L036 - Fri 20 Jun 1986 / Ven 20 jun 1986
HEALTH CARE ACCESSIBILITY ACT (CONTINUED FROM NO. 35)
12:43 a.m.
HEALTH CARE ACCESSIBILITY ACT (CONTINUED FROM NO. 35)
Debate on the motion for third reading of Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services that are Insured Services under the Health Insurance Act.
Hon. Ms. Munro: With all the energy on this side, I want to speak to the question. On December 19, 1985, the Minister of Health (Mr. Elston) introduced the Health Care Accessibility Act, which will prohibit all physicians, including those who are opted out of the Ontario health insurance plan and who bill their patients directly, from charging more than OHIP rates.
What do we mean by "accessibility"? We mean accessibility of patients to a health care system which is not differentiated based on socioeconomic status. Extra billing jeopardizes accessibility. It introduces the danger of a two-tiered system based on two sets of rules. The Canada Health Act, the national legislation, guides the actions and programs of provincial governments. Its basic tenets are accessibility, affordability and portability. Extra billing denies patients these fundamental rights.
Individual doctors are aware of this. The values of caring are uppermost in most of their minds and yet they are faced with conflict presented to them by a group said to represent them. The Ontario Medical Association, as a professionally organized group, has become bigger than the membership and with a louder voice than the people it purports to serve. Professions should reflect the values and rules of their memberships. When professionalism becomes a power unto itself, it needs to be evaluated. The public, patients and doctors are right now evaluating the principles and philosophy of health care.
Some doctors are in a dilemma; some are in conflict. We are seeing the paradox of individual ethics versus professionalism. The health care professions are in conflict. The public, however, is caught in a bad position; the patient is in danger of losing access. We have a compassionate minister; a minister who has met with doctors and with the OMA and who has negotiated in good faith. Through a process of 11 formal bargaining sessions, the government made fair process to the doctors to address their concerns but would not put extra billing on the table. Throughout all those good bargaining sessions, no negotiated settlement was reached.
Actions by striking doctors will not force this government to withdraw the bill. We have gone through a lot of debate. The bill was introduced in December, debated in the Legislature and went before the standing committee on social development. The government is listening; we are open to consultation. People spoke to us about the issue before the election. We are now here in government and we are speaking for the people who asked us to speak.
The bill has received support from affiliated nursing organizations, labour, business and women's concerns. Doctors are not the only ones who care about the health of people; we in government do as well. I would also like to draw the attention of the House to the fact that three other provinces have banned extra billing.
We faced well into the myths and the people are behind us. We now know that extra billing will not improve access to health care but that our bill will cement the doctor-patient relationship and not deteriorate it.
Our minister has gone on record as showing the people of Ontario that he cares about shoring up and improving our health care system. We have entered into a review of the health professions. We have introduced assistive devices programs. We have put money into research and development of hospitals. We have taken a look at the function of district health councils and have listened to them. We have looked at drug pricing. We have looked at the needs and care of seniors. We have looked, through the Ministry of Colleges and Universities, at what geriatric schools are all about. We have taken a good, hard look at the need for cancer research. We can go on and on. We are the social conscience of health care.
[Applause]
Hon. Ms. Munro: Thank you. At least I know you are awake.
We have continued to negotiate with groups right across this province. It has been clear to us that accessibility and affordability of health care are paramount in the minds of most people. The major difference between what the two sides of this House are talking about is what really constitutes the health care system. The Tories seem to be saying that doctors are the health care system. That is simply not true.
The excellent health care system in this province is composed of nurses, cleaners, ward clerks, receptionists, nursing assistants, paramedics and many others. They are not striking. They are not trying to bring health care to an unhealthy stop.
At a town meeting I held in Hamilton last night -- or two nights ago, now -- I was expecting that there would be a real debate about this current problem. I had expected to be faced with doctors protesting or at least with representatives of the doctors. Of the 50 or so people there, there turned out to be two who supported the doctors and neither of them was talking about the end to extra billing. Rather, they talked about the process to end extra billing. It was not the end they were debating, but the means to the end.
I sometimes get the feeling from my colleagues opposite that they are not against the action of this government but against the way this government is acting. I challenge them to come up with a better way to bring health care back to the control of those who are really important: the people. I challenge them to recognize the reality of today's world, the reality of Canadian law and the predominance of Canadian government. I challenge them to end extra billing more equitably.
I do not mean to solve the problem in any other way, such as by negotiating in some form acceptable to the doctors rather than ending extra billing. That is not what the people of Ontario want. I do not mean to solve it by bowing to hardliners within the OMA but by ending extra billing, by not making patients face additional fees when they need treatment.
I have not heard a single reasonable argument from my colleagues opposite. I have heard lots of rhetoric, a good deal of issue-dodging and some rather obviously self-serving statements, but I have not heard an argument for a better way to end extra billing than that proposed in this bill.
12:50 a.m.
This issue is not about doctors' rights; it is about patients' rights. I hear the doctors say that it is not about money but about freedoms. Let me paraphrase one of the people at the town meeting I mentioned earlier. He asked what rights the doctors were giving up. He said that no one was telling them what hours they had to work, when to take a vacation or a day off, when to accept or reject a patient, how hard they can work or how much money they can make. He ended up by asking exactly what rights they are losing. I ask the same question.
I am not here to beat up on doctors or to do damage to the health care system. I am here to make sure no one beats up on patients or does damage to the openness and accessibility of the health care system. The entire province is being hurt by this issue.
Let me cite one example close to me. One member of my staff has just been informed that she has cataracts in both eyes. Her ophthalmologist made an appointment for her with another specialist and asked that she have some blood work done before that appointment. Her doctor and her husband's doctor are not working. Luckily, she has the resources of the health care system within Queen's Park available to her. But what about those who do not have this sort of resource available?
This is a just and reasonable bill. It proposes a just and reasonable end to what I consider an unjust and inequitable ability to bill patients beyond the OHIP benefit package. That package was worked out by previous governments and the medical profession. New packages will be worked out between new governments and new representatives of the medical profession.
The Tory party is arguing for the precious right of the doctor to charge what he wants. I am arguing for the precious right of the patient to have accessibility to health care without having to worry about a doctor charging more than the patient can afford to pay.
I will be supporting this bill tomorrow afternoon or whenever the party opposite finally allows the majority of the members in this House to vote for the bill. I am not voting against doctors; I want to make that perfectly clear. I will be voting in favour of patients. I believe that is all we are talking about here this evening. When we finally vote, the Tories, in their own minds, will be voting for the rights of doctors. We will be voting for the rights of the patients and for the protection of our health care system.
Mr. Ashe: I rise to speak in this debate because I abhor this piece of legislation known as Bill 94. I feel frustrated and hurt about this legislation. Imagine how the doctors, the profession being directly attacked by Bill 94, feel. Imagine a profession, a group of people whose personal feelings are so much the opposite of what they have had to show in the past few days. Their upbringing, their education and even their oath are so foreign to what they have come to in the past number of days that they do not know what to do. As professionals, they are concerned about the future of the best health care system in the world here in Ontario.
We have a government that in the past let on it was one of the parties of the free enterprise system, a party of the people and a party of open government. Yet they come forward with this draconian, socialist legislation. That is what it is. It is down the path to socialism. The people to our left just put their hands together in glee because they have a few more cohorts to go down that path of destruction with them.
I find it unbelievable when I look, for example, in today's Globe and Mail, the Friday edition of the Globe and Mail, and see a few of the things that have happened and are going to happen. The Premier (Mr. Peterson) happened to be down in Ottawa.
Mr. Callahan: What happened?
Mr. Ashe: Some time on Thursday afternoon or whatever -- it must have been something to do with that -- he went down with all confidence that once he got away from Toronto there would be no militancy in the medical profession. They would not even know about it. Those things are unique to downtown Toronto and the greater metropolitan region. That is not the case.
Let me quote a few of the things the doctors have been forced to. Imagine "Screaming Doctors Surround Peterson at Ottawa Hospital." That is foreign to a doctor. That is foreign to his or her whole character. But they have been forced through frustration to get to that.
Imagine. "`You're wrong, David Peterson, you're dead wrong,' one doctor shouted, standing nose-to-nose with the Premier. `You're a tyrant, a gutless tyrant.'"
Mr. Epp: You have not heard your colleagues yet.
Mr. Ashe: We would never refer to one of our colleagues as that. I only quote that, Mr. Speaker, as I am sure you appreciate. I might call him a tyrant but I would not use the other word. I would not go that far.
Hon. Mr. Bradley: I heard "pigheaded" today.
Mr. Ashe: That is probably a good word too.
Mr. Stevenson: We are trying to think of the nicest things we can think of but it is difficult.
Mr. Ashe: Dr. Charles Shaver, the president of the Ottawa Academy of Medicine, was saying, "I feel the doctors have just been sledgehammered." Dr. Railton, the Ontario Medical Association president, "has already said the doctors will not end their strike just because the bill to ban extra billing is pursued." But the Minister of Health (Mr. Elston) "said yesterday that he does not believe the government will have to introduce back-to-work legislation and that passage of the law will `help end the stress on the system.'"
The stresses on the system are there but they have been caused exclusively by this government, supported by the little group on our left that has the indicated support -- at least it did in May of last year -- of 24 per cent of the population of Ontario. It is slipping quickly.
"Dr. Shaver said that if Mr. Peterson thinks doctors will call off the strike after the bill is passed, he and his government are dead wrong.
"`He's sadly mistaken,' confirmed Dr. John Kindle, a general practitioner at the Riverside Hospital," which is also in Ottawa. "The unity of this profession is so solid that the doctors won't return to work."
I think the Premier is getting a little edgy. Members heard me a few moments ago say what the Minister of Health is saying, that once the bill is passed it will "help end the stress on the system." But the Premier this afternoon "conceded that he was not confident that the strike would end with enactment of the legislation." Perhaps they should confer a little more often. I am speaking about the minister and the Premier.
Mr. Ward: The editorial is on page 6.
Mr. Reycraft: Turn to the editorial; page 6.
Mr. Callahan: Read the good stuff.
Mr. Ashe: That is all right. We will get to some others as well in the paper.
Mr. Callahan: Read to us from the Toronto Sun. That will be all bad.
Mr. Ashe: No, I happen to be going to page 13. To date, pretty well all the job action in the hospital context has been in nonteaching hospitals. What have we got now? What is the headline on "Doctors' Strike -- Day 9"? Mount Sinai, a very well respected and highly respected teaching hospital, associated of course with the University of Toronto -- and let me again point out something --
An hon. member: On a point of order, Mr. Speaker: The honourable member is reading a speech and I know that is an infraction of the rules.
Mr. O'Connor: You are not in your right seat.
Mr. Gillies: On a point of order, Mr. Speaker: The Attorney General (Mr. Scott) was clearly out of order with his interjection as he was not sitting in his seat, which is an infraction of the rules and customs of the House. The Attorney General was clearly out of order.
The Acting Speaker (Mr. Morin): I agree.
An hon. member: No, he is supposed to stand. I thought all members were supposed to stand, not sit in their seats.
Mr. Ward: On a point of order, Mr. Speaker: It is my understanding that all interjections are out of order. Is that not correct?
The Acting Speaker: Yes.
Mr. Ward: Then what difference does it make if one is in one's seat?
1 a.m.
Mr. Ashe: The impression is given by some of the members -- I think it is believed particularly by some of the members to the left when they put it out; I do not honestly think it is believed by many of the government members when they are forced to put it out -- that all doctors who extra bill, or all specialists, charge the system as much as it can handle.
Let me get back again to Mount Sinai, which is a highly respected teaching hospital. Because the majority of doctors in U of T teaching hospitals volunteer their teaching services, Dr. Lowy said the university is powerless if doctors decide to withdraw those services.
"Dr. Jack Brandes, a psychiatrist at Mount Sinai, said that the doctors at the hospital feel no dedication to a university that is `in the back pocket of the government.' He said that some doctors are paid as little as $108 a year to teach at U of T."
This is the major point: "If doctors are faced with sitting back while the entire medical system is being ruined, they will tell the dean and the assistant deans sitting in their ivory towers to take a flying hike."
It is hard to believe that a profession that is so well regarded and so professional can get to the kind of frustrating situation where they have to resort to this kind of change in ideology and this kind of verbiage. It is unbelievable, but it is happening.
Earlier today we heard the leader of the third party refer to a medical situation out in Durham. I have the honour to represent part of that region. Something in the order of one per cent of the doctors who practise in Durham region are opted out, which means --
Interjections.
The Acting Speaker: Please ignore the interjections.
Mr. Ashe: It happens to be a grand total of two, and I am guesstimating that we probably have something in the order of 200 doctors out there. I do not know if that is accurate. I am sure there are at least 200. We have an area where, if we go by some of the rhetoric that has been put out, it is only these doctors who are concerned about putting more dollars into their pockets and taking them out of everyone else's pockets. One per cent of the doctors in Durham extra bill; they are uptight. They are not uptight about their pocketbooks because it does not mean a thing. They are concerned about the health care system in Ontario. They are concerned about the health care system in Durham. That is why they are extremely upset.
This morning doctors were speaking to people boarding the GO trains. They were giving literature to people getting on the GO train at Pickering. That is hard to believe but it is fact. We have all done that -- that is among the duties of a politician -- at certain times in our careers when we call elections, but doctors should not have to do it if they had any kind of communication with the government that supposedly reports back to the people, that supposedly represents the people. It has let a situation that it perceived by its polling to be 80 to 90 per cent in its favour, back when it flip-flopped its position two years ago, slide to a minority position. Even at this time, unfortunately, an awful lot of people do not really understand the issue. They have let it slip, through mismanagement, down to the situation we are now in.
The leader of the third party again made reference to Dr. Atkinson out in Durham. I might quote further reference by that doctor, who happens to be the president of the OMA in Durham region. She is a highly respected medical doctor who operates in the town of Ajax, within my constituency.
"Dr. Atkinson added yesterday in an interview that the Durham Medical Society had presented and passed a resolution that if Bill 94 is passed by the Legislature, `we would withdraw all services.'"
I know this doctor. She is a very responsible doctor, but she and her colleagues are so frustrated, not about their own concerns but about how people can come forth with the diatribe that they have and create a situation that was not needed. There was a small problem, and they used a cannon to kill a fly. That is what Bill 94 is. The socialists have led the government down the path by the tail.
Mr. Foulds: Is the member calling the OMA a fly? Is he insulting the OMA? Shame on him.
The Acting Speaker: Order.
Mr. Ashe: The member would not know the difference anyway.
The whole presumption of Bill 94, and even going back to the well-conceived but poorly legislated Canada Health Act -- and I blame all political parties for that; so I say it in a nonpolitical sense. I would think we would agree that legislation drafted in haste is sometimes not the best legislation. We have all been party to that. Governments yesterday, today and tomorrow will introduce legislation that requires amendment. Sometimes they are able to amend it before it is passed and sometimes it is done afterward.
A few pieces come to mind that probably were passed in haste, which we now regret and where we see changes that should be made. Obviously, the Canada Health Act falls into that category, as does the Young Offenders Act and the spills bill. I could go on with examples of well-conceived and good-intentioned legislation that required change.
The presumption is that by banning the relationship of a patient with his doctor one makes the system more accessible. The presumption is that in the long run the quality of the health care system is raised and the cost of the system is lowered. The results of Bill 94 will be exactly the opposite. The system will ultimately become less accessible to many qualified doctors.
Members might ask how that can be. It is because the doctors will not be here. We have already seen them leaving. We have heard today and read in the paper that the head of one of the medical departments in a major hospital has said: "That is enough. I am leaving this socialist-line state now led by the so-called Liberal government." The costs will go up and the quality and accessibility will go down. The perceived results of Bill 94 will be exactly the opposite to what they were supposed to be.
Mr. Foulds: The member could speak all night on what he does not know.
Mr. Ashe: I certainly can speak all night on what the member for Port Arthur does not know. There is no doubt about that. That would be very easy. As a matter of fact, we could carry on a filibuster to the end of the summer.
The Acting Speaker: Order. Please address your remarks to the chair and ignore the interjections.
Mr. Ashe: Anyone who has had occasion recently to go into most doctors' offices will have seen a sign that is very appropriate. I did not write down the exact words, so I paraphrase. Some of my words may be slightly different, but the idea is the same.
Mr. Foulds: What is wrong? Can the member not write?
Mr. Ashe: I did not write it down. I have other things to do.
Basically, it is asking whether people want the organization that runs the post office to run the health care system. Members should think about the organization that runs the efficient post office running the medical system. In that case, I sure would not want to be lying --
Mr. Eves: "If you like the post office, you'll love government health services."
Mr. Ashe: That is exactly it. If they like the post office, they will sure like the government running the health care system.
In closing -- I did not intend to be this long --
Mr. Foulds: Hear, hear.
Mr. Ashe: We know they are alive over there from time to time, and that is a step in the right direction. Sometimes I wonder, with their philosophy, whether they are alive or whether they are in a different century.
1:10 a.m.
I want to give members one other example of frustration. In this case, it is not a personal frustration of mine. It is not about a doctor or anybody working in the health care system. I had a legitimate call today, among one of many but this one frankly rather touched me. It was from a female constituent in my riding who phoned and indicated -- I was not in the office -- that she wanted to hear from me urgently.
Upon returning from the Legislature this afternoon, I called her back. This is a concerned citizen of Canada, a concerned citizen of Ontario and a concerned citizen who happens to live in the constituency of Durham West. She is not associated directly or indirectly with the medical profession. She is so personally frustrated and hurt by the implications of Bill 94 and the future, as she sees it, that she is threatening to leave the province.
Can members imagine anybody feeling that badly about the impending disaster being imposed upon a province and a great system by an uncaring, unfeeling government? That is exactly what is happening in Bill 94.
Interjections.
The Acting Speaker: Order.
Mr. Ashe: The last thing that leaves us all a little concerned is that numerous times over the past few weeks, and particularly over the past week, we have heard a series of questions over and over about why the Premier did not appoint a mediator. We know what his non-answer was all the time; that is not really my point right now.
My point is that if the government and Premier felt so secure about their position on Bill 94 and so confident they were doing the right thing, why would they be so concerned about having a mediator, a third party, someone remote from both systems, to look at it to confirm that they were right?
It is because of their concern that that mediator would say: "Hey, you guys, you are not going the right way. There is disaster at the end of this. We suggest you do this and this and this." They would be backed into the corner. At least they would try to get out of the corner they had backed themselves into.
Bill 94 is not conducive to the future health of members and myself, their children, my children and our grandchildren. Again, it is draconian legislation.
Mr. Breaugh: It has been my displeasure to know the member for Durham West (Mr. Ashe) for some 13 years now. He remains consistent. He has the uncanny ability to alienate people, even when there is a faint chance they might agree with him. I give him that much.
He mentioned a couple of things in his ramble tonight that I would like to comment on and perhaps hear a response from him later on. I do not know who has done it, but someone clearly has distorted the truth. Someone clearly has told doctors, who are normally reasonable people, some untruths about this bill. Doctors whom I have talked to are quite amazed to find the bill is about six sections long. Somehow they have been led to believe this is a very comprehensive piece of legislation. It is not; it is simple and straightforward. It talks about one item: extra billing.
The doctor my friend mentioned in his comments made the remark that she felt her job now would be to sit on the curb and watch the ambulance roll up to the front door and the funeral director roll out the back door. That is not the truth. I am sure that if that doctor were informed about the bill, she would not make comments such as that about this legislation. It has nothing to do with that and she would be aware of that if, in calmer moments, she would reflect on that.
Finally, I am saddened somewhat in that I thought by 12:30 tonight at the latest the member for Oxford (Mr. Treleaven) would be on. I have been misled. I am now here because I wanted to hear a six-hour speech by the member for Oxford. I do not know why his seatmates will not let him speak, but I want him freed now.
Hon. Mr. Scott: I want to join with the member who spoke last in expressing the disappointment of many on these benches that the member for Oxford has not begun. My duty here freed me at 11 o'clock. I was told that it would be only moments before he began and that I should stay.
The Acting Speaker: You must address your remarks --
Hon. Mr. Scott: Yes. I am coming to the honourable member who interrupted the potential for hearing the member for Oxford. I hope there will not be a moment's delay before the member for Oxford rises to his feet and entertains us.
As to the member who spoke last, he warned us about the dangers of socialism. Of course, it is a matter to which all right-thinking people must direct a great deal of attention and concern. The onset of creeping socialism in this province has been so slow that if we began to devote some mild interest to it in about the year 2020 it would not be too late to avert the risk the member referred to.
While we are on the subject of creeping socialism, it has been brought to my attention by the cabinet historian, the member for Renfrew North (Mr. Conway), that the member speaking was Minister of Energy during the time when the last government purchased Suncor shares. It is hard to imagine a more profound example of the evils of socialism and the evils of bad business management rolled into one. I want the member in his two-minute reply at least to begin a rationalization for what has to be one of the great mistakes of the past decade.
Mr. Charlton: I assure the Attorney General that I will not unduly delay the member for Oxford. I must make a few comments about the analogies used by the member for Durham West when he tried to compare the post office to this government running the health care system. This government also runs nuclear power stations in Ontario. If they are as inefficient as the member implies, the health care system is probably not going to make a whole lot of difference to us in the long run.
The government we are talking about also runs the ambulance services in the province. If they are as bad as the member for Durham West implies, then the health care system is going to have a very limited impact, at least in serious emergency cases, in dealing with the health care needs of the people of Ontario. That is if this government is as incapable of providing direction as the member for Durham West implies.
Mr. Callahan: I am waiting in great abeyance with the Attorney General. I rushed here from the beautiful city of Brampton to hear the member for Oxford speak, expecting to walk into the chamber and find all the material he had walked in with was being rhymed off.
To address the speech of the member for Durham West, when he referred to the New Democratic Party there was a real shrill in his voice. I got the impression a socialist was someone he could not possibly stand. Then he proceeded to do another thing that really angered me. He read from the Globe and Mail. He has deprived me of the opportunity to savour that paper tomorrow with my coffee. I would have thought, listening to what appears to be the very right-wing approach to this whole issue, he would have quoted from the Sun, not from the Globe and Mail.
1:20 a.m.
Mr. Foulds: It is not published yet. There is no early edition of the Sun.
Mr. Callahan: Is that right?
I must comment seriously on one item. The member does not seem to pick up on the issue that one cannot negotiate something when there is one person here and one person there and neither is prepared to change his position. Negotiation requires some type of accommodation.
I have watched the member and his revered leader on numerous occasions, constantly asking the same question from photostat copies of questions and getting the same answer, but for some strange reason they were not able to understand it; either that, or they were giving the doctors a false message. It has to be one or the other.
I figure we will hear in the next couple of speeches, particularly when we hear from that good, honest gentleman the member for Oxford, that the member was just fooling the doctors.
Mr. Ashe: The member and all those who have been waiting will be happy to know our next speaker is the member for Oxford.
There are a great number of points to cover, and I do not know whether I can do them all in the time. The first is the obviously incorrect reference to my capacity in the past cabinet as the Minister of Energy when the Suncor window-of-opportunity purchase was made.
Mr. Breaugh: You socialist dog, you.
Hon. Mr. Scott: You should have put curtains on it.
Mr. Ashe: No doubt many did not think it was the best investment at the time.
Mr. Breaugh: Name names.
Interjections.
The Acting Speaker: Order.
Mr. Ashe: Contrary to the belief of the present Minister of Education (Mr. Conway), I was not the Minister of Energy at the time. As I recall, the Deputy Premier at the time was also the Minister of Energy.
Mr. Foulds: You did not sell it when you were the minister, you socialist. You hung on to it.
The Acting Speaker: Order.
Mr. Ashe: The member for Hamilton Mountain (Mr. Charlton) made an analogy to nuclear power. I am being very consistent. He may recall that during our many deliberations over numerous years in the select committee, I always indicated one of the reasons Ontario Hydro has such a worldwide reputation was that the day-to-day operations are not controlled by the government, as another government tries to control the post office. That is probably why Ontario Hydro is efficient and the post office is not.
As for the member for Brampton (Mr. Callahan), if I had known he could read, I would have left him the full opportunity to read the first copy of the Globe and Mail tomorrow.
Mr. Gillies: Mr. Speaker, on a point of order: I wonder if I might have the pleasant duty of introducing our guest speaker this evening.
Hon. Mr. Scott: Mr. Speaker, on a point of order: We have reached the point in the program to which all members have been looking forward all evening and this morning. Bearing in mind the importance of this address, is it an infraction of the rules that the honourable member might be invited to speak from a seat other than his own so that we can all get the full benefit of his remarks? To speak from behind a pillar, as he is now doing, is very unfair.
Mr. Treleaven: No. I have prepared the table before me and will therefore speak from here.
Interjections.
The Acting Speaker: Order.
Hon. Mr. Sorbara: Mr. Speaker, on a point of order: I would like to take this opportunity to thank the member for Oxford for his speech.
Mr. Treleaven: After my initial comments, as an outline of what I am going to do, I think the people in this chamber should imagine a little man with a green eye-shade and shirtsleeves and garters on his biceps poring over definitions in various statutes. If members picture that, they will not be disappointed in my comments. However, if they think of anything more exciting than that, they will be disappointed.
This is perhaps heresy. During the next little while, I may be castigating the Minister of Health (Mr. Elston) and the Minister of Community and Social Services (Mr. Sweeney).
Mr. Ramsay: And Bill 30, I will bet.
Mr. Treleaven: No; but I do want to say, and this is where the heresy comes in, that as I castigate a couple of ministries, this is one of those darts-and-laurels things. The darts go to those two ministries and their ministers, but at this point I do want to acknowledge publicly two ministers and their ministries who have been very helpful to me during the past year.
The first is the Minister of Transportation and Communications (Mr. Fulton) and his ministry. The second, I am glad to say, is the Attorney General (Mr. Scott). Both of these ministers have been extremely helpful to Oxford, just as the Ministry of Health and the Ministry of Community and Social Services have been unhelpful.
In fact, tonight the Attorney General personally delivered across the chamber a reply to my letter of June 3. The minister behind him, the Minister of Labour (Mr. Wrye), takes four months and six days to get the average reply just acknowledging a request. The Attorney General gives a reply in two weeks.
Mr. Martel: On a point of order, Mr. Speaker: Would you be prepared to tell me just what this has to do with the bill we are debating? To my knowledge, something about the Attorney General has nothing to do with the bill before the Legislature dealing with the Ministry of Health. If the member wants to talk about that bill, I am prepared to listen; but if he is going to talk about everything else, then we are in deep trouble, and I am not listening.
The Acting Speaker: Order. I appreciate that it is 1:30 in the morning and you must do something to keep yourselves awake. On the other hand, I am very much awake here. You must give the member for Oxford a chance.
Mr. Martel: He is not talking about the bill.
The Acting Speaker: Order.
Mr. Treleaven: I was down in my office trying to get a snooze from about 8:30 until 10:30. I was wrapped in a blanket that has dog hair on it; I got it from my car. It was all I could do to cover myself.
Mr. Sterling: On a point of order, Mr. Speaker: I have to agree with the member for Sudbury East (Mr. Martel). I do not know what a dog-haired blanket has to do with Bill 94.
Mr. Gillies: On a point of order, Mr. Speaker: By extension, what does a dog-hair-covered blanket have to do with the Attorney General?
Mr. Treleaven: I was listening on the squawk-box in my office. I listened to the member for Sarnia (Mr. Brandt) speaking on this bill. He was very noisy over the squawk-box, and I could not get to sleep while he was on. Then the member for Oshawa (Mr. Breaugh) took his two minutes just as I was nodding off, and I was awake again.
1:30 a.m.
Then the member for Brock (Mr. Partington) came along. I have never heard him so excited. On and on. The member for Lakeshore (Mrs. Grier) was upset with the member for Brock, who could not seem to understand. Then the member for Mississauga East (Mr. Gregory) got really cross with her because she could not understand him, and the member for Beaches-Woodbine (Ms. Bryden) was very disappointed in them both.
I hope my comments tonight are more erudite, as my friend the member for Wentworth (Mr. Dean) --
Hon. Mr. Scott: The member means more draconian.
Mr. Treleaven: No, later I also have "draconian" many times, but I believe "erudite" was a reference to the Attorney General. The member for St. David (Mr. Scott) had used some non sequiturs when he was talking about extra billing. I must deal with that. He was accused by one of the other members of talking about billing under legal aid. Perhaps the Attorney General has not and does not bill under legal aid. However, he was stating it is illegal to "extra bill" under legal aid.
Where the non sequitur comes in is that those who bill according to legal aid when a client has a legal aid certificate have to adhere to the law society's fee schedule. However, for those who bill outside the legal aid system, i.e. , virtually all the clients of the Attorney General in private practice, it would be at whatever fees they wish to charge those clients.
He mentioned in his speech a little while ago that be had the Ontario Medical Association as a client. I am sure the OMA does not qualify for a legal aid certificate. Therefore, I am certain the fee of the then solicitor for the OMA would have been "extra billed," i.e., not according to any tariff. Therefore, in the legal profession there is a two-tier system. I want to point out this two-tier legal fee system the Attorney General was trying to deflect.
He also asked various members, such as the member for Mississauga East, "Do you believe in extra billing?" He asked several others, who answered him very clearly, and I should anticipate that by saying that since doctors are small businessmen, as are solicitors, they should have the same rights as other small businessmen. They have businesses to run, employees to pay, rent, car expenses, black bags to buy and replace, etc. They are small businessmen. They should have the same rights as other small businessmen to bill on the free market in their offices. I am not speaking about while they are in a hospital, which is a publicly owned and supported institution. In their offices they should be small businessmen the same as the shoe dealer, etc.
Mr. Breaugh: Are you saying a doctor is the same as a shoe dealer?
Mr. Treleaven: The same as a shoe dealer, a clothier or a lawyer, they are small businessmen, and they should be treated as such.
Hon. Mr. Sorbara: Can I sell the member a transplant?
Mr. Treleaven: They are businessmen. When he was in private practice, I am certain if his client had asked the member for St. David ahead of time, "What will your fee be?" he would have told them upon what basis he was going to charge his fee. If they did not ask, at the end he would still add up his time, etc., and would then charge a fair fee based upon his time, his experience and the overhead of his "business."
Hon. Mr. Sorbara: I think that is being very fair.
Mr. Treleaven: I am sure the Attorney General was most fair as he considered his account, as most solicitors are.
We are on third reading, and the third reading debate is why Bill 94 should not be read a third time. There are many reasons.
By the way, as the Attorney General is leaving, I mentioned the little man in the green eye-shade. The reason he should picture that in his mind is because approximately one third of my talk is a comparison of definitions in different acts. He would like that. He would appreciate it, as the other solicitors here would, but it is not the highest form of entertainment. I know he intends to leave, and I just want to leave the word picture in his mind of why he is happy to escape, as is the Minister of Skills Development (Mr. Sorbara).
Hon. Mr. Scott: Actually, I am going to a meeting.
Hon. Mr. Sorbara: But this is very good.
Mr. Treleaven: Someone asked me if he had time to go home for a nap and he lives near Hamilton. Yes, and he can get back and I will still be here to greet him.
Bill 94 should not receive third reading because it has many inconsistencies in it. For example, let us look at the definition of "practitioner." This is just an example. I am going to give a few examples as I go through, a thumbnail sketch of what I will be dealing with in more detail later. I do not know why the place seems to be clearing out. Is it something I have said?
Hon. Mr. Bradley: John Williams used to do this.
The Acting Speaker: Relate to your topic, please.
Mr. Treleaven: Let us deal first with the definition of "practitioner" in section 1 of Bill 94. That is an amendment that just got in under the wire. When we look at the other amendments that were made latterly by the Minister of Health today, in the definitions added to section 1, if we look under the definition of "board," it means "the Health Services Appeal Board under the Health Insurance Act."
Moving down to "general manager," it means "the general manager appointed under section 4 of the Health Insurance Act." When you get down to "practitioner," it is defined as meaning "a physician, an optometrist or a dentist." The member for Kitchener (Mr. D. R. Cooke) is a solicitor. I thought he would find this enthralling.
Mr. D. R. Cooke: I was going to go and get my own glass of water because there are no pages here.
Mr. Treleaven: I can understand that. It may be dry and the member may be --
The Acting Speaker: Order.
Mr. Treleaven: Yes, Mr. Speaker. The definition of "practitioner" says it means "a physician, an optometrist or a dentist." Why does that definition not refer to the Health Insurance Act as do the definitions of "board" and "general manager"? If we look at the Health Insurance Act for that definition, it is different.
This is one of the inconsistencies and a reason that this bill should not receive third reading and why it should be amended. Instead of this closure motion, we should have reverted back to committee of the whole House or back to the standing committee, so the people could come in and discuss the bill as we now have it amended, which makes it a tremendously different bill than it was originally.
Let us look at the definition of "practitioner" under the Health Insurance Act: "`practitioner' means a person other than a physician who is lawfully entitled to render insured services in a place where they are rendered." How can we have the Health Insurance Act governing Bill 94? How can one law control the other and have a different definition of the same word?
