is taking away something of our constitutional rights.

Mr. Robarts went on to say, "It is not the bill I object to, it is the intent, the purpose and the underlying philosophy." He was talking about the sense that the federal government was forcing things down Ontario's throat.

I looked at some of the other remarks the Honourable John Robarts made. For example, in a speech he gave in the Legislature on Tuesday, October 13, 1970, he said:

"I take this opportunity on behalf of the people and government of Ontario to express our appreciation of the willing co-operation provided by the insurance industry. Their efforts to keep administrative costs at a reasonable level have been highly effective. This experience is an excellent example of how government and the private sector can work together effectively in the public interest.

"As we proceed with the next phase of this program, we look forward to the continued assistance of the insurance industry in the important transitional period."

Interjections.

Mr. Cousens: Those members can say what they want to say, but there was a working relationship among government, industry and private enterprise systems which is lacking today.

Mr. Robarts said: "In developing this new plan, it is our objective to achieve the highest standard of service for the people of Ontario. Every available mechanism of human ingenuity and technological development will be employed to streamline the operation of this system."

I would like to refer to one of the speeches given by the Honourable William G. Davis when he was Premier of Ontario. This also shows something of the spirit that was in the government and that government can have with the medical profession and with the service agencies around us. On Monday, June 18, 1979, he said:

"As with so many other complex situations in which any of us may become engrossed, I feel it is all too easy to become obsessed with the details to a point where we lose sight of the essentials. I begin with what is certainly one of the most fundamental observations of all, that here in the province of Ontario we have one of the finest health care systems in the world. It is efficient, effective and universally accessible to the people it is intended to serve.

"It is not a system without flaws and problems, but it has removed the need for fear of health costs that would be catastrophic to individuals and families. It has provided universal accessibility by any reasonable definition of that term, and it has removed privilege and wealth as determinants of who gets care and who does not. May I stress that so long as I am Premier of Ontario, these basic characteristics will not be altered.

"I doubt whether any other system anywhere has taken better advantage of the remarkable progress which medical science has made in the years since the Second World War: the countless breakthroughs in medication and therapeutic techniques, the truly awe-inspiring developments and methods in technology routinely performed which would have been regarded only a few short years ago as minor miracles."

Mr. Davis was here during the transitional period for health care and he said: "Its essence is a series of essential shifts in responsibility, from overemphasis on institutional care to greater emphasis on noninstitutional care, from centralized planning to local decision-making, and perhaps the most difficult adjustment of all, the shift of much of the moral responsibility for personal health from government and the profession to individuals and their families."

When one goes to a social medical system, as we are doing in Ontario, one will take away that individual concern about the cost of health care. It is as if it is all free, and then a number of people could go on and take advantage of that without considering the cost of each doctor's call and of all those services they now take for granted.

Mr. Davis went on to say: "We are going to ensure that no goal, whether it be fiscal economy or any other, supersedes that of assuring quality health care for the people of this province. I have campaigned on that theme; the Tory party has campaigned on that theme. I believe it. I know it to be true and I know the Conservative government has given the kind of health care the people of Ontario have come to take as one of those natural services we can all begin to expect, not only for ourselves but also for our mothers and fathers, the seniors and our children."

What we are doing in this House is changing that kind of balance. I think of some of the statements made by the member for Don Mills (Mr. Timbrell) when he was one of the longest-serving Ministers of Health in our province. This shows the kind of spirit of negotiation which existed in those days. The member for Don Mills said on March 13, 1979:

"We have a lot more to discuss with the OMA and we have been setting up mechanisms to discover and to dispatch minor irritations with bureaucratic procedures, and to review the means whereby the schedule of benefits is arrived at so that the results of such negotiations not only are fair to the public and to the profession but are seen to be fair."

It is that kind of negotiation and conciliation that is missing today. On May 25, 1979, the member for Don Mills also said: "I think it is best looked after on an individual basis. Where an individual moves into an area and wants to find a new physician or an opted-in physician, when he calls the medical association he is given names of doctors in that area who are available and who are opted in. That seems to work well, and I think it is best left that way."

When emphasizing the choice on both sides, the member for Don Mills said on March 27, 1979: "Secondly, the basic philosophy of our system is that it is based on options for the patient and options for the physician. In that particular area, there are a great many options available with opted-in physicians, as there are in all parts of the province."

10:10 p.m.

What we were seeing was a system that was working. If there were exceptions to it, they could have been worked out.

