L109 - Tue 4 Feb 1986 / Mar 4 fév 1986
HEALTH CARE ACCESSIBILITY ACT (CONTINUED)
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. McCague: Before the dinner hour, I was --
Mr. McKessock: You were just winding up.
Mr. McCague: I am not sure what the member for Grey just said.
Miss Stephenson: He said the member was just winding up.
Mr. McCague: Yes. He unwound in the local papers. I have been reading his material and he has been reading mine. He does not respond directly to it, but he gets the ministers and others in his party to respond. I rather enjoy the dialogue.
I was reminded by the Clerk of the House, before the member and I felt hungry, that I made a mistake in adjourning the debate. I should have suggested it was six o'clock and we should stop for a bite. I did not understand that and I appreciate the fact the Clerk brought it to my attention that I should not do that in future unless the subject after dinner is different from the one before it.
However, I have a number of points raised by physicians in my riding I want to put on the record. To sum up the issue, the Liberals are talking about a short-term gain that may well lead to long-term pain. I know what the Liberals are suggesting has a certain amount of political pizzazz, if I may put it that way. It is a very misunderstood issue out there. It is incumbent upon us in opposition to point out to the government it may be making a mistake in what it is proposing.
I have letters from 20 doctors. Some of them are radical opinions, but now that they have been prompted or disturbed to the point that they want to put their thoughts on paper, I should let what they have to say be part of the record of this House.
Dr. Lapointe in Collingwood talks about various things in a letter he wrote me. He says: "It is with great concern that I am writing this, my first letter ever to an MLA. Why would I, who have been practising in Ontario for 13 years and have been relatively apolitical during that time, write to you now? The proposed Health Care Accessibility Act has prompted me to this action."
This is a rather novel quote, but he says: "It has been said that if a frog is dropped into boiling water, it will immediately jump out. I would do the same. However, if the same amphibian is placed in a bowl of tepid water and the temperature gradually rises over a period of time, the frog will be cooked before ever becoming aware of its discomfort.
"The cost of providing medical care has risen exponentially. I cannot agree more, but is it the physicians' fault or is it the fault of the public who have been promised a free lunch in their demands for more frequent and more costly treatment for the most trivial of reasons?
"On Sunday, January 12, at 10:30 p.m., I was called to the emergency department. A 24-year-old lady had presented herself there as being an emergency patient. It is hospital policy that any patient brought to emergency should be seen by a physician before being released. I was called from home. The situation was this: While making a pizza, this lady was chopping onions. Her eyes began to water and she went to the hospital. This visit cost the government approximately $100, including myself and the hospital charge for the use of an emergency room.
"I am sure events such as this are not what the government had in mind when it promised free medical care, but this is what is happening almost universally in Ontario. Unnecessary expenses, totally unjustifiable in any medical sense, are inflating the cost to where even a government cannot afford them. There has to be a better system. There has to be some form of deterrent fee or otherwise to prevent totally unnecessary demands for medical service.
"The history of government-funded institutions and services has been a dismal one. Our hospital, the Collingwood General and Marine, has 115 beds. Presently we are being funded for only 83 of these beds. The hospital budget has been pared, staff has been reduced, wings have been closed. The necessary purchase of up-to-date equipment has been delayed. The administrator is unable to present a balanced budget without the input of aggressively solicited private funds from our community. Bazaars, bingos, services clubs, women's auxiliary all have to complement the government funding in order to provide a reasonable level of service.
"What once was an efficient, well-run, local, private ambulance company has been taken over and managed by a totally inefficient, centralized ambulance dispatch service which provides less than optimal service to this community.
"In this era, bag ladies freeze to death in Toronto stairways, parks and culverts. These same citizens have access to triple cardiac bypass surgery, renal transplants and other extremely expensive, life-prolonging medical intervention. We live in an era where doctors and other health professionals are being sued for failing to order exotic tests or X-rays, not having used the latest generation of antibiotics, failing to provide 100 per cent satisfactory results or failing to prolong life artificially.
"Since government has promised the people free medical care, this is what the public expects. The unfortunate situation is that government cannot afford such care and the whole medical profession is being damned for lack of medical accessibility. Accessibility is a huge smokescreen, an attempt to discredit doctors and other health professionals, letting them bear the brunt of professional dissatisfaction over underfunding.
"Witness the demonstrated need for chemotherapy and radiation apparatus at Toronto cancer hospitals. The need is for $746 million. The budget is $240 million. Are the medical professions being blamed for this great discrepancy?
"It is an old adage that where there is no reward for initiative, there is no initiative. Let the doctors get a fair return for their efforts. Reward them rather than suppress them. Address the real issues. Can Ontario and Canada afford free medical care?"
While I was reading, I noted the member for Grey was interjecting. I am reading from a letter from Dr. Lapointe in Collingwood, a gentleman who treats many people from the honourable member's riding. I hope he appreciates the sincerity of the remarks that were made. That is a longer letter, and I read more from it than I intend to from some others.
8:10 p.m.
Mr. McKessock: I wonder why the member's party did not bring in legislation over the last 10 years.
Mr. McCague: I think those are fair points. As I said when I started, when the member was not here, I want to present a balanced critique of this bill. I realize, as does the member, that there are people on many sides of it. I am having an easier job defending our party's position on it than he is protecting his party's position on it.
I have a letter from Dr. Peter Phillips who is also from Collingwood. He says: "Presently I am an opted-in physician. The Liberal government is about to take away my freedom of choice and that is what I am fighting for by opting out. The issue here is not money. Most opted-out physicians earn less than their opted-in colleagues because they see fewer patients, those who are really sick.
"We doctors who are opted in are forced to see many patients with trivial complaints. Because medicare is free, we have our problems. Quebec-style medicare is the poorest in the country with its extremely low fee schedule, restrictions on the number of visits patients may make to their doctor for any one problem, doctors forced to practise where they are told, ceilings on incomes so doctors are forced to close their offices every three months and under-the-table remuneration to physicians. Just ask any doctor in Quebec. Recall the horror stories of the British National Health Service and they will come about in our province. After all, the government has to control costs."
Dr. Jardine says: "This or any bill which reduces the authority of any practising physician is to be grossly deplored. Had I known when I embarked on a career in medicine how it would end, I would never have started. No one goes through medicine to become a civil servant."
Dr. Clark of Collingwood says: "I am primarily opposed to this bill because it is a major step to absolute socialism in our province and in our nation. OHIP, by its name, is a health insurance plan, not a blanket coverage of every eventuality. Accessibility has always been excellent from the medical standpoint."
Mr. Speaker, would you ask my colleagues behind to --
Miss Stephenson: Cease and desist.
Mr. McCague: That is correct.
The Deputy Speaker: Order, in the row behind the member speaking.
Hon. Mr. Sweeney: The member could never keep them under control before. Why should he start now?
Mr. McCague: I would be glad to have one of the pages get them some potato chips or something. I have the money here.
Hon. Mr. Sweeney: Try peanuts.
Miss Stephenson: Try peanuts over there.
Hon. Mr. Sweeney: Peanuts would work better, not chocolate bars.
Miss Stephenson: Over there they may. They can hang by their tails over there.
The Deputy Speaker: Order.
Mr. McCague: We will get a whole bunch of birdseed.
"The main obstruction to accessibility at the present time is --
Mr. Cureatz: On a point of order, Mr. Speaker: I was wondering whether there was quorum. I believe there is.
The Deputy Speaker: A quorum is present.
Mr. McCague: In case the members have forgotten, I was reading from a letter from Dr. Clark of Collingwood.
Mr. G. I. Miller: Does the member think he could run that by us one more time?
Mr. McCague: Yes.
"Accessibility has always been excellent from the medical standpoint and the main obstruction to accessibility at the present time is due to the lack of funding to hospitals, with restriction of beds and other treatment modalities that cause long delays with patients or causes them to travel long distances for their care. Why the government feels that it is perfectly satisfactory to have a patient travel many miles for care when it is related to hospital facilities but not to have to travel any distance at all when it comes to medical treatment is beyond my understanding. They have obviously adopted a double value system for their own political desires and goals."
Dr. Brown, again, is from Collingwood. He talks about problems in a letter he has written to his patients. We all have to realize that many people have a very coveted, warm and caring relationship with their doctor. They want to hear what the doctor has to say on this particular issue, because the population is confused. It is confused because 85 per cent of the people feel the health care system in the province is excellent; yet when one throws the red herring of extra billing in front of them, only about 20 per cent agree that extra billing should be allowed. I suggest to members that at least half the population does not know what extra billing means, but the government has been able to throw out that red herring and throw some degree of disarray into the system.
Mr. McKessock: The federal government made an issue out of it.
Mr. McCague: The honourable member will recall which federal government it was that caused the problem in the first instance.
Hon. Mr. Sweeney: All three parties agreed. The federal Conservative leader had a chance to get out of it in 1984 and he did not.
The Deputy Speaker: Order, the member for Kitchener-Wilmot.
Mr. McCague: That may well be, but there will come a day when the people sitting over there will realize that they are the government. There are 125 of us here, but the Liberals are the government. On the federal scene when this came in, it was their friends in Ottawa who did it to us.
Hon. Mr. Sweeney: Supported by all parties and in the election.
The Deputy Speaker: Order.
Mr. McCague: Dr. Brown writes to his patients that he is "writing this letter out of frustration and despair to help you understand the issues of extra billing and the so-called Health Care Accessibility Act, 1985.