A practitioner includes a physician under one law and does not include a physician under the other. A physician is defined separately under the Health Insurance Act. That is one example. The Canada Health Act is also inconsistent. Bill 94 defines a practitioner differently from the Health Insurance Act and the Canada Health Act.
1:40 a.m.
If we look at the Canada Health Act which provides the entire reason for Bill 94, which is to try to get money from and through what is governed by the Canada Health Act, and then look for the definition of practitioner, we cannot find it. One finds "health care practitioner." It means "a person lawfully entitled under the laws of the province to provide health services in the place in which the services are provided to that person."
Mr. Polsinelli: Look up the definition of draconian.
Mr. Treleaven: Draconian comes later. I do not have the definition for that. I am sure it is in none of the statutes I have in front of me or that I have dealt with.
In coming to the definition of medical practitioner, which is contemplated by practitioner, one sees under the amendment to section 1 of Bill 94, it means a physician, etc. Yet medical practitioner means "a person lawfully entitled to practice medicine in the place in which the practice is carried on by that person." That is not physician. That is under the Canada Health Act.
This will get much clearer as I proceed. Another example of where this act, Bill 94, is inconsistent and should be amended is the term "unauthorized payment." If one looks at the words "unauthorized payment" which is a new section, again brought in this afternoon into this act as one of the added section 1 definition amendments, "`unauthorized payment' means the amount of money by which the amount a practitioner has charged and been paid for rendering an insured service to an insured person" -- the emphasis is on insured person -- "exceeds the amount payable under the plan for rendering that service to that insured person."
Mr. Sterling: I would like to ask the speaker a question and I believe it is permissible under the standing orders.
The Acting Speaker: Is it a point of order?
Mr. Treleaven: I think he is trying to ask if I will yield the floor for a question. I will yield the floor only for a question.
Mr. Martel: That is not in order.
Mr. Sterling: He can do that. He can yield the floor and allow me to ask a question.
He has to agree to yield the floor.
Mr. Polsinelli: On a point of order: I believe the rules of procedure of this House were changed a short while ago permitting members to ask questions after the previous speaker, particularly for this type of situation. I have read through the standing orders and I do not see any part of the standing orders that allow this type of procedure.
Mr. Harris: On a point of order: I believe it is in the standing orders. It is my understanding from my thorough examination of them, that if the speaker agrees to yield for a question, that is in order.
The Acting Speaker: Thank you for helping me.
Mr. Breaugh: On a point of order, Mr. Speaker: I think you will find as you go through our standing orders that precise rule is not written, but I am sure the Speaker will be aware that it is a long-standing tradition at Westminster for members to yield the floor briefly for a question. It is a great and venerable tradition and one that obviously should be done when a member is in real trouble. We have a member in real trouble. He should be prepared to yield for almost anything.
Mr. Sterling: I was going to ask the member for Oxford why he was reading all these definitions and whether he could explain the thrust of what he is doing in a brief overview and then go into the particular definitions.
Mr. Treleaven: The overall thrust of what I am doing to you is pretty obvious.
The overall thrust is to show a couple of brief examples -- I am just starting through --
Mr. Breaugh: Take your time. There is no need to rush.
Mr. Treleaven: Yes -- of the inconsistencies in the definitions: improper draftsmanship, mistakes.
The member for Durham West (Mr. Ashe), who is yawning right now, stated that we in this chamber, being human, sometimes do act in haste. We do pass statutes in haste. That is what has happened here. Again, the member for Durham West was correct. We have passed this in haste. It has been drawn up in haste by the ministry, and therefore there are gaps in the definitions.
When I was reading the definition of "unauthorized payment," as the addition which went into the bill yesterday afternoon, I emphasized with my voice the words "insured person." This is incomplete. There are people in this province who are not insured persons, who do not have the Ontario health insurance plan.
I can give you an example: the old order Mennonites. There are a good number of them in Oxford county. There are a good number in Huron-Bruce, the riding of the Minister of Health, around the Lucknow area. There are others in the Peterborough-Madoc area. They are all related, basically, to the people in Oxford county. Oxford, Elgin, the east side of Middlesex county, Norfolk -- all these areas have these people.
They pay taxes, but they do not vote. They do not have health insurance of any kind. They do not have fire insurance unless a mortgage requires it. They do not believe in that, and if someone is injured they pay cash at the hospital for the doctor, etc. Therefore, if one takes this "unauthorized payment" and looks at "insured person," one has a problem with Bill 94.
Section 2, for example, the operative section of Bill 94, deals with opted-out physicians, etc. Section 2 of Bill 94
Mr. Sterling: On a point of order: The member for Yorkview (Mr. Polsinelli) was asking the speaker before the member for Oxford the definition of "draconian." Just to help the debate, I want him to know it is the colouring matter in a dragon's blood.
Mr. Polsinelli: It is what?
Mr. Sterling: The colouring matter in a dragon's blood.
Mr. Polsinelli: What piece of legislation does that refer to?
The Acting Speaker: Order.
Mr. Sterling: The member asked the question.
Mr. Treleaven: The opting-out section, section 2 of Bill 94, states: "A physician or an optometrist who does not submit his or her accounts directly to the plan under section 21 or 22 of the Health Insurance Act or a dentist shall not charge more or accept payment for more than the amount payable under the plan for rendering an insured service to an insured person."
1:50 a.m.
In other words, it says that a doctor who does not accept OHIP, who does not bill through OHIP; i.e., he bills his patients directly, cannot charge more than OHIP rates to an insured person. But what about a person who is not insured? A doctor can, therefore, render an account to a person who is not insured and he is not caught by section 2. Therefore, we have a gap in this statute.
One can have at least three types of doctors: those who bill OHIP for insured persons under the act; those who are opted out and who bill insured persons; and the third kind of doctor, physician, optometrist or dentist who bills a non-insured person. He can bill any amount he wants. He is not governed and does not fall within section 2, and this is a gap within the act.
The member for Yorkview is scrambling madly at his act, and I am sure he will find section 2 of Bill 94
Mr. Polsinelli: The member is misinterpreting.
Mr. Treleaven: I am sure I am not misinterpreting it. An insured person is a person who is insured under OHIP.
Mr. Martel: On a point of order: I have listened for some time now to this diatribe. Erskine May, the authority on parliamentary procedure, on page 576 says:
"The amendments that may be moved to the question for the third reading of a bill follow the same pattern as those that may be moved on second reading; and the provisions of SO No. 41 concerning the questions to be proposed on such amendments apply equally to second and third reading. Debate on third reading, however, is more restricted than at the earlier stage, being limited to the contents of the bill;..."
It has nothing to do with the office of the Attorney General. It has nothing to do with the Mennonites. It has to do with the content of the bill which is before the Legislature.
I am not prepared to listen all night to this drivel which has nothing to do with Bill 94 unless he is going to deal with what it says in Erskine May: "Debate on third reading, however, is more restricted than at the earlier stage, being limited to the contents of the bill; and reasoned amendments" which might have arisen.
Mr. Speaker, I ask you to apply the rules as under Erskine May
The Acting Speaker: Order. The member's point is very well made. On the other hand, I wanted to give my honourable colleague a chance to warm up. I am sure that shortly he will direct his remarks towards the topic, which is Bill 94. He will.
Mr. Martel: On a point of order: I do not want to cause any kind of kerfuffle, but he has been warming up now for some half hour. It is drivel, it does not deal with the content of the bill and when we get to third reading, as Erskine May says, one must deal in a more restricted fashion than one does on second reading, which is pretty wide and free-wheeling.
Here it is very concise. One must deal with that sort of presentation that has been put forth by Erskine May. The member is dealing with everything else but the bill. I am tired of waiting for him to get to whatever you think he might get to some time in the near future, Mr. Speaker.
The Acting Speaker: The member has made his point.
Mr. Polsinelli: On the same point of order and in defence of my colleague the member for Oxford: The past few minutes when he was talking about the Mennonites related directly to the bill in the sense that the member was submitting that there is a gap in the bill. His proposition is that a doctor could bill a Mennonite more than he could bill an insured person. I submit that, while he was on topic, he was misinterpreting section 2, and that is not the case.
The Acting Speaker: Would the member please resume his seat.
Mr. Martel: There is no clause-by-clause discussion on third reading. He may speak to the principle of the bill, but this is not a clause-by-clause, section-by-section debate. He should have done that in committee. This should deal with the principle and we should not have to listen to that drivel all night.
Mr. Gillies: On the point of order: In fairness to my colleague the member for Oxford, I think our interpretation in this House has been that speeches on the principle of a bill are fairly wide-ranging. How can one tell after merely half an hour of a speech whether it is going to turn into drivel?
Mr. Treleaven: To assist, I must agree with the member for Yorkview that I am dealing directly with section 2 of Bill 94. How can one possibly --
Mr. Martel: On a point of order: We are not dealing with a clause-by-clause debate on third reading. That is where my friend is wrong. That is why I ask that you bring him to order, Mr. Speaker. If he wants to talk about the principle of the bill, fine, but this is not a clause-by-clause debate.
Mr. Sterling: On a point of order: A few moments ago the member for Oxford yielded the floor to me to allow me to ask a question. I asked him for the thrust of his arguments in dealing with the definitions of the bill. He answered that he was showing the inconsistencies involved in the definitions of the bill. That has a large bearing on whether we should pass this on third reading.
Mr. Polsinelli: On the same point of order: The member for Oxford is dealing with a fundamental principle of this bill. The fundamental principle is that no one in Ontario should have to pay more for medical services than what is paid by OHIP. In his argument, he indicated that there was a possibility of a gap in the bill and that certain segments would have to pay more. In fact, he was mistaken.
The Acting Speaker: That is not a point of order.
Mr. Polsinelli: It was on the point.
Mr. Treleaven: With help like that, I do not need --
The Acting Speaker: Order.
Mr. Martel: May I quote Erskine May again?
The Acting Speaker: Please resume your seat. Will the member for Oxford make sure he sticks to Bill 94 and please stop raising the ire of his colleagues.
Mr. Treleaven: It takes very little to raise the ire of the member for Sudbury East. However, if the member for Sudbury East will read further on that page of Erskine May -- he may have a many years old edition. One cannot make amendments on third reading. Only in the House of Commons do they still make amendments on third readings.
2 a.m.
Mr. Martel: On a point of privilege: At no time did I talk about the member making amendments. I am talking about the debate. I quoted the entire paragraph, which in itself dealt partially with amendments. I am simply saying the member must deal with the principle of the bill.
On third reading, the debate is much more restricted than on second reading, which allows one to wander pretty freely and easily. The Speaker has ruled in this Legislature on more than one occasion that we cannot deal with clause-by-clause in second reading; that is done at the committee of the whole House stage. If my friend the new and learned member would only read Erskine May once in a while, he might understand it is not a clause-by-clause debate; it is a debate on the principle of the bill. He should try reading it. He is dealing with clause-by-clause and definitions, and that is out.
Hon. Mr. Curling: On a point of privilege, Mr. Speaker: I was just getting the drift of the drivel, and this member interrupted me. I want to see where the drivel is going to lead. It is my privilege to let him continue so I can find out where the drivel is leading.
Mr. Treleaven: The member for Sudbury East is quite correct. It says we must be more closely restricted on third reading than on second reading. Second reading is on the principle of the bill. Third reading is on the bill as amended at this point. The question is, should the bill be given third reading? I am stating why Bill 94 should not receive third reading. That is straight out of Beauchesne and Erskine May. I am adhering strictly to the bill as amended. Section 2 is part of the original bill.
Mr. Martel: On a point of order, Mr. Speaker: It is not a clause-by-clause debate, and you have to rule on that, sir. He is attempting to deal with the bill clause by clause, and that is not a third reading debate. I ask you to bring him back to order and make him talk about the principle of the bill. I am prepared to listen to that, but I am not prepared to listen to a clause-by-clause debate. That belongs in committee of the whole, even if my friend the member for Yorkview cannot read.
Mr. Sterling: In defence of the member for Oxford, he is not dealing with it on a clause-by-clause basis. He is comparing the clauses, how they interact with each other and how they interact with some federal legislation.
The definitions in the Canada Health Act as opposed to those in Bill 94 are very important, because they interact with each other. If the member for Sudbury East had been here for the committee hearings and had heard some of the debate in relation to those definitions, he would realize how important they are and how important the whole interrelationship between the different definitions is.
It is one of the major principles that can be talked about in general on third reading. I am sure the member for Sudbury East has seen the reason and the logic behind my argument, will accept it and will no longer interject so we can hear the member for Oxford continue with his very good remarks.
The Acting Speaker: Order. The member for Oxford is entitled to discuss the clauses in the debate.
Mr. Martel: Mr. Speaker, he is allowed to debate the principle on third reading. It is not a clause-by-clause or definition-by-definition debate. That is finished. It is the bill on principle.
The Acting Speaker: Order. I have made the ruling.
Mr. Treleaven: On second reading we discuss the philosophies and the principle of the bill, and we can be wide-ranging. I am on third reading, and in Beauchesne and in Erskine May it states that third reading debate, as I said, must be narrower and more specific to the bill than second reading debate.
Mr. Martel: And it is not clause-by-clause.
Mr. Treleaven: It is not clause-by-clause examination.
Mr. Martel: Or definition-by-definition.
Mr. Treleaven: It certainly is on definitions. The bill as it now exists, as amended, is what must be discussed on third reading. That is what third reading is for.
The Acting Speaker: We have agreed. I have made the ruling.
Mr. Treleaven: Thank you, Mr. Speaker. That is what I am doing. I am pointing out inconsistencies in this bill and why it should not be given third reading. There are inconsistencies with the Canada Health Act, which Bill 94 is trying to accommodate and adjust itself to.
Mr. Martel: That is not what third reading is about. And you are the Deputy Speaker; no wonder we are in trouble.
Mr. Treleaven: I am having a great deal of difficulty hearing even myself over the member for Sudbury East.
Mr. Martel: If the Deputy Speaker does not know the rules any better than that, we are in serious trouble.
The Acting Speaker: Order.
Mr. Treleaven: I am comparing it not only with the Canada Health Act but also with the Health Insurance Act and with the Health Disciplines Act, which are acts referred to specifically in this bill.
I talked about the amendments, the added definitions, that were put in section 1 today. I am pointing out inconsistencies. Those very definitions refer to the Health Insurance Act --
Interjection.
Mr. Treleaven: Fine. May I continue, Mr. Speaker? I am right on point. I am right within the authorities --
Mr. Martel: Baloney, he is.
Mr. Treleaven: Thank you. Back to section 2, which is an original section of Bill 94: The member for Yorkview does not agree with me. However, I submit there is a third group of persons in Ontario who are not covered by section 2 of Bill 94. I gave the members one example of these people. A physician, an optometrist or a dentist may extra bill them or charge what he wishes because they are not insured persons and do not come under section 2.
The act is deficient under section 2 as a result. That is one more reason why the bill should not be given third reading. It should be voted against on third reading and, quite frankly, sent back to the standing committee.
It has been very difficult. The member for Sudbury East is making this a lengthy debate. I hope he will not continue this kind of obstruction. It certainly does lengthen one's comments.
Mr. Martel: For a windbag like you, it does not take much.
Mr. Treleaven: With the interjections of the member for Sudbury East, I am only a fifth of the way through my preliminary comments of what I am going to discuss in my speech.
The Acting Speaker: The member for Oxford will please address his remarks to the chair.
Mr. Treleaven: Yes; thank you. I do hope the member for Sudbury East will restrain himself.
Mr. Martel: Will you get to the drivel?
Mr. Treleaven: I will show where it is leading. This bill is a different bill now from the one the witnesses addressed in the standing committee. One immediate example is the New Democratic Party amendment placed by the member for Windsor-Riverside (Mr. D. S. Cooke) on Tuesday, June 3. I believe it is the newly amended subsection 2(2)
Mr. D. R. Cooke: Does the member not have to go to the washroom?
Mr. Treleaven: That is no problem; I am not imbibing the water.
Remember that the original section 2, which I just dealt with, became subsection 2(1) upon subsection (2) being passed; it was an automatic change of designation. Therefore, subsection 2(2) states:
"A practitioner referred to in subsection (1)" -- that is, an opted-out physician, etc. -- "shall not accept payment in respect of an insured service rendered to an insured person until after the practitioner receives notice that the patient has been reimbursed by the plan unless the insured person consents to make the payment on an earlier date."
2:10 a.m.
I will be dealing much later with how unfair that is from a straight business point of view; no other businessman in the world has that placed against him. We do not have the right when we buy shoes to say to the man who sells us shoes, "I do not have to pay you until I know you have paid your wholesaler and your wholesaler has sent me confirmation." I will get into that later. I am trying to point out that this section is draconian; that is the dragon's blood, I think.
That was not in there when the witnesses appeared before the standing committee on social development to discuss this bill. It is a different bill. That is only one very small example. This bill should not go forward to third reading but should go back to the standing committee so the witnesses are able to review it in its present form, as amended. That seems fair; it should not go forward to third reading.
Mr. Polsinelli: Mr. Speaker, will the member permit a question?
Mr. Treleaven: Yes, I will permit one question.
Mr. Polsinelli: I refer the member for Oxford to section 2. He is saying essentially that there are gaps in this bill. I submit that he is misinterpreting section 2; perhaps he should reread it. It says effectively that a physician, an optometrist or a dentist cannot charge "more than the amount payable under the plan for rendering an insured service to an insured person." The maximum that can be charged is the amount the plan would pay for an insured service to an insured person, not that one has to be an insured person to be covered by the bill. The bill covers everybody.
Mr. Treleaven: Exactly; dead on. That is where the member for Yorkview and I come apart. Not everyone is covered. That is the very issue. How can a person be covered by the plan if he pays no OHIP premium and no one pays the OHIP premium for him? If he does not pay and no one pays for him, he is not an insured person. He is not under the plan; therefore this bill cannot cover him.
While section 2 states that those physicians, optometrists or dentists who are opted out will not charge more to certain groups of people, it is silent on the others. The implication is that these care givers can charge more if a person is not an insured person under this act.
Mr. Polsinelli: No. It says the doctors cannot charge more than what OHIP would have paid. That is what it says.
Mr. Treleaven: It says, "to an insured person." The old order Mennonites in my riding are not insured persons.
Mr. Polsinelli: OHIP would pay nothing to an uninsured person.
Mr. Treleaven: At this point, I am in only my preliminary comments. I am not fully into section 2. Perhaps later, when I get through my preliminary comments --
Mr. Polsinelli: What can we expect three hours later?
The Acting Speaker: Order.
Mr. Treleaven: I can then go at it more fully and try to explain more clearly. Obviously, I am not making myself clear enough so that the member for Yorkview can get the point. I will do more of that a little later.
My next comment in a preliminary way is that the bill is machiavellian.
Mr. Laughren: That is unparliamentary.
Mr. Treleaven: It is not unparliamentary.
The Acting Speaker: Address your remarks to the chair.
Mr. Treleaven: I will address you, Mr. Speaker, and look at you and ignore the interjectors.
The Acting Speaker: Ignore the interjectors.
Mr. Treleaven: Correct. The bill is machiavellian because the amendments deleted the heavy fines, which made the government look bad. The fines have been dropped from $10,000 to $250 and $1,000, but through its amendment, this bill beefs up the Health Services Appeal Board.
I do not want to get into the Health Services Appeal Board at this point in my preliminary comments, but I -- no.
Mr. Cordiano: The member should read us the note he just received. He should not be shy.
Mr. Treleaven: We would not want that on the record.
Mr. Ward: The member can sip his water and not think about it.
An hon. member: One knows it is Toronto water if one can smell it.
Mr. Treleaven: Toronto's water is heavily chlorinated, much more so than Oxford water, which comes from the Sweaburg swamp, right north of my house.
The Acting Speaker: Peace, and back to the debate.
Mr. Treleaven: The Health Services Appeal Board has inconsistencies. In a preliminary way, I will paraphrase this. Many times during his comments, the minister kept stating that a member -- singular, and it is in the act -- of this appeal board will constitute a panel by himself. However, if we look at section 8 of the Health Insurance Act, which is the guiding act for Bill 94, it states that it shall be "not fewer than five and not more than nine."
Subsection 4b(1), as amended a couple of days ago, changed that and made it more open-ended. I remember the member for York Mills (Miss Stephenson) suggesting 30 or 36, and I think the minister concurred with 36. At the moment I do not have the exact number. It was increased by a great number so it would be not fewer than five and not more than 36 or whatever.
The act goes on to call for at least three to constitute a quorum. There is a chairman and a vice-chairman, and one of them is contemplated as being on that board. If we look at the table of contents of the document outlining the proceedings of the Health Services Appeal Board, which were put out by the Ministry of Health in 1984, we will see that the panels on various cases ran between three and eight. I could not find one where the full nine were on a panel.
Incidentally, during the debate, I remember the member for Lincoln (Mr. Andrewes) and the member for Oakville (Mr. O'Connor) stated they believed the board was two years behind in its case load. The member for Wentworth North (Mr. Ward) checked with the officials and found out "it was improving."
The first case that came with these proceedings of the Health Services Appeal Board, in the matter of a hearing under the Health Insurance Act, involved a Gordon Bissessar, MD, versus the general manager of OHIP and the medical review committee of the College of Physicians and Surgeons of Ontario. That one took almost three years. There was a decision of the general manager in November 1981. The matter came before the board in April 1984, and I think the final decision was on May 22, 1984. It took almost three years from the decision of the general manager in appealing it to the Health Services Appeal Board. I will get to that in more detail. I was just going by that. That was just an aside regarding a problem with the act and a reason this act has to be changed further. I will get to that specific point in detail later.
2:20 a.m.
Right now, the point is why, under the act and under the amendment, we have a singular person constituting a panel, whereas in the past and under the Health Insurance Act, there have been at least three. I therefore believe that with the beefed-up board -- now no less than three and up to 36 -- Bill 94 must be amended again; we must have a panel that is no less than three rather than a single panel, so the procedures are not changed and the act is consistent. Otherwise, we have real problems.
Because this bill is not reprinted, because we have the situation at hand now, because we are under the guillotine and because of the time allocation, we moved directly from committee of the whole House and the amendments right to third reading. Therefore, we set aside the standing orders that call for reprinting of the bill, as amended, before it goes to third reading. That is why we have to have unanimous consent to allow that.
I am sure all members debating on third reading up to this time have found a real handicap in that the bill has not been totally reprinted. One must go from the Hansards of the amendments, jump back and forth into the act itself and then back to the amendments. I am having a little difficulty right now laying my hands exactly on this singular reference to the members of the board.
Subsection 3b(4) says, "A member of the board conducting a review shall inquire into...." Subsection 3b(3) says, "The chairman of the board may from time to time appoint a member of the board to conduct a review under this act." That is, a single-man or single-woman panel, a one-person panel, is now an amendment to the act. It should not be. It is inconsistent with this. Of course, I am talking about the Health Services Appeal Board. It should not be, because the board was set up and is set up under the Health Insurance Act, which calls for no less than three and no more than 36.
How can one have a quorum of three and then have Bill 94 say a panel can be one? Bill 94 is wrong. The amendments have been hurried too much. Bill 94 should go back for amendment to make it consistent with the Health Insurance Act in that the quorum for a panel is no less than three.
Members will see that I am consistently on topic on why Bill 94 should not be read a third time. The overall thrust of the bill is different. It is now an anti-doctor bill. When it started out, it was not such an anti-doctor bill. We have, for example, subsection 2(2) of the act -- I am again under that handicap because the bill has not been reprinted. Even with the lack of reprinting, I believe it was on June 3.
The new subsection 2(2) states: "A practitioner referred to in subsection (1)" -- that is again an opted-out practitioner -- "shall not accept payment in respect of an insured service rendered to an insured person until after the practitioner receives notice that the patient has been reimbursed by the plan unless the insured person consents to make the payment on an earlier date." That says the practitioner has been singled out against all the laws of Ontario and Canada, particularly those of Ontario.
As I said before, civil law states -- and if the member for Carleton-Grenville (Mr. Sterling) were here, he would certainly know -- that if a man sells one a suit or a pair of shoes, the terms of his sale are cash at that point, cash on delivery. If he gives one 30 days, that is his choice, but without any specific arrangement for payment on a delayed basis, the terms of all such sales in the marketplace are cash at that time.
One does not buy a car from a dealer on the basis that one does not have to pay for it until General Motors, Chrysler, Honda or whomever sends notice that the wholesaler or manufacturing company has been paid. Of course not. However, that is what this amending subsection 2(2) does to the doctor, dentist or optometrist. Not only can he not bill but also he cannot even accept the money.
Let us say he has had a patient for years. As the patient leaves, he pays in cash, as happens reasonably often. As he walks out, he asks the nurse, "How much is that?" She says: "That will be $25. We will send you a bill." The patient says, "Never mind," pulls out the money and lays it down.
Where is he? The doctor is now in violation and subject to all the penalties of the act, because not only can he not bill but also he cannot accept the money, even if it is paid at his office. This is why it is an anti-doctor, anti-dentist or anti-optometrist bill. In commerce, this kind of law is placed on no one else.
I suspect that if some practitioner wants to take this thing to court on a constitutional basis, he will win, because this is discrimination against him as compared with all others who provide and sell goods or services in the commercial law field. That is why I call it an anti-doctor bill.
That amendment should not have been allowed, and it should not be there now. It is an extremely valid reason why Bill 94 should not be given a third reading.
I have a reprinted bill with arrows on it. That is very good. It does not contain all my notes, but it is helpful. Perhaps I will be able to use that instead of jumping back and forth into the Hansards.
2:30 a.m.
This bill is draconian now because of the hearings under the Health Insurance Act. Again, we are talking about the Health Services Appeal Board. This is another reason why the professionals -- I mentioned them a minute or two before -- are being discriminated against. I am sure the Charter of Rights and Freedoms would set aside various sections of Bill 94 as it is amended and throw it out as unconstitutional, because professionals do not get the same rights as ordinary citizens. These three professions are being discriminated against.
For example, in hearings before the Health Services Appeal Board under the Health Insurance Act, section 5 says, "The chairman of the board may appoint a member of the board," etc. We have the two acts in conflict with each other. The professionals do not get the rights of ordinary citizens; for example, there is no specified right to counsel. Under these two acts, the professional who is charged and brought up before the Health Services Appeal Board not only does not have the right to counsel but also does not even have the right to appear. He has the right to make a submission in the same way as does the patient and the general manager. He does not have the legal, specified right either to appear in person or to have counsel.
I draw the attention of the members to the Statutory Powers Procedure Act, which deals with boards, commissions, etc., that, by statute, are given powers by this Legislature. That is exactly what we have here. We have a board. It is a tribunal, etc., for the sake of and under the Statutory Powers Procedure Act. Subsection 3(1) states that it "applies to proceedings by a tribunal in the exercise of a statutory power of decision conferred by or under an act of the Legislature, where the tribunal is required by or under such act or otherwise by law to hold or to afford to the parties to the proceedings an opportunity for a hearing before making a decision." That is dead on here. In the Statutory Powers Procedure Act it is a hearing and it basically sets out the rights that anyone in Ontario gets when one comes up against an agency, board or commission of the government. They are guaranteed certain rights.
In the standing committee on procedural affairs I remember the then member for Wilson Heights, Mr. Rotenberg, was a strong advocate of this act. The member for Oshawa will remember Mr. Rotenberg going on strongly with regard to the Statutory Powers Procedure Act.
I read to members what subsection 3(1) applies to. Subsection 3(2) states, "This part does not apply to proceedings...(h) of a tribunal empowered to make regulations, rules or bylaws, in so far as its power to make regulations, rules or bylaws is concerned." One would think at first blush it would include the Health Services Appeal Board but it does not, because that Health Services Appeal Board does not make its own rules, regulations and bylaws. Therefore, this act governs.
We now have another conflict. Being hastily drawn, incomplete, improper, Bill 94 is violating another act which guarantees the people of Ontario, including doctors, optometrists and dentists, fair hearings. This act, Bill 94, comes along and tries to set up more ferry-built rules that fly in the face of the Statutory Powers Procedure Act. For example, hearings are to be public under this act. That is guaranteed except in the case of public security or intimate or financial personal reasons, when it will be held in camera.
Hearings are to be public. Under the Statutory Powers Procedure Act, everyone in Ontario is guaranteed the right to a hearing and is guaranteed the right to counsel. That is section 10. One is given the right to examine witnesses at hearings, etc. That is in particular. Everyone in this province is guaranteed the right under that act, to counsel at a hearing -- I am disappointed that the Minister of the Environment (Mr. Bradley) is not staying around. The night is early. The morning is young.
Hon. Mr. Bradley: I am around.
Mr. Treleaven: I know he is around.
Under section 10, everyone in Ontario is guaranteed to "(a) be represented by counsel or an agent; (b) call and examine witnesses and present his arguments and submissions; (c) conduct cross-examinations of witnesses at a hearing reasonably required for a full and fair disclosure of the facts in relation to which they have given evidence."
Under the procedures of the Health Services Appeal Board, a person does not have a counsel, cannot call and examine witnesses and cannot cross-examine. All he can do is to send in written submissions. How can one cross-examine --
Mr. Callahan: On a point of order, Mr. Speaker: The honourable member is talking about the Charter of Rights and Freedoms, which I do not believe is before this august body. According to standing order --
Mr. Shymko: Is the member the self-appointed expert on this?
Mr. Callahan: The member should listen and learn something. According to standing orders 19(2) and 19(3), he is not addressing his remarks to the question under discussion. We have no authority to deal with the Charter of Rights.
The Acting Speaker: We have gone through this before.
Mr. Treleaven: I suspect the member for Brampton (Mr. Callahan) is joshing us. He is a solicitor and he knows; he can read these better than I can.
The Acting Speaker: Would the member please bring his remarks back to the topic.
Mr. Treleaven: Mr. Speaker, to convince you that I am constantly on topic and never off Bill 94, the Health Services Appeal Board is referred to in the amendment to the act. I cannot possibly be off topic. I believe it was the new section 4. This is difficult.
The new definition put in the board. It is the newly amended section 1. The first definition says, "`Board' means the Health Services Appeal Board under the Health Insurance Act." How can I possibly be off topic when it is the very first definition, the first mention in section 1ss of the act?
Therefore, the Statutory Powers Procedure Act, which is a guarantee --
Mr. Callahan: On a point of order: I refer to section 19(11) of the standing orders. I suggest this member is using "abusive or insulting language of a nature likely to create disorder."
2:40 a.m.
Mr. Treleaven: I think the hour is getting to the member.
Mrs. Marland: I have news for you. He is like that first thing in the morning.
Mr. Treleaven: I would not know.
Interjections.
The Acting Speaker: Order.
Mr. Treleaven: I will not touch that one.
A guarantee is set out under section 10 of the Statutory Powers Procedure Act, as I said. How can one conduct cross-examination? The member for Brampton certainly knows about cross-examination of witnesses. How can one do that when under the Health Services Appeal Board all one can do is send in a written submission?
Mr. Martel: On a point of order, Mr. Speaker: I went out for a while and allowed you to let this fellow have a lot of latitude. He went through a clause-by-clause debate. Let me read you another section from Erskine May on the topic of third reading. I want you to get the import of what I am going to say, Mr. Speaker.
"The purpose of the third reading is to review a bill in its final form after the shaping it has received in the earlier stages. In the interests of brevity, debate at this stage is eliminated unless six members give notice of an amendment to the question for third reading....When debate takes place, it is confined strictly to the contents of a bill and cannot wander afield as on second reading."
That is according to Erskine May. Mr. Speaker, you have allowed this member to wander around and go through it clause by clause, and I have listened to the drivel for a while. This is third reading, according to the experts, and I ask you to get this member to refrain from clause-by-clause debate and deal, as Erskine May says, with the principle.
The Acting Speaker: Thank you again.
Mr. Martel: How long do you intend to listen to this sort of drivel before you enforce the procedures followed in this Legislature, Mr. Speaker?
The Acting Speaker: I made a previous ruling.
Mr. Martel: Yes, but the previous ruling was wrong.
The Acting Speaker: Are you challenging the chair?
Mr. Martel: I would not challenge your ruling at this hour of the morning, Mr. Speaker, but I suggest that based on what third readings are about, you might reconsider your previous decision.
Interjections.
The Acting Speaker: The member for Oxford will please stick to the topic.
Mr. Treleaven: I am, but in this democracy, we cannot give in to intimidation. I will and I am. It is just that the member for Sudbury East sometimes cannot understand things. I will stay on and I will go slower for him so he can understand me. As I stated, there is no specified right to counsel. I hope to get through this before the member for Sudbury East interrupts me again.
Mr. Martel: On a point of order: I understand quite well what the member is saying and doing, even if it contradicts the rules of this House. As the Deputy Speaker of this House the member should know that full well. For the Deputy Speaker to violate the rules of the House is questionable. I ask you, Mr. Speaker, to look at the discussion of third reading on page 528 of Erskine May and reconsider what you have allowed the member to get away with so far by being lenient this late in the morning. How long do you intend to allow him to contradict, to conflict, or whatever you want to call it, with what third reading debate is all about?