The member for Don Mills went on to say in some of his comments on March 14, 1980:

"It is misleading and unfair in the extreme to suggest nothing has been done. It is true I have avoided taking advice from the member's party" -- he was responding to Mr. Cassidy, who was here once and, thank goodness, has gone -- "and from certain daily journals, to use a club that in the short term might be very sexy politically, but in the not-too-distant term -- certainly in the long term -- would have a very negative impact on the province."

He was talking about the negotiations he had with the OMA. That is how the discussions would have taken place. That is how the leaders in the past would have handled it. What we see now is a new spirit of confrontation, of not working things out.

I have some suggestions as to what the government should do. First, the process must be right. If the process is right, then there must be discussion and dialogue, as in any kind of negotiation. Many in this House have been involved in negotiations for salary disputes. I have, the honourable member has and the Speaker has through his former work in the Office of the Ombudsman; he knows the attitude people should bring to the table. That attitude is missing today in Ontario in the government's relationship with the doctors. The most damnable thing the government is doing is not being willing to sit down honestly and fairly to discuss these subjects with the doctors.

Mr. McLean: And the pharmacists.

Mr. Cousens: That is another problem. The member for Simcoe East is right. That is another example. The pharmacists were dealt a bad deal through the failure of the government to discuss things with them and work things out.

There is still time for negotiations to take place and for the process to be worked out. That is what I am calling for in my presentation this evening. Let that process take place, let there be honest discussion and let there be disagreement. When the spirit is right, we can work out a solution.

The government should also be working towards a healthier system of health care in the province. This was discussed at the Markham Stouffville Hospital. Promotion of health has great possibilities. It is not just responding in a reactive mode to people who have problems and are sick; it is developing a feeling and an attitude within people through exercise, care programs, weight reduction and a variety of techniques.

This province could become more concerned about what people can do to be healthy themselves. There are so many things all of us can do through diet and exercise programs and through systems and techniques, with proper guidance from doctors. We would be sick less often. I support that kind of thinking. It would be radically fresh and it is a program we could do, working together with doctors.

I also believe the government should look for a way to have better accountability. I do not know why the previous government, of which I was a member, never instituted a card system so that when a sick person went to the doctor he would have a plastic card he could give to the doctor, who would run it through. There would be a record in the patient's mind that there would be a billing through the system under OHIP, and the doctor or his secretary would have made a purposeful move to register the call.

The same thing would be true in a hospital. When a person came out of hospital, he would know how many times the doctor had visited him or how many calls had been made. People using the health care system would have some understanding of the costs of the services being rendered to them.

The member for Algoma-Manitoulin (Mr. Lane) brought this suggestion up in caucus a number of years ago and it was not responded to. It could be responded to now. We have the technology so that government can have a better accounting of what doctors are doing. Through that accounting we could begin to say how many calls are being made. Some measurements could be thrown back. We could begin to see how many calls are made on average for a certain treatment or situation.

One would begin to get averages and to know whether there are abuses. There may be abuses in some areas. A government that is accountable to the people for the money it spends should be following through on those abuses, but the system has to be right in the first place. It would not be all that hard if this government began to look at that kind of accounting process and to institute it. Tremendous savings could be brought in through that kind of better technique, much greater than are now possible.

I also suggest the government should be looking to the broader context of what the whole medical system needs in this province. The fact of the matter is that the amount we are going to save, the $50 million a year we will able to regain for the year and a half or so that is due, is just a minor amount compared with the amount this government is going to have to spend to work out a deal with the doctors once they start working out the new schedule of fees. No one has been prepared to answer that question in the House. The Leader of the Opposition (Mr. Grossman) in question period today and on other days has asked the question, and the Minister of Health has sidestepped the issue, knowing he is going to encounter a serious problem because of the bad negotiating flavour that exists.

Who has the responsibility for health care in this province? When one has some kind of balance that is not truly perfect but a balance that exists with some costs for people and some costs for government, one ends up with a sense of participation in the cost of running the health care system.

With this new legislation, Bill 94, that responsibility will be taken away from the individual and we will be facing a situation where people will not feel a sense of responsibility for health care. Some people see a doctor four or five times a week for different things. Are they going just because it is free? I do not know. Maybe some are. Are the doctors providing services to people who do not always need those services? Can we build into the system a way so people who truly need service can get that service; and then if they are abusing it have some way of having them pay some kind of penalty?