"With this letter I hope to obtain your support, not only for the medical profession but also for those requiring health care services now and, more importantly, in the future. The Premier of this province has with this act made an ill attempt at addressing a nonproblem. Example: extra billing.
"Let me illustrate. The Ontario Hospital Association in December 1985 polled various public focus groups. When asked of their concerns relative to health care issues, the top five responses were: (1) ageing population, (2) emergency care, (3) funding and operations, (4) development of community-based health care facilities and (5) hospital user fees.
"In other words, the extra billing issue, which was among the issues ranked in the poll, did not even make it to the top five. Indeed, it was last or almost last on the priority list. The extra billing issue is not an issue the public generally feels concerned about relative to overall health care." That is an excellent point. "Why does this government not address what concerns the public and the doctors have instead of playing politics with the NDP?
"The accessibility of physicians' services to you has not been denied or hampered by the few doctors, approximately 12 per cent of all the physicians in Ontario, who have decided to opt out. `Extra billing' is indeed a poor term and refers to a difference in dollars between what your insurance company pays for your visit to me and the actual fee as per the Ontario Medical Association schedule.
8:20 p.m.
"OHIP pays approximately 70 per cent of the fee. The act, in its present form, will in one motion have the effect of nationalizing an entire profession. Losing our economic freedom indeed, as our intellectual freedom, will most certainly stifle initiative. The art of medicine will die and the practice of medicine will suffer.
"The government will have 15,000 new civil servants and with that comes the gradual and inevitable decline in morale, productivity, the willingness to go that extra mile on behalf of you, my patients." That is an excellent point.
"Waiting lists for specialist's appointments, already long, will probably be even longer. If our experience reflects the British experience, the ideal of availability of health care services, equal to all, will indeed become a nonreality as those with money buy their way (under the table) to the head of waiting lists. These events will not happen overnight but they will happen." Dr. Brown makes an excellent point.
Dr. Eagleson from Collingwood makes the point:
"The Ontario and federal governments for reasons of their own have chosen to deliberately misrepresent the nature of the problem by exaggerating the importance of extra billing by a few doctors, while remaining silent on the real causes of inaccessibility and of financial crisis, and in the process have maligned and alienated my honourable profession, have set patients against doctors and are determined to deprive me of a basic freedom.
"With respect to professional fees, they are determined to oppose a system that they would never tolerate for the legal profession, even if they thought it might correct the scandalous inaccessibility to justice that the poor in Ontario experience, as compared to the rich.
"How will I respond if the government forces this legislation through? No kind of oppression by government will make me withhold my services from patients." That is a very honourable point. "I can think of legislation that would move me to civil disobedience, but this is not one of them. This does not leave me many options for protest, but as a token I will opt out of OHIP at great inconvenience and financial loss. Furthermore, I will resign from my hospital appointment and at the same time make myself available to hospital patients, if allowed."
Dr. Timpson from Collingwood says:
"As one who has practised family medicine in Ontario for 25 years, I am tired of government influence and attempts to control the practice of medicine. At no time have I ever seen the medical profession more militant, united and prepared to fight this absolute inroad of political injustice into the health care field. We will not stand by and see the political power destroy one of the best health care delivery systems in the world."
These are all very excellent points. We are fortunate to have a few lady doctors in the area too. Dr. Thora Hayes says:
"Competition stimulates and generates: Why try to penalize the citizen who is willing, unselfishly, to work 23 or 24 hours a day to save lives of strangers without thought of self and exemplifying an edifice of character to our youth. If this bill succeeds in being passed, would it not be a logical extension to penalize lawyers who work overtime, to ministers, to members of parliament who spend many long hours beyond the nine-to-five average work day, unselfishly dedicated to the needs of others. How will this decision be criticized in Canadian history?
"A further step: Why are we willing to risk nuclear holocaust to defend our system of free enterprise when we in practice attempt to violate those very principles with punitive legislation? Why should we ask our most vigorous, potentially productive youth, to lay down their lives to defend this system in the armed services? Should they not turn and ask, what is the point?"
All doctors do not write well. This looks like Dr. Grit but it cannot be his name. Maybe another doctor can tell me what it says. However, Dr. Houston points out that he is an opted-in family physician who has never extra billed.
"Government-issue health service means underfunding, waiting lists, crowding and lack of access to quality medical care. Who will speak out for the needs of my patients when I am a civil servant paid to implement government policy?"
Miss Stephenson: Dr. Grills.
Mr. McCague: The member for York Mills says it is Dr. Grills rather than Dr. Grit.
Anyway, he feels, "The government does not have the right to conscript the medical profession and remove our rights to practise independently."
To carry on with the points Dr. Houston was making: "I am an opted-in family physician and, therefore, this legislation would have no immediate effect on my income or in the way in which my patients receive medical care.
"I am certain that this type of government over-control will ultimately give us a medical system in which patient freedom is restricted rather than increased. The government will find it necessary to regulate services more and more. In a system where only the government pays, only the government will have a say in what institutions and programs receive what money, in what procedures a patient is allowed to have and which doctor a patient must see."
Dr. McGillivray from Collingwood has, as I told him personally on Saturday, a different way of expressing things than a lot of people. He was a candidate in the both federal and provincial elections on behalf of the Social Credit Party. I shall read a few things he pointed out to me.
"The effect on patients is not always visible at first, but the effect in the last 25 years has been a gradual deterioration of their responsibility for their own health and increasing demands for more and better care, more and faster service, more expensive tests and X-rays, and to a degree that is wasteful and becoming more so.
"As I write this, I have just been called to come to attend to a man who fractured his hand by punching a door in a fit of temper. Such actions are becoming more common. The result is that physicians are so busy with the volume of work that they cannot give the proper attention to those really needing good care.
"Our emergency room nurses state the `garbage' calls decreased remarkably when three general practitioners opted out of OHIP. Patients then phoned to see who was on call in the evening, and if an opted-in doctor was on call they would come with insignificant or longstanding complaints, and if an opted-out doctor was on call they would wait until morning, as they should do, for these non-emergency complaints.
"The rights of contract may seem insignificant at first, but this bill is a price-control measure aimed at 1,700 physicians. It will be a precedent for all lawyers to be restricted to legal aid fees and for dentists to be restricted similarly and eventually for price controls to be fastened on everyone."
Hon. Mr. Sweeney: He is quoting doctors' letters.
Mr. McCague: That is right. Was that not clear to the member?
Miss Stephenson: These are letters from physicians in his riding.
Hon. Mr. Kerrio: He is not supposed to read letters.
Miss Stephenson: Oh, none of the minister's colleagues has ever done that?
Mr. McCague: It is still a democracy.
"The point is I am reliably informed that there is more private practice in medicine in Poland, Hungary, Czechoslovakia and East Germany than there will be in Ontario if this bill is passed."
I pointed out to you that Dr. McGillivray was a little different. "Certainly there have been great changes in the communist countries. It is because they have tried the systems that the Liberals and NDP want us to try. Must we make all the same mistakes ourselves? Experience keeps a hard school but fools will learn in no other.
8:30 p.m.
"To me, the most annoying thing is that this bill is aimed at, a nonexistent or one-in-a-million problem, 10 cases of overbilling a year in a province of eight million. Even when the NDP advertised for victims they could not find them.
"Physicians have looked after the poor for hundreds of years and have been glad if they were paid anything, and even thanked. Now, for political purposes, we are being conscripted by the state in peacetime as if we were undesirable vultures who preyed upon the sick instead of helping them. If you want more letters from me, please ask your secretary to phone me." He says he has lots of material, and with that I agree.
Dr. Don Smith says he is a family doctor who has been opted out of OHIP for more than five years: "In this period --
Hon. Mr. Kerrio: We are not supposed to read letters. Debate the bill.
Miss Stephenson: Has none of the member's colleagues ever done that?
The Deputy Speaker: Order. The member for Don Mills and the member for Niagara Falls are having a little history lesson here at the expense of the member for Dufferin-Simcoe.
Miss Stephenson: I am the member for York Mills, Mr. Speaker.
Mr. McCague: Why does the member for Niagara Falls not pay $10 and go fishing? In fact, if he will go fishing I will give him the $10.
Miss Stephenson: We will take up a collection.
Mr. G. I. Miller: We will put a line in wherever you like.
Mr. McCague: Yes, the member already has a sucker on it.
As I was saying when I was so rudely interrupted, Dr. Don Smith says he is a family doctor who has been opted out of OHIP for more than five years. He goes on:
"In this period of time I have billed some patients according to the OMA schedule of fees and some according to the OHIP fee schedule. The determining of whom was billed according to which fee schedule has never been a difficult problem. It involved communication with my patients, sensitivity and erring on the side of caution. As all of these are involved in the practice of medicine it is not difficult.
"The present government somehow finds the application of this judgement distasteful. They allow me to use my judgement in treating my patients' medical problems, but are stating that I am incapable of making a similar judgement regarding my patients' ability to pay my bills." That is an excellent point.
Dr. Harrington, again of Collingwood -- we have a lot of excellent doctors in Collingwood. As I told the member for Grey, half the time they are working for my constituents and half the time they are working for his constituents. Dr. Harrington says:
"I enjoy working in what I think is the best health care system in the world. The system is not perfect, and there are concerns with funding and waiting periods at hospitals for patients who are sick, but I think the current system works and is unequalled by any other in the world.