Hon. Mr. Sorbara: Mr. Speaker, on the point of order that my friend raises: The member for Sudbury East is eloquent in his arguments. He is a veteran of I do not know how many years in this House. He has this evening raised the same point of order on a number of occasions, and you have made your ruling. When you asked whether he was challenging the chair, he said, "No, I am not challenging the chair."
It would perhaps be incumbent upon you, Mr. Speaker, to call the member for Sudbury East to order so that we can get on with the drivel.
The Acting Speaker: For the attention of the member for Sudbury East, I have made a ruling. In my opinion, the member for Oxford is relating to the content of the bill.
Mr. Cousens: On a point of order, Mr. Speaker: If there are going to be continuing outbursts by the member for Sudbury East in the future, will you start dealing with his behaviour? At this point, if he is going to interrupt the stream of thought coming from --
The Acting Speaker: That is not a point of order.
Mr. Warner: The member would not know a rule if he fell over it.
Mr. Treleaven: It is very difficult to keep oneself on track with these interruptions.
Mr. Barlow: Why does the member not start over again?
Mr. Treleaven: No. That would be repetitious, and under standing order 19, the member for Brampton would be after me.
Section 5, which deals with the Health Services Appeal Board and its procedures, is incomplete. It does not give these practitioners -- the doctors, optometrists and dentists -- the ordinary rights and protection of every citizen of Ontario. Therefore, this Health Services Appeal Board and its procedures, as set forth in the newly-amended Bill 94, are unconstitutional.
The bill should not be passed. It should not get third reading. It does not provide for counsel or an agent. It does not allow the physician or the professional to examine witnesses and present his arguments. It does not permit him to cross-examine witnesses.
Under Bill 94 and the Health Services Appeal Board, under the Health Insurance Act, the patient, the general manager and the professional -- the practitioners -- have the right only to submit in writing the arguments of their case as to whether they extra billed, took more money than OHIP authorizes. How can one get one's rights under the Statutory Powers Procedure Act to examine and cross-examine the other witness, the accuser?
This is totally unconstitutional and against the laws of Ontario as in this act and many other acts. It is a basic principle of law in this province that one has a right to cross-examine one's accuser. That is fundamental to our system of justice. It is not in Bill 94.
Section 11 of the Statutory Powers Procedure Act talks about the rights of witnesses to counsel. Again, that is not in Bill 94. Subsection 11(2) of the act says, "Where a hearing is in camera, a counsel or agent for a witness is not entitled to be present except when that witness is giving evidence." Again, the accused person's protection against what a witness is saying against him is not in Bill 94. For that additional reason, Bill 94 should not receive third reading.
2:50 a.m.
This is draconian. Here is another example of why the bill should not proceed to third reading. The professionals do not get the same rights as ordinary citizens. Bill 94 refers to the Provincial Offences Act. Members will remember virtually every other subsection in section 4 was deleted by a new amending section, but subsections 4(1) and 4(3) remained.
Subsection 4(3) of Bill 94 states, "When a prosecution is conducted by a private prosecutor and the defendant is convicted, the court may determine the actual costs reasonably incurred in conducting the prosecution and, despite section 61 of the Provincial Offences Act, may order those costs to be paid by the defendant to the prosecutor." I am quoting subsection 4(3) of Bill 94, which refers to section 61 of the Provincial Offences Act.
Traffic tickets and so on are relatively minor provincial offences, and one still has protection. Everybody in Ontario gets protection under that act and yet under Bill 94, doctors, optometrists and dentists do not get those protections of the ordinary citizen.
Section 61 of the Provincial Offences Act, which is mentioned in subsection 4(3) of Bill 94, states in subsection 1, "Upon conviction, the defendant is liable to pay to the court an amount by way of costs that is fixed by the regulations." Subsection 61(2) deals with costs respecting witnesses. It says, "The court may, in its discretion, order costs towards fees" and so on. At the end it says, "shall not exceed $100."
Subsection 4(3) talks of when a prosecution is conducted by a private prosecutor. Presumably that would be a lawyer retained by the Ministry of Health to conduct the prosecution. We have his costs being added in against --
Mr. Callahan: On a point of order, Mr. Speaker: According to standing order 19(d)3 this honourable member is not speaking on the topic. He has included the Charter of Rights and Freedoms and the Provincial Offences Act. The next thing we will be into is the Warble Fly Control Act. I suggest he is out of order and should be so ruled.
The Acting Speaker (Mr. D. R. Cooke): He is speaking on those acts only in reference to Bill 94, to which he is speaking.
Mr. Martel: If I might speak to the same point of order, Mr. Speaker: Let me indicate what it says in "Proceedings in Passing Public Bills," on page 528 of Erskine May's Parliamentary Practice:
"The purpose of the third reading is to review a bill in its final form after the shaping it has received in the earlier stages. In the interests of brevity...when debate takes place, it is confined strictly to the contents of a bill."
There is a second section; please bear with me, Mr. Speaker, while I find the section that further defines what should be done at third reading. On page 576, it says: "The amendments that may be moved to the question for the third reading of a bill follow the same pattern as those that may be moved on second reading; and the provisions of SO No. 41 concerning the questions to be proposed on such amendments apply equally to second and third reading.... Debate on third reading, however, is more restricted than at the earlier stage, being limited to the contents of the bill; and reasoned amendments which raise matters not included in the provisions of the bill are not permissible."
It says in Erskine May, which is the authority, that it is not a clause-by-clause --
The Acting Speaker: Order. I have heard the argument from the member for Sudbury East several times this morning. A ruling has already been made by the Speaker on that point. The speech we are hearing has not deviated substantially from the time that ruling was first made, and I do not accept the point of order.
Mr. Callahan: On a point of order, Mr. Speaker: I would like to move a motion to appeal the ruling of the chair.
Mr. Breaugh: You did it.
Mr. Martel: Ring the bells.
The Acting Speaker: Does the member for Brampton wish to appeal the ruling of the chair?
Mr. Breaugh: He did not mean to say that.
Mr. Callahan: Mr. Speaker, after obtaining advice from two members in front of me, I withdraw that motion.
Mr. Martel: Mr. Speaker, before we proceed --
The Acting Speaker: Is this a new point of order?
Mr. Martel: Yes. I ask the Speaker for his guidance in this matter. The definition of third reading is quite clear. It does not allow for clause-by-clause debate on third reading. Will you tell me what parliamentary procedure you are following, so that I will know in future just what --
The Acting Speaker: Order. We are following the rules. The chair has ruled that the member for Oxford is following the rules.
Mr. Martel: On a point of order, Mr. Speaker: Erskine May is the authority on the Legislature.
The Acting Speaker: I have ruled on that point. Will you sit down, please?
Mr. Martel: Mr. Speaker, may I ask for your assistance? What do you think it means? Maybe you will explain to me --
The Acting Speaker: Order. Will you take your seat, please?
Mr. Martel: Mr. Speaker, will you explain to me what the following passage from Erskine May means, so that I will know how you are interpreting Erskine May? Obviously, we are at loggerheads --
The Acting Speaker: Will the member take his seat, please? The chair has ruled that the member for Oxford is not in fact debating this clause by clause. He is following the rules. I am not going to hear any more on this.
Mr. Martel: Mr. Speaker, may I ask for your assistance?
The Acting Speaker: Will you take your seat, please?
Mr. Martel: On a point of order, Mr. Speaker: I ask the Speaker to assist me so that I will understand the ruling. What does it mean when it says, "Debate on third reading, however, is more restricted than at the earlier stage, being limited to the contents of the bill"? What does that mean?
Mr. Ward: Mr. Speaker, we do want to hear the member for Oxford. I would ask the member for Nickel Belt (Mr. Laughren) to restrain his colleague physically if necessary.
An hon. member: He is talking out of his seat.
3 a.m.
Mr. Martel: Mr. Speaker, how could he get your attention? He does not even know where he is supposed to be sitting and you recognized him. This has degenerated into a zoo.
The Acting Speaker: I believe the parliamentary assistant to the minister can take a seat in the front row.
Mr. Treleaven: It is difficult to keep one's train of thought. I am obviously on topic. Subsection 4(3) of Bill 94 makes reference to the Provincial Offences Act, so when I go to the Provincial Offences Act, following Bill 94, I cannot be off topic.
Mr. Cordiano: On a point of order, Mr. Speaker: I think the member for Oxford is following unparliamentary procedure. I just wanted to make that point. He can go ahead anyway.
Mr. Treleaven: As I have stated before, under Bill 94, the professionals do not get the same rights as every other citizen under many statutes. In particular, I am referring to the Provincial Offences Act that is referred to in subsection 4(3) of Bill 94. When we look at section 61 and those following, such as section 63 and section 67, we see that the professionals do not get these rights. In section 67, under the Provincial Offences Act, in which the offences are more important and more serious than overbilling by $10, the guilty parties --
Hon. Mr. Sorbara: Mr. Speaker, on a point of order: I am very sympathetic to the point my friend the member for Sudbury East has raised. I am not raising that point to you, Mr. Speaker, but I think there is merit in what he says. I am confident my friend would press that point, even perhaps to a challenge to the chair, were it not for the fact that he does not want to get thrown out, which is probably the appropriate course because he has raised that point on a number of occasions.
In that general area, on that point, regarding our friend the member for Oxford, who has been going on ad infinitum, referring to section after section, perhaps you could direct or entreat him to take five or 10 minutes to explain to this House at 3:03 in the morning where his argument is going. If you were to direct him in that regard, we could get some sense of the general point he is trying to make. We could satisfy my friend the member for Sudbury East and the rest of the members who are in this House, now at 3:04 a.m., and who are trying to follow along.
The Acting Speaker: That is not a point of order. If you have a question for which you want the member to interrupt his speech --
Mr. Warner: On a point of order, Mr. Speaker: I think the member for Oxford rightly and properly has the floor. I ask that other members, including the member for Sudbury East, not interrupt. I have been listening intently to his speech. During the past three hours he has made two relevant points and that is above batting average for him. I wish to listen further.
The Acting Speaker: That is a good point of view and well taken.
Hon. Mr. Curling: On a point of order, Mr. Speaker: As you know, I am the most patient member in this House and I want to learn as much as possible. I gather that the member should speak on the principle of the bill. The point I am making is that he is so irrelevant that I cannot even get the relevance in his irrelevance. Where is the principle in what he is talking about? I cannot make any sense of what he is saying.
The Acting Speaker: The chair has already ruled on that point.
Mr. Epp: We are very concerned about the direction he has taken. Somebody has raised a point as to where he is going. I suggest if somebody had Ex-Lax, we would all know where he is going.
Mr. Ward: On a point of order, Mr. Speaker: I am getting concerned about the number of interjections as well. l have listened for two and a half hours and I think the member is speaking in support of the bill.
Mr. Treleaven: Actually, I have been going only an hour and three quarters, although it may seem like two and a half hours. In Erskine May and Beauchesne, from which my friend the member for Sudbury East likes to keep quoting, it also says -- I am sure if the Speaker checks with the clerks they will confirm it -- that on third reading debate the proper question is why third reading should be carried or why the bill should not proceed to third reading.
That is the whole purpose of speaking on it and that is where I am headed. Each of these points is right on as to why the bill should not proceed to third reading. I am dead on point. I hope I have clarified it for the member for Sudbury East.
Mr. Martel: Do not provoke me or I will not leave my chair.
Mr. Treleaven: Yes, I do not want to antagonize him.
In Bill 94, under the procedures of the Health Services Appeal Board, what happens if a doctor is found guilty? There is what is known as a writ of fieri facias, or fi. fa. The member for Brampton has now left. There is seizure, fi. fa., etc. There are many things under the Provincial Offences Act, which is referred to in subsection 4(3) of Bill 94, through which the ordinary person gets all kinds of benefits; i.e., if there is a fine, he can ask for an extension from the courts and he will get time to pay.
Mr. Speaker, you as a solicitor know that. I am sure in the past you have asked for extensions of fines many times in court. The physician, the optometrist and the dentist sure do not get that under Bill 94 or any of the acts flowing from it, but one does under the Provincial Offences Act and under any number of other acts. There is the granting of an extension and so on.
I can go on about section 67 but I will not do that. There is also the suspension of fines in section 71 of the Provincial Offences Act, again referred to in Bill 94. The section states, "Where an act provides that a fine may be suspended subject to the performance of a condition," the court may suspend the fine on conditions. Those are ordinary rights that every citizen of Ontario has under many acts, such as the Statutory Powers Procedure Act and the Provincial Offences Act but does not have under Bill 94 from the Health Services Appeal Board.
Perhaps I have made my point there. I could go on, but I have shown that the bill is draconian for all those reasons. It is probably unconstitutional and should not be given third reading. Bill 94 is imperfect, and I have dealt with the past, the draconian and machiavellian reasons it should be either amended or turned down.
3:10 a.m.
Now I will deal with the imperfections in it. It needs to be amended further. At least two areas immediately come to mind. Under certain circumstances this act will not qualify under the Canada Health Act. Anyone who has been here throughout second reading or in the debate in committee of the whole House will remember that the minister has continually stated -- and I believe through question period, questions to the Premier (Mr. Peterson), etc. -- that the whole purpose in bringing in Bill 94 was to get the $53 million or $100 million or $25 million -- whatever the figure might be -- that the feds are holding in a pot up there until Ontario brings its legislation into line with the Canada Health Act. That, we understand, is the whole purpose of Bill 94.
Hon. Mr. Sorbara: Will my friend the member for Oxford yield the floor for a question? It will be very quick.
Mr. Treleaven: Yes, I will yield for one question.
Hon. Mr. Sorbara: My question to my friend from Oxford is this: After all the debate we have had in this House, does he really, honestly believe that the sole purpose of this bill is to recover $53 million? Is that the point of his argument? Is it his view, in summary of all the things that have gone on here in the past months, that this is the sole purpose? I would be very surprised if his answer were yes, but I would be interested in hearing it.
Mr. Treleaven: It may not be the only purpose --
Hon. Mr. Sorbara: The member just said it was the only purpose.
Mr. Treleaven: No. There may be biases on the part of the third party and the government. They may have biases in philosophies.
Mr. Callahan: On a point of order, Mr. Speaker: In his statement, the member has obviously made an allegation against the third party and he was just about to make one against the government. I submit that this is unparliamentary. I ask that he retract this statement or be called to leave the House.
I will avoid the one about being called to order. Order him out of the House.
The Acting Speaker: It is not unparliamentary to make an allegation against the government.
Mr. Treleaven: It was just a bias, really. All I said was that the government and the third party may have a bias or a philosophy with regard to Bill 94, but the main purpose has been stated over and over in this House by the government. The main purpose for hurrying -- although various others say the government had until next April for the three years to be up -- is to get this money that the feds are holding in the pot.
Mr. Callahan: If we are hurrying, why are we here tonight?
Mr. Barlow: It is that party's idea. It is part of the closure motion.
Mr. Callahan: I had a better day than the member for Oxford did.
Mr. Treleaven: But I accepted the member for Brampton.
In the debate and in committee of the whole House the member for Lincoln, the member for Oakville, the member for Carleton-Grenville and the member for Dovercourt (Mr. Lupusella) each tried to ask the minister about the Canada Health Act. This is crucial. I did not understand his answers. The members kept trying to explain themselves in different ways and tried to get the minister to understand. Either he did not understand or they did not and I do not. It may well be that we do understand and that there is a fundamental gap here in this bill.
Take section 12 of the Canada Health Act. I do not have to pull it out. Let us start with the assumption that one of the main purposes, or the main purpose, of going through with Bill 94 is that the province not be penalized by the holdback of moneys by the federal government under the transfer payments, established programs financing -- whatever you will -- under the Canada Health Act.
Section 12 of the Canada Health Act lays out the reasons, the criteria under which a province can qualify for the flow-through of funds, what it must do to qualify and the conditions under which the money will be held back; then, after that, the conditions under which it will flow the moneys through. Section 12 of the Canada Health Act is the main section; it deals with accessibility. As the members know, there are five program criteria under the Canada Health Act for a province to get the money, the full cash contribution.
Section 7 starts out by saying, "In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year," sections 8 to 12 must be adhered to. I am paraphrasing. Sections 8 to 12 go through public administration, comprehensiveness, universality, portability and accessibility. Those are the criteria the provincial plans must meet to qualify for federal money. Section 12 is the most important of those.
Section 12, accessibility, sets out the criteria a province must meet to get this money from the federal government. Subsection 12(1) says, "In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province" -- and that is what we are talking about in Bill 94: the Ontario health insurance plan and the Health Insurance Act; the Health Insurance Act is the "health care insurance plan" of Ontario referred to in subsection 12(1). Paragraph 12(1)(a) says that to satisfy the criterion -- i.e., to get the money -- one "must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons."
Incidentally, we are again on the point we were at a while ago about insured persons: "either directly or indirectly...made to insured persons or otherwise." One must take this to mean uninsured persons. I will deal with that again. I did before in a preliminary way; I will again, in a fuller way, get into "insured persons," which the member for Yorkview was so interested in.
Let us paraphrase paragraph 12(1)(a): The province must provide health services on uniform terms to everyone, with reasonable access to insured persons or otherwise.
Paragraph 12(1)(b) says, "must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province." That is OHIP.
Paragraph 12(1)(c) says, "must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists." That is the key item.
Whenever the members for Lincoln, Carleton-Grenville, Oakville and Dovercourt kept asking the Minister of Health (Mr. Elston) about this, saying that something -- an agreement -- was missing, the Minister of Health kept giving them the answer that all a province has to do is provide reasonable compensation to these professionals.
He kept saying that. These members were not understanding. Frankly, I was not understanding. I just wonder if the Minister of Health is really understanding and all these other members are incorrect -- reasonable compensation to the practitioners.
In subsection 12(2), this "reasonable compensation" term is dealt with. There is a deeming clause which begins, "In respect of any province in which extra billing is not permitted." Bill 94 attempts to do that. It attempts to say, "No extra billing." Right? If it is passed, there will be no legal extra billing in Ontario. Ontario will then qualify under subsection 12(2).
3:20 a.m.
Again, "In respect of any province in which extra billing is not permitted" -- that is Ontario -- "paragraph 1(c)" -- the reasonable compensation clause -- "shall be deemed to be complied with if the province has chosen to enter into, and has entered into, an agreement with the medical practitioners or dentists of the province." It says if they have agreed to enter and have entered into an agreement for negotiation, this agreement has to provide, "(a) for negotiations," etc., and "(b) for the settlement of disputes...conciliation or binding arbitration by a panel...."
This is my point. There is no agreement. At this time we still have an agreement under OHIP. We will not have an agreement after April, 1987. The current agreement runs out in 1987. At that point, any agreement with the doctors is off. Therefore, there is no agreement after 1987.
There will be no agreement. It takes two to enter into an agreement, the OMA and the province. One cannot have a unilateral agreement. There must be at least two parties to an agreement; it is privity of contract, from my law school days. There must be two people in a contract. If the OMA does not willingly, voluntarily, come to an agreement at April 1, 1987, there will be no agreement. It will be in limbo.
One remembers the kerfuffle in the newspapers about whether the government had offered the OMA that, if no new agreement were entered into after the present one terminated by the passage of time next year, the doctors could extra bill. They would have that right to extra bill, opt out, etc. One remembers the discussion and claims over that. Therefore, there will be no agreement at that point unless the doctors agree.
Let me work back. If there is no agreement entered into under subsection 12(2), then it will not be deemed to fulfil paragraph 12(1)(c), which means reasonable compensation to the professionals. If it does not meet that test, it does not meet the test to get funding. As all those members were trying to say and I am trying to understand, unless it meets all the criteria of section 12 of the Canada Health Act, how can Bill 94 do what the government wishes it to do to qualify for this money? If it falls down on any of the criteria, it does not get the money. One of the criteria is that there is and will be an agreement that has been entered into.
Bill 94 does not close that gap. I wonder whether the minister, in the hurry to amend and sort around this bill, has a lame-duck bill which will not do what he wants. Again, this should be clarified. Amendments should be put in. An agreement should be entered into to qualify for that.
There was an amendment which tried to get close. The member for Windsor-Riverside proposed an amendment, which was voted down, that tried to set out an agreement or a formula for these negotiations. I did not read the whole thing, but this agreement that must be entered into to qualify for the money has to provide, under paragraph 12(2)(a), "for negotiations relating to compensation for insured health services between the province and provincial organizations which represent practising medical practitioners or dentists in the province;" i.e., this agreement has to provide for negotiations between the province and the OMA, the Ontario Dental Association or the Ontario Association of Optometrists. It already has to provide for negotiations in there.
There have to be clauses providing for settlement of disputes relating to compensation in there. This is paragraph 12(2)(b) of the Canada Health Act. Right now, the present agreement does not set out provisions for negotiations and the method they are going to negotiate for compensation, ie. the fees. It does not set out the settlement, a formula for settlement or details or anything for the settlement of disputes relating to compensation; i.e., if they cannot agree, how do they determine the medical fees, the OHIP fees and the schedule?
Then it says, "for the settlement of disputes relating to compensation through, at the option of the appropriate provincial organizations referred to in paragraph (a)." Let us say the OMA --
Mr. Callahan: Could I inquire how long the member for Oxford is going to be, because I am trying to catch --
The Acting Speaker: I think the House should be excited and aware of the fact that the member for Oxford has just passed the two-hour mark.
Mr. Callahan: Is he wrapping up or what?
The Acting Speaker: Does the member for Oxford wish to yield the floor for a question?
Mr. Treleaven: No. I do not think there was a question. Well, there was a question asked.
Perhaps I can simply answer that I am now nearly halfway through my preliminary comments, the preliminary thumbnail sketch of what I will be discussing more fully.
Bill 94 is silent on this settlement of disputes that must be in the agreement for the province to get the money. It has nothing. There is no agreement with the OMA, for example, or any agreement for the settlement of dispute. It says at the option of the OMA, through "conciliation or binding arbitration by a panel that is equally representative of the provincial organizations and the province and that has an independent chairman." Then paragraph (c) says, "A decision of a panel referred to in paragraph (b) may not be altered except by an act of the Legislature of the province."
In other words, the federal government is saying in section 12 that it cannot just spring this panel, which has doctors well organized, equal OMA and equal province, on this panel. It cannot be altered without coming before this Legislature and receiving legislation.
The province cannot just by regulation or an add-on of some type simply amend, delete or cancel the decision of the panel. What has me puzzled -- and I think has other members puzzled -- is not there. I believe the minister has overlooked the fact that to qualify for the funds under the established programs financing legislation --
Interjection.
3:30 a.m.
Mr. Treleaven: Thank you, Mr. Speaker. Perhaps the smell of flowers will cover the smell of the chlorine in the drinking water.
There is no agreement in Bill 94, even though there were amendments that attempted to put it in and attempted to follow very much the wording of subsection 12(2). There is no agreement that provides for negotiations between the OMA and the government and that sets out a formula for settlement of dispute by conciliation or binding arbitration. Therefore, the bottom line is that Bill 94 can and will be passed and it still will not qualify for the funds from the federal government.
I started out by saying that the main purpose of this government in bringing down Bill 94 was to gain the federal money. The bill is going to fail in getting that. As a result, it should go back, be amended and examined again and more properly redrafted.
That was the one area where the bill is imperfect and where it will not qualify under the program criteria under the Canada Health Act. There will still be a withholding. Sections 18 and 20 of the Canada Health Act talk about withholding money if a province defaults and so on. Section 18 of the Canada Health Act is the section that deals with extra billing and user charges.
Section 18 reads as follows: "In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, no payments may be permitted by the province for that fiscal year under the health care insurance plan of the province in respect of the insured health services that have been subject to extra billing by medical practitioners or dentists."
In other words, in order for the province to qualify there will not have been any extra billing during that fiscal year. Then section 20 states that if "a province fails to comply with the conditions set out in section 18, there shall be deducted from the cash contribution to the province" -- that is, they will deduct elsewhere from other transfer payments -- "an amount that the minister, on the basis of information provided in accordance with the regulations, determines to have been charged through extra billing by medical practitioners or dentists in that fiscal year," etc. It goes on to talk about the minister estimating how much has been charged through extra billing.
Sections 18 and 20 demonstrate what happens when the federal government finds out a province has not been playing the game. It may have allowed extra billing. We may also be back to a situation such as that of the old order Mennonites. A province has allowed a gap in the provincial act that does not catch everyone and is not fully encompassing of the entire population.
For these reasons the bill should not proceed. It should not be given third reading.
There is what I will call a neat point in section 20 of the Canada Health Act. I suppose it is an aside in that section. The province does not need the permanence of Bill 94 to get this federal money.
Mr. Speaker, as a solicitor, you will remember that when people got behind in their taxes, a municipality could take action against the real property only when taxes were three years in arrears. There were various procedures under various acts specifying what a municipality could do: seize and sell, put liens on, etc. However, the time period was three years. You will remember that often when somebody was in rather dire straits, in the early part of year four or maybe at the end of December so that he was never quite three years in arrears, he would pay year one's taxes.
The ratepayer tried to go in to pay the first instalment of year one and pay nothing on the balance of year one and nothing on years two and three, but he was never quite three years in arrears. To get around that, municipalities started saying they would not accept less than the whole year's taxes.
This really is much the same under subsection 20(6) of the Canada Health Act, which is the main reason for Bill 94 being in existence. It is a refund to the province and it is on the same theory as the three-year payment of taxes.
Subsection 20(6) says, "Where, in any" -- emphasis on the word "any" -- "of the three fiscal years referred to in subsection 5..." Subsection 5 talks about separate accounting in public accounts and says, "Any amount deducted under subsections 1 and 2 from a cash contribution...." That is where they find they have not lived up to expectations and are withholding.
We now are in the middle of the third year of the present agreement with the federal government. It has withheld transfer payments pertaining to opted-out physicians, etc., for two years and we now are in the third year. Subsection 20(6) says, "Where, in any of the three fiscal years referred to in subsection 5, extra billing or user charges have, in the opinion of the minister" -- the federal minister -- "been eliminated in a province, the total amount deducted in respect of extra billing or user charges, as the case may be, shall be paid to the province." Where it says, "in any of the three fiscal years," one has to read, "any one of the three fiscal years." I think the members will agree with that construction.
This is the analogy with the arrears of taxes on real property. "Where, in any of the three fiscal years...extra billing...has been eliminated," i.e. , in the last one, in the middle one, in the first, in any one, "the total amount deducted in respect of extra billing...as the case may be, shall be paid to the province."
It is strange but it means that all the province has to do is pay one year in three and it gets the money for all three years. Do away with extra billing and in one year you get all three years. Sign a one-year agreement. Work it along. If you ban extra billing in any one year, you get all three years. The way I read this is that by banning extra billing for one year on a one-year contract, you pick up the last three years' payments. Enter into an agreement only every third year and you will continually get the money from the federal government.
Under this system, Bill 94 could state that there will be no extra billing in year one, and it is a one-year agreement, and then away you go with extra billing in years two and three. Then there is another one-year agreement in year four, nothing in years five and six; you will get all six years -- one year in three. I believe that because "where, in any" year, you get the total.
Hon. Mr. Sorbara: Would the member yield for a question?
Mr. Treleaven: Yes, for one question.
Hon. Mr. Sorbara: Earlier in the member's remarks he referred to doctors as small businessmen. I presume he meant small businessmen trading in the health of the people of this province. If I follow the tenor of his remarks, he now is suggesting a different mechanism to infuse, by way of transfer payments, an additional $53 million, a way to get the money, perhaps for these small businessmen or perhaps just for the province. Is it the view of my friend the member for Oxford that the Canada Health Act and Bill 94 are simply economic measures or does he see in these bills some other, greater social objectives?
3:40 a.m.
Mr. Treleaven: Measures. I would not call them yardsticks. Perhaps the member is trying to refer to yardsticks. No; I am simply saying that Bill 94 is not necessary in its present form to get that money back. All it has to do is have an agreement that is effective one year out of every three to get back the money for all three years. Therefore, it is draconian. It is pushing on the doctors a three-year ban on extra billing when it needs to do only one year, according to my interpretation of section 20, the effective section of the Canada Health Act.
Mr. Shymko: Mr. Speaker, to follow on this, with your permission, I want to have some clarification from the member.
Mr. Treleaven: I will yield for one question.
Mr. Shymko: I just want some clarification. It is my understanding that the famous Erik Nielsen report, recently tabled in the House of Commons, makes reference to a review of the Canada Health Act as passed originally by the Honourable Monique Bégin and supported by the present government concerning certain criteria and arguments that may verge on the concerns we have just heard from the government side of the House.
The suggestion from Erik Nielsen in his report simply and very clearly asks the government to review the present policy of penalizing provinces and -- correct me if I am wrong -- asks the government to review it. I wanted the members to clarify whether that review is --
Hon. Mr. Sorbara: On a point of order: My friend the member for High Park-Swansea (Mr. Shymko) asked the member for Oxford, who was making an argument, to yield the floor for a question. The member for Oxford kindly yielded the floor for a question. Now my friend from High Park-Swansea is standing up and making a speech about the Canada Health Act and Erik Nielsen. I simply ask you to rule him out of order.
The Acting Speaker: The point is well taken. I would ask the member for High Park-Swansea to get to his question.
Mr. Shymko: My question to my honourable colleague was for a clarification of the relationship of the Erik Nielsen report and its request of the present federal government to review its decision to penalize the provinces for allowing extra billing. He has specifically asked for a review. I want to know whether that review is being considered by the federal government, because it has a major impact on this bill, on the passage of this bill, on its implementation, on the effect the bill may have after its passage and on the possibility of the present federal policy being withdrawn or reviewed. Is my honourable colleague aware of that and can he answer my question on the relationship of the Erik Nielsen report to what we are doing here today?
Mr. Treleaven: I thank the member for High Park-Swansea for his question. In fairness, I am not familiar with the Erik Nielsen report. It may well be that it tries to straighten out the problems in subsection 20(6), where it is possible to ban extra billing for one year only and collect money for all three years.
Mr. Cordiano: On a point of order: I would like to ask a question.
Mr. Treleaven: I will yield the floor for one question.
Mr. Cordiano: Does the member for Oxford not feel that the requirement for natural bodily functions might overtake him at this time? I ask that on a personal note.
Mr. Treleaven: No. I went on a nonliquid diet at three o'clock yesterday afternoon and have taken very little liquid since then in contemplation of a concern such as the member has which might become a concern of mine. To forestall that, I have taken very little liquid.
Mr. Callahan: Did the member examine the flowers I sent him?
Mr. Treleaven: I am not sure about the flowers. Something might jump out and bite me. On this question, this three-in-one, if I may call it that, the note I have puts it more succinctly than I have done. The bottom line is, if the province wants to get federal money, it must put machinery in Bill 94 to get the agreement of the doctors' and dentists' and optometrists' associations. We cannot leave it. The bottom line of section 12 of the Canada Health Act is that the agreement must be in place. It cannot be left loose in the hope that the OMA, etc., will enter an agreement next April. That is much more succinct than I had it before.
I am probably going to get into difficulty with my fellow members in the official opposition because I have to take issue with one of the amendments of the member for Lincoln. I believe it was his amendment. The bill previously stated that administration fees could be added on to any fine --
Mr. Epp: Mr. Speaker, I have one short question to ask of the member. Is it his intention to continue to speak in support of this bill for the next two or three hours?
Mr. Treleaven: No. While there are some things in it that a person could agree with, there are too many inconsistencies and irregularities, bad draftsmanship, that a thinking person should vote against on third reading. The bill should not proceed to third reading. I cannot support it, I cannot give it third reading and I am trying to list the many reasons why it should not proceed to third reading.
There was something in it which, although it was previously too loose, has now been trivialized by the member for Lincoln's amendment. If I can find that amendment in this new --
The Acting Speaker: May I remind the member that the amendment to which I believe he is referring was not passed and so is not part of the bill.
Mr. Treleaven: It is one that was passed. Under the original act, the administration fees could be added to the fine of the doctor if he was found to have extra billed. He was to be fined the amount he had overbilled, plus the administration costs necessary to fine him, try him, collect the money, etc. The amendment of the member for Lincoln put a cap of $150 on the administration fees.
It is section 9 of Bill 94 as now stands, not quite reprinted, but almost. It says, "The Lieutenant Governor in Council may make a regulation prescribing the administrative charge for the purpose of subsection 4(2), such charges not to exceed $150." Subsection 4(2), you will remember, was where a person has made an unauthorized payment to a practitioner.
3:50 a.m.
By the way, this bill is badly flawed in the use of the word "person." There are umpteen uses of the word "person." In some cases it means the health practitioner, in other places, it means the patient and in yet others, the one-person panel of the Health Services Appeal Board.
Mr. Epp: It is always dealing with people.
Mr. Treleaven: It is always dealing with people. It is terribly flawed in that it does not define "person" consistently. It creates confusion and, I suspect --
Mr. Epp: On a point of order, Mr. Speaker, if you will let me indulge for a moment on the common usage of the word "person." We refer to engineers as persons; we refer to nurses as persons; we refer to doctors as persons. It is only natural that, in a bill that deals with such important subjects as health care, we would use the word "persons" in more than one context. I do not see anything unhealthy about that context.