I am bringing up a problem about which some people would say, "You are taking away the universal aspect of it." I do not want to do that for people who cannot afford health care, but if there are people in this province who are abusing the free service we now have, is there anything we can do? Is there anything addressed in this bill that can come along and build that kind of efficiency into it? I do not know how we would do it, but I would like to keep a balance between what people really need to have and what they are just taking because they want to take it.

Government has a lot it can do. First of all, it could work on the process of negotiation. It could promote more health systems in the form of health prevention. More accountability could be built into the billing mechanisms of the Ontario health insurance plan. It could broaden the context of what we are talking about as the total cost and realize there are going to be huge costs associated with Bill 94. Indeed, we might look to ways of finding methods of protecting the people in Ontario from taking advantage of a system that ceases to be theirs in their own mind.

I have a number of letters that support a number of the views I have expressed. My constituents have been active in writing letters and I would like to refer to some of them. I have a feeling the people in my riding are more concerned about the future of the health care system and its quality than they are about the kind of arbitrary decision being presented in Bill 94.

This is a letter from Beulah Davidson in Richmond Hill. She says:

"I am appalled at the way that the Liberal Party intends to push through a ban on doctors' extra billing without extra time to thoroughly investigate the issue. Unfortunately, the proposed legislation will likely be in place before the public has wakened up to the enormity of its consequences.

"The democratic system allows for people to have a voice in politics, but it seems people are too busy being busy, doing whatever they have to do, giving little or no thought to the processes that are going on which will vastly affect their lives and even less action to possibly averting some of those processes.

"Mine is only one voice. No, there are many voices; it is a topic that is discussed at great length among friends and acquaintances and I hope that you will receive many letters on the subject."

10:20 p.m.

She goes on to make a number of points: " `Let the buyer beware' should be just as much a privilege and responsibility for the doctor's patients as it is in any other realm." This is a lady who knows what health care is all about. She is asking me, the Minister of Health and the Premier to hear what she is saying and to do something.

I received today a letter on extra billing by doctors from Mr. Ellis, also from Richmond Hill. He says: "I support our medical doctors from the point of view that we, as patients, are in a position to judge merit and are quite willing to recognize the extra billing in our dealings with them. In Ontario, we have an exceptional health care system and I feel that people should be aware of the cost of health care and be directly responsible for a small portion of it."

Mr. Ellis is echoing a common concern in this province. He says further: "The majority of us still admire the talent and dedication of our medical profession and I do not want to see their image destroyed by the wranglings of government which is attempting to organize this system to death. Government involvement has already destroyed the excellent image once enjoyed by the teachers of this province and now it appears that the doctors are next on the list. The only profession remaining which is respected by the general public appears to be our clergy people. ..I assume that their turn will come if our bureaucracy can find a method to discredit them." Who knows?

I have another letter from Mr. Maxwell Coutts, who has waxed eloquent on several pages: "I wish to express my personal disagreement with the position of your government on this subject" -- by the way, the letter was to the Minister of Health -- "and more especially your method of handling it.

"I personally feel that you are treating our medical doctors unjustly, terribly unfairly and almost as if they were renegades rather than as skilled, competent and great allies among our interdependent groups making up our society; dedicated and concerned men and women helping us live a better life.

"Some figures I have read indicate that over 90 per cent of our medical doctors work at the Ontario health insurance plan rates, surely an overwhelming number of them doing yeoman service to our citizens at your fee schedule, a situation deserving respect and commendation, not condemnation and disrespect. And in my own personal experience, I have found a responsible and caring attitude on the part of the medical specialists whose services I have had to use. In three out of five cases over the past six years, the specialists have not extra billed even though they regularly notify patients they work at the OMA fee schedule."

Max goes on to make excellent points throughout his letter, asking for this government to restore the harmonious relations that previously existed with the medical profession.

I have a letter from Mrs. Kirkham from Thornhill who wrote me in early January to say, "I was more than a little disturbed when I heard that the Ontario government wishes to discontinue doctors' extra billing.

"I have relatives and friends in Britain where health care is less than adequate and I understand that should this bill be passed, we will not be fortunate to have even the care the Britons do. At least there, if a patient is dissatisfied with National Health, he can seek out a private practitioner and pay for better health care. My understanding is that here, all doctors will be treated equally and we the public will not have a choice."