"Doctors will be forced to work in a system run by a government which has a very poor track record for maintaining access to the system, as evidenced by hospital bed shortages and long waiting lists for urgent operations. A patient in my practice suffered a heart attack in the last three months while waiting for bypass surgery, a heart attack which can be attributed to our government's inability to deal with providing adequate funding for access to services on an urgent basis."
Dr. Wagg mentioned: "The quality of medical care will gradually be lessened as the doctors try to see more patients and work longer hours to maintain an income to cope with higher expenses, a higher cost of living and higher taxes. Mistakes will be made, not tragic errors, which will result in higher costs to everyone, greater aggravation to patient and doctor and further erosion of the doctor-patient relationship already damaged by attacks of the government and the news media.
"Costs to everyone will rise as patients seek medical attention for minor things rather than coping with a bit of inconvenience. Costs to the medical system will increase as doctors practise defensive medicine to prevent abuse of their integrity by more and more medical-legal issues, aided by a publicly supported legal system led by lawyers who fan the flame of public distress of doctors, irritated by an abusive government and news media, whose abusive actions are condoned by a noncaring government and public.
"I believe the public has been deceived by the government. The government was the first to become angered, and literally walked out on the discussions, then stated that the doctors refused to negotiate."
I have a letter addressed to the Minister of Health (Mr. Elston) from Dr. Peter Savage of Collingwood.
Mr. McKessock: You have quite a few letters.
Mr. McCague: I do have quite a few letters. I could get copies for the member if he would like.
Mr. McKessock: Mr. Speaker, is there not some rule about reading, some limitations?
The Deputy Speaker: It is permissible to read excerpts from letters and documents but not whole documents.
Miss Stephenson: Speak to the Minister of Education (Mr. Conway) who read the telephone book for five hours at one point.
Mr. McCague: Before the dinner hour I did read a letter from Dr. Scott of Orangeville. It was an excellent letter and I must confess I read it word for word. I will give these letters to you, Mr. Speaker, to let you determine whether I read excerpts or the full letter. I suggest the latter.
As I was saying, there was a letter dated October 28, 1985 from Dr. Savage of Collingwood to the Minister of Health. I will not read any of it. I have one dated January 30, 1986 from Dr. Savage again, this time addressed to me. He says "I would like to take this opportunity to express my concern with regard to the current health care legislation. First, I think I should draw your attention to my letter of October 28, 1985 to the Minister of Health. At that time I expressed to him my concerns pertinent to the health care system, and I feel that it sums up my general feeling. If anyone would like to know what those are, I would be glad to show them the letter.
"It is interesting to note that Mr. Elston did not acknowledge this letter or respond to it. I find that surprising as any other politician I have ever written to has at least acknowledged a personal letter that has been addressed to him." I find that revolting.
Earlier in my remarks I mentioned I was somewhat dismayed so few people in my riding had written on any side of the health care issue. I guess it is fair to say I have one letter which reads: "We the undersigned taxpayers respectfully request you and your party give your wholehearted support to completely ban extra billing by the medical profession in Ontario." That is signed by Mr. and Mrs. Harry Tiemens of Box 52, Stayner, and Mr. and Mrs. Don Pickel, Box 115, Collingwood. That is all in the interest of presenting a balanced approach.
Miss Stephenson: Of course they want to co-operate. They do not want to co-operate with a gun to their heads. That is all he received.
Mr. McCague: I am giving the opinions I received as a member.
Interjections.
8:40 p.m.
Mr. McCague: The difference is I am prepared to listen to others who are not prepared to listen to me. I have another note from Mrs. M. A. Wallis, registered nurse, Tottenham, Ontario who says she is writing to express her outrage at the bill being presented to make extra billing by doctors illegal.
"These highly trained professionals work long hours and must keep their expertise up to date at all times. As a member of the nursing profession for 13 years, I have never heard of a patient being refused treatment by any doctor because he or she was unable to pay. Perhaps the government should investigate more appropriate OHIP fees rather than penalizing doctors who specialize in their field.
"Our health care system has deteriorated badly in the last 10 years because of budget cuts. It must not be allowed to deteriorate further. The bill to stop extra billing should be stopped."
Hon. Mr. Kerrio: They did not charge for the last 10 years.
Mr. Ashe: It was a postscript. She said at the end it was even worse in the last 10 years.
Miss Stephenson: The member is only providing some balanced input.
Mr. Speaker: I thought the member for Dufferin-Simcoe had the floor.
Mr. McCague: I think you are right, Mr. Speaker, but there is a lot of chirping.
My leader has made excellent points in several speeches regarding this bill. I know he will be speaking later next week as we address this bill and I will not repeat what he has said.
As I said before and will say again, this bill is politically motivated. There is not a doubt in the world about that.
Hon. Mr. Kerrio: That is a revelation.
Mr. McCague: It is very clear to this party that the Liberal Party is prepared to spend more money to pacify the doctors than it will save by banning extra billing. They are stubbornly proceeding with this bill and we know and they know that in committee they are going to capitulate. They are going to do it to try and make themselves look good with the doctors. They will not get away with it.
It is our job as an opposition to point out to the public that there is short-term gain for the government in return for long-term pain, and I mean that. The government is not presenting the whole case to the public out there.
Interjection.
Mr. McCague: I guess they do. Dr. Young in Alliston does, he is a veterinarian.
We should endeavour to resolve the extra-billing issue fairly and equitably and with complete information to the public. We should resolve it in a way that will meet the needs of both the doctors and citizens of the province, not the needs, desires and whims of the Liberal Party. If we have to appoint a royal commission we could do that. But why does the government not do the responsible thing, stand down the bill, decide it will negotiate in a fair and equitable manner with the doctors and stop the grandstanding?
Thank you for your indulgence, Mr. Speaker, and keep chirping.
Mr. Foulds: I want to join in this debate because it is an important one. A number of important issues have been raised during the course of the debate and a number have been raised out there in the public.
I want to address a couple of those concerns that have been raised and a couple of the arguments that have been put into the mix here in the Legislature.
I find one argument to be rather strange. We hear that in Ontario we have the best health care system in the world and we should not tamper with it; leave it the way it is. That is one theme we have heard from members of the official opposition.
The other theme they use to counterbalance that is this: We cannot tackle the problem of extra billing being an impediment to health care or accessibility unless we tackle all the problems of accessibility. Then they go on with a long list of what is wrong with the health care system in the province.
There seems to be an inconsistency in that argument. We may have the best health care system in the world; I do not know. I think we have a darned good one. Everybody in this Legislature and this province thinks we have a pretty good health care system. All of us are conscious that it can do with improvements, and we can increase accessibility. I want to talk about that in a few minutes.
The second problem and the second reason this debate is important is that we are debating the rights of patients and the rights of doctors. In most cases, those two rights coincide. In some cases, they part. When it comes to the question of extra billing, the rights and interests of patients and doctors part company. It is in those circumstances that in a democracy a body like this has to make a tough decision about adjudicating the rights and wrongs of those divergent interests.
The third point has been raised a number of times, especially in letters from, if not uninformed, somewhat biased doctors about the British health care system. We are told about the horrors of the British system. I do not want to apologize for the British health care system in 1985, but let me relate two personal stories about it in 1952 and 1959, soon after it was implemented and running relatively smoothly.
A young Canadian woman, a friend of mine resident in Britain in 1952, found herself to be severely ill with a lung disease, which in 1952 was very difficult to treat. It so happened she was living in London and was given access to the health care system. Without a question or a lot of bureaucratic red tape, she was given the best health care of the time in the world. Because of the British health care system at that time, she was given the world's top specialists in that disease. She is alive and well today, somewhat older, much wiser and a very productive member of our society.
8:50 p.m.
In 1959, a young Canadian from Thunder Bay happened to be travelling on a bicycle in northern Devon, in England; the bicycle happened to be on one of those hills in Devon, and it was raining. British bike brakes do not work all that well in the rain, because they are dependent on friction, and he crashed and smashed his leg. Immediately, he was taken to the local hospital. There was no bureaucratic red tape, no "where is your OHIP card or your social insurance card?" There was simply: "The doctor is in the operating room. As soon as he is out, he will see you," which is what happened. There was no need for that young man to be hospitalized. His leg was taped up, his bike was written off and he was sent back to London, where he had some friends with whom he could live while the leg recovered.
There was no undue burden on the health care system. There was no fee. Because I was that young man, I asked the people at the hospital, "Why do you not charge a fee?" They said, "The bureaucracy of taking down all the details, getting in touch with Canada through the Department of External Affairs and so on is not worth it." I suppose I had, in total, about an hour of direct, precise tests.
While we hear about the horrors of the British health care system, there are and have been many good things about the British health care system and about so-called socialized medicine. The word "socialized" is thrown around as if it were a dirty word. Socialized medicine simply means medicine that is available to all the social classes of our society. That is all it is.
The Ontario Medical Association has not served its membership well in this whole dispute. I do not believe it has served the public well. It has escalated the battle to fever pitch on its side when it was not necessary. It has also escalated the official opposition to some kind of frenetic pitch, which was not necessary. If anything has brought the medical profession and its credibility into question, it has been the tactics of the Ontario Medical Association, aided and abetted by the tactics of the Progressive Conservative Party. Frankly, it is about time both of those very traditional institutions made themselves aware of the realities of the 1980s and of the 20th century.
We all recognize that things are wrong with the health care system. We all recognize that there are other impediments to accessibility. Geography is an impediment to accessibility. I fought a battle for two and a half years to try to reduce that impediment to accessibility to the health care system.