Mr. Treleaven: For the sake of the member for Waterloo North, that was an aside that I will get to on the problems with the word "person." It was referred to in subsection 4(2) and that is what really got me to that specific issue which I do not want to discuss yet. That is down the road.
Mr. Epp: These are still your preliminary comments?
Mr. Treleaven: These are still my preliminary comments. I did not know when I was going to debate this, so I had to prepare for two, three, four, or five days. I had to prepare for any number of days.
Mr. Epp: The member is at day four now.
Mr. Treleaven: No, this is the first opportunity I have had and it is just two days. I may hardly get past my preliminary remarks on this. Were it to be five days, I am sure I would get down nearly to the end of my total remarks. This is third reading; it is on second reading where one can debate philosophy. One can go wild.
In subsection 4(2) -- remember the new section 9 that caps the administrative charges at $150 -- this is where a person -- read patient -- has paid an unauthorized payment to a practitioner and the general manager has paid the person, i.e. the general manager found out that there was an overpayment. The general manager paid out of his pocket or out of his pot, to the patient, the amount of the overpayment. This section says that the practitioner -- read doctor -- is indebted to the plan for an amount equal to the overcharge amount that the general manager has paid to the patient plus "the administrative charge prescribed by the regulations."
Before, this was too loose; it was just wide-open. It could be any amount with no cap. The member for Lincoln was exercised and proposed this $150 cap which was agreed to by the House. That was good to get rid of the looseness, the open-endedness, the unlimited amount that a practitioner could be found liable for as an administration charge. Now it is $150.
Subsection 8(2) in Bill 94 talks about having a private prosecutor: "When a prosecution is conducted by a private prosecutor" -- I presume one must read "lawyer" there. If one is going to have a private prosecutor, I doubt it would be otherwise -- "and the defendant" -- read doctor -- "is convicted," -- that is, of overcharging -- "the court may determine the actual costs reasonably incurred in conducting the prosecution and, despite section 61 of the Provincial Offences Act" -- which I have already dealt with in a preliminary way -- "may order those costs to be paid by the defendant to the prosecutor."
We now know from the procedures of the Health Services Appeal Board that some of these cases go up to three years from the time the general manager finds something wrong with the practitioner's billing and it is three years later before the Health Services Appeal Board brings down its decision.
In those three years, they also bring in panels and there are examples of up to eight people in a panel with general managers. It is transcribed, so there are very expensive transcription services. I do know from ordering old transcripts in court that they are extremely expensive. Many years ago it was $2 per page and I am sure it is way beyond that now. There are tremendous expenses --
I am sorry, Mr. Speaker, but the member for Waterloo North (Mr. Epp) was actually paying attention to what I was saying so I was looking at him in awe finding this really interesting. Either he and I are on the same wavelength -- if so, he has problems -- or he is asleep and just happened to be facing this way.
Under section 9, we have a cap of $150 on the administration charge. Yet, if there is a three-day trial -- I will call them trials; that is not unusual for these hearings under the Health Services Appeal Board.
One gets an outside, private prosecutor -- that is, a nongovemmental private prosecutor -- and one is going to pay $1,000 per day, including preparation time. There will be a minimum of $3,000 in his fees. Then one adds in the expenses of a panel of eight -- it could be three and it could be eight; they vary here and I cannot find any rhyme or reason for why it is three, eight, five or six on various panels. I have conservatively estimated that it could well be $5,000 in costs. The way bureaucrats run things up, it could be more.
It is a three-day trial, in essence, for $5,000 with a cap of $150. Who picks up the difference? It is the taxpayer, who pays $4,850. That is why I am a little critical even though a member of my own party -- the official opposition -- moved the amendment. It was passed in the House but I have to be a little critical of that because, as I say, the taxpayer pays the other $4,850.
It is unfair, especially if it is a Mickey-Mouse offence of $10, $15, or $25 that is overbilled by accident, or whatever, and we are into huge expenses simply because of this cap and the taxpayer has to pick up the difference. This should be amended and the amount raised.
When it was passed as an amendment, it was called subsection 4b(1) but I am not sure what it is now. It is amending subsection 8(1) of the Health Insurance Act. I had better go back to Hansard. I cannot get it from the newly numbered sections. I am having trouble with the renumbering. It is most frustrating when it has all been renumbered.
4 a.m.
It is probably subsection 5(1). Subsection 4b(1) amends subsection 8(1) of the Health Insurance Act. Here is where you have several panels. It is an obvious problem and something has to be amended.
You will remember I talked before about the problem of the minister referring to a panel being a single person. Yet, the Health Insurance Act sets forth that the Health Services Appeal Board will have a quorum of three which means there can be no more than three people in a panel. To make it worse, the newly amended Bill 94 sets forth this single person constituting a quorum and the minister referred to it time after time. It certainly is in the amendment. It is a long amendment --
Mr. Martel: On a point of order: I know the silly hour has run on for a long time and I have listened to the drivel for a considerable period of time and I have reflected upon what Mr. Speaker said earlier about his having ruled. Since I last discussed with Mr. Speaker about what was going on in third reading, little substance has been added, or little in dealing with what a third reading is supposed to be about.
I know that Mr. Speaker has looked at what a third reading is supposed to be about. May I refresh your memory, sir, that the purpose of the third reading is to review a bill. It says here that when debate takes place it is confined strictly to the content of the bill. Further in Erskine May it says, "Debate on third reading, however, is more restricted."
I draw your attention to the word "restricted." This means more restricted than at an earlier stage. Quite frankly, sir, this member has gone through this bill clause by clause.
Either Erskine May is wrong or your ruling is wrong or I do not understand what Erskine May is saying. Perhaps you can help me and tell me how it is that I am misinterpreting what the parliamentary procedures are under Erskine May. If this is a restricted debate on third reading, I would hate to see what a wide-open debate is. We would deal with it word by word then, I suppose. We are dealing clause by clause, which is not the purpose of third reading.
I would ask you, after a couple of hours of drivel, to suggest to my friend that he deal with the principle of the bill and not clause by clause.
Hon. Mr. Sorbara: On the point raised by my friend the member for Sudbury East (Mr. Martel) --
Mr. Cousens: Oh, the member is friends with Elie?
Hon. Mr. Sorbara: I am friends with Elie and friends with the member. He knows that. I do not discriminate among members of the opposition.
On the point raised by my friend from Sudbury East, Mr. Speaker, I ask you to consider that there was a time when the member for Oxford (Mr. Treleaven) talked about principles. Frankly, over the past half hour he has done little but quote and cross reference sections of statutes of this province. When he is not quoting sections he is busily searching through his papers to find the right section he wants to quote. Frankly, I am now beginning to agree with my friend the member for Sudbury East that the member for Oxford is going a little too far. Given your rulings over the course of the past three hours, Mr. Speaker, you are likely to rule that the member for Oxford is in order.
I ask the member for Oxford to consider. He sat in the chair as chairman of committee of the whole House and listened to 26 hours of clause-by-clause debate. I would ask him, in the event that he is ruled in order, to spend a little time differentiating for us here -- we who are now sitting at 4:05 a.m. What is different between what went on in those 26 hours and what he is doing here? It seems to me that there is no way one can differentiate between what went on in committee of the whole House and what he is doing.
Mr. Speaker, I ask you simply to direct the member for Oxford to comply with the view of Erskine May of what third reading is all about.
The Acting Speaker (Mr. Morin): In my humble opinion, the principles were discussed in second reading. In third reading -- again, in my humble opinion -- the member for Oxford has discussed the contents. However, he does stray. He should make sure he sticks to the debate.
Mr. Martel: I would like to know which debate you are talking about, Mr. Speaker, because he has talked about everything else but the bill.
The Acting Speaker: I have just reminded the member for Oxford to relate strictly to Bill 94.
Mr. Treleaven: Thank you, Mr. Speaker. That is exactly in order and quite correct. I cannot deal with the principle of the bill. That was decided on second reading. This is third reading.
Mr. Martel: The member cannot do it clause by clause, either.
Mr. Treleaven: No, I am not doing it clause by clause. This is the examination of the bill as it now exists, as amended. It does not have six sections, as my friend the member for Sudbury East has said. As reprinted, it has 12 sections, and therein lies part of my problem in trying to get the amendments in a sort of reprinted form -- with a certain amount of handwriting, which is the best there is in this House.
It has not been reprinted in Orders and Notices. Therefore, I must read about the amendments partly from Hansard and partly from this. It has 12 sections, which are all renumbered, and it is difficult to follow.
The Acting Speaker: I must remind the member that I will bring him back in line quickly if he strays.
Mr. Treleaven: Thank you.
Mr. Martel: On a point of privilege: Again, my friend is wrong. It was my colleague, the member for Windsor-Riverside (Mr. D. S. Cooke), who said there were six sections, not me. I wish he would withdraw.
Mr. D. S. Cooke: I am definitely wrong.
Mr. Treleaven: I am not sure. I think I hear the member for Windsor-Riverside recounting.
Mr. D. S. Cooke: I was looking at the original bill.
Mr. Treleaven: Yes.
Mr. Martel: I will tell the member: there were only six sections, and the member is wrong again.
Mr. Treleaven: I thank the member.
The Acting Speaker: In my opinion, there were no words that were offensive.
Mr. Martel: On a point of privilege: He said I indicated that there were six sections to this bill. I did not. I would not say he was misleading the House, but it is pretty close when he says I said there were six sections, and there are 12.
Since I did not say it, it is highly irresponsible of the member to make that accusation.
The Acting Speaker: The member for Oxford will make his correction.
Mr. Treleaven: Correct. If the member for Sudbury East did not say there were six sections, it was someone who looked and sounded like the member for Sudbury East. I certainly would withdraw that he was mistaken, and that he could not tell the difference between six and 12.
4:10 a.m.
It was not subsection 4b(1). It was subsection 3b(1), and therein lies the problem with this renumbering. It is difficult to keep one's train of thought with the member for Sudbury East interrupting.
Mr. Martel: The member has difficulty without anyone interrupting.
Mr. Treleaven: I will go back. The subsection 3b(1) amendment of Bill 94 amends subsection 8(1) of the Health Insurance Act. There is a problem here. It refers to a singular member. Let us go to the subsection 3b(3) amendment, "The chairman of the board may from time to time appoint a member of the board to conduct a review under this act," meaning that is a single-person board. Yet, in the Health Insurance Act, subsection 8(2) states: "One member of the appeal board shall be designated as appeal board chairman and another member of the board shall be designated as vice-chairman by the Lieutenant Governor in Council." Then it goes on to say that a quorum is three, etc. The ambiguity is subsection 8(4) of the Health Insurance Act, which states: "The decision of the majority of the members of the appeal board present and constituting a quorum is the decision of the board, but, if there is no majority, the decision of the appeal board chairman or vice-chairman governs."
Here is the problem. If we have a single-member board under Bill 94, we have one man, one woman or one person in the appeal board set forth in Bill 94. At the same time we have in the Health Insurance Act the vice-chairman or chairman breaking a tie, in essence. How can it be? It means that the vice-chairman has never sat on that board. It is ridiculous.
The Acting Speaker: Order. The member is discussing the principle again.
Mr. Treleaven: Am I?
The Acting Speaker: Yes.
Mr. Treleaven: The principle of the bill?
The Acting Speaker: Yes, and that was done in second reading.
Mr. Treleaven: I was discussing ambiguity in Bill 94.
The Acting Speaker: The member should be very brief and discuss why it should not be given third reading.
Mr. Treleaven: It should not be.
The Acting Speaker: Discuss that and let us know about it.
Mr. Treleaven: Third reading should not be proceeded with because Bill 94, the section 3b amendment, subsections 1 to 7 inclusive, are inconsistent with and in opposition, in many ways, to section 8 of the Health Insurance Act, which sets out the rules and regulations of the Health Services Appeal Board. Therefore, Bill 94 is incorrect, improperly drawn, ambiguous and it should not be proceeded with to third reading. It needs further amendment. It requires that we go back and change it. In no way should it go through for third reading.
There is another problem. The decisions of the Health Services Appeal Board are not always yes or no, black or white. Very often they deal with, for example, whether a doctor did overbill or not. That is clean and tidy, sort of guilty or not guilty. In the act, it is all right to have a tie, but some of these cases do not say yes or no. Some of them take an example where they wish to decrease or increase an amount, so it is not yes or no. Therefore, these are improper. Again, section 8 of the Health Insurance Act and the section 3b amendment of Bill 94 are in conflict with each other because they only provide for a tie -- yes or no, black or white -- but not for any third type of decision.
I would like to refer members to a decision of the Health Services Appeal Board on April 24 and 25, 1984, with seven people on the panel. It is a hearing under clause 26(1)(d) of the Health Insurance Act between Gordon Bissessar, MD, the appellant, and both the general manager of the Ontario health insurance plan and the medical review committee of the College of Physicians and Surgeons of Ontario, respondents. They gave the final decision and reason.
This is a case that started in 1981. Almost three years later, it came to a decision. This board took nearly three years after the general manager had already found Dr. Bissessar guilty.
The recommendation of the medical review committee, which was the first tribunal, was that "The general manager should recover from the individual appellant 15 per cent of all accounts submitted for services of individual psychotherapy for the period January 1, 1977 to February 28, 1979." The committee said that the general manager should recover 15 per cent.
This appeal was taken to the Health Services Appeal Board on January 1, 1977. The decision was actually dated May 22, 1984. Members should look at the length of time this took. It was far longer than the two years the member for Lincoln was talking about. The member for Wentworth North said the time in which decisions were made was improving.
The Minister for Skills Development (Mr. Sorbara) would never have anything to do with a tribunal that took years to come to a decision; I am sure of that. That is why this Health Services Appeal Board looks like real trouble, even though the minister has amended Bill 94 to provide for more people to serve on panels.
In the conclusion, the committee was dealing with this 15 per cent, and whether the general manager should deduct or hold back 15 per cent of all the billings of this doctor for a two-year period. It stated: "Having found that the appellant failed to meet professional standards required by the pertinent regulations" -- and so on -- "the board must turn its attention to how much of the public funds paid to Dr. Bissessar should be recovered. Counsel on behalf of Dr. Bissessar argued that the figure claimed was arbitrary." It goes on to say that 15 per cent was acceptable.
I am reading from the decision: "In view of the evidence before this board as to the total inadequacy of Dr. Bissessar's records, the board was tempted to increase the amount to be recovered by the general manager. The board found, however, that the evidence of the medical review committee was persuasive on this point. In these circumstances, we will not disturb the 15 per cent recovery."
There is the point. It is not yes or no, black or white, 15 per cent or not. In this case, they were tempted, and could have increased the percentage. They could have decided on 20 or 10 per cent, so there is no yes or no, black or white. We have a situation that is not a tie.
As I stated before, in the case of a tie, the chairman and the vice-chairman must vote to break it, but what happens when the decision is not a tie? What happens if it is simply an increase, and the board is all over the place? One says, "Increase it to 20 per cent," a couple say, "Increase it to 23 per cent," and some others say, "Leave it at 15 per cent."
Mr. Charlton: Average it out.
4:20 a.m.
Mr. Treleaven: Right. That is fine. One does not have a tie. However, Bill 94 should set forth the formula, the machinery, for breaking the tie or averaging out.
My friend, the member for Hamilton Mountain (Mr. Charlton), has an excellent idea. Put in the machinery on how to break the tie and average it out. That is an excellent idea. It is too bad the member for Hamilton Mountain did not move that amendment when Bill 94 was at that point.
That is another reason Bill 94 should not proceed to third reading.
We have confusion on the quorum in subsection 3b(3) amendment. We need more amendments and clarification as to what the panel is. I have referred briefly to the confusion between one-man panels, three-person panels or nine-person panels. Which procedures are to be followed? We have two conflicting procedures. Bill 94 creates this confusion. Things were fine under section 8 of the Health Insurance Act. At the suggestion of the member for York Mills, the minister amended subsection 8(1) and deleted subsection 4b(1) which I have marked here. Of course, that is not the correct numbering under the semi-reprinted bill. Again, there is confusion on the number. I have it marked as subsection 4b(1). Let us assume it was subsection 4b(1) when the amendment to Bill 94 was passed.
Subsection 8(1) of the Health Insurance Act, dealing with and setting out the rules of the Health Services Appeal Board, states: "The Health Services Appeal Board is continued and shall be composed of not fewer than five and not more than nine members, of whom not more than three shall be physicians, who shall be appointed by the Lieutenant Governor in Council."
The amendment increased the number. It took off the nine at the top. However, section 8 still goes ahead. The new section 10 under the reprinted bill -- Mr. Speaker, I do not know if you have a copy in front of you, but I imagine you are having as much difficulty as I am in following these sections.
Section 10 says: "Subsection 8(1) of the Health Insurance Act, being chapter 197 of the Revised Statutes of Ontario 1980, is amended by striking out `and not more than nine' in the second and third lines." That is section 10 of Bill 94. It takes that out. It is open-ended. It is unlimited. However, we have this procedure in section 8 of the Health Insurance Act. It sets out nicely that there will be a chairman, a vice-chairman and a quorum of three. The decision of the majority of the board "present and constituting a quorum is the decision of the board, but, if there is no majority, the decision of the appeal board chairman or vice-chairman governs." In other words, either the chairman or vice-chairman must be present. We have this nice, neat set of rules for the Health Services Appeal Board.
It goes on, "No member of the appeal board shall be employed in the service of Ontario or any agency of the crown," and so on. The appeal board reports to the assembly annually through cabinet, etc.
It was nice and neat until Bill 94 came along and set out this single-member procedure. Now, we cannot have a single-member panel that also has on it a chairman or vice-chairman who is present. Bill 94 messes up instead of improving or assisting section 8 of the Health Insurance Act, which governs the Health Services Appeal Board. The minister did not deal with this apparent conflict. Additional clarification is needed on Bill 94 to clarify how many people are going to be on these panels. That is an excellent reason for Bill 94 not proceeding to third reading and being voted against.
Mr. Warner: On a point of order: Unfortunately, the member for Oxford is confused. The number was specified in the amendment which was placed, and agreed to, by the House. Will the member for Oxford reflect upon the amendment that was placed, thus amending the section to which he takes objection and noting, of course, that if it is amended as agreed to by the House, he has negated his own argument?
The Acting Speaker: Order. Is this a question or a point of order?
Mr. Warner: It is a point of order.
The Acting Speaker: It is not a point of order.
An hon. member: It is a point of confusion.
Mr. Warner: It is a point of confusion for the member for Oxford.
The Acting Speaker: Is the member asking a question of the member for Oxford?
Mr. Warner: Yes. I am asking whether the member for Oxford has taken into account an amendment placed to the section which then specified the number of individuals who would serve on the panel.
The Acting Speaker: Does the member for Oxford wish to reply to his question?
Mr. Treleaven: Yes, I will, Mr. Speaker. Perhaps an hour or so ago I said I recollected being in this chamber when the question-and-answer discussion went on between the minister and the member for York Mills. I thought there were suggestions of 30 or 36, or some specific open-ended number from nine up to 36. I believe my friend is referring to section 10 of Bill 94.
Mr. Warner: There is no section 10.
Mr. Treleaven: Yes, in the reprint. Mr. Speaker, there is an example of why I have difficulty getting the sections. It is section 10 in the reprinted bill.
Mr. Warner: Oh, the reprinted one.
Mr. Treleaven: That is correct. It removes the cap. It strikes out the words "and not more than nine," so that the total board is open-ended. There can be as many as the minister wishes. I am stating how many are on a panel for the hearings. That is section 5, which used to be subsection 4b as it came through. It is now section 5 under Bill 94. That is the place where it talks about a member.
Subsection 5(3) in the reprinted bill reads, "The chairman of the board may from time to time appoint a member of the board to conduct a review under this act." Here is the confusion. It says "a member" here, but section 8 of the Health Insurance Act -- which already sets up a nice, neat set of rules for the Health Services Appeal Board -- says there is a quorum of three. Sometimes there have been as many as seven or eight sitting in the past. How can there be a panel of one when the quorum is three? That is the question.
I notice the puzzlement on the face of the member for Scarborough-Ellesmere (Mr. Warner). He must agree with me.
Mr. Warner: Mr. Speaker, on a point of order, if the member for Oxford will permit a question.
Mr. Treleaven: Yes, I will permit one.
Mr. Warner: Will the member for Oxford distinguish the difference between the number of persons appointed to a panel on a regional basis and on a provincial basis, vis-à-vis whether it should be three or more per region, or a larger number for the entire province? Will the member elaborate?
4:30 a.m.
Mr. Treleaven: Herein lies the problem. I do not have the answers. I can see the problems Bill 94 creates. We have a board, the Ontario Municipal Board, for example.
Mr. Warner: Go back to section 8.
Mr. Treleaven: Section 8: This is the section of the Health Insurance Act that sets out the nice, neat formula and set of rules for the Health Services Appeal Board. It states that the quorum is three and that these people have to be present. It also states that if there is a tie or no majority, the decision of the chairman or vice-chairman governs. Therefore, under the old set of rules in section 8 of the Health Insurance Act, the chairman or vice-chairman must be on every panel. How can we have a quorum of three if this new section 5 of Bill 94 states that a review may be conducted by only one?
Subsection 5(1) states, "A practitioner is entitled to a review of the issue of whether the practitioner has received an unauthorized payment if within 15 days after receiving the notice under subsection 4(4) the practitioner mails or delivers to the general manager written notice requesting a review." That is the appeal procedure.
It goes on to say in subsection 5(2) that the general manager shall refer it to the chairman of the board. Subsection 5(3) says, "The chairman of the board may from time to time appoint a member of the board to conduct a review." It is like the Ontario Municipal Board, which may have 15, 20 or 25 different members.
Mr. Warner: I have a question for the member for Oxford. Is what he is saying not in conflict with the powers and procedure act?
Mr. Treleaven: Did I hear the member refer to the Statutory Powers Procedure Act?
Mr. Warner: That is correct.
Mr. Treleaven: I just happen to have the Statutory Powers Procedure Act with me. Clause 1(1)(e) defines "tribunal" as meaning "one or more persons." It is wide open. It does not have a quorum of three. Section 1 defines "committee," which means the statutory powers procedure rules committee, and it defines "tribunal," but it does not have that set of rules.
Mr. Warner: The Statutory Powers Procedure Act specifies that there must be a quorum of at least three.
Mr. Treleaven: He may well be --
The Acting Speaker (Mr. Morin): Order. I remind the member for Oxford to come back to the topic and to state the reasons the bill should not be read a third time.
Mr. Treleaven: Mr. Speaker, the member for Scarborough-Ellesmere asked me a question. Should I not answer it?
The Acting Speaker: There should not be questions and answers back and forth as on second reading. Come back to Bill 94.
Mr. Treleaven: That is fine. I must state that on a quorum basis, Bill 94 should not be proceeded with because it creates confusion and contradicts section 8 of the Health Insurance Act, which states the rules of the Health Services Appeal Board. That section of the bill should be set aside, or since it cannot be set aside at this point in third reading, the bill should not be proceeded with. It should not be given third reading. It should be voted against.
Mr. Warner: On a point of order, Mr. Speaker: Perhaps I can be permitted a question of the member for Oxford.
Mr. Treleaven: Yes, I will yield for one question.
Mr. Warner: Is the member now deciding that he should run counter to the Statutory Powers Procedure Act?
Mr. Treleaven: Will the member repeat that question?
Mr. Warner: The member is suggesting that what he is proposing would be contrary to the Statutory Powers Procedure Act, that as a lawyer he is suggesting that. I ask that he reflect soberly that the Statutory Powers Procedure Act has power and precedence over what he is suggesting, that there would be only a so-called tribunal. There is a contradiction in terms; a tribunal is three.
Mr. Cousens: Does it have to be?
Mr. Warner: Tribunal; he is suggesting that it be fewer than three.
An hon. member: That is Latin.
The Acting Speaker: Order. The member for Oxford.
Mr. Treleaven: I can only go back to subsection 5(3) of Bill 94 where that bill contradicts the Health Insurance Act and the provisions of the Health Services Appeal Board under the Health Insurance Act wherein it says, "The chairman of the board may from time to time appoint a member of the board to conduct a review under this act." It says a "member"; it does not say "numerous members." That is like the Ontario Municipal Board. Sometimes there are three members, two members or one member sitting on a --
Hon. Mr. Sorbara: On a point of order, Mr. Speaker: We have degenerated a little into a legal debate that perhaps ought more appropriately to take place in a courtroom than in a legislative assembly. I have listened for three and a half hours now and this is the poorest rendition of Mr. Smith Goes to Washington that I could ever imagine. The member has on a number of occasions now --
Mr. Warner: He thinks he is James Stewart.
Hon. Mr. Sorbara: Does the member think he does?
Mr. Warner: Yes, he does. He thinks he is James Stewart.
The Acting Speaker: Will you speak to your point of order. What is your point of order?
Hon. Mr. Sorbara: My point is very simple. This is being televised. This is an embarrassment in the whole of Oxford county. Pity the poor people who are staying up for late-night television and who are really concerned about this bill. Mr. Speaker, you now have, on four occasions if I have been keeping track, directed the member for Oxford to state succinctly why he thinks Bill 30 -- I mean Bill 94 -- ought not to pass.
An hon. member: Bill 30?
Hon. Mr. Sorbara: We will deal with Bill 30 at another time. It is very late.
I can imagine, Mr. Speaker, that your patience is being tried as my patience is being tried. I now know the member views doctors as businessmen who trade in the health of the population. He made that clear. I am not sure whether all the opposition members in the Conservative Party agree with that, but he has made that point clear.
I am afraid that when the member for Oxford rises to his feet again -- I see him shuffling paper there, organizing his notes as if he were prepared to argue a very fine point in front of the Supreme Court of Canada. I think it is section 8, but it may be section 3b. On a point of order, I ask you to direct him again and to move him with your great authority to speak to third reading of this bill, which you have very appropriately defined for him, and at some point call him to order if he persists in shuffling papers, quoting sections and reading cases.
The Acting Speaker: Thank you for your point of view.
Mr. Shymko: On a point of order, Mr. Speaker: The member for York North (Mr. Sorbara) talks about testing the patience of the honourable members, but time and again he gets up and interrupts the most eloquent debate ever heard in this chamber.
The Acting Speaker: That is not a point of order.
Mr. Shymko: Constant interruptions of the nature I have been hearing are unacceptable.
The Acting Speaker: That is not a point of order. Please resume your seat.
Mr. Shymko: Because of these interruptions --
The Acting Speaker: Please resume your seat. The member for Hamilton Mountain.
4:40 a.m.
Mr. Charlton: Mr. Speaker, I rise on the point of order raised by the honourable member. Subsection 4(3) of the bill says, "The general manager may recover," but the member for Oxford should understand that there is no provision in this bill for the members of the House to recover.
The Acting Speaker: The member for Oxford will please keep in mind the remarks I have previously made.
Mr. Treleaven: Certainly, Mr. Speaker.
We get into an extremely bad area in section 7. Section 3d of the original bill was an amendment by the minister and is now section 7 in the new, reprinted, 12-section Bill 94. It is a ferry-built bill. The members know the old saying about a camel being a horse built by a committee. Bill 94 is a camel built by the committee of the whole House. It enters into the world of freedom of access, but it breaks the rules of Bill 34, the Freedom of Information and Protection of Privacy Act.
It enters into the world of inspection and seizure, but it breaks all the common law rules, the Statutory Powers Procedure Act, etc. It breaks into the commercial services area. That was the amendment of the member for Windsor-Riverside, originally subsection 2(2), which carried. It breaks into that and that is where it discriminates against the doctors in not even permitting them to accept money until they get notice.
Mr. Warner: No, not at all.
The Acting Speaker: Order. Will the member for Scarborough-Ellesmere keep his remarks --
Mr. Warner: I am sorry, Mr. Speaker, but the remarks of the member for Oxford --
The Acting Speaker: Order. Please resume your seat.
Mr. Treleaven: Section 3d of Bill 94, which is now renumbered section 7, refers on the side to "disclosure of information," and begins, "despite subsection 44(1) of the Health Insurance Act." There was a double negative. Subsection 44(1) talks about information that is confidential. As an example of how ferry-built this Bill 94 is, the members will remember that subsection 4b(2), the minister's amendment, added the words "the Health Care Accessibility Act, 1986" to the first line of clause 44(2)(a) of the Health Insurance Act. He had a double negative. He then took it out. He amended it. He moved it out.
That shows how bad the draftsmanship was; he had to delete his own. The members will remember the confab in the committee of the whole House over whether the vote was on section 4a alone or whether it included 4b. When it got back to 4b(1) and 4b(2), when the dust settled and it was decided by unanimous consent that the vote had been only on 4a and we would now deal with 4b -- that is, 4b(1) and 4b(2) -- the minister then withdrew 4b(2), at which late point he discovered the poor draftsmanship. At that point, after all the debate had been gone through and there was a vote on it, he discovered he had a double negative. He says, "despite subsection 44(1)," and then he adds an exception. He has two exceptions.
That is poor draftsmanship. That is the camel we have. Bill 94 is a camel and that is evidence of it, but I will not pursue it because we must deal with the bill as it now is in front of us, as amended, and why it should not proceed to third reading. Two exceptions are a double negative.
Mr. Charlton: Two exceptions make a rule.
Mr. Treleaven: That is correct and he wanted one negative. That is the camel and he just chopped off one hump. That shows what bad draftsmanship it was.
Section 3d, which is section 7 of the newly reprinted Bill 94, has a number of problems. If one compares section 3d, it gets into freedom of information provisions and conflicts with Bill 34, the Freedom of Information and Protection of Privacy Act. It reads, "despite subsection 44(1) of the Health Insurance Act, the general manager and each person engaged in the administration of this act." That was amended to say "the general manager, the minister and one other person engaged in the administration of this act...may furnish to." There is a list of people to whom "the general manager, the minister and one other person designated in writing by the minister" may furnish confidential information.
Clause (a) reads "to a member of the board." They can furnish this confidential information to a member of the board. That is fair enough. They are talking about the Health Services Appeal Board.
Clause (b) reads "the person to whom insured services were rendered or where a person other than the person to whom the insured services were rendered was charged for those services, the person who was so charged."
I talked before about the confusion of the word "person" without a definition. There is no definition of the word "person." Listen to that clause. It says "the general manager, the minister and one other person...designated in writing by the minister may furnish to...the person to whom insured services" --
Hon. Mr. Sorbara: On a point of order, Mr. Speaker: We will get back to Mr. Smith Goes to Washington after this point of order. We have a new speaker. I wonder, Mr. Speaker, what your views are on whether our friend the member for Oxford is complying with the directions he has received repeatedly during the night. I hear sections quoted. I have heard Speakers rule that he must confine himself to brief remarks about why Bill 94 ought not to pass. Now we are into our fourth hour. I feel a great deal of sympathy for those people in Oxford who are listening and wondering tonight what their representatives do.
Mr. Cousens: What about us?
Hon. Mr. Sorbara: I see that his colleagues --
The Acting Speaker (Mr. Polsinelli): Order. The member for York North again raises an interesting point of view. Please continue.
Hon. Mr. Sorbara: It is a point of order. I am asking you to rule on it.
Mr. D. W. Smith: I have listened to this gentleman now for four hours and he keeps referring to camels in Oxford.
The Acting Speaker: Order. Will the member take his seat, please. This matter has been ruled on a number of times already this evening.
Mr. Treleaven: I am giving the reason this bill should not be proceeded with, why on third reading all members should vote against Bill 94. I am showing the confusion. There is no definition of the word "person." Listen to this. These are persons who can be given under Bill 94 confidential patients' information. One is "a member of the board." That is fair enough.
4:50 a.m.
Mr. Callahan: On a point of order, Mr. Speaker: With all due respect to my friend the member for Oxford, the reason he got to speak was that the Attorney General had indicated he could speak before the rotation. The next speaker should have been a member of the New Democratic Party.
The Acting Speaker: Order. Will the member take his seat, please. I was here when that occurred. The Speaker at the time asked whether there were any other speakers and the member for Oxford was the only one to stand.
Mr. Callahan: With the greatest respect
The Acting Speaker: Order. Will the member take his seat, please.
Mrs. Marland: Will the member for Oxford yield the floor for a question?
Mr. Treleaven: I yield for one question.
Mrs. Marland: As this day dawns at 4:51 a.m. , on one of the darkest days in the history of health care and the history of the medical profession in this province, I ask the member how much longer he is going to speak.
Mr. Treleaven: That is easy, the equivalent of two days. Since most days we start at approximately 3:30 p.m. until 6:30 p.m., that would be three hours times two, which is six hours.
Mr. Callahan: There has to be a ruling here about being a hog.
The Acting Speaker: That is another interesting point of view.
Mr. Treleaven: To go back to the definition of the word "person." There is only about another two and a half hours. I should be through my preliminary comments by then.