Mrs. Kirkham is right. We will not have the option of a double system in Ontario. The government has instituted a program that allows for only one system; it does not allow for any options at all. It is that kind of arbitrary, non-negotiable stance that is going to destroy our health care system.

As well, I must admit I had one letter in December in the form of a petition from five constituents who approved of the move to introduce legislation to end extra billing. They sent a small petition.

I am running out of time, which probably means I will have to go for another day on this. May I suggest further that one of the best letters was from Dr. Randall, a doctor in Richmond Hill. I believe his letter basically answers an awful lot of the questions from the doctors' point of view.

First, he indicates: "Physicians are the most accessible component of the health care system. I do not think there is any of us who could fault our doctors who are available on four-hour, seven-day-a-week coverage. They are on call; they carry their pagers. They are there to provide that service in emergencies at any time of the day.

"Why do we do this? It is because we have a strong sense of professionalism and a well-organized, co-operative and loyal medical staff." He is speaking in particular of the York Central Hospital in Richmond Hill.

"We wish to provide good care to our patients and provide good service to our hospitals, especially the emergency department. We are very accessible and available.

"Secondly, I should like to point out that we also co-operate amongst ourselves and with the hospital administration to improve access to hospital facilities." He outlines in detail how they do that.

"Thirdly," because I am running short of time, "with our increasing volume in the emergency department, it is woefully apparent that we lack a patient care facility to treat the fracture clinic and minor surgery patients.

"Fourthly"

Mr. Warner: We want to stay here much longer. I am enjoying this. Four more hours.

Mr. Cousens: If the honourable member would allow me to go on, I would be honoured, because I have a number of others that I would like to share.

He goes on to talk about their emergency department and the way it is working overtime to treat a great number of people per week. He goes on to describe how the obstetricians are giving extra services. He goes on to talk about the staff. They are working hard, but with a shortage of all the facilities they need. He talks about the outpatient therapy they are working on. He talks of how doctors, nurses, therapists and hospital staff are blamed for the inconvenience, the delays and the inaccessibility to the system by disgruntled patients. "We are forced to be the apologists for central planning and inefficiency by the Ministry of Health and government fiscal policy which ensures inaccessibility."

I want to see a health care system in this province that serves all the people, a system that is responsive and caring, a system that lives up to the high standards we all espouse, a system that looks more deeply into the needs of people and talks about providing good administration, comprehensive care, universal availability and the care that is needed for people who come to Ontario from other provinces: total accessibility so that all who need treatment are treated in a quality way.

I can say this because I believe it; it is there now. If any refinements are to be made under the new federal Canada Health Act, those changes can be made in a way that has been done in other provinces, because we in Ontario are now going to be unique by setting up a system that has not considered some of the ways in which this can be done.

All it takes is a little conversation. It takes a little bit of care and help. Other provinces have worked it out. Why can we not do the same? If we go ahead and do as they did in Quebec, we will see an exodus of several hundred of our doctors heading out of this province to other countries or other provinces. That is in itself going to be the kind of thing they face.

Even Quebec allows doctors to opt out; it allows them to extra bill. If one wants to be in the system, one can be in the system; if one wants to be out of it, one is out of it exclusively. Why can we not have some of that kind of flexibility in this government program?

Bill 94 can still be amended. We can still come out with changes if this government is willing to understand the fundamental thought that I am presenting here. I do not apologize for the doctors. I do not apologize for anyone. I want to see the people of York Centre and the people of Ontario -- my wife, my children, my friends and my constituents -- have a sense of trust in the services we are presenting to them.

In this bill we are beginning to destroy that trust because we are destroying the system. We are going to make it into something less than it has always been. We are going to make it into a mediocre, second-class socialist system like Britain's, and I do not want that. Surely the government at hand is willing to reconsider on the basis of these data.

Mr. Speaker, if you are willing to allow me to continue, I would be pleased to do so. If you would like me to adjourn the debate, I will do so.

Mr. Newman: Carry on.

Mr. Cousens: I will continue, then. I would like to follow further. I have a letter from one of the doctors in my area.

The Acting Speaker (Mr. Morin): Would you please move the adjournment of the debate?

Mr. Cousens: I would be pleased to continue.

The Acting Speaker: Would you please move the adjournment of the debate?

Mr. Cousens: I have a number of other things to say, and I do not know whether I can make it when the House convenes the next time. However, in the hope that I can, I will adjourn.

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

The House adjourned at 10:30 p.m.