We all recognize that poverty is an impediment to accessibility to the health care system. We know that fear and ignorance are also impediments. People are often afraid of illness and will not seek help. We know that the bottlenecking in emergency wards, chronic care patients using acute treatment beds and self-inflicted environmental attacks on ourselves and on our own wellbeing, whether it be by acid rain, smoking or a whole host of industrial diseases, are all impediments to accessibility to the health care system.
I recognize that a number of things are wrong and need to be improved. However, in this bill we are dealing with only one inhibiting factor to accessibility to the health care system, and that is the factor of extra billing.
I rise to support this bill. I will state clearly not only here but across the province, to my own medical practitioners and to those in the back behind the seats who are heckling, that extra billing does restrict access to some people some of the time.
Let me give a couple of examples. We all know only a small number of doctors are opted out. In my part of the province in northern Ontario, very few doctors are opted out. Why am I concerned about this? Why is this an important issue for me? We know that in some areas, all specialists are opted out. For example, all obstetricians in the town of Guelph are opted out. If one has a community where even one specialist or one specialty is opted out, then one has an accessibility problem for the people of that community.
More important, we have made some progress since the change in government with respect to getting people of the north accessibility to the fine facilities here in southern Ontario. People can now travel for medically necessary reasons and get that travel reimbursed. What happens, however, is that when those people come from northern Ontario and are referred to a specialty here, they are often referred by necessity to an opted-out doctor. Therefore, they have to pay the extra fee.
We have had read into the record a number of letters by the official opposition. There are just a couple which I would like to read parts of into the record. These people have said that I can use the case, the name and so on. This letter says:
"Dear Jim,
"This is the report I promised you as a result of our conversation over the phone in Toronto in late November" -- this person phoned me when he was here in late November -- "concerning the extra billing for medical services rendered during my nine-year-old son's eye operation at Mount Sinai Hospital on November 22, 1985."
He goes on to outline the extra fee which amounts to 32 per cent on one charge and 100 per cent extra on the second charge. He points out that that meant being out of pocket about $700 in financial terms. He says:
"My concern is with the extra billing. The surgeon informed me prior to the operation that these extra charges would be made. With my son's eyesight in his skilled hands, I did not feel that this was an appropriate time to register a philosophical objection to extra billing. What we have here is a not-so-subtle case of blackmail.
"An additional concern regarding the extra billing issue generally is the effect on collective bargaining as it pertains to fringe benefit clauses. My union negotiators bargained for and won an excellent deal for us during negotiations; for example, 100 per cent payment of employees' OHIP premiums. Our negotiators believed this to be a valuable benefit to pursue, and other contract goals may have been ranked lower as a result.
"What we have with extra billing is doctors robbing many unions of their employee benefits. I must say that the doctors do not hold all the blame here. The government has to be considered a culprit in dragging its heels. A happy medium must be found."
9 p.m.
Then he wrote a very touching covering note about his son who is receiving treatment, indicating that the boy hopes to be able to become an eye surgeon. His respect for the medical profession is high. This is not an attempt to damage or to attack the professional reputation of doctors. I wish both the doctors and the Conservative Party would understand that.
Another letter was from a person in Thunder Bay. It said: "After repeatedly reading in the newspaper these days that opted-out doctors are charging a token amount above the OHIP schedule, you might be interested in taking a look at the enclosed bills. Our dentist referred our doctor to the oral surgeon in Thunder Bay for the removal of four impacted wisdom teeth. This operation was done at St. Joseph's Hospital.
"The doctor, as an opted-out doctor, charged us $440 for the operation and an additional $30 for an X-ray in his office three weeks before. OHIP refunded us $247.80 for the extraction of the four teeth and I am trying to recover the $30 for the X-ray from our dental insurance company.
"However, the nonrecoverable portion between the OHIP fee and the doctor's actual charge for the surgical procedure was $192.20. That consists of a surcharge of 77.5 per cent above the OHIP schedule. The expression `token amount' is hardly appropriate for this gouging charge."
Miss Stephenson: OHIP covers only 40 per cent of dental surgery.
Mr. Foulds: It seems to me that the interjection from the very knowledgeable member for York Mills is well taken. If the OHIP fee does not cover an adequate amount, surely it is the obligation of the Ontario Medical Association to negotiate an adequate fee on behalf of its membership.
The OMA cannot have it both ways. If it wishes to negotiate an OHIP fee schedule on behalf of the medical profession, then it should do so in good faith. No other union and no other bargaining agent can bargain a wage scale or fee scale and then allow its members not to abide by that collective agreement.
Mr. McCague: Mr. Speaker, do you see a quorum?
The Deputy Speaker ordered the bells rung.
9:08 p.m.
Mr. Foulds: I want to thank the member for Dufferin-Simcoe (Mr. McCague) for requesting the quorum so more of his colleagues could come to listen to the few modest remarks I have to make in support of Bill 94.
Very simply, I support the bill because I believe we should take what steps we can to improve access. I do not see this as a magic solution to all access problems, but it will improve access. I think it will dramatically improve access in some cases.
We have heard a lot of talk during the debate, both in public by the OMA and in the Legislature by the Conservative Party, about interfering in the doctor-patient relationship, that somehow banning extra billing interferes in that relationship. I do not think anybody in our society who has any sensitivity at all would want to interfere in the doctor-patient relationship when it comes to the professional skill of the doctor and the illness of the patient.
This bill does not do that. I simply do not see how extra billing, how having the right to charge on top of what the union negotiates, on top of what the OMA has negotiated for doctors, how being able to charge more than they said they would charge under OHIP, strengthens or ensures the professional relationship between doctor and patient.
I readily admit that this bill is restrictive. It restricts the financial relationship between the doctor and his or her patient. It does restrict the money relationship between a doctor and his or her patient. Does anyone seriously believe, however, that this will lessen the professionalism that a medical practitioner brings to the relationship between himself or herself and his or her patient? For example, do nurses give less professional service and care at their level of the health care system because they are on salary? Certainly not. Do doctors on salary, do interns give less dedicated and professional service than doctors who extra bill? Certainly not.
It is a very simple principle both of professional health ethics and of our system -- and that is one of the glories of it -- that it is the obligation of every health care professional to give absolutely the best service he or she is capable of at the moment that service is needed. This bill does not restrict that in any way, shape or form.
Let us readily admit that society as a whole owes a lot to doctors, to the medical profession, for care, for research, for comfort and for good health. In many ways, doctors save the vast majority of us who are lucky enough to live in this society from a lot of pain. They save us from a lot of disease and from a lot of debilitating life. Some of us may even owe our lives to doctors.
However, doctors also owe something to society, if I may say so, and I do say so. Society has paid for and given them a lot of training. Society traditionally has paid and given them a lot of respect. Society has paid for and given them most of the facilities they use: hospitals, computerized axial tomography scanners and specialist equipment.
In return, by and large, doctors get a pretty good financial return. The average income I have seen estimated for 1980-81 is about $84,000. That is not bad. It is more than most of us make. It is more than the vast majority of the patients make.
So what are we trying to do? What we are trying to do is to strike a balance. What we are in a very modest way trying to achieve with the health care system in this province and what we are trying to achieve in a very modest way, one small step, with this bill is to meet a principle I happen to think is a very good principle, the principle of from each according to his ability, to each according to his work. That is the principle we have established.
Doctors have a lot of power and a lot of respect in our society. In many cases, they have responsibility as well as power over our health, our lives and our physical wellbeing. The question then becomes, should they have power over other things? Should they have the power to judge our financial circumstances and whether we have the economic ability to pay an extra fee?
My answer to that question is no. Skilled though they may be in their own profession, skilled though they may be in medical practice, I do not think they have the skill to judge whether someone has the financial resources to pay an extra fee. Nor do I believe they should have the right to assess that fee and establish it at the moment when the patient is most vulnerable, that is, when he or she feels ill and is seeking help.
This bill has been called an act of terrorism against the OMA. If it is an act of terrorism against the OMA, then the OMA does not have the backbone I thought it had. Is it a totalitarian act as it is being charged it is? I think I have even heard that dreaded word "communistic" used about the act. It is that kind of rhetoric, that kind of unnecessary, inflammatory talk that does our society, this debate and the medical profession no good at all.
What does the bill do? It prohibits a practice known as extra billing. It does restrict a certain financial procedure or method by the medical profession. It does not restrict the medical practice, the medical judgement, the professional judgement of doctors in any way, shape or form. It does not intervene between the judgement of the medical practitioner and his or her patient.
In my humble view, therefore, I submit this is not a totalitarian or authoritarian act, but it is a restrictive act. Then the question becomes whether society has a right to restrict in this way. That is what the argument of freedom put forward by the medical profession and by the Conservative Party comes down to.
By and large in our society, we have come to the conclusion that we do have the right to restrict certain activities if it results in a good, not merely for one small group but for society as a whole. I suggest that by restricting the practice of extra billing we achieve the result of a positive good.
Not only do those who might have been inhibited from or impeded in access to the health care system benefit, but society as a whole also benefits, because those individuals who might have been restricted in their access to the health care system have increased ability, as a result of receiving health care, to contribute to society in a much fuller way than they otherwise would have done.
It is the old principle established and enunciated so well by John Donne in the 17th century when he said: "No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thy own were; any man's death diminishes me, because I am involved in mankind."
9:20 p.m.
Even if there were a million-to-one chance that the inefficiency of extra billing would prevent some poor soul through ignorance from seeking help, from seeking access -- and it might be ignorance on the part of both the practitioner and the patient -- if this bill prevents that from happening and a person's life is saved, then it will be worth it restricting the financial method by which the doctor now can practise; not his medical ability, not his medical practice and not his professional skill, but the method by which he or she can extra charge.