Let us go to clause 3d(b) which now is --
Hon. Mr. Curling: On a point of order, Mr. Speaker: The member is going back to clause-by-clause. I thought we were talking about the principle. He is quoting a certain section when he should be talking about the principle of the bill.
Mr. Treleaven: It is improper to speak on the principle of the bill on third reading. That can only be spoken to on second reading. On third reading, one must stay much closer to the bill than on second reading and state why third reading should not be given or why one should not vote for the bill on third reading. This bill should not be voted for on third reading. It should not proceed. That is what the debate is about. It must be about the bill as it now --
Interjection.
Mr. Treleaven: Yes, as it now stands, as amended, as it now is semi-reprinted.
Mr. Callahan: On a point of order, Mr. Speaker: I direct your attention to standing order 19(2) that the speaker must direct his speech to the question under discussion. That is what my friend the member for Sudbury East was trying to say to the former Speakers who failed to recognize it. What he was doing was addressing clause-by-clause, which is what goes on before -- excuse me; do not stand up yet, Mr. Speaker.
The Acting Speaker: Will the member please take his seat. This matter has been brought up as a point of order at least half a dozen times this evening. I ask the members of this assembly please to maintain some decorum. It is 4:55 a.m. and I understand that at this time it may be a little difficult. However, I rule that the member is confining himself within the general terms of the bill sufficient for him to continue.
Mr. Treleaven: That is quite correct. I am within the bill and at all times I am addressing Bill 94.
I want to get back to section 3d(b), which is now section 7 of the semi-reprinted bill, "disclosure of information." These are persons to whom confidential information can be given by "the general manager, the minister and one other person...designated in writing by the minister. Section 3d(b) states, "The person to whom insured services were rendered" -- one must assume that is the patient -- "or where a person other than the person to whom the insured services were rendered was charged for those services."
That is somebody else. The second person is a different person than the first person in that clause, as wild as that sounds. Then, in the last line, it says "the person who was so charged." That third person is the same person as the second person and not the same person as the first person. We need definitions. We do not need things like this.
Mr. Callahan: On a point of order, Mr. Speaker: I refer to standing order 19(1). The member has spoken twice to a question and he is not entitled to do that "except in explanation of a material part of his speech in which he may have been misunderstood" -- he has not been misunderstood; although I do not know what he has said thus far -- "in which case he may not introduce new matter." I suggest that he has done that and is out of order.
The Acting Speaker: Speaking twice to a question is speaking two separate times in a debate on the same matter. Will the member please take his seat. This matter has been brought up to the chair at least six, seven -- this is the eighth time this evening. Please let the member continue.
Mr. Warner: On a point of order, Mr. Speaker: I want to hear the words of the member for Oxford because there is possibly a kernel of truth even when one cracks a nut. I specifically ask whether the member for Oxford will permit a question. I think, contrary to the member for Brampton, that the member for Oxford is entirely on the point. He has the right and the opportunity to speak as he will on the issue. I ask the member for Oxford which definition he is using when he attempts to define "person."
The Acting Speaker: That is definitely not a point of order. It may be interpreted as a question and when the member for Oxford returns to speak, as he will shortly, he may want to address your point and your question.
5 a.m.
Mr. Treleaven: It is confusing and that is the whole point of my objection to Bill 94. It needs amendment. It should not be proceeded with to third reading. It should be voted against because of confusion over the word "person." There are no more than 35 words in clause 7(b), and "person" is used four times with two different meanings. It should be defined. That is why the bill should not be proceeded with.
One can work one's way through this, but there is then another thing that is even worse. If I can paraphrase by stopping at the right time, I can show what I mean using the phrase "person who was so charged." We should remember that when this was moved as an amendment -- as section 3d; it is now section 7 of Bill 94 -- it read, "the person" -- this is, the person who may receive confidential patient information -- "to whom insured services were rendered." Fine. That is the patient himself or herself.
It continued, "or where a person other than the person to whom the insured services were rendered" -- that is, a person other than the patient -- "was charged for those services, the person who was so charged." In other words, where somebody else paid for or was charged for the insured services, that other person would get the information.
What, then, does the word "charged" mean? If someone pays his own Ontario health insurance plan premium, that person is the patient, and under clause 7(b), information may be released to him. Where somebody else pays the OHIP premium, the information goes to the person who is charged and not to the patient.
Who is charged? Is it an employer? If one is an employee, is it the employer who is charged for the insured services? If so, the information does not go to the patient; it goes to the employer. That is wrong. We need a definition for the word "person" and we need a definition for "charged." They could mean several things. The patient might be denied access under this section and the health information could go to someone else because that other person was charged for the services. It could be an employer who is charged; that is one possible meaning. These are the problems.
Mr. Charlton: On a point of order, Mr. Speaker: I regret to inform the House that the cable network has taken the program off the air.
The Acting Speaker: Another point of information.
Mr. Treleaven: There are very few people in Oxford with cable television, in any event.
Hon. Mr. Sorbara: On a point of order, Mr. Speaker: It would be a good idea if Mr. Smith did go to Washington. I am not sure he would fare very well there.
Mr. Speaker, I refer you to standing order 19(d)3. This is the first time I have done this, but I think it is important and would like to hear your view and the views of other members on it. The standing order says, "Persists in needless repetition or raises matters that have been decided during the current session."
If we are not hearing it this evening -- now, at 5:04 a.m., with probably the beginning of a beautiful sunrise -- to refer to the point the member for Mississauga South (Mrs. Marland) raised, in her view we are seeing the saddest day in the history of public health in this province. I disagree with her categorically and I am waiting to hear the real views of the member for Oxford.
However, at this point I would like to hear your views on the point of order, Mr. Speaker, about whether this evening, during the past three and a half hours, we have not heard needless repetition.
The Acting Speaker: It appears that the point of order raised by the member for York North does seem to have some substance to it, as did the points of order that were raised previously dealing with the same matter.
I ask that the member for Oxford restrict himself more closely to the bill and refrain from introducing extraneous matters or other matters that do not have anything to do with the bill or with the principles. That was already decided in second reading.
Mr. Treleaven: I am right on clause 7(b) of Bill 94. How can I be more on the bill than on clause 7(b) of the bill?
Mr. Warner: Right on.
Mr. Treleaven: I welcome the support of the member for Scarborough-Ellesmere, just as I used to enjoy the support of his predecessor. It seems to be a friendly riding that supports everyone.
What does the word "charged" mean in clause 7(b)? I am quite serious. Does it mean that if an employer pays an employee's OHIP premium, he is the person charged? What about people on Workers' Compensation Board benefits? People on WCB benefits, family benefits, children on their parents' OHIP until the age of 21, and perhaps at college, or senior citizens in nursing homes, etc. , do not pay their own OHIP; they are not charged for their own OHIP. Somebody else is charged for these services and, under clause 7(b), that other person gets the confidential information on the health files, not the patient himself.
Who is charged? There are two sections. The person to whom the insured services were rendered is the patient. The other says that where the patient does not pay his own, it is the person who is charged. I am saying that there is no definition of the word "charged." There is no indication of who is meant.
As I say, if it is an employer, it is totally improper that the patient be denied access to the information on himself but that the employer get the health information, or that the WCB get the information for somebody if it is paying the OHIP premiums, or the government if it is paying family benefits, or the parents. If one has a 20-year-old child at university or community college and if the child is on the parents' OHIP and the parents are paying, does this mean -- and obviously in clause 7(b) it does -- that the parents get the confidential health information?
Hon. Mr. Curling: On a point of order, Mr. Speaker: I just want to inform the honourable member that he is not on television now. The cable is off, so he can sit down. Nobody in Oxford can see him. They have taken it off TV.
The Acting Speaker: Order. That is not a point of order.
Mr. Treleaven: I have a certain understanding of how long it is going to take me, and I do hope the people of Oxford, one way or another, do find out what I am doing for them.
Concerning a senior citizen who is in the nursing home administration, if a son or daughter pays his OHIP premiums -- maybe he is not 65 -- someone else is paying or being charged for his OHIP. The same applies for separated wives or husbands who are still on the family OHIP plan and for whom the other spouse is paying OHIP premiums. This means, without any further definition of the word "charged" or of the person charged or any clarification in clause 7(b) of the act, that the separated or divorced spouse, whatever is in the separation or maintenance agreement or whatever the court orders regarding OHIP premiums, does not get the confidential medical information, but the other spouse does. It depends on the word "charged."
5:10 a.m.
We have two things. First, the way clause 7(b) of the act reads, we have a set of people or a potential set of people -- I have thought of at least six groups -- who, because of the poor draftsmanship of this section, will get the information but who should not, to the detriment of the patient. The patient, on the other hand, is deprived of his own medical information, because he is not paying his own OHIP premiums. He is not charged.
Mr. Warner: The member is wrong.
Mr. Treleaven: I hope that when I wind up, the member for Scarborough-Ellesmere, if he has not already spoken, will help me out with some of these explanations, such as his understanding of the definitions of the words "person" and "charged" in clause 7(b). At this point, the definitions are not there. If we look at section 1, the definitions section, there is no definition of "person," "charged" or "person charged." As a result, this bill should not be proceeded with; it should not go to third reading.
I have dealt with the double negative, which the minister did withdraw. We have confidentiality problems with regard to Bill 34, the Freedom of Information and Protection of Privacy Act.
I would like to get the act itself out, but I will have some problems and a certain amount of confusion because of the reprinting. I will refer to a very short quotation of the minister. It is improper under standing order 19 for me to refer at length to Hansard or to any other document, and I would not think of doing so. However, I will take the odd little excerpt --
The Acting Speaker: I also remind the member that we are in third reading. You should confine yourself strictly to the bill, and no extraneous material should be introduced.
Mr. Treleaven: Quite so, Mr. Speaker.
The minister made the statement, and it is just five lines: "Decades ago the people of Ontario chose to adopt a system that would deny to no one necessary medical treatment, where no one would be barred because they were poor, elderly or new immigrants to this country" --
Mr. Warner: The member should not read out of the rulebook.
Mr. Treleaven: I am not reading verbatim at length.
-- "where everyone would have an equal opportunity to receive the same high-quality care."
Mr. Warner: Will the member for Oxford accept a question?
Mr. Treleaven: Yes. One question, Mr. Speaker.
Mr. Warner: Does the member for Oxford recognize that, with respect to OHIP, participation is not equated with payment? Does the member for Oxford realize that one of the principles of the Ontario health insurance plan is that participation in the plan is not equated with being a person in Ontario?
Mr. Treleaven: Yes, I totally agree. That gets back to the word "charged." Participation is not equivalent to payment; that is quite correct. One's child participates without payment.
Mr. Warner: Right.
Mr. Treleaven: The member for Scarborough-Ellesmere agrees.
Therefore, if that member has young children, his children are under his plan. Let us make that assumption: He pays the OHIP premiums and his children are covered. Is he the person charged? That is the point with the old section 3d, section 7 in the reprinted bill. In clause 7(b), is the member for Scarborough-Ellesmere therefore the person charged? This means that the member, if he is the person charged, gets this confidential information and his children do not, regardless of their age, until they are 21.
Is payment the same as being charged? That is why we need definitions in Bill 94. That is why Bill 94 is improper. That is why I called it a camel and that is why it should not be proceeded with.
Mr. Warner: May I be permitted another question to the member for Oxford?
The Acting Speaker: Will the member for Oxford take another question?
Mr. Treleaven: Yes. One more question.
Mr. Warner: Is the member for Oxford equating payment to the Ontario health insurance plan by whatever means with universality of coverage? Is payment, to the member for Oxford --
I do not want to interrupt his conversation.
Mr. Treleaven: No. The member's question, please.
Mr. Warner: Good; we will try it again. Does the member distinguish between payment to the Ontario health insurance plan and universality of coverage?
Mr. Treleaven: I do not really see that universality comes in there. The issue is, who is the person charged? Whom do they mean when they say, "the person...charged"? Is it an employer? Is it a government? Who is the person charged?
It is not the same as the patient. The section itself gives two alternatives for who gets the confidential information: the person to whom insured services were rendered -- i.e., the patient -- or, where somebody else was charged, the person so charged. I do not see that universality really has very much to do with it.
The member for Humber (Mr. Henderson) had an amendment that did not carry. That is unfortunate, because it dealt with extra charges not being made to various other people: senior citizens and people under various acts. They are typical of people who perhaps could have satisfied this problem with regard to who was being charged. Since it did not pass, I do not recall whether this was defined in the member's amendment, but it may well have been.
5:20 a.m.
The minister also said, "We believe that we had avoided the hardship and inequity that has resulted from the way medicine has been practised in the United States." No less a person than T. C. Douglas refers to the situation in the United States and compares the two jurisdictions, Canada and the United States, in a 1984 paper called We Must Go Forward.
He says, "Our American friends envy what we have been able to do." He is talking about Canada, not necessarily about Ontario. He is talking about Canada and not necessarily just Ontario. He says: "In the United States, they are spending nine per cent of the gross national product on health care. In Canada, it is only seven per cent." There is a belief in Ontario that Canada spends more on health care per person than the US does. That is not correct.
I want to bring to the attention of the members the McCaffrey committee in Ontario. I call it the McCaffrey committee because a member of this House, the member for Armourdale (Mr. McCaffrey), became the chairman after the resignation of Dr. Elgie as chairman in 1978. I want to mention what that committee found with regard to figures for Ontario and Canada. It stated, "Canada is second only to West Germany in physicians per capita, Canada has the lowest ratio of beds per capita and it ranks third in bed days and second in admissions." Canada is extremely heavy in the use of beds and medical facilities.
Bill 94 has further problems with definitions. Here is another reason third reading should not proceed. I ask the members to look at section 1, "insured person." The bill is a mess in its definitions. "Insured person" is now the fourth definition in the newly amended bill with 12 sections: "`insured person' means a person who is entitled to insured services under the Health Insurance Act." When we look at the Health Insurance Act, we have a problem under clause 1(h), "insured services."
Let us go from Bill 94 and the definition of "insured services" to try to find out what an insured person is, "a person who is entitled to insured services under the Health Insurance Act."
Mr. Warner: On a point of order, Mr. Speaker: I hate to interrupt the member for Oxford, but surely to goodness either he is using the definitions set down by the Attorney General through the statutory information act, which provides definitions for the various identifications, or he is using definitions accepted through the United Nations. It has to be one or the other. He cannot pick and choose. Either he has a definition for "persons" that is accepted or he is inventing his own.
The Acting Speaker: Will the member for Oxford please confine himself to a brief description of why this bill should or should not be read a third time? He seems to be wandering a bit.
Mr. D. R. Cooke: On a point of order, Mr. Speaker: I think the whole House will want to join me in wishing the member for Oxford well. He now has just passed the four-hour mark in his speech.
The Acting Speaker: That is a point of view.
Mr. Treleaven: This is why the bill is so bad. It has more than imperfections. It has enough problems with the definitions that the minister withdrew sections. The members will recall the reference to subsection 44(1) of the Health Insurance Act. "insured services" has problems. Section 1 of Bill 94 says, "`insured service' means a service that is an insured service under the Health Insurance Act and the regulations made under it." There is a problem.
The Acting Speaker: Order. The appropriate time to have raised these concerns would have been when we were going through clause-by-clause debate. Please confine yourself to discussing why the bill should or should not be read a third time instead of going through an extensive analysis of the sections of the act.
Mr. Treleaven: That is correct, Mr. Speaker. The definition is improper. We are referred to the Health Insurance Act by Bill 94. Under section 1, the definitions section of the Health Insurance Act, when one looks at "insured services," a triple negative is created here.
Mr. Laughren: On a point of order, Mr. Speaker: First, may I commend you for the wisdom of the judgement you have already made in your admonition to the member to stick to the principle of the bill on third reading.
May I also suggest that you listen carefully, because he persists in discussing this bill clause by clause by clause, which is not the purpose of third reading of any bill in this chamber. I encourage you to listen as attentively in the future as you have been doing for the past 10 minutes, because your judgements are already bringing a new clarity to the debate. I encourage you to continue.
The Acting Speaker: I thank the member for Nickel Belt for his point of advice.
Hon. Mr. Sorbara: Mr. Speaker, I want to say a few words on the point of order raised by my friend the member for Nickel Belt.
The Acting Speaker: That was not a point of order.
Hon. Mr. Sorbara: A point of order was raised.
The Acting Speaker: Order. Will the member please take his seat? That was not a point of order.
Hon. Mr. Sorbara: Mr. Speaker, a point of order was raised by my friend the member for Nickel Belt, and it has been the general custom in this House that when a point of order is raised by a member, other members have an opportunity to speak.
The Acting Speaker: Order. The member for Nickel Belt raised an appropriate point of advice for the Speaker.
Mr. Laughren: On a point of privilege, Mr. Speaker: On behalf of other members in this chamber, may I congratulate you on your promotion to Deputy Speaker, replacing the member for Oxford in that elevated position.
Mr. Treleaven: Perhaps the member for Nickel Belt is having trouble following the definitions and the difficulties and the improprieties in Bill 94 with regard to these definitions.
Hon. Mr. Sorbara: On a point of order, Mr. Speaker: All evening long, on point after point of order, we have asked Speaker after Speaker to help the member for Oxford refrain from this foolish, tedious, insane, unbecoming process.
This is one of the most significant days in the one-year history of this government. We have taken a very difficult piece of legislation through a very difficult process. There may be members who have different views on the bill as a matter of principle. Nevertheless, it is a very important piece of legislation, perhaps the most important piece of legislation this House will pass. This is a very important day.
The member for Oxford, by general consent in this House, had an opportunity to speak for what he considers to be two speaking days on this very important bill. Frankly, I had assumed --
Interjections.
The Acting Speaker: Order.
5:30 a.m.
Hon. Mr. Sorbara: Mr. Speaker, I am just trying to complete my point of order and make the point one last time, because I will be off duty pretty soon, then my friend the member for Oxford can continue with his inanity. He may have a lot of very good points to make on the legal construction of the bill, but I ask you to entreat him to spend perhaps half an hour or an hour expressing his heartfelt views on this bill to the House.
The Acting Speaker: Order. The member again raises a very interesting point of order with which I have already concurred. Five minutes ago I asked the member for Oxford to confine his remarks briefly to why the bill should or should not be read a third time. I asked him not to introduce any extraneous material or matters to this debate, and I am monitoring him in the hope he will do that.
Since I have given him that advice, the House has interrupted on two occasions with the same point of order. We owe the member for Oxford the courtesy of letting him continue.
Mr. Shymko: On a point of order, Mr. Speaker: I am shocked by some of the remarks I have just heard from the honourable member insinuating --
The Acting Speaker: That is not a point of order.
Mr. Shymko: I would like you to check the adjectives the honourable member used to see whether they were unparliamentary, or verging on being unparliamentary, in the shocking description attacking and criticizing --
The Acting Speaker: Order. I paid careful attention to the adjectives the member for York North was using. In my opinion, they were not unparliamentary. However, I will leave the decision to a more experienced occupant of this chair.
Mr. J. M. Johnson: On a point of order, Mr. Speaker: I have sat up all night watching this debate on television, and I am shocked at the number of times the member for York North has interrupted the excellent speech being given by the member for Oxford. I challenge him, if he wishes to speak, to do so when his turn comes in rotation.
Mr. Treleaven: Under subsection 3(1) --
Mr. D. S. Cooke: We are not doing clause-by-clause.
Mr. Treleaven: We cannot discuss the principle of the bill --
The Acting Speaker: Interjections are out of order.
Mr. Treleaven: How can we discuss the bill unless we discuss the contents of the bill? How can we identify the contents of the bill unless we refer to section numbers?
Mr. D. S. Cooke: We are not doing clause-by-clause.
Mr. Treleaven: Of course we are not doing clause-by-clause. I am pointing out why Bill 94 should not be proceeded with, and I have to refer to bad clauses to give the reason why it should not proceed.
Therefore, I will refer to subsection 3(1) of the original bill, where it says that the minister may enter into agreements. It is still subsection 3(1) of the reprinted bill. It says, "The Minister of Health may enter into agreements with the associations mentioned in subsection (2)" and it lists them. They are the Ontario Medical Association, the Ontario Dental Association and the Ontario Association of Optometrists. That is consistent with the past recommendations. The committee chaired by the member for Armourdale recommended that.
The minister talked about this in his debate in the standing committee on social development. I am not going to refer to Hansard; I will only get into a problem with more interjections. Subsection 3(1) says, "The Minister of Health may enter into agreements with the associations mentioned in subsection (2), as representatives of physicians, dentists and optometrists, to provide for methods of negotiating and determining the amount payable under the plan in respect of the rendering of insured services to insured persons."
The idea of this is wide open. It talks about the methods of negotiating and determining the amount. If we look at the Canada Health Act, which is the bottom line -- the member for Windsor-Riverside has perhaps missed that point emphasized by many other people in this House -- the recovery of this money, however much it is, is the bottom line for Bill 94 and one of the main reasons for Bill 94 being introduced.
The method referred to in subsection 3(1) of negotiating and determining the amount payable under the plan is wide open. It is permissive and it violates section 12 of the Canada Health Act, which sets down the guidelines under which a province may get money from the federal government. Section 12, accessibility, states:
"(1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province" -- and that means Bill 94 and OHIP
"(a) must provide for insured health services on uniform terms," etc.;
"(b) must provide for payment for insured health services in accordance with a tariff," etc.;
"(c) must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists," etc.
The words "must provide" mean it is mandatory under section 12 of the Canada Health Act.
Mr. D. S. Cooke: The member is out of order.
Mr. Treleaven: I am not out of order. The whole purpose in subsection 3(1) of Bill 94 is to obtain money from the transfer payments under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, and the Canada Health Act sets forth the terms and conditions upon which each province may get that money.
I submit that the wording in Bill 94 must be changed and made subject to section 12. It must be the same as section 12, to make it mandatory with a "must" not a loose "may." Subsection 3(1) of the bill says, "The Minister of Health may enter into agreements," whereas the Canada Health Act says "must." The member is shaking his head, but in order to satisfy that, it has to be "must provide."
Subsection 12(2) of the Canada Health Act says, "paragraph (1)(c) shall be deemed to be complied with if the province has chosen to enter into, and has entered into, an agreement with the medical practitioners and dentists of the province that provides (a) for negotiations relating to compensation for insured health services," etc.
We are talking about subsection 12(1) which uses the word "must" in the clauses. Bill 94 is incorrect because it uses "may." It must be amended to fit properly with section 12 of the Canada Health Act. Otherwise, Ontario will not pick up its $53 million or $100 million, or whatever the figure is. It may not qualify for that money.
5:40 a.m.
The members do not like definitions so I will not get into "insured service" or "insured person," but, again, subsection 2(2) is bad and should not be adhered to. Bill 94 should not be proceeded with and should be voted against. Subsection 2(2) was an amendment of the member for Windsor-Riverside.
Mr. D. S. Cooke: We are not on clause-by-clause.
Mr. Epp: It seems to me I have heard that.
Mr. Treleaven: That is right. That subsection is discriminatory under the Charter of Rights. It is unconstitutional. It states:
"A practitioner" -- that can be a doctor or whoever, but let us leave it at practitioner -- "referred to in subsection (1) shall not accept payment in respect of an insured service rendered to an insured person until after the practitioner receives notice that the patient has been reimbursed by the plan unless the insured person consents to make the payment on an earlier date."
There are several things wrong. What if they do not have the capacity to consent?
Interjections.
The Acting Speaker: Order. Will the speaker please address his comments to the chair.
Mr. Treleaven: I am pointing out why the bill should not be proceeded with. It is unconstitutional, inaccurate --
The Acting Speaker: Order.
Mr. D. S. Cooke: On a point of order, Mr. Speaker: I thought we were not dealing with clause-by-clause, but the member for Oxford is speaking about clause-by-clause of a whole bunch of other bills. More important than that, I thought the reason we were hearing this tonight was that the member wanted to talk about his riding. We have not heard a thing about Oxford tonight.
The Acting Speaker: The member for Oxford does seem to be straying a little bit but he is staying on the general principle of the bill.
Mr. Treleaven: We know I cannot speak about the things that bother me most about health services in Oxford. I cannot. Mr. Speaker, you would not allow that and therefore I cannot respond to the member for Windsor-Riverside.
Mr. D. S. Cooke: The member for Oxford, the Deputy Speaker, says he cannot speak about the things that are dear to his heart. I can, and I would like to speak to them at a decent time instead of listening all night to this diatribe which is absolutely worthless.
The Acting Speaker: Order. I notice the member for Windsor-Riverside is not in his chair.
Mr. Treleaven: On third reading, one cannot discuss the principle of the bill in general terms. One cannot do that. That is second reading principle. On third reading, one has to talk on the bill and how it is amended and as it is in front of us right now with 12 sections.
There, I said 12 sections. One cannot talk about this bill and point out what is wrong with it without referring to where it is wrong, and the only way one can refer to it is by section. Therefore, if I talk about a section, it is not clause-by-clause; it is only identifying what I am talking about.
Mr. Pierce: That is correct.
Mr. Treleaven: I am glad to see there are several members who can appreciate the point I just made.
Now, to get back to section 12 -- no, we are through with section 12. We are at subsection 2(2) of the bill which is the amendment of the member for Windsor-Riverside. That is unconstitutional because the practitioner is being discriminated against in a way that no other person in this province is being discriminated against.
The member for Stormont, Dundas and Glengarry (Mr. Villeneuve) is waving his newspaper in front of me and distracting me.
Mr. Laughren: On a point of order, Mr. Speaker: I am sorry to interrupt the member for Oxford just when he is just getting into full flight but I wonder whether he would entertain a short, serious question.
The Acting Speaker: Will the member for Oxford entertain a question?
Mr. Treleaven: Yes, one question.
Mr. Laughren: I know his speech is carefully constructed and there may be a later point at which he would like to answer, but could he tell us in the chamber whether he has not had problems in his riding with patients who have had large extra-billing charges and who simply cannot afford them?
Mr. Treleaven: No. To the best of my knowledge I have not had a complaint about extra billing in my constituency office in more than five years as member for Oxford. I have had many complaints about lack of children's mental health services, nursing home beds and speech therapy, but no complaints about extra billing.
Interjection.
Mr. Treleaven: I am sorry. I misled --
The Acting Speaker: Order. The member for Windsor-Riverside.
Mr. D. S. Cooke: On a point of order, Mr. Speaker: I wonder whether the member for Oxford would allow a short question.
The Acting Speaker: Will the member for Oxford allow a question?
Mr. Treleaven: Not until I clarify my answer to the member for Nickel Belt.
Mr. D. S. Cooke: Maybe the member can tell me when he is ready for the short question.
Mr. Treleaven: Yes, thank you. The member for Nickel Belt asked me if I had complaints about extra billing. I am sorry. During the last two or three weeks since we had Bill 94 in front of us I have had a few phone calls, but I cannot recall a complaint on extra billing until Bill 94 came in front of us and the matter heated up.
Now I will consent to one question from the member for Windsor-Riverside.
Mr. D. S. Cooke: The member for Oxford points out, rightly I am sure, that not many concerns have been expressed to him by his constituents about extra billing, but he has heard concerns about children's mental health services. Could he tell us how many times between 1981 and 1985 -- May 2, 1985, in particular -- he raised the problem of children's mental health services in the Legislature with the former government during question period?
Mr. Treleaven: Not in the chamber; but outside the chamber probably five pounds worth of paper and three or four inches.
Mr. D. S. Cooke: May I have a supplementary question?
Mr. Speaker: Order. I do not think this has anything particularly to do with the legislation. The member for Oxford.
Mr. Treleaven: Can I get back to subsection 2(2), which is the amendment? I stated that the subsection is unconstitutional. It should not have been added to the bill, it should be voted against and it is a reason why Bill 94 should not be proceeded with and should be voted against on third reading. It is unconstitutional because it treats the practitioners in a way no other group in Ontario is treated by law. It cannot be constitutional.
5:50 a.m.
When a person buys goods or performs services, whether a clothing store owner, a shoe shop owner or a car dealer, it is fundamental to the transaction under the laws of Ontario that it is a cash sale or transaction unless the seller gives credit to the purchaser over a period of time. That is common law and has been for many years. It is automatic, unless there is an arrangement made by the parties, in this case the doctors.
Subsection 2(2) of the bill is a discriminatory clause which states that the practitioner not only cannot bill for his services but also cannot accept payment in respect of his services until someone tells him the patient, in this case, has been paid. This refers to opted-out doctors only. I will not go into the third category. I have been into that well enough. The third category is not provided for in this bill, and Bill 94 should again therefore be voted against.
In subsection 3(3) we have another irregularity. It says, "The Lieutenant Governor in Council may make a regulation providing that the minister may enter into an agreement under subsection (1) with a specified person or organization other than an association mentioned in subsection (2)." What does that mean? Who is the person "other than"? There is no definition. There is no clarification.
Subsection 3(1) says the minister may enter into agreements with the organizations listed in subsection 3(2). Subsection 3(2) sets out the medical, dental and optometrists' associations. Subsection 3(3) says that the cabinet "may make a regulation providing that the minister may enter into an agreement under subsection (1) with a specified person or organization other than" the doctors, dentists or optometrists.
Who is the specified person? How far does that go? Does it mean that cabinet can pick a person out of the blue, anyone in the world except the OMA, the ODA and the optometrists, simply to provide some health service? Surely everyone in the world is not contemplated under that. It needs definition; it needs specification as to exactly who this is, with a specified person or organization. If the OMA and those organizations -- I have been into this before. I do not want to be repetitious. I am going to leave that alone.
I now go to sections 4a and 4b. We have provincial offences whereby the doctors and the other health providers are treated in a much different fashion than any other provider in the world, any other person in the world.
I will go down to what was 3a(1). It says, "4(1) Where the minister is satisfied that a person has paid an unauthorized payment to a practitioner, the minister may direct the general manager to pay to the person the amount of the unauthorized payment." In ordinary language, where the patient has paid too much and the minister is satisfied, then the minister directs the general manager to reimburse the patient and get the patient straightened up. Then the general manager stands in the shoes of the patient for the overpayment.
How do we establish that the minister is satisfied? Upon what criteria? What is the yardstick by which the minister is satisfied there has been an unauthorized payment? Where are the guidelines? Where are the criteria by which the ministry becomes satisfied or unsatisfied? We need a definition of this satisfaction.
According to subsection 3a(2), where an unauthorized payment is made, they charge back to the doctor the amount of the administration fee, now limited to $150, and the overpayment. Here we get into the setoff. We have problems with the setoff. When do we establish this administration charge? We have several problems. There are a couple of classifications of doctors. There are those who bill outside OHIP, and we know how they will be dealt with by the subsection 2(2) amendment of the member for Windsor-Riverside. In that case, the person who bills outside OHIP cannot get paid until the patient has been paid and he has been notified.
Let us talk about the usual situation where the person bills within OHIP and a large amount of money owing to that practitioner is built up. Then one can set off money under section 3a. One can deduct money because one has a large amount of money to set that off against.
There is a problem where doctors, optometrists and dentists -- perhaps dentists would fit into this best -- either very occasionally charge through OHIP and most of the time outside the plan or more frequently charge OHIP very small additional amounts. In those latter two cases, there is no appreciable money being held in the kitty to the practitioner's credit from which to deduct or set this off.
Such a person does not fit in either as a practitioner who bills OHIP all the time and can be set off against under subsection 3a(3) or as a practitioner who bills outside OHIP all the time and in OHIP none of the time. These other practitioners fall between the cracks in Bill 94. They are not covered by Bill 94, which is another reason Bill 94 should be voted against, another reason it should not proceed to third reading.
Hon. Mr. Sorbara: Is the member coming to an end yet?
Mr. Treleaven: At some point. We have subsection 3a(5). Again, we have a situation where the practitioner is being discriminated against.
Mr. Laughren: Clause by clause?
Mr. Treleaven: I have to refer to the clause to refer to the point I am on and the point I am making. There is no other way of identifying where I am. I hope we do not have to go through that again.
We have in subsection 3a(5) -- it was subsection 3a(5) under the old act; it is now subsection 4(5) in the reprinted bill -- "Service of Notice," which is again unfair to the practitioner. It reads:
"The notice...shall be served by registered mail addressed to the person to whom the notice is being given at the person's latest known address and the service shall be considered to have been made on the seventh day after the day of mailing" -- they deem the practitioner has got it -- "unless the person to whom notice is given establishes that he or she, acting in good faith, did not receive the notice until a later date."
6 a.m.
What if it is never received? We have all had situations where registered mail has not arrived. What does the practitioner do? All they have is covered in subsection 4(5). What does the practitioner do if he never receives notice? It is not covered in this bill. It is covered only if he receives it --
Hon. Mr. Sorbara: On a point of order, Mr. Speaker: I am almost off duty now, but you have missed a very exciting evening. Frankly, we have had very interesting challenges to the clause-by-clause analysis we have heard from our friend the member for Oxford.
I have been criticized by my friend the member for Wellington-Dufferin-Peel (Mr. J. M. Johnson) for having interrupted, and yet we have had ruling after ruling from the chair that the member for Oxford ought not to be analysing the bill point by point.
I make that final point again to you, Mr. Speaker, to determine whether what we have been doing all night is in the best traditions of parliamentary procedure.
Mr. Speaker: Would the honourable member tell me under which standing order his point of order comes?
Hon. Mr. Sorbara: I believe it is standing order 19(d)3, which deals with needless repetition and, to be quite frank, a reference to Erskine May.
Mr. Speaker: Thank you. I will check that one out.
Mr. Ward: I wonder whether the member for Oxford will entertain a question, as he has done occasionally this evening.
Mrs. Marland: On a point of order, Mr. Speaker: Recognizing that it is six o'clock and that you have just assumed the chair, as someone who has been here for five hours and who has observed the member for York North, I think in fairness to your judgement that everyone else in the House who has been here for the last five hours would concur with me in advising you that the member for York North has stood up every hour on the hour, recorded the time and challenged what the member for Oxford has been saying.
Mr. Speaker: What is your point of order?
Mrs. Marland: In fact, the ruling from the chair has been in favour of the member for Oxford, not as just reported.
Mr. Speaker: Order. I did not hear a point of order at all there; I just heard some information. The member for Wentworth North asked the member for Oxford whether he could ask a question.
Hon. Mr. Sorbara: On a point of privilege, Mr. Speaker.
Mr. Speaker: I will give it a try.
Hon. Mr. Sorbara: My friend the member for Mississauga South suggested in her remarks that I have risen in my place --
Mr. Shymko: Fifteen times.
Hon. Mr. Sorbara: Wait a minute.
Mr. Speaker, you had a little rest, but she suggested that I have stood in my place regularly, hour by hour, raising points of order in a number of contexts, including that of references by my friend the member for Sudbury East, to the repetition. She has suggested --
Mr. Speaker: Order. I gave you ample time to present your point of privilege. It certainly is far from a point of privilege.
Mr. Cureatz: On a point of order, Mr. Speaker: I congratulate you on your ruling in regard to the comments of the member who just spoke, because as a member who has just now attended this assembly to take part in this very interesting debate, I would like to get on with the debate and hear what the member for Oxford has to say.
Mr. Speaker: Order. The member for Wentworth North asked the member for Oxford whether he could ask a question.
Mr. Ward: My colleague the Minister of Colleges and Universities (Mr. Sorbara) has been defending the member for Oxford from the attacks of the member for Sudbury East all evening, for those members who arrived late.
I thought I heard the member for Oxford respond to the member for Nickel Belt that he had never run into a problem with a constituent who had been extra billed, and yet I am told that the member's constituency office contacted the minister's office about a constituent of his who was extra billed $1,200 for an operation on May 8 to inquire whether this legislation would be retroactive. I wonder whether the member was overlooking that example or whether he found some other way to handle the situation.
Mr. Treleaven: I thought I explained that well. I said until Bill 94 --
Mr. D. S. Cooke: Come on.
Mr. Treleaven: If Hansard is checked, the member will find that I said at the beginning that I had not had any complaints in five years about extra billing that I could recall. Then I corrected myself and said, "until this matter heated up on Bill 94." I said I have, of course, had complaints during these past days and weeks, but until Bill 94 came along, I could not recall any complaint on extra billing. There is not a single doctor in Oxford who extra bills.
Mr. Laughren: On a point of privilege, Mr. Speaker: When the member for Oxford replied to my serious question about whether he had had complaints in his constituency about constituents who had extra billing problems, he clearly replied that he had not had any such problems. He then followed up his comment with the statement, "since this debate began," and implied that there were general problems or general objections to the whole idea of extra billing.
Mr. Speaker: Order. With respect, the member has the opportunity to correct something he has said, not what someone else has said.
Mr. Treleaven: It was not a casual reference to having no record or recollection of ever having received an extra billing complaint until Bill 94 heated up. That is logical because no doctor in Oxford county extra bills.
There are certainly people who go to specialists in London, but no doctor in Oxford county extra bills. It is entirely consistent that I would have had no such complaints.
Would the member like to ask another question?
Mr. Ward: I thought the member said, "No doctor in Oxford county."
Mr. Speaker: Are you asking a question?
Mr. Ward: Yes.
Mr. Treleaven: It is my understanding that no doctor in Oxford county extra bills.
Mr. Ward: That is not to say, though --
Mr. Speaker: Order. Two members cannot be up speaking at the same time. You want to ask another question? Will the member for Oxford accept another question?
Mr. Treleaven: Yes.
Mr. Ward: Have any of the member's constituents in Oxford been extra billed?
Mr. Treleaven: I know of only one. My wife was extra billed by a doctor in London. Frankly, that is the only one I can think of at this moment that I know of for certain.
Mr. D. S. Cooke: What about this constituent?
Mr. Laughren: On a point of order, Mr. Speaker: Would the member for Oxford permit a short, even pithy, question?
Mr. Speaker: I believe the member for Oxford agrees.
Mr. Laughren: I have to thank the member for Oxford for his indulgence. Would he tell us some of the specifics of that patient, referred to by the member for Wentworth North, who was extra billed to the tune of $1,200? Can the member for Oxford tell us whether he made any attempt to relieve the constituent's problem and the extent to which he got involved with the problem?
Mr. Treleaven: I cannot recall exactly. The member for Wentworth North mentioned May 8.
Mr. Ward: That is when the individual was extra billed.
6:10 a.m.
Mr. Treleaven: The individual was billed on May 8. If the member knows about it, presumably my office wrote to the ministry. My answer is obviously that I am writing and questioning and helping my constituent out. Is it not the job of all of us here to get in touch with the ministry to get an explanation?
Mr. D. S. Cooke: On a point of order, Mr. Speaker: To follow up on my friend and colleague the member for Nickel Belt, can the member for Oxford tell us whether he supported the fact that his constituent had been extra billed to the tune of $1,200 and whether the efforts of his constituency office staff were on his behalf or were independent?
Mr. Treleaven: I will take a back seat to no one, certainly not to the member for Kitchener-Riverside, in being a constituency man and looking after my constituents.
Mr. D. S. Cooke: On a point of personal privilege, Mr. Speaker: I represent a large riding, but it does not go all the way from Kitchener to Riverside.
Mr. Speaker: I knew you wanted to correct the record on that.
Mr. Treleaven: Did I get the wrong riding?
Mr. Speaker: It is Windsor-Riverside.
Mr. Treleaven: It is difficult to know exactly where I was when that interruption arose.
Mr. Morin-Strom: Did the member lose the clause he was on?
Mr. Treleaven: Yes. We were dealing with the discrepancies in subsection 4(5). One must identify where the problem is in this bill if one is going to persuade the members to vote against it. After all, we are debating, on third reading, why Bill 94 should not be proceeded with, and subsection 4(5) gives yet another reason it should not proceed to third reading.
We have registered mail. I am asking what happens if the physician or the health professional never receives the notice by registered mail. There is a gap here. Two eventualities are taken care of in subsection 4(5): (a) it does arrive and (b) it arrives later than seven days. However, it is silent on the third eventuality, that in which it does not arrive. It does not give the practitioner the right he has under the Provincial Offences Act, the Expropriations Act and the Statutory Powers Procedure Act. He gets rights under all those provincial statutes.
The answer is that this is silent, it has a gap, it has a blank. Therefore, it is a faulty bill and a faulty section.
Let us look at subsection 5(1). Let us get to the right of the health practitioner.
Mr. Villeneuve: He has no rights, according to the New Democratic Party.
Mr. Treleaven: He does not have many rights. Why is it not by registered mail? Why does he send his in by ordinary mail? Why is it not tit for tat? When you get it out by registered mail, why does it not come in by registered mail? Why is it not both ways? That is also improper. It should be both.
Let us look at subsection 5(3). Of course, we are talking about the Health Services Appeal Board: "The chairman of the board may from time to time appoint a member of the board to conduct a review under this act." The next subsection says, "A member of the board conducting a review shall inquire into whether the practitioner has received an unauthorized payment." Is that it? No rules, guidelines or criteria are set out for how that member is going to look into it.
All the other acts that are coming down the way -- Bills 54, 55, 109; the nurses; all of the areas in the Health Disciplines Act, whether it be dentists, pharmacists, etc. -- set out inspectors' rights, when they can come around and look, etc. There is a set of rules for when investigations can take place and for what the inspectors' rights are and are not. Here we have no such rights spelled out. All it says is, "A member of the board... shall inquire into whether the practitioner," etc.
Now we have a totally discriminatory subsection. Originally subsection 3d(5), it is now subsection 5(5) of the reprinted bill. It says: "The general manager, the practitioner and the insured person have the right to make written representations to the member of the board conducting the review." Written representations only. In all these other acts a person in Ontario who has run afoul of the law, if you will, or who wants to get a hearing on the basis of the Statutory Powers Procedure Act -- and that is in front of a tribunal, an agency, board or commission -- gets protection. Under section 10 of the Statutory Powers Procedure Act he gets the right to counsel at a hearing. He may call and examine witnesses and present his arguments and submissions, and he may conduct cross-examinations of witnesses at a hearing, all for the fair disclosure of the facts in relation to which they have given evidence.
All those safeguards, with many others, are written into the Statutory Powers Procedure Act, an act that covers the great majority of tribunals and people's rights in regard to those tribunals. Here, in subsection 5(5) of Bill 94, all the practitioner gets is the right to make written representations to the member of the board conducting the review. He is allowed no cross-examination.
It goes on to say that the other people -- the patient -- can write, etc., but the health practitioner gets no right to examine or cross-examine, no right to call and examine witnesses of his own or to present his arguments and submissions orally. All he can do is send them in writing. He cannot cross-examine the other about allegations made in written presentations from the complainant, or patient, if you will.
There are many other protections. In section 11 are the rights of witnesses to counsel --
Mr. D. S. Cooke: It sounds like clause-by-clause to me.
Mr. Treleaven: All I am doing is showing why Bill 94 is not a proper, well-drawn bill. The clauses are badly drawn or missing. They are in conflict with many other rights of people across Ontario. The bill should be voted down. It should not proceed to third reading.
Let us look at subsection 5(6). Again we have the same clauses that are additionally bad.
Mr. D. S. Cooke: It sounds like clause-by-clause to me.
6:20 a.m.
Mr. Treleaven: Again, I have to identify them. I cannot say, "Somewhere in the bill." I have to identify where it is bad.
On subsection 5(6), I do not want to go too badly on this wording, "a person," but it is a mess. If one looks at sections 4 and 5, they use the word "person." Subsection 4(1) says, "Where the minister is satisfied that a person has paid an unauthorized payment," that person is the patient. It goes on to say in subsection 4(2), "Where a person has paid an unauthorized payment to a practitioner"; that is again the patient. But when we go to section 5, and particularly subsection 5(6), we are now saying, "The member of the board conducting a review shall advise the general manager and the practitioner in writing as to whether, in the person's opinion." Now the member of the board is the person.
The word "person" is mangled all over Bill 94. It means everyone from the practitioner to the patient to the member of the board. It is used interchangeably all over and lacks definition. It not only is totally confusing but also leaves gaps. Therefore, the bill should not be proceeded with. We have old section 3d on insured persons.
Mr. D. S. Cooke: Come on. Get on with it.
Mr. Treleaven: Okay. I will not harangue that one. It is "person." It is bad. Let me get back to the act.
Mr. Morin-Strom: Back to clause-by-clause?
Mr. Treleaven: No. Here we are. This afternoon we had very little time to deal with the short title of this bill.
An hon. member: This afternoon? That was Thursday afternoon.
Mr. Treleaven: Yesterday. Time passes when one is having fun. "Health Care Accessibility Act" is a misnomer. As the member for Stormont, Dundas and Glengarry says, it is a misnomer and should not be called that.
When this bill first came out, I did a little research to find out whether there were any rules -- I looked in Erskine May and Beauchesne and so on -- that stated whether a short title even had to resemble a long title. Here, the long title talks about an act regulating the amount that persons may charge for rendering services and so on. There is no relationship between section 12 in the reprinted Bill 94 and the long title. Unfortunately, I found absolutely nothing that restricted one to some semblance.
If one looks at the Orders and Notices of any day, one will find acts. Yesterday's Orders and Notices says, "Second reading of Bill 11, An Act respecting the Protection of Rental Housing." The long title will be very close to that. Second reading of Bill 79 says, "An Act to amend the Municipal Act." Bill 72, one that is quite close to my heart, says, "An Act to amend the Powers of Attorney Act." It is exactly that. We had a Powers of Attorney Act passed about three years ago.
Mr. Speaker: That is most interesting, but I fail to see how it affects section 6.
Mr. Sheppard: The member should have a glass of water.
Mr. Treleaven: I dare not enter into the topic of the generosity of everyone.
The point is that if one looks at bill after bill, one will find that the long and short title very closely resemble each other. In this act they do not. It is very unusual. I do not believe it is an appropriate name. Calling it the Health Care Accessibility Act is entirely improper. It should relate to the long title.
I know there are many other people wishing to debate and enter into this. I do not want to hold them up unduly. I will not be very much longer.
With regard to the Health Services Appeal Board, you will remember, Mr. Speaker, that during clause-by-clause debate the member for Lincoln mentioned to the parliamentary assistant to the Minister of Health, the member for Wentworth North, that this board was taking upwards of two years to hear appeals where professionals were charged with overcharging, etc. In fact, when one looks at the procedures of the Health Services Appeal Board, one finds that it is in some cases well over two years.
This is the form, the procedures of the Health Services Appeal Board, and it sets out the procedures as to how people file and so on. In that very handout from the Ministry of Health to people who wish to be involved in an appeal, it says in item 6 at the bottom, "The length of its list at this time means that a two-year delay before the appeal comes on for hearing is possible."
I remember the member for Wentworth North saying it was improving. That may well be. I have some cases and the first one that pops up randomly is a situation where a physician was charged with submitting accounts during the period January 1, 1977, to February 28, 1979. He had bad bookkeeping. The first general manager made a decision that he should be charged 15 per cent on all accounts for that period of time. Therefore, we are speaking of the period from the beginning of 1977 until early 1979. The complaint was made in November 1981
Mr. Ward: Mr. Speaker, on a point of order: The member made reference to a response to a question by the member for Lincoln with regard to the appeal board. I think the member for Oxford omitted in his remarks that one of the reasons for the delay was the limited number of board members that were available. One of the amendments to Bill 94, which was not supported by the Conservative Party, was to increase the number of board members who are available for hearings to address this long-standing problem.
Mr. Speaker: What is the point of order?
Mr. Ward: The point was he forgot that.
Mr. Speaker: With respect, that is far from being a point of order.
Mr. Treleaven: It was in November 1981 when the general manager made the decision. The board met. It came before the board in April 1984 and the decision was in May 1984. We now have a situation where there is a purported overcharging on January 1, 1977, and it is finally dispensed with and disposed of in May 1984. That is well over seven years. I agree that is the longest and it is extreme, but this bill, giving the board new procedures, is a terrible idea when one considers that Bill 94 has confused matters in itself by appointing panels of one member.
6:30 a.m.
Perhaps the parliamentary assistant understands this better than I do, but we in this House cannot figure out why the Health Insurance Act should deal with quorums of three, yet Bill 94 talks about panels of one. How can one have a quorum of three on a panel of one? That is totally confusing. It also says the chairman and vice-chairman of the board will make a decision when there is a tie. How can there be that kind of thing when there is a panel of one? Bill 94 does nothing except mess up an already well-organized formula under section 8 of the Health Insurance Act. Those well-set-out rules now are messed up by the addition of section 5 of Bill 94 which says "appoint a member of the board to conduct a review."
Perhaps when the member for Wentworth North is speaking on this, he will explain that to us. Perhaps he will also explain, in these cases of the Health Services Appeal Board, why there are sometimes three members, sometimes eight, sometimes six or sometimes seven members hearing appeals. What is the yardstick by which the numbers are chosen? What will be the yardstick under the new system with Bill 94 feeding into this? Will it be one? Will it be three? How many will it be? Here is one with eight.
The member is showing me a newspaper article and I guess I must qualify for part of it.
Mr. Speaker: Has the member for Oxford completed his comments?
Mr. Treleaven: I have additional comments. I was slightly distracted. A person cannot read the newspaper in the House while he has the floor. That would be terribly unparliamentary.
I do not wish to be repetitious. I have a great deal more, but I might run into some difficulties. Many members of my caucus wish to speak. They are eager to give fresh information. Therefore, I am in my sixth hour and I will wind up my remarks.
Mr. Speaker: Are there comments or questions?
Mr. McClellan: Unfortunately, I missed the last four hours of the honourable member's speech. Could he summarize?
Mr. D. S. Cooke: I have been here for the entire set of remarks by the member for Oxford. After five hours, I am not quite sure what was the point. I heard about this speech that was to be given on whatever health bill or social-service bill came up first. I have heard we will get a longer one on the next health or social-service bill and an even longer one on the bill after that.
The member for Oxford has been a member since 1981. Now he is engaged in this parliamentary effort. Other words could be used to describe the effort but they probably would be unparliamentary. What other efforts has the member attempted in the parliament of Ontario when the former government, namely, his party, was in power from 1981 to 1985? Ever since I ran for office, all the Conservative candidates in my riding have used the argument that, if one is a member of the government, one can get what he needs for his riding. The member for Oxford was a member of the government party. Why did he not get what was needed for the kids of his riding, the mental health services and all the other things he has talked about?
Why is it only now, on June 19? It was supposed to be June 19, but in reality he did not start until June 20. He said he would go for two days but he did not. Why not before? Why did the member for Oxford not deliver on his promises to his constituents when he could?
Mr. Ward: I too have been here, either in the chamber or in the ante-room, glued to the television for the last five hours, listening to the fine rhetoric of the member for Oxford.
One concern I have is the one great inconsistency in his response to the member for Nickel Belt, and the actions of his office on behalf of a constituent who was extra billed on May 8 for $1,200. Rightfully, the member did what he could on behalf of that individual through his staff, including inquiring as to whether the bill would be retroactive.
That aside, I am struck by the fact that the quality of the remarks in the debate from the member for Oxford has been consistent with the quality of the comments of the members of the official opposition over the course of the past two weeks, where nothing has really been added to this debate other than a prolongation.
I want to convey to the member for Oxford a very real story of something that occurred last evening. I phoned home, and my wife indicated that a constituent -- whose name I recognized, and who in fact is not supportive of this legislation; one of the few in my riding who is not -- was anxious to have me call her. I assumed it was over the time allocation.
She is not a supporter of our party. She is not a supporter of this bill. She did, however, want to speak to me urgently to let me know that she could not tolerate the actions of the member's party in thwarting the democratic process, and would never bring herself to support it again.
Mr. Speaker: Further comments or questions?
Mr. Davis: I got 21 calls from people who said they are not going to support the government party next time, either.
Hon. Mr. Riddell: I just have a short comment.
I have sat here about an hour now listening to the comments of the member for Oxford. I have come to respect very much the person who coined the phrase, "Blessed is the man who, having nothing to say, refrains from giving ample evidence of that fact."
Mr. Treleaven: Regarding the comments of the member for Windsor-Riverside -- oh, he has disappeared. Anyway, I did exactly the same things, from March 1981, when I was first elected, until February 1986.
I did everything the same way through the change in government. I wrote, phoned and met with the various bureaucrats, etc., of those two ministries, Health and Community and Social Services. At that point, I changed tactics, because I was getting nowhere dealing with the bureaucrats. It is not the ministers; it is the same bureaucrats sitting there now who were sitting there three years ago.
Mr. Wildman: Who is in charge of the government?
Mr. Treleaven: That is a good question. The bureaucrats are. That is my observation.
Since the member for Windsor-Riverside is exercised that I fell a little bit short of my full six hours, perhaps he is suggesting I will add the shortage to my next prolonged debate on the next health or social services bill that comes along.
My comment to the member for Wentworth North is that any time the bureaucrats give Oxford its fair share, my actions will stop immediately. My comment on what the member for Huron-Middlesex (Mr. Riddell) said is that if I had been allowed to stray from Bill 94 tonight and to say what is in these three horror files from Oxford, it would have been really relevant. I would have had no trouble going my six hours in a very angry fashion.
Maybe I will get more latitude in second reading of Bill 109. I will have more latitude on that. We will see if these two ministries pick up their socks.
Mr. McClellan: Maybe, after that brief interlude of six hours or so; I left around 2:30 a.m.
Mr. Davis: Too bad the member came back.
6:40 a.m.
Mr. McClellan: I came back because I thought it would be nice if somebody started to speak again about extra billing and the reason we are having this debate.
I look on this as the happiest and proudest day since I was elected to this Legislature because today this Legislature is finally going to wipe out extra billing in Ontario. That is a great accomplishment that will happen at one o'clock this afternoon. My colleagues in the New Democratic Party have participated in the campaign to end extra billing since 1978. We have done so with a great deal of energy and determination because we recognize that extra billing is a fundamental threat to universal medicare. It threatened, until today, to destroy our medicare system. That was recognized unanimously by the Parliament of Canada when it passed the Canada Health Act which bans extra billing. It has been recognized by the majority of provinces across this country.
Ontario is the last large province to be dragged kicking and screaming into the realization that one cannot have a medicare system when one permits doctors to extra bill outside the system. In the first place, extra billing is a deterrent, a barrier to access and bars the poor from access to medical services. That is not just my opinion. That is not just political rhetoric by some politician. There have been studies since the 1970s documenting, one after the other, that extra billing fees are deterrent fees and that the fact some doctors extra bill some patients acts as a positive barrier keeping poor people away from health care services. It sets up a two-tier system where the rich and affluent are able to get first-class services in doctors' offices and others are streamed into hospitals for a different kind of service.
The studies have been available to governments, to legislators since the 1970s. I will not list them all; they are all in the library. We have Wolfson's study and the study by the Ontario Council of Health on deterrents and deterrent fees, which identified extra billing as a major deterrent. We have the studies that were done for the Hall commission and studies by Stoddard and others that showed extra billing was a barrier to the poor. All this is objective, empirical evidence and not rhetoric, not opinion, not politics. It is objective, scientific evidence done by objective social scientists with no political axe to grind. They simply tried to analyse and understand our health care system. They all came to the same conclusion that extra billing was a barrier to service.
There are those who stand up in this House in 1986 and say: "I never saw a patient in my riding who was extra billed. I never heard of anybody having any problems with extra billing." They are either so out of touch with their constituents that they have neither seen nor listened to their own people over the course of the past 10 years; or they are deliberately blind and deaf.
Hundreds of my constituents have expressed their deep bitterness at having to pay large amounts of money at a time when they thought they would be covered by our medicare system for surgery, operations and childbirth. Perhaps the members of the opposition, who are so blithe about this problem, are used to having their surgery without benefit of anaesthesia because in Metropolitan Toronto it is impossible to obtain anaesthetist service outside of the insurance plan. Inside the insurance plan, all of the anaesthetists in my community are opted out and extra bill -- every single one.
Mrs. Marland: On a point of order: In fairness to the House, I would like to ask the member for Bellwoods to retract his statement --
Mr. Speaker: Order. Is the member asking the member for Bellwoods whether he will accept a question?
Mrs. Marland: Yes.
Mr. McClellan: I will accept a question at the conclusion of my speech.
There is the question of deterrence, which is a matter of scientific fact, a matter of everyday observance for those of us who have the honour to be in this House and represent constituents. Second, there is the question of cost. Now that the Canada Health Act has been introduced, according to the figures that I have, the total amount that has been paid out in extra billing by patients in this province, since the Canada Health Act was proclaimed in July 1984, was in excess of $100 million by the end of May.
The people of this province have paid over $100 million in extra billing fees since the Canada Health Act was proclaimed on July 1, 1984. For the Conservative Party to say that extra billing is insignificant, that it does not affect anybody and it is not important, is sheer and absolute rubbish.
Mr. Davis: That is only if you believe in socialized medicine.
Mr. McClellan: That brings me to my third point: Do I believe in socialized medicine, and does the Conservative Party believe in socialized medicine. The answer, of course, is no. The Conservative Party and their friends in the Ontario Medical Association do not believe in socialized medicine. They do not believe in medicare. They have fought medicare ever since it was conceived, ever since it was introduced in Saskatchewan, ever since it was proposed for Ontario.
This is not the first doctors' strike we have ever had. My friends in the Conservative Party have been out there on the picket lines cheerleading and egging on the doctors in their increasingly extremist and irresponsible behaviour. I do not know who is being more irresponsible, the doctors of this province or the Conservative Party of this province.
It is not the first doctors' strike we have had.
Mr. Davis: It is called justice and fairness.
Mr. McClellan: The first strike we had was in Saskatchewan when the New Democratic Party government of Tommy Douglas introduced medicare. That was the first time the doctors in this country went on strike. It was not against fees. It was not against extra billing. It was against the principle itself of socialized medicine; it was against the principle of medicare. That is why they went on strike the first time. There was a historic compromise in settling that strike.
6:50 a.m.
In retrospect it is clear that the compromise that is now called "extra billing" was indeed a Trojan horse which was brought into the medicare system and which threatened it from inside. We have recognized that fact some 25 years later. We cannot preserve and protect and keep and continue a medicare system as long as the Trojan horse of extra billing is inside.
Other countries have had the experience of a discrepancy between what the doctors are allowed to charge and free-enterprise medicine. The amount payable under the medicare insurance plan has risen to the kind of gap that has existed in Ontario, in the order of 30 per cent to 40 per cent. We have seen that rise in other countries to 80 per cent or 90 per cent. We have seen medicare systems deteriorate to the extent that the insurance plan reimburses patients for a tiny fraction of their medical fees, in the order of 10 per cent to 15 per cent. When extra billing is allowed to continue inside a medical insurance plan, it is simply a matter of time before the people demand private insurance and coinsurance to cover the differential.
Mr. Davis: Just as in England, where labour is now asking for private insurance because it does not like state medicine.
Mr. Mackenzie: The member does not know very much about labour. That is obvious.
Mr. Davis: Want to bet?
Mr. Speaker: Order.
Mr. McClellan: We do not want the kind of combined free-enterprise/public-enterprise system that is in England. We do not want that here. We do not want the rich having to set up their own clinics; we do not want clinics such as those set up for the oil sheikhs on Harley Street in London. Literally hundreds of millions of dollars of health care resources in Great Britain are dedicated and devoted exclusively to the rich. That is what two-tiered medicine leads to.
In the past 25 years, my friends in the Conservative Party have never accepted in their hearts the validity of medical care and socialized medicine. Still in 1986 they throw back the taunts, "Members of the third party support socialized medicine, and we do not." Of course we support socialized medicine. Everybody in Ontario supports socialized medicine with the exception of two groups, the Ontario Medical Association and its political lackeys in the Legislature, the Ontario Progressive Conservative Party.
The Conservatives are equally out of touch with the people of this province. The Conservative Party does not have the courage to stand up openly and say what it says about socialized medicine in its snide, jeering heckles from the sidelines. We know what its members mean when they defend extra billing. We know what they meant when they egged on the doctors to more and more extremist behaviour during the debate on Bill 94. We recognize their attack on medicare for what it is, and we do not intend to knuckle under to their blackmail. We intend to see this bill passed, and that is why it is going to be passed at one o'clock today. My Conservative friends can howl and jeer and weep and carry on with their friends in the Ontario Medical Association.
Later today in Hamilton, starting at about nine o'clock, our party will be having its annual convention. The first item on the agenda is a tribute to Tommy Douglas, the man who brought medicare to this country and the man who took on the Saskatchewan Medical Association and the Canadian Medical Association in the first strike against medicare.
We in the New Democratic Party are honouring his memory here today in the best way we know. We are ending extra billing in Ontario today, and we are preserving medicare for all time in this country.
Time and again in the last few years of his life, Tommy Douglas warned us in the New Democratic Party about the threat to medicare that extra billing represented. He told us in our councils and at our conventions that two generations had fought to bring medicare to this country and he said, "By God, nobody is going to take it away from us." We say again to those inside and outside this Legislature who are waging a strike against medicare -- threatening the patients of our province, threatening to sit on the curbs while the ambulances pull up to the front door and the funeral director pulls up to the back door, those who make those kinds of threats --
Mr. Davis: Where is that happening now in Canada?
Mr. McClellan: That is what doctors in this province are saying in 1986 as they wage a last-ditch fight against medicare. I say to them, and I say to their friends in this assembly in the Conservative Party, medicare is here and they will not take it away from us.
Mr. Speaker: Are there any comments or questions for the member for Bellwoods?
Mrs. Marland: I have a question. The member for Bellwoods made a very grave statement at the outset of his comments this morning.
Mr. Jackson: That was "grave," not "great."
Mrs. Marland: Grave, g-r-a-v-e. It was grave in the extent of its error. He said there were no anaesthetists available in Metro Toronto because they all extra bill. I would like the member for Bellwoods to place before this House the record of every anaesthetist in Metro Toronto and the fact that they extra bill. I recognize he may not be able to do that today, but I look forward to having it in the future. Otherwise, I will accuse him of misleading this House. He made a major statement that is totally inaccurate and I take strong exception to it.
A 72-year-old constituent of mine had a triple bypass performed at the Toronto General Hospital by the leading cardiovascular team in Canada, which involves about eight specialists, one of whom is an anaesthetist. My constituent has not received a single bill from any of the physicians and specialists on that eight-man team.
If the member for Bellwoods would like to keep his record clear, he can tell us each and every anaesthetist in Metro Toronto who extra bills, or I will accuse him of misleading the House. If he has that evidence now, I would like him to comment on it.
Ms. Gigantes: But does the anaesthetist extra bill?
Mrs. Marland: Mr. Speaker, do I have the floor to ask questions of the previous speaker?
Mr. Speaker: For about six seconds.
Mrs. Marland: Do I have to have the interjections so that I cannot hear?
Mr. Speaker: The member's time has expired. Are there any other comments or questions?
The member for Bellwoods may respond for up to two minutes.
7 a.m.
Mr. McClellan: I will respond very briefly. I do not want to egg my friend on to unparliamentary language, but the statistics that I quote are published every year in a book, whose title I have forgotten, put out by the Ministry of Health.
Mr. D. S. Cooke: It shows all the opted-in doctors and there are no anaesthetists.
Mr. McClellan: It shows all the opted-in doctors and there are no anaesthetists. It is a matter of record that is published by the Ministry of Health. It was published as part of the Conservative government's response to our anti-extra-billing campaign.
Mrs. Marland: There is a difference between --
Mr. McClellan: If the member for Mississauga South (Mrs. Marland) wants to go back to the bad old days --
Mr. Speaker: Order. I remember the member for Mississauga South saying a few minutes ago that she did not like interjections. Please.
Mr. McClellan: The member for Mississauga South is talking about charity medicine. It is a fact that the anaesthetists in this community are all opted out and all extra bill. The only way we can get away from an extra bill from an anaesthetist is to plead, beg or go down on one's knees and say, "Please, sir; please, your reverence; I do not want to have to pay this bill because I cannot afford it." This is the point we are trying to make in this whole debate. Charity medicine in Ontario is dead.
Hon. Mr. Riddell: It was not my intention to enter into this debate until I was given to understand that many doctors throughout the province have been misled into thinking there is more to this bill than banning extra billing. This bill is all about extra billing. It bans extra billing; nothing more and nothing less. It does not take freedoms away from doctors. Unfortunately, some of the comments that have been made --
Mr. Jackson: On a point of order, Mr. Speaker: The member is clearly indicating a statement that is incorrect with respect to the content of this bill.
Mr. Speaker: The member does not have a point of order. He does not agree with what the other member is saying, but he does not have a point of order.
Hon. Mr. Riddell: It is obvious that the doctors have been misled into thinking there are things in this bill that are going to take away their freedoms, that they are not going to be able to see all their patients, that everything they do is going to be dictated and that it is going to lead to state medicine. It is absolute nonsense.
I noticed that some of the Conservative members were passing one of the daily papers around and putting it in front of the members who were speaking on the bill. I have no idea what article they wanted to draw to the attention of those members, but I think the members opposite should take a look at an article that appears in today's Globe and Mail, written by Jeffrey Simpson. This article sums it up very well. Some of his comments are worthy of note when we talk about taking doctors' freedom away. Jeffrey Simpson states:
"In a sense, the doctors' position, now wrapped in pejorative declarations about `freedom,' began eroding in Canada decades ago. The erosion started in Saskatchewan and later spread across the country, so that free-market medicine, from which extra billing emanates, was rejected as the principle underlining health care.
"The doctors' strike, therefore, is the final desperate struggle against an irreversible tide of public opinion. When the struggle is lost, as it will surely be, feelings will be sorely wounded, but such is the price paid by those who hurl their own naked self-interest against the greater social good.
"As often happens in these disputes, terms are thrown around with loose abandon." I believe that has been the case for the 42 days we have been listening to debates in this Legislature and in committee. Getting back to what Mr. Simpson says:
"The striking doctors claim that their `freedom' is at stake. The only freedom truly at stake is that of charging what the market will bear, since no one is interfering with their freedom to choose a profession, to practise it where they will, to relate to patients as they choose or to extract from society on average the highest incomes.