I did not intend to speak this long. However, I do want to say that I have received a copy of a letter from the Thunder Bay and District Health Coalition to the Legislature's standing committee on social development in which it supports Bill 94. I will not go into detail because the submission will undoubtedly be before that committee. It says, "The Thunder Bay and District Health Coalition hopes that the legislation in a strengthened form, to ensure that its purposes cannot be subverted, will be passed into law speedily."
The bill we have before us is a reasonable bill. It is not an unnecessary bill. I admit it does not tackle all the health care problems; it tackles one and does so effectively and well. Let us get on with passing it. Let us discuss it in committee and see what amendments are necessary.
Miss Stephenson: I rise to join this debate, with grave concern for the future of the health care system in the province and for the future health of the citizens of Ontario, and with great anxiety about the continuing viability in Ontario of parliamentary democracy and the individual freedom upon which it is founded.
On Thursday, February 6, my classmates and I, the 130 or so who still survive, will celebrate the 40th anniversary of our graduation from the faculty of medicine at the University of Toronto. For four decades we have been proud physicians and have felt privileged to have provided expert care in Ontario, across Canada and in some parts of the United States. As free members of a noble profession, we have been dedicated to public service because that is the primary role of physicians.
The current government wants to change all that because it believes it is politically popular and expediently sexy for the government to do so. It apparently believes that being re-elected is far more important than doing that which is right, proper or best for Ontario and its citizens. The elimination of individual freedom is the principle of this bill. The seizure of total control of the health care system by politicians is its objective and statism is its goal.
The destruction of the profession of medicine, which is inherent in this bill, is a giant step in the direction of total state control of all aspects of our lives. Do you not wonder, Mr. Speaker, how long it will be, if they are permitted to do this to the profession of medicine, before they unilaterally tell all the architects how they can practise, where they can practise and how much they can earn, and almost any other group in society as well?
I think one of the problems is there is inherent within this coalition in the Legislature of Ontario an anti-intellectualism and antiprofessionalism that is becoming rampant. It might be wise for the members of this House to be aware of the history of the learned professions and what they have meant to society, because the profession of medicine is indeed an honourable and a learned profession. It is important within this province because it is upon that foundation that the health care systems of our society have been built.
Self-governing professions have had a long and important role in the history of western European society and North American society. It was during the reign of Henry I, between 1068 and 1135, I would remind members, that the first glimmers of self-governance of a profession appeared. The profession of law was the first to win the right of self-government, and its experience set the pattern for medicine, for engineering and for all others. As the member for St. David (Mr. Scott) knows, until Henry came along, all the lawyers were priests administering canon law in the ecclesiastical courts.
Hon. Mr. Scott: What did the doctors do?
Miss Stephenson: They were priests as well.
An hon. member: They were barbers.
Miss Stephenson: No, the surgeons were barbers. The physicians were priests.
In 1113 Henry initiated the establishment of common law throughout England, as distinct from local or canon or Roman law. At this point the lawyers began to move out of the priory and into the public, and they set in motion the process from which evolved the concept and the fact of self-governing professions.
Henry II, who was the first Henry's nephew, consolidated the common law system and established the Court of Common Pleas in 1178 to hear all those matters that did not directly affect the crown. By 1300 the lawyers who dealt with common law had totally separated themselves from both the church and the king, founded the inns of court, and became the first recorded self-governing profession.
During the next two centuries medicine began to evolve in a similar pattern into a similar self-governing profession.
We all know there have been monumental changes in the level of knowledge and skill of both laymen and professionals during the intervening centuries. However, the unique relationship that these self-governing professions have shared with society since that period is in fact a social contract not unlike the relationship that Jean-Jacques Rousseau envisioned should exist between the public and its government.
Essentially, society, or the body public, has delegated the responsibility for the day-to-day conduct of the members of the profession to the professional body, and in the case of medicine in this province that is the College of Physicians and Surgeons of Ontario. In exchange for this, the profession has assumed as its primary responsibility service to the public for its benefit and for the protection of society. This mutually acceptable exchange of responsibilities and rights between the professions and society is indeed a social contract that has greatly benefited both parties.
Perhaps one of the concerns we have about this bill might be addressed if there were less lack of understanding of the concept of real professionalism. The widespread slovenly misuse of the word "profession" in appellation of a multitude of human labours has distorted the import and, I believe, the essence of professionalism in the public mind and, from time to time I have a terrible suspicion, within the professional's mind as well.
What is a profession? I had asked that question of one of my mentors many years ago and was given a definition that I would like to share with members. A profession is a vocation founded on prolonged and specialized education and training that enables an expert service to be provided. The members of a profession are bound together in a common discipline, dedicated to service to the public, linked by a spirit of fraternity and committed individually and collectively to the scholarship necessary to increase and improve the body of knowledge upon which the discipline is based.
The professional practitioner deals on an individual basis with clients or patients in a close relationship, not at arm's length. The rule of caveat emptor cannot in fact apply when the expert practitioner is providing his or her services to the layman, because the consumer of that service is an individual in need of that service and not an opponent in the game of trade.
Hon. Mr. Scott: How about teachers?
9:30 p.m.
Miss Stephenson: Teachers are professionals as well. I have been trying to persuade them to become self-governing professionals for some time.
Hon. Mr. Scott: They contract to the state.
Miss Stephenson: That is because there was a poor law introduced in this province in 1943, which needs to be rescinded.
The professional practitioner expects to provide service to everyone and expects some of that will be provided gratuitously. He does not expect financial gain for every single service, in spite of the fact lawyers charge for telephone calls. The professional is ever mindful of his duty to sustain the honour and integrity of his profession in all conduct. I believe firmly, and have believed for all the 40 years I have been a member of this profession, the members of a profession must not, should not, and in fact do not simply maintain the standard of morality and ethics generally accepted by society. They are expected to strive to practise at levels superior to those commonly followed within general intercourse.
The responsibilities of professionals are formidable. They must establish the criteria for selection of candidates to the preparatory educational program and the form and content of that program. They must be involved in the process of evaluating student performance in the admission of graduates to the profession, and they must now -- this is new and something in which the medical profession has led all the others -- provide programs of continuing education to maintain the competence of their members and the stimuli to encourage participation in those programs. Upgrading is a significant responsibility of each professional.
They must ensure there is reasonable emolument for the services the profession provides. They must maintain a vigilant surveillance of the service provided by all members of the profession and, where necessary, discipline. Each member of the profession has that kind of responsibility, not just to fulfil the daily requirements of an ethical professional practitioner, but to assist the profession itself in the discharge of its onerous duties.
In the eyes of the public, discipline is probably the most important duty of the profession. Public reprimand or cancellation of the licence or ability to practice of a fellow professional is probably the most painful task the profession has to carry out, but it has to be done and is done. Abscission of an unethical or incompetent member is absolutely essential for the protection of the public generally, of the profession's present and future patients or clients and all those who would be affected by that professional's work. The right and responsibility to discipline itself to protect the public, painful as it is, is the keystone of a self-governing profession and an integral part of the social contract between the profession and the public. That must be maintained.
The self-governing professions are the bulwark of our social system. They are a vital cornerstone of a democratic society. One might suggest a self-governing profession is a visible example of the successful and fruitful marriage of principled personal independence with dedication to public service which provides an effective barrier against the ever-possible threat of tyranny by the state. I hope my colleagues in this House will recall that threat is ever-present, no matter how benevolent the state is. In our society, there is nothing a politician abhors more than a policy vacuum.
The worth of the contribution of the self-governing professions to the development of society in the western world is incalculable. The quality of our lives has gained immeasurably from it. If one destroys the self-governing professions, one dismembers society. That is precisely what the reaction of the members of the medical profession is to this bill which has been introduced by the Minister of Health. In 40 years, I have never seen the kind of reaction I am seeing and hearing now among my colleagues. Quiet members of the academic teaching staff in all our faculties of medicine are absolutely livid that the Minister of Health would dare to introduce with Bill 94 something that could amputate the legs upon which this profession stands for no reason other than political expediency.
I remind the members of this House that the self-governing professions have been the instigators and initiators of most of the advances in our society, certainly in this country. In medicine I will name only a very tiny number of the huge list of activities begun by the medical profession that have benefited society as a whole.
I mention only such things as the purification of water supplies; the distribution of pure milk; the system of public health, which I hope the members of this society realize in Ontario is one of the best in the world; and immunization against exanthemata, which has been a cornerstone of the public health system in this province and has made Ontario one of the safest places in the world to raise children.
One other item I should mention is the strong support of doctors for the introduction of the concept of prepaid medical care insurance in 1922. There is nothing original in the thought that the NDP dreamed up the prepayment of medical care in order to provide for protection against catastrophic or chronic illness. In fact, the medical profession introduced the concept at the federal level in the very early 1920s, but it was not taken up at that time. I do not understand why. I believe we would have had a resolution of most of the problems by this time and we would not be facing silly legislation such as that which has been introduced here.
I also remind members of this House that in the early 1930s it was the medical profession in conjunction with the then provincial government that established the first program to ensure that health care, and particularly hospital care because it was much more expensive, was provided to those who were without reasonable financial means during the very difficult times of the Depression.
The medical profession administered that program with very limited sums of money made available by the provincial government and no thought for the level of remuneration that would be achieved by the members of the profession. There was no two-tiered system of health care, because every patient received the best possible care at all times whether or not they could pay. That has always been the history of the profession of medicine.