"Regrettably for many doctors, Canadian society determined in the Sixties the principles on which it wanted to organize the care of its citizens. Those principles did not include the application of the free market in medicine, with all the rewards and penalties, burdens and benefits associated with the free market.
"The principles were thoroughly debated in the `60s at the inception of nationwide medicate. They were reaffirmed in the Canada Health Act of 1984," which, I must say, the Tories unanimously supported at that time. "If anything, whatever doubts sceptics harboured about the nation's decision have largely dissipated.
"It is immensely sad to see doctors shredding their credibility by prolonging the insensate and increasingly injurious strike."
Doctors, being the honourable people they are, will surely stop trying to confuse this issue. This issue is nothing more and nothing less than the banning of extra billing.
Mr. Jackson: I am a little disappointed in the previous speaker's comments. I would ask him to consider, if he is so concerned about the doctors' position and about why they are taking their concerns beyond what he thinks are the limits of this bill, whether he would not be concerned as a professional if the Premier made a statement in London, Ontario, that there were too many doctors and that clearly the agenda for the Ministry of Health would be to restrict the numbers of doctors.
Would he not, as a professional, as a medical practitioner, be concerned when the Premier indicated in a radio interview in Kitchener that there were not enough private moneys in the health care system and that we were going to have to consider a sick tax or some other mechanism by which to inject private funds into the system?
Does the member not agree, and why would he accept, that when the Ontario Medical Association asks for negotiations, when it asks to sit down at the bargaining table, in the opening salvo the Premier (Mr. Peterson) advised them of his contempt for the doctors by calling them overrated and overpaid gougers?
The member states with some authority that the doctors are in some way overstating their case. Their fears are not imagined; their fears are real. Upon a closer examination of the content of this bill, the member would realize that the doctors are going to be subjected to regulations that would set administrative charges. No wonder this province is concerned with politicians and their promises from any political party when Physicians' Services Inc. is abandoned in favour of the Ontario health insurance plan and they are told there will be a 10 per cent gap between the OHIP rate and the OMA fee schedule. It is now 25 per cent.
Now the government is talking in this bill about loading on additional administrative charges. No wonder the public of Ontario, not just doctors, feels so insecure about promises from any politician.
I ask the member to respond to the four questions I have posed to him. Why would he limit this discussion entirely to a perception that this bill is only about extra billing?
Mr. Speaker: Are there any other members who wish to make comments? Do you have a question?
Mr. Ward: I want to --
Mr. Davis: What about the Minister of Agriculture and Food (Mr. Riddell)? Does he not get to respond?
Mr. Ward: He does get to respond. The member opposite should come to the House more often and he would understand that.
I congratulate the Minister of Agriculture and Food for an excellent speech --
Mr. Davis: Speech? He read it, for heaven's sake, and a reporter had to write it for him. He did not have the ability to do anything else.
7:10 a.m.
Mr. Ward: It clearly identified the issue and clearly indicated some of the confusion that members such as my reverend friend the member for Scarborough Centre (Mr. Davis) insist on instilling in everyone. I remind my two friends who sat on the standing committee on social development that it was their leader who came to that committee first and asked: "Why are we dealing with this issue? The real number-one issue in health care in this province should be to address the problems of physician manpower supply." They raised that issue first and they know full well that Bill 94 addresses one aspect of medical care, namely, extra billing by doctors above and beyond the Ontario health insurance plan rate.
Mr. Villeneuve: I have a few notes I would like to put on record. I believe the Minister of Agriculture and Food read an editorial. I would like to know what newspaper he read it from.
Second, I recall him as a champion of free enterprise and such things. He is concerned that free enterprise is not working in the health care delivery system. How have we had such a good system to this point? The Premier has stated he will try to put the pieces of the health delivery system back together. How, if the pieces are all over the place? I well recall not very long ago this province had the best health care delivery system anywhere. What has happened to the member who used to be the champion of the entrepreneurship, the free-enterprise system? He is speaking like a socialist. Could the Minister of Agriculture and Food please explain what has happened to him?
Mr. Davis: It is called "power corrupts and absolute power corrupts absolutely." I hope the member heard that.
Mr. Speaker: Order. I would like to inform the member for Scarborough Centre that interjections with great volume are certainly out of order. The member for Windsor-Riverside.
Mr. D. S. Cooke: I would like the minister to tell us what it was in our arguments we presented time and again that finally convinced him to support the New Democratic Party position? For 16 years our party supported a ban on extra billing, and for many of those years we took that position by ourselves. The Premier said in the late 1970s that extra billing was a necessary safety valve for doctors.
Ms. Gigantes: It is a great pleasure to have the honour of participating in this debate. As my colleague --
Mr. Speaker: Order. Have you any questions on the comments by the Minister of Agriculture and Food?
Ms. Gigantes: None at all. I fully endorse his comments.
Mrs. Marland: Is he going to respond?
Mr. Speaker: Yes, after any other members ask questions. The Minister of Agriculture and Food has up to two minutes.
Hon. Mr. Riddell: I did not realize that my few brief comments would spark such a response from the opposition members. It surely must have been one of the livelier sessions since this thing started at 3:30 yesterday afternoon.
I cannot comment on what the Premier said. I was not in the parts of the province where he made the statements the Conservatives allege. They would not expect me to comment on that. If I am around and hear somebody make a statement, then I am in a position to comment on it, but I did not hear the statements made and I certainly have no intention of commenting.
As far as negotiating is concerned, there were 11 attempts to negotiate with the medical profession. As far as I am concerned, in those negotiations they were offered the best of all worlds, yet the doctors refused even to listen to the offers made by the Minister of Health (Mr. Elston). They took the stand that, unless the bill was withdrawn, unless we decided to scrap a bill which banned extra billing, they were not prepared to listen to anything. That is the fact of the matter. There were many attempts to negotiate with the doctors, so let us not further confuse the issue by saying this government did not try to negotiate with the doctors.
Mr. Davis: On a point of order, Mr. Speaker: I believe the member for Windsor-Riverside asked a question to which the minister failed to respond.
Mrs. Marland: At the outset, I request the indulgence of the members in this House. There are members in the Legislature now at 7:15 a.m. who have been here as long as I have, which is since 1 a.m., and I respectfully request that the members who are newly arrived and slightly fresher than the rest of us might show a little courtesy and perhaps limit their interjections until the time at the end of the speech when they can ask their questions. In fairness, that little consideration might be shown. We have been showing it all evening and it has nothing to do with what we can withstand.
I feel there is some irony in standing at this time of the day, on this particular day in the history of Ontario, because I feel very seriously and very gravely that as this day dawns it will be proved to be one of the darkest days in the history of health care and the medical profession in Ontario.
I never really thought any member in any Legislature who was elected to serve his or her electorate would ever think he or she should completely ignore any portion of that constituency. There is not one member in this Legislature who does not have a portion of his or her constituency that is not concerned with the implications of Bill 94. There is not one member of the Legislature who does not have doctors in his or her constituency and people who support their doctors. The numbers do not matter. What matters, and I think it is very serious, is when elected representatives choose to ignore anyone whom they represent.
In this particular example of legislation, we have had an increasing demonstration by the Liberal government and its supporters, the New Democratic Party, of no caring and no compassion but everything for political expediency. If I were sitting in either of those two parties, I would have to look very closely at my responsibility.
7:20 a.m.
When we talk about whether we should be caring and whether we should be compassionate, we should look at the implications that are already before us. I do not yet have an example of anyone who has died from extra billing, but we certainly have, unfortunately, many examples of people who have died because of the lack of accessibility to health care in the purest sense. In the purest sense, I would be talking about surgical beds.
About two weeks ago, I told the House about a neighbour of mine who had been tested and evaluated at Toronto General Hospital and had proved to be an ideal patient for a triple bypass. This man had always been very healthy. He had been a referee with the Canadian Football League. He had congestive heart failure about six weeks prior to May 28, at which time he was hospitalized in the Oakville hospital and in intensive care for three or four days.
When he recovered from that intensive care, he was sent to Toronto General Hospital, where he received the tests and evaluation. They were happy to tell him that in 1986 he would not have to risk the loss of his life because of the condition of his heart. However, he would have to go home to wait for a hospital bed, perhaps for two or three weeks.
He waited for two or three weeks, and he waited another two or three weeks. The day before the end of six weeks, he had a second heart attack at home. In a day and age when we have enough loss of life because of things we do not yet have remedies for -- such as cancer and other diseases, and certainly always the tragedy associated with unavoidable motor vehicle accidents -- it is a terribly sad example when a 53-year-old man dies in 1986 of something he did not have to die of. If he could have had a surgical bed, he would be alive today, because he was a prime patient for that procedure.
I would like to point out that the team which saw him at Toronto General Hospital had not extra billed, although, again, they are the same team of specialists to which I referred earlier. In the particular case of John Mee, he actually told us that -- whether or not he had good results from it -- if he had the choice of having the surgery, and having it soon by paying for it, even by going to the United States, so he would not have to go through the anxiety of waiting, he might in fact go to the United States and pay for it.
He said: "I would even think of remortgaging my house, selling my car. It would be my choice to do whatever was necessary to finance my return to good health." That was a choice he felt he should have. Unfortunately for John Mee, he did not live long enough to make that choice.
Mr. Speaker, you permitted the member for Huron-Middlesex (Mr. Riddells) to read from the Globe and Mail, so I am sure you will permit me to read from a comment delivered on February 12 of this year in a broadcast over CFRB by Charles Doering. He said: "I like what Conservative leader Larry Grossman is saying about the doctors, his sane approach to the proposed legislation on extra billing, his reasoning as to why the Peterson government is charging forward with a `damn the torpedoes...full speed ahead' approach."
Hon. Mr. Nixon: "Signed Allan Grossman."
Mrs. Marland: That is in inverted commas. "You see, Larry points out there are better ways to achieve the goal of universal accessibility. Other provinces have done it without starting a war with the doctors. Without driving wedges of divisiveness in society."
"He points out that Premier Peterson says he won't withdraw the legislation and sit down and negotiate with the Ontario Medical Association. Why not? Other provinces have demonstrated they can arrive at settlements. They did not threaten the doctors with a $10,000 fine and create a climate of hostility and confrontation.
"And when it comes to money, Mr. Grossman says if the Peterson Liberals push ahead with this bill and are forced to close the gap between the OHIP fee schedule and the OMA fee schedule, it will cost the taxpayers of Ontario $660 million."
"Mr. Grossman has sensible suggestions. Explore alternatives with the medical profession. Ask them if they would consider that all seniors, the needy, the hospital-based services receive no extra billing."
I point out that this was in February 1986. "Vastly increase our resources in community health clinics and in specialties where extra billing may threaten the principle of universal accessibility. Ask the OMA to suggest their own alternatives for compensating physicians.
"Mr. Grossman asked the Peterson government to repair the damage which has been done to the fabric of the health care system. To close the chasm it has fostered. To provide all Ontarians with full accessibility to quality health care. But Peterson has gone ahead, and as Mr. Grossman points out, the reason is obvious. He is caving in to the dictates of the New Democrats, because that is the price David Peterson has to pay in order to remain in power. He has to fulfil his agreement with the NDP at whatever cost. And that is not good for the people of Ontario."
So said Charles Doering on February 12, 1986.
What is very interesting is that we heard a few minutes ago about the concerns of the member for Bellwoods (Mr. McClellan). The member said: "Today is a great day. Today is the dream that the New Democratic Party has been dreaming since" whatever year. He said the New Democratic Party is the party responsible for health care in the first place in socialized medicine in this province.
The member for Bellwoods' comments are an indication of the limits of the intelligence and understanding of the members of the New Democratic Party. Because of their limited intelligence and understanding, they fail to recognize that it was not the New Democratic Party which introduced a health care insurance system in this province, as those of us who have intelligence and understanding know. It was the physicians themselves who introduced an insurance scheme to protect the people who became sick in the province.
7:30 a.m.
When one reflects on the Physicians' Services Inc. insurance scheme, it is rather interesting that going back all those years, which I think is in excess of 47 years, the physicians then, as today, cared enough and were concerned enough about their patients that they organized Physicians' Services Inc. Today the New Democratic Party, with the support of the Liberal government, wishes to penalize the profession that all these years has protected the health care of the patients of Ontario whilst giving them a service.
When we talk about cost, how interesting it would be to go back over the six months and come up with a figure as to what it has cost the province in terms of senior staff time; physicians' time; the time of members of the executive and board of the Ontario Medical Association, who do not receive any remuneration for their service in the interest of public health in this province; all the people, all the staff and indeed all the members of this Legislature who have been involved in this issue, this so-called extra billing. When we look at the health care budget of approximately $8.3 billion and we recognize that OHIP billing is 19 per cent of that and extra billing is one per cent, I am quite sure that for all the time and all the people who have been involved in this debate in the past six months, we have well overspent the amount we have been quibbling about; namely, the amount that is extra billed.
There is no question that if third reading of this bill passes today, we will be dealing with more than things that are on the table. We are obviously dealing with a lot of other things that are under the table. I think it was the member for Huron-Middlesex who said, "All we are dealing with is extra billing." Is that not interesting? That is what the doctors and patients in the other provinces thought. They, too, thought what was happening all had to do with extra billing. They had no idea it would involve limiting the number of doctors in training. That goes without saying.
If a doctor practises in British Columbia today, he does not have a choice of where to practise. He is not given a billing number except for the geographic location where it suits the government to have him practise. They limit the number of doctors by that process and they limit the salaries. Therefore, they limit the patients' choice of physician. They limit how and where the treatment is rendered and what the treatment is. They limit the number of tests and therefore the decision-making of both the patient and the doctor.
As long as Ontario is not the Union of Soviet Socialist Republics, I have to ask, why is it we are so interested in forcing one of our groups, be it professional or nonprofessional, and in this case it is a professional group --
Ms. Gigantes: What if all the teachers lived in Mississauga?
Mrs. Marland: That is very interesting; I am coming to the teachers. Why is it we are deciding, and I say "we" in the "royal we" sense, the majority of this House
Mr. Wildman: In the "royal we"?
Mr. Barlow: Some are more royal than others.
Mrs. Marland: How is it that the Liberal government and the New Democratic Party think we will tell the doctors that they will work for the government? How is it that we do not say to the teachers, to the plumbers, to the electricians, "You will work for the government"?
Mr. Wildman: Whom do the teachers work for? They do not work for themselves.
The Acting Speaker (Mr. Morin): Order, the member for Algoma (Mr. Wildman).
Mrs. Marland: Since so many of the New Democratic Party members are teachers, I wonder how they would feel if the government said to the teachers: "Not only will you continue to work for this board of education for the rest of your life, but you will also stay in this school for the rest of your life. You now are going to be controlled by the government. Your salary will be set by the government, not by your professional association. You will remain in this school. You will remain teaching with this board."
Is that not an innovative form of thinking? Would it not be interesting to compare the doctors with, let us say, the plumbers? Of all the self-employed plumbers, who are highly successful businessmen, very hardworking people and professional in their area of responsibility, I am sure not one in this province would choose to have the government tell him where he was going to work, what he was going to earn or where his future lay.
We have heard a lot about democracy in the past six months, and the one salvation for this province -- indeed, for this country -- is that we still are a democracy. Under a democracy, not only do we have the choice of whom we elect to represent us but we also have individual choices to follow as to the vocation we choose; or perhaps, as some do, we choose not to work at all. As long as we live in a free country, that freedom must be available for everyone, for every professional, every blue-collar worker and every nonprofessional.
Perhaps I might more easily accept the legislating of doctors to work for government if there were an arbitrary decision that everyone would work for and be controlled by government. However, in this day and age, thank goodness, that is not the wish of the people of this province or of this country. There is a slight difference, fortunately, between Canada and Cuba and any other communist country. We still have freedom of choice. Thus, I fail to understand why we have selected one profession and said, "Thou shalt work for the government."
The funny thing is that we seem to treat doctors with less respect, regard and even common understanding than any other person who is employed. The funny thing is that when a plumber makes a repair to a pipe, if the work is not done properly and the pipe leaks, that is the only problem: the pipe leaks. There is no risk, although there may be some flooding and some damage where the water is leaking.
In a surgeon's delicate neurosurgery, ophthalmic surgery or cardiovascular surgery -- in any of those specialties, where technically we could talk about a vein, an artery or something to do with the eye or the brain in terms of the repair of a pipe -- one minute mistake would cost the patient's life. Yet we seem to hold in complete disregard the responsibility the doctor is willing to assume on the part of the patient.
7:40 a.m.
God willing, it will not be you, Mr. Speaker, me or any of those who are close to us, but if and when our families are faced with that kind of life-sustaining surgery, how is it that we could ever have the right to turn around to that person and say: "You are going to work for the government, Doctor. You are going to earn so much money. Furthermore, Doctor, if you want to work 12 hours a day, you will only be paid for eight hours because we are only going to allocate a certain amount of money for a certain number of procedures"?
Perhaps the members think this example does not exist in Canada. It exists in British Columbia today, where there are billing practices that restrict the number of certain types of tests that a patient can have and a certain number of procedures that a general practitioner can do. When a GP works in British Columbia, he is limited in the amount of gynaecological, obstetrical, and ear, nose and throat services he can do. After he has done the number he is permitted, if he has done them all by June and somebody comes in in July or August and wants that procedure done, he has to say: "I cannot do it for you because I have filled my allocation. Perhaps I can do it for you and not get paid for it."
That scenario does not exist 10 or 15 years from now in some other country. It exists today in British Columbia. Given the kind of mentality that generated Bill 94, there is no reason it will not evolve into that in this province.
We talk about whether there has been true negotiation in the past six months. The reason third reading of this bill should not take place is that there has not been negotiation in the past six months on both sides on this issue. There has, however, been tremendous negotiation on one side, and that is on the side of the Ontario Medical Association.
I referred to Charles Doering's comment of February 12, 1986. He listed the groups we have heard about, especially those the New Democratic Party was concerned about: the single mother, the person on subsistence allowance, the seniors, all these people we have been hearing were underprivileged and needed to have full and open access to any specialist, any opted-in or opted-out physician.
Is it not interesting that we now have a list from the OMA that gives us the concessions that have been made since February 1986? I wonder whether the members are aware of this list, in particular the members of the New Democratic Party because they are the biggest thrust behind this legislation. It is for their purposes that I will read a list headed, "Concessions Offered by the Ontario Medical Association to Government in Context of the Bill 94 Dispute." It reads:
"In discussions prior to and since the introduction of Bill 94, the Ontario Medical Association has offered the following in an effort to reach an acceptable compromise:
"1. No patient over the age of 65 would be charged more than the OHIP rate.
"2. No patient receiving treatment of an emergency nature would be charged more than the OHIP rate.
" 3. No patient receiving financial assistance from your government would be charged more than the OHIP rate."
The final paragraph addresses all the concerns of the New Democratic Party and the Liberal government. It is this: "In a further effort to honour both your concerns and ours" -- this is the Ontario Medical Association speaking -- "we offered to work with government to guarantee that every citizen of Ontario would obtain medical services from an opted-in physician, or from an opted-out physician -- at the choice of the patient."
Mr. Wildman: Of the physician, you mean.
Mrs. Marland: I will read it again because there seems to be a misunderstanding. Perhaps if they knew what was on the table and what was being offered by the Ontario Medical Association today, they would see that it is not necessary to pass Bill 94 to address their concerns.
"In a further effort to honour both your concerns and ours," the Ontario Medical Association says, "we offered to work with government to guarantee that every citizen of Ontario would obtain medical services from an opted-in physician, or from an opted-out physician -- at the choice of the patient." This is a list of the Ontario Medical Association's concessions, addressing all the concerns that have been raised in all the arguments and all the rhetoric we have heard from both sides of the House.
It is interesting that one gives people what they have been asking for, yet they are so blind and have blinkers on. They have chosen this only for political expediency, not for the sincere protection of health care for the people they represent. That protection is here; they now have it. However, they have gone flag-waving down the road on their great white chargers of salvation and they cannot back away.
They do not have the decency to be honest. I would not care even if they wished to take the credit for it. However, they do not feel they can own up and be honest enough to say that all these things are the things they were championing in the cause of the need for Bill 94 six months ago.
When I look at this list of concessions by the Ontario Medical Association, I see one thing missing and that is a list from the Ontario government of what its concessions have been. Of course, we do not have any negotiations because all the concessions have been on the part of the doctors of this province. I do not have a list of any concessions by the government.
I see that the Minister of Health (Mr. Elston) has arrived. Perhaps the minister will do me the honour of hearing the list of concessions offered the people of Ontario in terms of their health care.
This is the irony. All the concerns that were asked for have been finally addressed and conceded. Still, there is political expediency, which proves once and for all that it is not health care these elected representatives care about; it is purely their own politics. This is a dark, sad, gloomy day in the history of Ontario.
I am encouraged to know the Minister of Health has arrived because another reason this bill should not be given third and final reading today is that I have an indication in my hand of the kind of thing happening today prior to this legislation being in place. If this is the kind of thing that is happening today, I have even graver concern for what will happen afterwards.
7:50 a.m.
The minister received a letter about seven weeks ago from a patient with whom he is very familiar. The mother of the patient is Mrs. Lori Mcleod. Mrs. Mcleod has two children who require craniofacial surgery. Mrs. Mcleod is the president of a group called About Face. It was with great interest that I listened to the member for York South (Mr. Rae) earlier this week. In great drama, he stood up and showed tremendous concern about the cancellation of a cleft-palate procedure that day. This procedure was to be performed by Dr. Ian Munro.
How ironic that of all people in this Legislature, the member for York South should suddenly be concerned because a procedure to be performed by Dr. Munro had to be cancelled. It is too bad that concern was not here six months ago when we were all concerned about Dr. Munro.
Now that Dr. Munro is going, an unlimited number of his present patients and patients who will need his services in the future are left in jeopardy. The Minister of Health says there will be other, equally competent doctors who will be able to take Dr. Munro's place and perform that craniofacial surgery.
I would like to take a minute to tell the members about the Mcleod children. When they were born, to use their mother's words, they had extremely gross faces. I have seen photographs of these children when they were born. Their eyes were at the sides of their faces, almost where ears should be, and one was up and one was down. They did not have mouths. Their brains were extruded through the tops of their skulls. They were so incredibly gross that they were covered up in their bassinets and put at the back of the nursery. That was where this mother found those children and she chose to adopt them.
The first operation on one of these babies was done in Winnipeg by someone who was supposedly a specialist in craniofacial surgery. At the time the operation was done, the child had full use of his limbs, and other than his appearance, was a totally well, normally functioning baby. After the surgery and to this date, this child is paralysed down one side of his body. The tragedy is not the failure of the surgeon, who with all good intent was trying to help the child. He did not have the skill or the experience of Dr. Ian Munro.
As always with craniofacial surgery, which involves operation on the brain, ophthalmic surgery and everything to do with the head, there is a tremendously high risk. In that case the surgery was not successful. However, that mother heard about a doctor, Dr. Ian Munro, who was a specialist in Ontario. For two and a half years she brought the children to Dr. Munro in Toronto. He performed all the subsequent operations, to the point where the mother can take those children out shopping and they are attending a regular public school. Their ages are four and six.
By the time they are teenagers, with progressive procedures by someone of Dr. Munro's skill, these children will have faces such that when they go into a room no one will take more notice of them than of anyone else in the room. The members will realize the concern about the impact of Bill 94 when we do not have any assurances today from our Minister of Health about the future of patients such as those in the Mcleod family. They will also recognize that these surgical procedures cannot be done in two years; they have to be timed with the physical growth and development of the children.
On May 2, the mother, Lori Mcleod, wrote a letter to the Minister of Health and he owes a reply to this mother before he passes Bill 94. Bill 94 is called the Health Care Accessibility Act. This mother wants to know, where will the health care be accessible for her children?
Perhaps I should say that back in February, Mrs. Mcleod had a meeting with the minister in his office and she purposely brought her two children with her. She has five children under the age of eight, three of whom she has adopted, including these children with gross deformities. The minister has had these children climbing over his knee in his office. I am sure he has the same difficulty I have in recalling how these children looked. When I think of the appearance of these children today, I am warmed in my heart and am full of admiration for the courage that young mother has had and what she has done so far for these children. Her letter says:
"Dear Mr. Elston:
"In light of Dr. Ian Munro's announcement last week, the silence from your office has been a source of great distress to craniofacial patients who will no longer have access to appropriate care in this country. We anxiously await reassurance from you in a public statement that the government of Ontario will commit to providing coverage as outlined in its own Health Insurance Act, regulation 452, section 56-66, for the cost incurred by families who now must travel outside Canada to obtain care. We anticipate your prompt response."
That letter was dated May 2. The Mcleod child, who is almost six, has had 48 operations. If a six-year-old has had 48 operations, it does not take much calculation to work out approximately how many operations per year that child is faced with. Now that Dr. Ian Munro is going to Dallas, there is a requirement for travel costs, accommodation costs while they are there, and furthermore, there is the cost for the balance of the family whom they have to leave at home in Mississauga while they seek the only medical surgical care for their children, which is in the United States.
8 a.m.
One can understand the level of anxiety that has accelerated. This letter is dated May 2. However, the question was first asked of the Minister of Health in February. The reason I bring this to your attention today, Mr. Speaker, is to emphasize that if this is an indication of accessibility to health care today without the passing of Bill 94, then we naturally have grave apprehension about what accessibility to health care will mean after today if that bill is passed. I have appreciated the opportunity to speak again on Bill 94. This is the second time I have spoken on this bill. As I think about what I said when I first spoke back in January, I was being optimistic then that at the very least, through a process of negotiation, we would have a Premier who would recognize that every person residing in Ontario has an equal right to health care. If the argument is that every resident in Ontario has this equal right, it would follow that every resident in Ontario has an equal right to be heard. On this issue, it is not only the doctors who have not been heard but it is also the patients who have chosen to go to a doctor of their choice who have not been heard.
It is interesting when we hear how demoralizing it will be for people to have some coded identity to make them eligible to go to a doctor who extra bills. First, when only five per cent extra bill, we can appreciate how few patients that will involve.
I recognize it is eight o'clock in the morning and there are not a great number of us here, although some of us have been here since 12 o'clock last night. As we sit here this morning, I challenge that there is not a member in this Legislature who does not like to shop for a bargain. When one goes out shopping and one likes to bargain and barter, it is because one has appreciation for the value of what one receives. When seniors turn 65 -- indeed, when some of them are 60 -- they are eligible at some banks to have a banking privilege card. They do not feel at all embarrassed about applying for that privilege. They do not feel embarrassed about applying for their theatre tickets or airline tickets at a reduced cost because they are seniors.
It follows that they would not feel at all embarrassed about being identified as seniors and being eligible for the consideration the Ontario Medical Association is now willing to extend; i.e., that no patient over 65 years of age would be charged more than Ontario health insurance plan rates.
It is the same for the patients who have the Ontario drug benefit plan. It is no shame for them to want to benefit from a scheme which the Progressive Conservative Party introduced to the patients of Ontario for their benefit if they have that need for medication. How interesting it is that all the good things that have been done in the past, not only for seniors but also for people who have needed financial assistance, suddenly become demeaning. Suddenly, the New Democratic Party says, "It is demeaning to ask somebody to be identified as being in need."
The first time one ever gives out free transit tickets or a free transit pass to people on the street -- in Mississauga the seniors ride free and I have given out free transit tickets on promotion days for Mississauga Transit -- there is no embarrassment at all in people using the opportunity. The fact is, if they cannot afford it, it is an even greater joy that they have this opportunity. I want to tell the members that when we talk about the choices of people --
The Acting Speaker: Order. May I remind the honourable member that she must direct her remarks towards the third reading of the bill. The principles were discussed at the second reading.
Mrs. Marland: There is no need for the third reading of the bill to take place, because when the bill was introduced in the Legislature this list of concessions from the OMA had not been provided. I will simply close my comments by referring members of the Legislature to this list of concessions by the OMA, and ask the Minister of Health to furnish me with the list of concessions that have been made by the Ontario government in the interest of the health care of the people of Ontario.
Mr. Foulds: After listening to the lengthy remarks of the previous honourable member, I am struck by the phrase that logic is a stranger to her mind. She said during the course of her speech, "How would teachers or plumbers like it if they were treated like the doctors?"
I do not know of any teacher who, after his union negotiates a contract with the board of education and that agreement is signed, when he gets a child with a learning disability in his class, can then go to that child's family to say: "Your kid takes a bit more time. Your child has a learning disability and I have to spend extra time working with that child. I am going to charge you five bucks an hour more per lesson." Nonsense.
I do not know of any plumber who, after coming to an agreement through his union in the collective bargaining sense, after setting the hourly rate, can then go to his boss and say, "I want to charge $5 an hour extra for the hour between midnight and 1 a.m." They either negotiate that in the agreement ahead of time, or it is not there. The parallelism is weak, to say the least.
I would like to know who is putting the patients at risk. Who is withdrawing services from the emergency wards? Who moved from Toronto to the US so that the case the member pointed out has to go to the US? Was it the government that moved? Was it the health care scheme that moved? No, it was the doctors. This bill is about responsibility. The responsibility has to be that of the medical profession. If they are failing to provide the services that one wants, then the responsibility should be put right where it belongs: on the individual who makes the decision to move or to withdraw services.
8:10 a.m.
Mr. Wildman: I listened to the member for Mississauga South (Mrs. Marland). She talked at length about concessions that doctors were willing to make. She mentioned that doctors have said repeatedly they would not extra bill seniors or welfare recipients. That is basically talking about charity medicine, which puts the patient in the demeaning position of having to explain to the doctor that he or she cannot afford to pay, and puts the doctor in the invidious position of having to determine the financial situation of his patient before determining how to bill that patient. This is completely unacceptable in 1986. I find it extremely unpleasant to have to listen in this debate in the 1980s to arguments that we have heard since the early 1940s.
Even if we were willing to accept these so-called concessions from the medical profession, perhaps the member could explain how on earth that would meet the requirements of the Canada Health Act. How on earth does a promise not to extra bill seniors and welfare recipients deal with the federal legislation, which is administered by the federal Conservative government and states that there cannot be extra billing or this province will lose the funding that is transferred from the federal government to the provinces to assist in the health care system? How does that so-called concession meet the requirements of the federal legislation?
Mrs. Marland: It is always interesting to hear the debate about plumbers versus doctors in the context in which the member just referred to it. In fact, the doctor who goes out on a night call receives less than the plumber who goes out on a night call. I use a night call because that is usually the most expensive rate.
To answer the question about Dr. Ian Munro's move, I will tell the member that one of the main reasons Dr. Ian Munro has moved is that he knows how many patients he is capable of helping. If he saw his patients -- I have tried to describe only two of them, but there are hundreds -- he would recognize that, with the kind of success he has, he wants to help as many as he can because his surgery means --
Interjections.
Mrs. Marland: The member asked me a question. Why does he not do me the courtesy of listening to the answer?
His surgery is a matter of giving a child an opportunity to live normally and not be institutionalized. The reason he is leaving is that in Toronto he is allowed to operate from nine o'clock in the morning until one o'clock in the afternoon, and that man wants to work 12 hours a day. The reason he cannot work more than four hours a day is that there are no surgical beds available.
With regard to the eligibility for assistance being demeaning, it is funny. The members do not even listen, because when I was talking about demeaning I was saying it is not demeaning to get a special bank rate or a senior's pass. It is funny that when one talks about the Canada Health Act, as soon as the New Democrats lose the argument, they fall back on how one deals with the Canada Health Act. I will tell the members that one deals with the Canada Health Act by negotiation.
Ms. Gigantes: I am not going to fall back on the Canada Health Act. I will try to address my remarks to the principle of this bill and to the issues that have surrounded it in our discussions during the past many months and years.
Just in passing, I am sure my colleague the member for Nickel Belt (Mr. Laughren), who listened to the first speech by the member for Mississauga South (Mrs. Marland) and who was here through many of the hours she has spent in this Legislature, would have been very sorry to have missed her second speech. I know the depth of his admiration for the member for Mississauga South. However, I also feel a bit glad in my heart that he was not here. I know he would have been disappointed by many of the things she said.
Where do we start to deal with these many issues? It has been said time and again by the doctors and by the Conservatives that this bill involves far more than extra billing. This is true, because extra billing in itself is a threat to the system of public health insurance that we have. Therefore, any discussion of extra billing involves a discussion of the very principles of public health insurance. It involves a discussion of access to medical services by all those people who have to look in their wallets or think about their bank accounts before they seek a certain type of service.
The member for Mississauga South has repeated many of the notions the doctors and other members of her party have raised during the very intense discussions we have had over the past few weeks about the principles involved in this bill. She talks plaintively about the government's unwillingness to negotiate. It may seem a little unkind of me, but it is precisely the government's willingness to negotiate on the principle of this legislation that has disturbed me most over the past several weeks and months.