Prepaid health care insurance for the protection of the public was introduced very early in Ontario. In the early 1940s, Associated Medical Services Inc. was begun by a physician in this province and was one of the forerunners of health insurance programs. In 1946, Physicians' Services Inc. was founded by the physicians of Ontario to serve large groups and individuals, providing protection against catastrophic costs and very shortly against most of the costs of health care.
In the beginning, the provision of a very wide range of services was envisioned and introduced. Physicians subsidized that program from the beginning, providing five per cent of all billings each month in support of the administration of the program. In addition, they provided five per cent to ensure that the program would continue.
9:40 p.m.
In effect they agreed that 90 per cent of the schedule of fees set by the OMA -- an activity that was carried out by that professional group as it is by other professional groups -- was acceptable to those physicians who participated in Physicians' Services Inc., and to those who did not participate as well. This program was constantly monitored to ensure that no misuse or abuse occurred by both professionals and lay members of the board of Physicians' Services Inc. As a result, it was an extremely successful health care insurance program which was copied in all the other provinces of Canada.
When it was found either patients or physicians were abusing or misusing the program, appropriate remedies were initiated. Physicians were treated very roughly at times and patients were reprimanded rather than anything else. It became a very good model for all the other provinces. It was the model for the introduction of the Ontario medical services insurance plan, which some members will recall.
By 1966, about 80 per cent of all the people of this province were covered by some form of health insurance, except for those who were elderly and had pre-existing illnesses or were unable to buy the premiums because they were not working or were retired. With the cooperation of the physicians of Ontario, OMSIP was introduced to ensure there would be protection for that group as well. The government underwrote the insurance program and the physicians of the province guaranteed they would look after all those patients in the same way they did PSI patients and at the same rate of remuneration.
By 1968, when the Pearson government decided it was going to introduce the Health Services Act throughout Canada, Ontario had insurance coverage for medical services of almost 98 per cent of all its citizens, some of them under private insurance, some under PSI, and those who had difficulty in acquiring that insurance were insured by government insurance called OMSIP.
Unhappily, the federal Liberal government did not like that arrangement and was very adamant. It refused to accept Ontario's multifaceted management and economically sound program. This province was blackmailed into participation in the federal system when Lester Pearson informed John Robarts, great Canadian that he was, that unless Ontario came into it he was going to cancel the plan for all of Canada. In addition, Ontario taxpayers would not receive the benefit of the $163 million -- what a paltry sum that seems now -- the Ontario taxpayers contributed to the federal government through their taxes for the support of a health care program. He was going to withhold that from Ontario. The politicians of the day were upset about this and decided they had to fall into line with the concepts which were then being put forward in Ottawa.
This was a program with a somewhat socialistic base which insisted that it be entirely managed by bureaucrats. There could not be any flexibility which would permit the introduction or participation of insuring agencies outside government control. It would have to have first-dollar coverage in all instances, but it would have absolutely no way of ensuring there was no abuse, misuse or inappropriate use of the system because there would not be any mechanism for that.
Hon. Mr. Scott: Was John Robarts right or wrong?
Miss Stephenson: Philosophically, I think he was right for the wrong reasons. He should never have been blackmailed by Lester Pearson and should not have bent quite so far as he did.
Hon. Mr. Scott: He did the right thing, did he not?
Miss Stephenson: No, he did not. I think it probably would have been better if he had done part of the right thing and part of the wrong thing.
Hon. Mr. Scott: Like the egg; good in part and bad in part.
Miss Stephenson: Yes; and the member can eat all of it, that will be just fine.
One thing that was insisted upon was universality. Speaking as someone who was actively involved in the devolution of this entire program within Ontario, universality was never defined. We asked succeeding Ministers of National Health and Welfare please to define universality for us. Ontario asked the federal government to define universality. Finally, Monique Bégin, in her review of the Canada Health Act, decided universality meant every single physician within Canada had to be an employee of his or her provincial government to function within the plan. That was Monique Bégin's definition of universality.
In Ontario, there had been an arrangement that was reasonable and was the basis on which the profession of medicine functioned within the program established. Physicians could participate in OHIP, and if they did they had to participate totally. They could not, as they did in other provinces such as Saskatchewan, decide on a case-to-case basis, on the basis of the income of the individual, whether they were going to be in the plan or outside of the plan. That was not good.
In Ontario, you had to be all in or all out. Nonparticipating physicians were required, and agreed readily, to provide all of the information necessary to OHIP in order that the patient could receive all of OHIP's benefits, but they would bill the patient directly. If the patient decided to pay them, fine; if they did not decide to pay them, that was it as well.
There were fluctuating percentages of physicians within the province who determined they would remain out of OHIP, and I have talked to almost all of them. The reason for their nonparticipation is very clear. They feel strongly that they are a part of a free profession with the right to determine whether they will participate or not in OHIP. They will never, in any way, jeopardize the patient's right to receive full benefits from the insurance plan, but they will ensure that they remain free professionals providing quality health care to their patients.
At the time this was instituted, the plan paid, again 90 per cent of the Ontario Medical Association fee schedule. The physicians agreed to that, because they felt they were really subsidizing the program, that they were following the pattern which they had established in the Physicians' Services Inc.
It was fine, I suppose, in the beginning, that that 90 per cent was the payment from OHIP; but it should be clear to all of the members of this House that what is discussed or negotiated with that negotiating team made up of members of the OMA and members of the Ministry of Health, with an independent chairman, is not the Ontario Medical Association's schedule of fees -- which that free profession has the right to establish just like any other free profession does -- but the OHIP schedule of benefits, which does not necessarily relate very directly to the OMA schedule of fees. In fact, that relationship has become increasingly divergent within the past five years.
That our profession continues to establish its schedule of fees is, of course, the correct thing for it to do. That is one of the responsibilities it has. What is being eroded now is the right of that profession, not only to exercise that responsibility but to practice that responsibility. That is a significant part of a profession's responsibility and this bill is going to eliminate that completely.
This bill makes it a criminal act to abide by the profession's fee schedule if the fee for any act of medical care differs from the benefit allowed by the government under OHIP, as determined primarily by the budgetary directions of the government of the day. This bill brands as a criminal any physician who does deviate. Felony is not a part of the traditional role of physicians, and being so branded is certainly not one of the positions that the medical profession of this province deserves.
9:50 p.m.
This bill is an act of conscription of physicians into service as prescribed by the Minister of Health, in other words, to become employees of the government of Ontario. In doing that, I believe the government will ensure the transition of a responsible, free, totally committed profession in this province into a trade union such as we see in the USSR and in East Germany.
Those who liken the Ontario Medical Association to a trade union should be aware of the fact that membership within the Ontario Medical Association is entirely voluntary. Of the 17,000 physicians in Ontario, 15,000 are voluntarily members of the Ontario Medical Association, and the decisions of the OMA council are not binding upon individual members. The clout the OMA has, if it has any, arises as a result of its logical arguments and moral suasion and nothing else. It has no authority to demand that its members do what it asks at any time. The association is entirely voluntary.
This bill will not provide funds for other health care initiatives, for if the physicians are forced out of their professional mould -- as they surely will be if this bill is enacted -- the ensuing structure will negotiate conditions of work, as the minister was wont to say today, that ordinarily would be negotiated in any labour-management discussion.
If they do negotiate such things as conditions of work, hours of work will be one of the first things to be negotiated. Most of my colleagues are, at this point, working on behalf of patients 60 hours a week and on behalf of the hospitals or the delivery of health care for at least another five hours, on average, every week, at no remuneration at all. So they will begin to be concerned about negotiating their hours of work. They will not want, in true labour-management fashion, to work longer than 40 hours a week.
If that is so, there must be a dramatic increase in the number of physicians in this province to provide even the level of service which is available now. We will have to provide for at least an additional 7,000 physicians, almost immediately but certainly over the next several years, by enlarging our medical schools.
I remind the members that the medical schools of this province were willing to do that back in the 1970s, but the then Minister of National Health and Welfare, the Honourable Marc Lalonde, decided that the cost of too many physicians was something more than he could bear. He made a request to freeze admissions to medical schools, which was acceded to by ministers of health across Canada.
During these intervening 10 years, the only province that has abided by that is Ontario. There has not been a significant increase in admissions to medical schools and therefore there has been a limitation upon the number of graduates.
All that will have to change. The position the Liberal Minister of National Health and Welfare took in 1975 will be turned around completely by the provincial government at a much higher cost, because significantly more doctors will have to be educated within this province. We also will have to increase the immigration of a large number of physicians, another position which the federal Liberal government cut off about 10 years ago.
There is no doubt the medical union which will be established will demand a premium for overtime and for weekends, as is the usual pattern. They will demand payment in full for all the time they spend in committee work ensuring that the hospitals of this province run effectively and efficiently. They will also demand full payment for teaching at the universities, which is something the physicians in this province have never done. Unless they were full-time staff members, they have never been paid at the level of teachers, lecturers or assistant professors, any other faculty member, is paid within this province.
Undoubtedly, they would ensure -- and very correctly so -- that in their negotiations the benefits which they now provide themselves out of their incomes, such benefits as health and dental insurance programs and retirement programs, would be part of the salary negotiation.
It is my understanding that in most labour union contracts this year, that program accounts for about 25 per cent of the total pay package. It will be evident that the $50 million the government says it has introduced its bill to acquire will be dissipated overnight as a result of the insensitive movement of the government in the direction of attempting to bludgeon the medical profession in this province into some kind of total, prostrate submission.
The medical profession in this province is one of the most progressive groups in our society in terms of benefit to society. To my knowledge, they have not impeded the enhancement of health care in any way in Ontario. Those few physicians, 12 per cent, who are nonparticipating, do not extra bill as the government is wont to call it; I would like it to call it balanced billing, because what they are doing is billing, when they do it, at the level of the Ontario Medical Association fee schedule, which is their right as a free profession in this province.
The members of this profession who are opted out do not cost this province large amounts of money. If one looks carefully at the information OHIP can provide, one will find that only five per cent of all the accounts submitted to OHIP have an additional bill attached to them. I know the Ontario Medical Association and the College of Physicians and Surgeons of Ontario have said very clearly that there is a commitment on the part of the profession to ensure that anyone for whom balanced billing might be construed as a financial hardship will be totally protected and that it will never occur.
If the physicians are not to judge the financial status, as the member for Port Arthur (Mr. Foulds) feels they are not capable of doing -- he feels they are capable of judging their medical state, but not their financial state -- if he does not want the physicians to be given that responsibility, that is just fine. The profession has been asking for years that there be some kind of identification of the individuals whose premiums are partially or fully subsidized, so that the patients would never be embarrassed by being asked by an opted-out physician whether they could afford to pay anything.
I am also aware that there is grave concern about the fact that in some places all the obstetricians are opted out. That is a circumstance I do not find particularly surprising. Unhappily, the fee for full prenatal care and delivery for a patient is not one of the most glorious of the fees in the schedule established by the Ontario Medical Association. The concern of some obstetricians has been that too little value has been placed on this.
The concern that has been expressed about that problem is that patients who decide they want to have their normal pregnancy cared for by a specialist obstetrician have difficulty finding a specialist obstetrician who is not opted out. In actual fact, 90 per cent of all normal pregnancies never need to see a specialist obstetrician and there is no need for those patients to seek that care.
10 p.m.
The specialist obstetrician is not terribly interested in doing normal obstetrics. In all circumstances, he or she is much more interested in dealing with the abnormalities for which he or she has been trained than with dealing with normal pregnancies. However, if patients want to be delivered by a specialist obstetrician and insist on going to a specialist obstetrician, for which there is no good reason, then surely some kind of premium should be paid for that insistence.
I am not sure the individual who decides he wants to buy a Cadillac instead of a Volkswagen is going to be subsidized by the government to buy a Cadillac, and that is really what is being requested in this kind of circumstance in relation to obstetricians.
In all the years I have practised, I have never had any difficulty with a patient who had any kind of financial constraint in ensuring that that patient would never be extra billed by an opted-out specialist.
Mr. Grande: Balanced billing.
Miss Stephenson: Would the member just be quiet and stop chirping for a minute?
One of the roles of the family physician is to ensure that the welfare of that patient is looked after in all circumstances. All I have ever had to do was to telephone my colleague to whom I was referring the patient and simply say: "This patient is not to be billed. You will treat this patient at the level of your best care, but you will accept OHIP as full payment, will you not?" I have never yet been denied that request, not once.
If the family physicians of this province do carry out their responsibility in that way, there is no problem with referral to specialists who are opted out. However, that is one of the responsibilities of family physicians and it is one of the matters I would like to deal with specifically if some sensibility arises within the mind of the Minister of Health, if this bill is withdrawn or restored to the appropriate receptacle and if we can provide some kind of direction for the way in which we can protect all of those citizens who have concerns about extra billing.
It is unfortunate the Minister of Health is not here, because I would like to share with him some information I think is rather clear in other parts of western European society in relation to the right and the responsibility of physicians to practise either within the insurance program of those various states or countries or without it.
As the Speaker probably knows, in France private insurance has been available in a number of ways for about 28.8 per cent of all the services that are provided in France; in Germany it accounts for about 19.4 per cent of the medical-surgical services provided; in Sweden, 10 per cent of the medical-surgical services provided, in the Netherlands, 21.5 per cent of all the services provided; and in the United Kingdom, 12 per cent. We are asking that five per cent be permitted within Ontario. Surely there is some understanding that the profession of medicine in Ontario is as responsible as it is in any of those jurisdictions.
One of the things that has been touted regularly in all of the discussions that have been heard in this House is the fact that the party to my left, which remains consistently to my left, states clearly that if we do not ban what they call extra billing, there will be two-tiered medicine.
I said before this evening and I will say again for the benefit of those who are within this House -- and even the member for Port Arthur agrees -- that the profession of medicine does not deliver two-tiered medicine. It delivers care at the best possible quality for every patient every time it must provide care for patients, and it does this without concern about the level of payment that is going to be achieved.
That has always been the tradition of medicine. It is now the tradition of medicine and it will continue to be unless this bill is passed into law. If that happens, I fear for that traditional concern for the maintenance of the highest quality of care in all circumstances, no matter what the financial condition of the patient.
The practitioners of medicine in this province are extremely honourable people. They are the people who have ensured that the health care system that this province enjoys is one of the top two in the world. I can say that without equivocation, having had the opportunity to visit 43 countries viewing their health care systems. That is a very high degree of success and quality, and it is because there has been co-operation, consultation and a good deal of participation by health care professionals in the planning and development of the health care system.
What is being proposed tonight ensures participation will be reluctantly provided and co-operation grudging in it submission to the program. The kind of co-operation we have seen in the past simply will not be present because the profession feels it is being singled out for unnecessary degradation by the Minister of Health.
He could correct all that if he would do as has been suggested and establish a brain trust -- not a task force, there are enough of those -- a committee of people made up of the providers and the consumers of health care, some of the really bright people we have in Ontario.
We have people who have helped establish health care systems in 20 other jurisdictions around the world because they have the expertise. We have people who are knowledgeable about consumers' rights and concerns here and in other places. We need to bring them together under the auspices of the Minister of Health to solve the problem of health care both now and in the future.
I must reiterate the statement so clearly made by my colleague the member for Dufferin-Simcoe. When all the people concerned with the delivery of health care in Ontario were polled by the Ontario Hospital Association -- not the medical profession, I would remind members -- they were asked to list matters of concern.
The kind of concern expressed by the socialists who have induced the Liberals to pursue it is way down on the list. It is not a matter of real concern because it is an impediment which can be corrected relatively easily and without this kind of difficult and totally draconian legislation.
The concerns expressed are about our ability to move into the 21st century with the kind of health care program that is necessary. The demographics we are facing are very significant. Within this century we have developed a specialty which has provided for a total turnaround of the infant death rate in the first year. In 1910, the death rate of children admitted to the Hospital for Sick Children, which was the first hospital for children in Canada and a very good institution, was nine out of 10.
In 1911, as a result of nutritional knowledge brought to that hospital by the speciality of paediatrics, the death rate had been turned around. Of 10 patients admitted with serious illnesses, nine were discharged. That is the kind of improvement in care we have been able to develop in a specialized area. The whole area of paediatrics and adolescent medicine in Ontario has been developed within one half of this century and has provided leadership throughout the world.
We can do the same thing in the area in which we must now be concerned, that is, the greying population, which includes all of us. We must be concerned because we are going to become the dominant group within our society, and our society must provide the health care system to meet the needs of that group. That whole demographic shift is one which must be looked at as logically, rationally and carefully as possible.
10:10 p.m.
I do not think any member of this Legislature wants to have rationing of the delivery of health care, as will happen unless we begin this kind of discussion. I do not think we want physicians to say one patient may have this but another may not because of the fact the first patient was more valuable to society than the other. We have to find a way to ensure that we can provide what is necessary for all our citizens. The greying of our population demands that we begin the examination and development of that kind of specialized service in which we can develop the kind of excellence we have in paediatrics and adolescent medicine.
We have within Ontario one of the most medically sophisticated populations in the world. People are inundated with information provided by all the latest medical journals, Cosmopolitan, Reader's Digest, Time and Newsweek. They all have medical columns, all of which report, usually prematurely and with rising expectation that is not entirely justified, the latest developments in the field of health care.
The sophistication of our population has increased dramatically, but it has not yet understood that all those things are not available immediately and that the demands that are made for very high-tech medicine are growing at a rate we are unable to afford with the present public funds and the present level of taxation.
In addition, we have made very significant advances in ensuring that there is an understanding of the responsibility for the maintenance of individual help on the part of each citizen. However, we have not done well enough in that area because we are at present seeing huge increases in lung cancer. We know there is an activity which, if curtailed, will ensure that number decreases slightly.
We are ensuring that there are increases in the numbers of very severe genetic diseases, which can be treated successfully, because we are prolonging the lives of many of those young people to the stage where they reproduce children who have the same genetic disease. We know we have to find ways to ensure there is some kind of honest, moral and ethical manipulation of genes to ensure that they can reproduce without reproducing the genetic difficulty.
These are the kinds of problems facing us and we are not addressing them. At this point, we are not even addressing the concern expressed right across this province that older patients who require just a little bit of tender loving care cannot be sent home to their families, because families do not have room or the kind of open-mindedness about that activity any more. They want that relative placed in some kind of institution or noninstitutional institution, that is, a place that does not look like an institution but is actually run as one. That whole area of personal responsibility is one we have not fostered very well.
These are the types of difficulties that have to be faced. These are the kinds of problems we must begin to address. Those are the problems that all the people surveyed by the Ontario Hospital Association listed as their primary concerns. The one the minister is addressing, simply because he is required to do so by the accord, is a nonissue which can be resolved almost overnight with very little difficulty.
I simply ask all the members of the Liberal caucus to read the remarks made by their very courageous colleague. The member for Humber (Mr. Henderson) made a rational, logical, unemotional and very knowledgeable submission on this whole subject. It is a matter which should be of interest to all of them. The presentation he made is one they should pay attention to because he is extremely knowledgeable and an expert in a number of areas of health care delivery.
I am speaking tonight not because I have concern about my future nor concern about the future of the Progressive Conservative Party; I have concern about the future of health care delivery in this province. I have concern about the health of the people of Ontario. I have grave concern about a profession I know well, which has provided the leadership that has made the quality of health care in this province what it is.
Do they want that kind of leadership to continue? Do they want to have the profession of medicine in this province functioning effectively as active participants, full co-operators and knowledgeable providers, in conjunction with the other providers in the development of the future programs for which this province could become noted, as it is now? Do they want the profession of medicine in Ontario to remain the guiding light for the development of health care, which it has been for most of Canada?
Do they want the faculties of medicine of this province to continue to teach, as they always have, the concept of selfless public service to the members of the student body within their faculties? Or do they want all of those who are currently in medical school to say, "These guys changed the rules before I even got through."
Do they want the future students to determine that what they are going to do is work a 32-hour week and demand full payment, payment at the same level, because that is what everyone else does? That is the traditional position. One reduces the hours, but one does not reduce the income. Do they really want the additional cost without necessarily a great deal of increase in productivity? This will occur if they force the medical profession into the kind of mould the Minister of Health appears to want them to pursue.
I am not sure that is what he wants, but his actions and the actions of the government over the past several months would lead members of the self-governing professions to be very concerned about the minister's attitude and about whether he cares that those self-governing professions have provided the kind of direction which has made much of this country great. It has improved the status of the citizens of Ontario.
If the government cared, then why would it unilaterally take away the earned QC of many of the lawyers of this province? Many of them are very hurt by that. They did earn it. Why would they suggest the pharmacists of this province become simply counters of pills? Why would they not suggest the medical profession would not have to become employees of the provincial government --
Mr. McKessock: To save another $50 million.
Miss Stephenson: They are not going to save a cent. Why would they not suggest there could be an active co-operative participation between government and those professions in the development of new programs to solve the problems? Surely that is the kind of sensible direction any thoughtful sensitive government would pursue.
If it is going to save any large amount of money, I would be the first to say, "By all means, go ahead." I am not convinced. There is no evidence it will save a cent. The government will probably expend far more as a result of the action it is taking. It will not be to the benefit of the health care system nor the health of the people. It will be to the detriment of those people. A conscripted army does not provide the kind of service that a free and voluntary participating group within society, the members of which are proud to be a part of the group, will provide for the people of the province.
10:20 p.m.
The minister appears to have tunnel vision. Is his tunnel vision occasioned by direction of the first minister of the province? Is there the kind of vindictiveness and malice, seen by the profession in this legislation, which is motivating the Liberal Party to do this? Do the members really want to make the doctors of this province felons? Is that what their objective is? If not, I beg them to reconsider this bill, to suggest very strongly to the minister and the first minister to reconsider this bill.
I suggest very strongly to the minister and to the Premier (Mr. Peterson) that it would be wise to cease and desist from the direction of this activity right now and to move to establish the group that will investigate with care, insight and incisiveness the problems that are really facing the health care delivery system within this province, and they have precious little to do with what the government calls extra billing. We all know that extra billing accounts for lack of accessibility in a minute number of situations -- not a large number, a very minute number -- which can be corrected very easily with a little co-operation from the government.
It will have a commitment on the part of the profession that it will ensure that no individual who has his OHIP premiums subsidized partially or totally will ever be the recipient of a bill beyond the level of OHIP payments. The physicians will commit themselves to receiving the OHIP payment as full and final payment for any service they provide for those individuals, and that is the only group in which there is any potential problem of inhibition.
Hon. Mr. Bradley: But they will decide it.
Miss Stephenson: They have already decided and they have made that kind of commitment.
Hon. Mr. Bradley: No, they will decide those who will have their full premium paid.
Miss Stephenson: No, they will not decide.
Mr. Speaker: Order.
Miss Stephenson: No, that is not decided by physicians. It is decided by government, as the member very well knows. The government determines who will have his premiums subsidized either partially or totally.
What I am saying is that the government will have a full commitment by the profession that this group will never, ever receive a bill. What they will receive is first-class care, as they always have, at the level of emolument that OHIP provides for physicians and for specialists. That commitment has been made. All that has to happen is for the government to let them know it is willing to do this.
But no, that is not the way the government goes. It brings out a bludgeon with a nail in it to hit the profession over the head, to beat it into submission to demonstrate that the government is going to run the health care system, direct what care and services patients can have and decide how much the profession can be paid. Then, of course, it will decide exactly how much a carpenter can be paid for his services, how much a plumber can be paid for his services, how much a lawyer can be paid or an architect or anyone else. The government will make those decisions.
When the government starts on the road of removing the freedom and rights of self-governing professions, it has started on the road to total destruction of the freedom of individuals within the society.
Interjections.
Miss Stephenson: If the member for Oakwood (Mr. Grande) does not know that, then he has not learned very much in the 10 years he has been here. It is a very unfortunate situation.
Mr. McKessock: It is $9 billion.
Miss Stephenson: The member for Grey says $9 billion. I know that. The member for Grey seems to believe it all goes to doctors. He is wrong, wrong, wrong. It goes to the health care system. Most of it goes to hospitals.
Mr. McKessock: For the doctors to work.
Miss Stephenson: But they do not get paid from the amount of money that goes to hospitals. The hospital bill is a separate bill.
Mr. McKessock: Yes, but it helps them.
Miss Stephenson: Courthouses help lawyers and schoolhouses help teachers, do they not? The Minister of the Environment (Mr. Bradley) could never have functioned if the province had not supplied a schoolhouse for him to teach in, nor could the member for London North (Mr. Van Horne) have. He had to have a schoolhouse in which to function, and so did the member for Kitchener-Wilmot (Mr. Sweeney). The teachers did not supply that.
Hon. Mr. Sweeney: Hospitals are a lot more expensive than schools.
Miss Stephenson: They were not in the beginning, I can tell the member.
What the government really wants to do, I gather, is to make all the physicians in this province employees of the government of Ontario so it can direct their activities and the kind of care they can provide. If that is really what it wants, then I am terribly afraid there will be very significant destruction of the health care system in this province.
I hope the government will recognize that the road it has embarked on with this piece of legislation is a slippery slope down to the pit of total societal destruction. I am not exaggerating when I say that. If the Premier wants to suggest I am exercising hyperbole, he has not heard hyperbole until he hears the doctors of London tell him exactly what they think about the kind of legislation he is proposing to introduce.
I must admit that within the province, to my knowledge, there are approximately 140 physicians who disagree with the profession.
Hon. Mr. Bradley: Publicly.
Ms. Gigantes: Secret ballot?
Miss Stephenson: No. There are many who are not saying anything who are terribly concerned about the fact that this piece of legislation has precious little to do with the improvement of health care delivery and has nothing to do with the concern that is being expressed by the members opposite and to my left, that all of this is related only to physicians' incomes.
Most of the physicians who are opted out at present would probably make one and a half times the money they make right now if they were opted in. That is a fact. They do not want to make more money. They want to preserve the freedom of a self-governing profession, which is what this government is removing with this legislation. If the members cannot see that, then I am afraid they are as tunnel-visioned, as myopic and as amblyopic as the minister appears to be.
That is unfortunate, because I believe the government is not in any way improving the health care system within this province. Surely that has to be our concern. In any legislative act in which we are involved, surely our primary objective should be not to make things worse for the people of Ontario. If we cannot do good, let us do as little evil as possible.
If the government wants to do as little evil as possible, then by all means it should withdraw this dreadful piece of legislation which will do nothing to improve the health or health care of the people of this province, a matter for which each one of us should have concern.
We should understand that although we may have responsibility, 123 of us do not have any of the expertise to provide the care that is necessary. The members of the Legislature cannot deliver health care and cannot ensure that the health of the people of this province is improved if they insist on denigrating those who deliver the health care program to the people of Ontario.
I ask members to consider very seriously what their role and their responsibility are in this matter. It is a matter of grave and real concern to the profession which has been the foundation of the quality health care system in this province. I ask members, please, to reconsider seriously the kind of direction they are pursuing for the good of the health care system, for the health of the people and for the good of Ontario.
Mr. Speaker: The member for Ottawa West. I presume he wants to adjourn the debate.
Mr. Baetz: I do want to adjourn the debate. Could I make one comment?
Mr. Speaker: We still have 60 seconds.
Mr. Baetz: One and a half minutes.
I simply want to say I hope that through the parliamentary assistant for the Minister of Health this tremendous address we have just heard on this very vital subject will get to the neophyte minister. We have heard here an outstanding address, something that drew on the history of health care services from way back. Nobody can speak in a more informed manner on that subject than the member for York Mills, who has addressed us tonight.
She has said quite honestly and factually that she has no personal axe to grind, but she speaks from her close acquaintance and association with the medical profession. All of us should consider very carefully what she has said. I do hope the neophyte minister hears all about it. I shall continue with my subject at the next sitting.
On motion by Mr. Baetz, the debate was adjourned.
The House adjourned at 10:30 p.m.