It seemed to me at various points over the past weeks and months that the Liberals were looking for any way they could to get away from dealing with this matter in Bill 94. As a member of this Legislature and as a representative of people who care intensely about public health and public health insurance in this province and in this country, I was quite frightened that the Liberals were going to sell out. There were many indications that it might happen. We had a period of months where time after time we were told by the leaders of this government that they were negotiating with the doctors.
There is nothing to negotiate when it comes to extra billing. There are only two things involved to talk about; one is extra billing and the other is not extra billing. If we have made up our minds that there shall not be extra billing, there is nothing to discuss.
We see what we come to when we discuss the matter of not extra billing. We come to what the member for Mississauga South calls the "concessions" of the Ontario Medical Association. She is quite correct in calling them concessions because they come from people who have the power to concede. It is the rest of us, the nondoctors, the nonmedical divinities of this province, who are the beggars, the applicants and the supplicants in this balance. We seek medical services. They decide what medical services we get, when we get them, where we get them, and up till now they have decided how much we pay for them.
There is nothing to negotiate, and the government has been mistaken in going through this business of so-called negotiation of a nonnegotiable item. If we believe in the public health insurance system and if we believe that people have a right to medical service even if they do not have money, then there is nothing to negotiate when it comes to the question of extra billing. We shall have no extra billing and it is not negotiable.
Interjections.
Mr. McClellan: On a point of order, Mr. Speaker: The member for York West (Mr. Leluk) said my colleague's remarks had something to do with Nazi Germany. I would ask you to instruct him to withdraw those remarks.
Hon. Mr. Riddell: Come on; be a man.
The Acting Speaker: Will the member for York West use terms that may not be possibly offensive?
Mr. Leluk: Mr. Speaker, I withdraw my remark.
Ms. Gigantes: I had not even heard the remark so it did not bother me. I did, however, hear the remark of the Minister of Agriculture and Food (Mr. Riddell), who challenged the member who has withdrawn his remark to stand up and be a man. I consider that a little outrageous.
8:20 a.m.
The Acting Speaker: I remind the member that her remarks should be on the bill as accepted or not accepted.
Ms. Gigantes: The principle is either accepted or not accepted.
The Acting Speaker: The principle has already been accepted on second reading.
Ms. Gigantes: I am proud and pleased to be part of a caucus that has fought for the principle embodied in this bill, not only in its present form but also in its previous forms. Through decades, members of this party who have been elected as representatives, who have run as candidates and who have been volunteers have fought for this principle. We are proud and pleased to be able to support it today in the form in which we find it in Bill 94, with the Liberal government finally willing to go down the line and give it support.
When the member for Mississauga South talked about how she had little sense of people feeling demeaned when she handed out public transit tickets in the fair riding of Mississauga South, the image of Lady Bountiful came regretfully to mind.
Mrs. Marland: On a point of personal privilege, Mr. Speaker: I ask the member for Ottawa Centre to withdraw her comments which are a personal assassination of me.
Ms. Gigantes: I think Lady Bountiful is well known --
The Acting Speaker: Order. Will the member for Mississauga South repeat her comment?
Mrs. Marland: The member for Ottawa Centre made an outright personal slur when she accused me of standing and giving out transit tickets in Mississauga as Lady Bountiful. If she would like to ask me how that was done and why, I will be happy to explain it to her, but if she wants to be as ignorant as she is in making that slur, I do not even wish to discuss it with her. Mr. Speaker, you should ask her to withdraw that comment.
Ms. Gigantes: I meant no personal slur. If the member for Mississauga South considers it a personal slur, I will be happy to remove those words and have them stricken from the record.
The Acting Speaker: You say that you are happy to remove them.
Ms. Gigantes: I certainly am, Mr. Speaker. I intend no personal slur. It was the thought of the member for Mississauga South standing in the transit stations of Mississauga South and handing out public transit tickets to the residents of Mississauga South and finding that none of them was demeaned by this charity -- and she stressed that -- it was the thought that none of our poor people in this province who are forced to depend on government subsidies for income should feel demeaned if they get a special ticket saying they should not be extra billed by doctors, and that none of our senior citizens should feel demeaned in that way when they reach the age of 65 and are entitled under our laws and programs to certain benefits that people under 65 do not have as a matter of right.
I think she fails to understand that part of the pride of senior citizens has do with the fact that all senior citizens, whether rich or poor, once they reach the age of 65 are entitled to programs and benefits that are universal. Therefore, no senior citizen feels demeaned in receiving those benefits. I often meet senior citizens who say to me: "I have lots of money. I do not need these benefits." I say to them: "Take them. Do what you will with them. Give them to the charity of your choice. Support programs that do not have government support, but do take them, because that ensures that every senior citizen feels entitled as a matter of right."
That is a very different thing from being given a special card by concession from the OMA to go and get medical treatment which is not extra billed.
When we talk about private enterprise, socialist medicine and that kind of notion, I want the member for Mississauga South to think about what a private enterprise medicine system looks like. She talks about the great concern this government is going to have to limit the number of doctors who will practise in this province. Let me point out to her that the number of doctors who practise in this province is a monopoly.
The government has licensed a number of individuals who make up that group to be self-regulating and to practise medicine in this province. They constitute a monopoly of medical service provided by physicians in this province. To decrease the number of individuals involved in that profession would increase the amount of fees they could expect to charge. It would increase their incomes.
I do not think she understands that the medical profession is a monopoly. Under our so-called socialized medicine here in Ontario, this monopoly provides services where it wants, when it wants and to whom it wants. The doctors choose how many patients they see, what services are provided and what lab tests are run within a monopoly situation. The members of our medical profession have enormous freedom.
The member raised the spectre of controls on doctors' services, on lab tests, on the location of medical services and the locations where doctors have to practise, as in British Columbia. She talks about that as one of the awful outcomes of socialized medicine, as though Bill Bennett, who instituted all these practices, was similar to Fidel Castro. She compared the two jurisdictions of Cuba and British Columbia and she seemed to suggest to the observant listener that the kind of political regime which has brought about all those features of the practice of medicine that she does not like in BC was akin to socialist Cuba.
I wonder whether she would have voted for the New Democratic Party so that the Social Credit Party would not bring in these kinds of --
The Acting Speaker: Please address your remarks towards third reading of the bill.
Ms. Gigantes: All these issues surround the matter of extra billing. They always do, they always have and they always will, because extra billing is at the heart of public health insurance. The monopoly we have in Ontario in terms of medical practitioners is a monopoly that is free to practise as it wishes. That monopoly is assured payment by the government of Ontario, and the payment has been most generous.
8:30 a.m.
We know our physicians are hardworking and very talented and we know many of them are extremely dedicated, but it is important for the member for Mississauga South and other members of her party to remember that in the past year the average income for a general practitioner in Ontario was $105,000, once the cost of overheads for the office, the receptionist, the nurse and so on was taken out. The average net income for a specialist was $165,000. They are not starving. They work hard for their money.
Mrs. Marland: Thank you for that concession.
Ms. Gigantes: But they are not starving, nor will they starve.
Mr. Villeneuve: Nobody said they were.
Ms. Gigantes: One of the problems from the physician's point of view is that he has to decide who he treats, and how many patients he treats, each day, each week, each month. That, of course, governs the income, because we pay our physicians on a fee-for-service basis.
Any time the physicians of Ontario want to propose that they be put on salary so that they can spend as much time as they want with their patients, I am sure a government in Ontario would be willing to sit down and negotiate that. That might be a negotiable item.
Interjections.
The Acting Speaker: I cannot hear anything. I just cannot. Would the members please refrain from interjecting?
Ms. Gigantes: Thank you, Mr. Speaker. You are sitting near the wrong group; that is the problem, but I will repeat myself for your benefit.
I was saying that any time the physicians of Ontario decide they want to devote as much time to each patient as they can -- that instead of spending 15 or 25 minutes with the average patient, they want to spend 45 minutes -- they could make a proposal to the government of Ontario. They could propose that instead of being on a fee-for-service basis, they be put on salary.
If they wished to propose that they be put on salary, I am sure any reasonable government would be glad to discuss the matter. This is a negotiable item within a public health insurance scheme. However, that is not the cry we hear from the doctors, and it is not the cry we hear from the member for Mississauga South or her colleagues. The cry we hear from them is that if doctors are going to spend enough time with their patients, they have to extra bill, because the fee schedule -- the negotiated contract of payment for service provided -- is not high enough.
If the doctors want to negotiate around that, any reasonable government is going to listen. Perhaps the member for Mississauga South might encourage the members of her party and of the Ontario Medical Association to consider that kind of proposition, but I doubt that we are going to hear that kind of suggestion from her.
Time is money, and the doctors of Ontario understand that very well. The time, however, involves our money, and we have set up a fee schedule which was negotiated with the doctors. If the doctors want to have a different way of getting paid, they should suggest it.
I find it extremely surprising that a person such as the member for Mississauga South, a woman, should suggest that extra billing is not a problem. She must know that most gynaecologists in Ontario extra bill. And whereas that will not be a great concern to most members of this House except in their relationships with women in this province -- it should be a concern to her.
For her, for me and for the other women of this province, if you have to see a gynaecologist, you usually have to check your bank account or your purse first. That is a major problem; gynaecologists, anaesthesiologists -- there are whole communities in this province where all the medical services are provided only on an extra-billed basis.
We heard the member for Mississauga South saying that she has never heard of anybody dying from extra billing. How does she know? How does she know which people have not gone at some time to which doctors because they were afraid of being extra charged? How does she know which people could not get an operation because they did not have the up-front money for the anaesthesiologist? How does one prove a negative? She is being naïve.
This bill does call into question all the philosophical matters that surround the issue of public health insurance and our medicare system. When we compare both service and cost to that of the American system, we thank our lucky stars that Tommy Douglas introduced public health insurance to this country when he did; that his absolute conviction allowed us to put into practice a system which has so well proven its benefits for the public of Canada that every government, including the Progressive Conservative government of Ontario under Premier Robarts, had to accept it. It was politically expedient.
Mr. Robarts, who liked to be called Prime Minister Robarts, said that medicare would come to Ontario over his dead body. He said it was a machiavellian plot. He gave in to that machiavellian plot. He gave in to it and lived to tell the story because it was politically expedient. That is what political expedience means. It means that the public has become so convinced of the benefits of our health insurance scheme that it will not let go. Nor will it allow extra billing to continue. I am proud and pleased to join other members of this Legislature in supporting the passage of Bill 94.
Mr. Speaker: Are there comments or questions for the member for Ottawa Centre?
Mrs. Marland: I am certainly glad that I had not slipped away for my rest because I would not have wanted to miss the dissertation of the member for Ottawa Centre. It was like listening to Alice in Wonderland. When the member for Ottawa Centre asks why we should ask people to be identified for eligibility to these various plans, I have to ask her if she is not in favour of a plan like the Ontario drug benefit plan. Does she think that we should all have free drugs? We can all have free everything. We can have absolutely free anything and everything that we are willing to put on the taxpayers of this province. As a responsible parliamentarian, I am not willing to give out everything free to everybody because there is absolutely no proof that system works.
I lived in England when health care was introduced. I lived in England when everything was free as far as dentistry and eye examinations and glasses were concerned. Even in England, they decided that the system was not working and they started having a user-pay system.
Mr. Morin-Strom: On a point of order: Is there not a two-minute limit on questions and comments? I do not see the clock running and I am sure the member is well over two minutes by now.
Mr. Cureatz: On a point of order, Mr. Speaker: It is only appropriate that you add on the appropriate number of seconds already used up by the member who called the point of order.
8:40 a.m.
Mr. Speaker: I thank the member for his advice. We are having a little trouble with the clock but I am sure we will come close to the two minutes.
Mrs. Marland: I was very interested to hear the member for Ottawa Centre talk about the rates of incomes. I realize that from time to time the rates of incomes vis-à-vis the costs of overhead are published and every time they are published, they are different figures. I wonder whether the member for Ottawa Centre has considered the figures, for example, of a Toronto Transit Commission driver who, this past year, with very little overtime, could very easily earn $66,000. Indeed, a friend of ours in that category did.
Mr. Speaker: The member's time has expired.
Mrs. Marland: I hardly think so, Mr. Speaker. The clock has just gone on.
Mr. Speaker: To compromise, we will give the honourable member 48 seconds more.
Mrs. Marland: When we compare incomes, we should also compare investments and education. There is a tremendous cost in education today and we know that to qualify people have invested anywhere upwards of $100,000. They have also invested seven or eight years without any income at all. When the member for Ottawa Centre talks about physicians wanting to be on salary versus fee-for-service payment, that is a very interesting question. She is quite right on one point, time is money, but if she wants the kind of medical care she is asking for, which is turnstile medicine, and if it were a matter of fees, then the member for Ottawa Centre would have 88 per cent of the opted-in doctors --
Mr. Speaker: The member's time has expired.
Hon. Mr. Nixon: I was glad to hear the remarks made by the honourable member, whose logic always burns with a gem-like flame. I am not sure we needed the clear re-enunciation of all of the crystal-clear reasons the doctors should not be allowed to extra bill, not that they do not bear reiteration and not that I do not agree with them. It seems, however, that we are approaching the end of that legal battle. We are just a few hours away from that.
Mr. Davis: We are just beginning.
Hon. Mr. Nixon: Probably that is my point. I wonder whether the honourable member would put her undoubted intellect to considering what happens next, perhaps broaden her appreciation of the humanity of the situation and perhaps even of the problem. There is not much sense lashing the doctors or lashing the people who disagree with this bill, because the bill is about to become law. His Honour the Lieutenant Governor will be in here within four hours and without doubt it will become law.
How can we adjust ourselves to understand the outrage of the medical profession? I do not understand it. I might as well make that clear. I have read everything that has been said. The bill is about to become law. I do not think we are going to gain much more by lashing the doctors or anybody else with how wrong their position is, because the law is about to become the law.
It is necessary for members, such as the honourable member for Ottawa Centre, who has lots of brains, to give us the benefit of their views. Is it just to put our foot on their necks? What comes next?
Mr. Morin-Strom: I would like to comment on one of the issues brought up by the member for Ottawa Centre, on whether doctors should go on salary. The comments by the member on that issue were made in response to some interjections during her excellent address. The issue of doctors on salary is a good one and perhaps it is a situation we should look at more closely.
In Sault Ste. Marie, we have an excellent example of many doctors on salary at the Group Health Centre. Perhaps that alternative health care model should be looked at in the future of this province.
The Group Health Centre in the Sault has about 40 doctors on salary. It was established in the late 1950s as a very innovative institution by the United Steelworkers of America. It is a health centre which anyone in Sault Ste. Marie and area can join voluntarily. No one was forced to join, but it had such success that today nearly 50 per cent of the residents of Sault Ste. Marie have joined the centre and are getting quality health care from that operation. Certainly, in my own case, my family finds we get as good health care there as we would get anywhere in this province.
I commend that as an excellent example of an alternative mode of health care that we should encourage in Ontario. It is a case where the doctors voluntarily have accepted the fact they are going to be on salary in that operation. It has turned out to be a tremendous institution, a leader in this province in the health care that we are providing our residents here.
Mr. Speaker: I believe that is all the time. The member for Ottawa Centre has up to two minutes to respond.
Ms. Gigantes: I am sorry the member for Mississauga South left before I could answer her questions.
Mrs. Marland: Oh no, I am here.
Ms. Gigantes: Oh, I hear her. Perhaps some time we should sit down and have a chat about the meaning of a progressive tax system and what, if used properly, it could do to enrich the public health system we have in Ontario.
To the Treasurer (Mr. Nixon), whose comments I appreciate as always, I suggest he reread the transcript of my remarks. He will find I made very many statements which thanked and acknowledged the work of the doctors in this province. I did not in any sense feel I was lashing the doctors nor do I feel this bill is lashing the doctors.
He asked innocently, as always, what we should be doing now and why doctors are so distressed. I tried to address that in my remarks by suggesting that time is money and a doctor who wants to spend a longer time with a patient can do that and still make lots of money if he extra bills. There may be an alternative which the medical profession would prefer. That is why I suggested that, if they are concerned about the amount of time they spend with patients, they should look seriously at salaried physicians in Ontario as opposed to fee-for-service physicians. I am sure he will want to take that under consideration too, though I am sure he would rather it came as a proposal from the doctors of Ontario, with whom the Liberals so much enjoy negotiating.
Mr. Barlow: I really wish it had not come to this day when we have to stand up and once more try to convince members of this House of the necessity of not voting for third reading.
Mr. Wildman: If the member does not feel like doing it, he should not.
Mr. Barlow: I did not say I do not feel like doing it. I said I wish I did not have to. Members of the Progressive Conservative Party were spontaneous in their response when this bill -- which was formerly called accessibility to medical care or whatever it was called before; it has a new name now -- was introduced. It struck us all exactly the same way. It is something that will throw the medical system in Ontario into chaos. That is exactly what has happened.
The people in Cambridge who have called and come into my office have trouble understanding. They understand there is a "we" and a "they" in this situation. There are the doctors standing up for what they believe is right and opposing what they believe is totally wrong. This is a position I and the members in my party have taken, that this is totally wrong. People come to me and ask: "Why are you fighting it? Why are the two socialist parties in the Legislature sponsoring this bill?"
Mr. Wildman: Two?
8:50 a.m.
Mr. Barlow: Yes, the socialists and the Liberal socialists. I would like to try to explain to them. As a matter of fact, I had an interview lined up today with one of the local newspapers which, of course, I had to cancel because of the timing, and being here to support what I feel is the right position in this matter.
The government does not understand that the doctors are not fighting on a money issue. As we know, most of the doctors who are opposing this bill are not opted-out doctors. Most of them are doctors who operate within the medical system and accept the Ontario health insurance plan fee for service. The government does not understand why those doctors are concerned and oppose this bill.
People have to realize the doctors hear about this $50 million, which is an amount that nobody is able to prove, or has even attempted to prove. That is not an accurate figure. It may be that much, it may be less, it may be more. It is a figure somebody has pulled out of the air that Ontario is not receiving until such time as the doctors cease the extra billing.
They do not understand the government has proposed some form -- and we do not know yet what it is -- of excellence fund to reward doctors who are the most skilled in their profession, such as specialists in their various fields of practice. Who knows how much that is going to cost. It will probably cost 50 per cent, 100 per cent or 500 per cent more. Nobody knows how much more it will cost to install, to implement this so-called excellence fund to reward certain doctors for their particular skills.
As far as the $50 million is concerned, if that is what the debate was about, and is the reason for the implementation or introduction of this bill in the first place, it is going to prove to be peanuts. The Treasurer, who has now left, is really going to have a problem trying to balance the financial books once the excellence fund is introduced.
Once again, it will come down from on high with no negotiation, no discussion with the doctors. For all of this period of time the doctors have been trying to negotiate. They wanted to talk to the ministers. They have asked for this bill to be withdrawn so they could sit down and talk.
Mr. Wildman: They can talk without it being withdrawn.
Mr. Barlow: They have lost faith in the government. The government would not negotiate meaningfully all throughout the hearings. Why should they have any trust in the government? They simply say, "Withdraw and let us negotiate."
On I do not know how many occasions in the past few weeks, our leader has proposed calling in a mediator. On many occasions yesterday several of our members proposed calling in a mediator. That will end the strike. That will end the chaos we have that the government and the New Democratic Party have caused in this medical system. It will end the chaos if a mediator is called in and they can sit down and talk.
It has been pointed out several times that the medical profession has offered on different occasions not to bill people over 65, those on any sort of assistance from the government and those in hospitals in an emergency situation. The member for Mississauga South (Mrs. Marland), read out the list of concessions that the Ontario Medical Association offered.
In the past two or three weeks while this debate has been going on, I have received many requests and phone calls in my office. Most of them support the doctors' position, the position that our party is taking on this, and not by a whip vote by any stretch of the imagination. It is a matter, as I said before, about which we feel very conscientious.
A total of 12 phone calls came into my office yesterday. They were all in support of the doctors' position, in support of the position that we, as the Progressive Conservatives, are taking. None were against that position.
On Wednesday the phone calls were seven to one; seven supported the doctors' position and one opposed it. On Tuesday it was two and two. On Monday the count was eight and two. Without question, the people who are phoning in or taking time to write letters to my office are supporting the doctors' position and opposing the bill.
Mr. McClellan: Careful. Remember what happened to Pinocchio.
Mr. Barlow: I have the letters here, and the ones that came into my office are all circled in red. The doctors' position in this matter is supported. People are supporting not so much the doctors' position as the health care system we have in place.
One letter that I have not seen yet but that my constituency assistant has read to me over the phone came from Susan Bardwell of Cambridge:
"I am writing to voice my disappointment over Bill 94. I feel that if this bill is passed, it will drive our medical system into state medicine. Who will the government try to control next: the lawyers, the dentists, the pharmacists" -- it has already gone after the pharmacists -- "or just anyone in private enterprise?"
I really feel some members on the government side of the House still believe in private enterprise. I am looking in particular at the Minister of Agriculture and Food (Mr. Riddell and at the Minister of Industry, Trade and Technology (Mr. O'Neil).
"The Liberals and their NDP partners do not tell plumbers at $24 an hour how much they can earn. I can reach my family doctor, and I can get better and quicker service from him than I can from any plumber that I know, and it will cost me less for my doctor's services."
This is one letter that just came into the office in the last day or so.
Hon. Mr. Riddells: Signed by the wife of a doctor.
Mr. Barlow: No, we have no Dr. Bardwell in our town. It is not Barlow; it is Bardwell, by the way.
I also have one here from Freida Schaaf. It is a very simple note, five handwritten lines:
"I just want to voice my opinion that doctors should be allowed to extra bill if they want to. We are supposed to be a free people and country. At the rate Mr. Peterson is going, we won't be a free people in a very short time."
I have another letter on company letterhead. It came from the general manager of Glengarry Industries, Mr. Szczucinski. I have blocked out two paragraphs here. This, incidentally, is a copy of a letter to the Minister of Health (Mr. Elston): "This proposed legislation is entirely repugnant to those who value the free enterprise system, extremely regressive to those who are concerned with the attrition of the health care system in Ontario and completely revolting to those affiliated to the medical profession."
This is not from a medical practitioner. It is from the general manager of a manufacturing plant.
I have one from Lenore Ridsdale that is addressed to me:
"My opinion is that the doctors should be allowed to extra bill. Have you considered the time and money they put in to become doctors and the extra years to become a specialist? We do not want our medical care system to become as England's, where they decide what doctor you will go to and wait, as a friend of ours had to, for a year to have a back operation. Why have you not been concerned about the lawyers and dentists" -- as we say, they may be next -- "who seem to be able to charge whatever they wish to?"
I have another here from Peter Worden. This is to me: "I fully agree with the Association of Independent Physicians of Ontario in their request that there be a full public inquiry into the health care in Ontario before any new legislation regarding extra billing is passed."
Peter Worden feels we should check into the total health care system, and he is right. This is why our party had a task force looking at all the health care provisions throughout Ontario as a package. Do not simply bring in legislation that will remove extra billing.
I have another letter here that I want to read into the record from Catherine Luce. She happens to be the daughter of the lady and the gentleman who sent the apple plastic bag over from Britain. She wrote to me and said:
9 a.m.
"We are already the victims at the mercy of the postal unions, public servants and other government-controlled services. Please do not allow our doctors to be controlled by the government too. They are medical professionals, not government employees." Yvonne Suffel writes a similar letter. These letters go on, and I may take the opportunity to read one or two of them as I go on here.
The points I have been wanting and trying to make on this matter are those on which I feel the majority of people in Ontario now have the same opinion. They have the opinion that doctors should be free to negotiate with their patients as to where and when services should be performed.
If a few of the doctors are charging a little bit extra to some people -- they are not charging everyone, as we know -- those who are opted out and wish to so remain would be glad to sit down and talk to any of their patients who feel they cannot afford the extra funds, whether or not they fall in the three categories the doctors have proposed. Our party had proposed an amendment on the same basis, which was rejected by both the Liberals and the New Democrats.
The people of Ontario should be able to have consultations with their doctors. If there is a fee for the service, fine. If they can afford it, they shall pay it, as they have in the past. There probably could be a few incidents. The member for Essex North (Mr. Hayes) brought in a letter from someone who had a particular hardship. I suppose the doctor could have been approached ahead of time and the patient not overcharged.
When I spoke on this bill on second reading, I mentioned a very personal case, that of our own daughter, who at age 23 had to visit a gynaecologist and have surgery for cancer. That was in Cambridge. She had her first operation, and she was not extra billed. When the time came for her second operation two weeks later, she had to go to a specialist in Toronto. The doctor said: "I do not charge within the OHIP schedule. I do have an extra fee, and I wanted to discuss that with you prior to your surgery."
The extra fee was something like $300, and $300 for a life is not very much money, so there was no question in the world. There was no problem. We were able to pay that. There are many people who would be in a different position and would be unable to pay it, but I know that doctor sat down with my daughter -- actually, my wife and I were there at the time -- and told us in advance about this extra fee. This doctor did not know who I was. As far as the doctor knew, I was just someone from Cambridge.
Doctors are human beings, and we want them to continue being human beings. There are those who want to continue to have the freedom to extra bill. I was talking to someone in that category, who does extra bill, on Monday of this week. He told me that when he sits down with a patient for consultation -- and he used a medical term I did not understand -- he is allowed to bill for $45, according to the OHIP fee schedule. He said: "That is ridiculous. I do not need $45 to talk to that person. I charge him $22.50 for a different consultation" -- it has a different name -- "and collect $2.50 from him. It saves the system money. However, if this bill goes through, I am not going to be saving the system money."
This doctor told me his annual income is one third less than the annual income of those who do bill and will be permitted to bill at the higher levels for their consultation work.
There is no question about it. We are not saving people in Ontario money by bringing in this legislation. People have to know this sort of information. It has to be brought out to them, to know what the government is doing with the support of their friends to my left. It is destroying a system we have in place and people have confidence in. The people are able to relate to their own family physician, whether he charges $2 for an examination in a clinic or whether it is in and out with no charge whatsoever.
There are some specialties where it is difficult to get an opted-in physician. However, we have been told by the OMA that there will always be an opted-in physician available to talk to people and to consult with them at no extra cost.
Mr. Wildman: Trust the OMA.
Mr. Barlow: The people of Ontario are being asked to trust my friend's party and the government party. Many members of his party are going to find it very difficult, and I am sure are going to choke, when they stand up to be counted later in the day as we vote on third reading of this bill. Many will have to go back to their ridings and explain to their people why they voted that way and why they brought in the hammer on the legislation, completely ignoring the democratic process of this and other parliaments. They will have to explain why they brought down the guillotine and said: "We are going to do this. We want it. We are sick and tired to talking to the people of Ontario."
Perhaps now the Minister of Health can sit down and start responding to the letters that have been written to him asking for an explanation. The Premier can also start answering his mail now. He can say: "Here we are. We are happy and free. We have no extra billing in this province any more. We do not have doctors working. They are still on strike, and they have accelerated their strike because this has been brought in. We do not want to talk to the doctors at all."
Mr. Mancini: You have encouraged them.
Mr. Barlow: The parliamentary assistant to the Premier can start answering the letters. I cannot see that. I have never seen that article. The member can send it over.
I still say it is not too late for this government to wake up and call in a mediator. It might be too late for them to wake up, but it is not too late for them to call in a mediator. They can ask a mediator to come in, and the doctors will be back at work about five minutes after that. The hospital emergency wards will no longer be closed in many areas. The whole medical system will no longer be threatened.
If this legislation goes through, and as long as it is on the books, it is going to threaten the total medical system in Ontario because nobody in the medical system will have any trust in this government at any time.
Hon. Mr. Riddell: The member does not believe that.
Mr. Barlow: I believe that with all my heart. I am going to end on this note. When I sit down, I will know I tried to convince the Minister of Agriculture and Food and every other minister and member of the government party. I am not going to try to convince the people on the left -- they have been preaching this and singing this song for too long -- but I am going to try to convince some of the people on the government side.
Mr. Wiseman: They are not very reasonable over there.
Mr. Barlow: They used to be a reasonable bunch of people, but to be appointed to power they had to bring in this legislation. Most of them will have to say, "Gosh, I never believed it in the past, but now, all of a sudden, it is a good thing because it is politically expedient to vote for it."
I ask some of the members on the government side to join us -- we will have one member from that side joining us -- to defeat this legislation on third reading.
9:10 a.m.
Mr. Wildman: I have a couple of questions for the member for Cambridge. He talked a great deal about political expediency. At the same time, he tried to argue that the bill we are debating on third reading is somehow unpopular.
He indicated that members of the Liberal Party will have to go back to their ridings and explain to their people why they passed it. Can the member please explain how these two elements of his speech fit together? How can it be politically expedient to do this if it is unpopular? If it is unpopular, it does not seem politically expedient to do it, because all that is going to happen is the government will become unpopular. It seems to me that if it is politically expedient, it must be a popular measure.
The member indicated he had received a lot of letters and phone calls about this issue. I have received the sum total of eight letters in all the months we have been discussing it. Three of them were from doctors who were opposed to the legislation, two were from members of the public who were opposed to the legislation and three were in favour of the legislation.
I have also received the sum total of five phone calls about this issue, three of which were in favour of the legislation and two opposed. One of the people phoned me at the behest of his doctor. He said: "You are right on. Keep it up. I do not agree with the doctors." I think this is a very popular measure, and I am glad we are finally bringing in the bill.
Mr. Barlow: I wish to respond to the member for Algoma (Mr. Wildman). I want it to be very clear that when I talked about political expediency, I said that to gain power, it was politically expedient for the Liberals to join with his party to ban extra billing. That was the only point I was trying to make, and I stick by it. There is no question about it. Without that, the third party might have joined us. God forbid, I do not know what we would have done then.
Mr. Sheppard: I have a couple of points I want to read into the record this morning in regard to the discussion on third reading of this bill. I have listened with a lot of interest since around five o'clock this morning. I must say it was a beautiful morning at five o'clock, and I am glad to see there are so many in the House this morning.
I am glad the debate on this bill is coming to an end at last, because the other parties would not listen to the advice of our leader asking them to appoint a mediator to have this doctors' strike come to an end. Our leader was not asking for a lot, just to get the strike over with.
I want to read into the record three items the OMA was asking for. I know they have already been read into the record, but I want to read them again. First, no patient over the age of 65 would be charged more than the OHIP rate. Second, no patient receiving emergency treatment would be charged more than the OHIP rate. Third, no patient receiving financial assistance from the government would be charged more than the OHIP rate. I find those to be three very minor requests, and I see no reason why the Minister of Health (Mr. Elston) and the Premier (Mr. Peterson) did not sit down and negotiate to get this strike over.
People say doctors are overpaid. I want to relate one incident that happened in the great riding of Northumberland last May when four people from Maine were killed. Dr. Scott from Cobourg was called out at 10:30 in the evening. He went to the Hospital for Sick Children in Toronto with two brothers. He did not get back until the next morning at 7:30. The four people from Maine who were killed did not have any hospitalization and did not have insurance coverage so Dr. Scott could be paid. He did not receive one red cent for being out from 10:30 in the evening until 7:30 in the morning. Nobody read that in the paper. Probably only a very few up until now knew anything about Dr. Scott giving his free time to two brothers from Maine.
In the great riding of Northumberland, no doctors extra bill. They are not concerned about the money. They are concerned about the principle that this government and the loyal opposition on my left are taking. I sometimes wonder who is running the government. I have heard it is the member for York South (Mr. Rae) who is running the government, and I have heard it is the Premier.
I want the record to show that the Conservative Party still has more seats than the government on that side or the government over here.
Here is a letter that was sent to me by Dr. Di Pasquale:
"I've had it up to here with all these doctors bickering about this extra billing. What's wrong with them anyway? If they'd all just lay low, then Rambo Peterson might even pass the legislation. If the feds can do it, why not Peterson? There's no monopoly on stupidity.
"The trouble is most doctors can't see past their idealistic noses. All this crazy talk about freedom versus government control and how efficient and costly the system would become.
"If the doctors would just clam up -- maybe showing some token resistance so Peterson won't catch on -- the next step would surely be the legislating of salaries for physicians. After all, what civil servant works piecemeal?
"Then we'd really have it made. We'd have five-day weeks and seven-hour days, complete with breaks and long lunches, paid holidays, pension plans and lot of other perks we just dream about now. And we'd be making more than we do now. There'd be no office expenses, just straight salary.
"There'd be no more problems with malpractice claims and high insurance costs either -- everyone knows you can't sue the government. Besides, the standard of medicare will be so low that anything will do.
"Of course, it will be tough getting time to actually see patients, what with the lunches and breaks, study times, seminars and just plain goofing off -- but, hey, we all have to make sacrifices.
"Besides, it will be a learning experience -- and boy do we have a lot to learn. Things like taking the phone off the hook an hour before quitting time: who needs an emergency when it's nearly time to go home?
"All in all, if we played it right, we could have the money without the commitment or responsibility. On the other hand, if you really wanted to practise medicine, there's always the States." That is the end of the letter.
Mr. Pouliot: Is that addressed to the member?
Mr. Sheppard: Listen. The member knows it is going to come back to haunt him some day, because he knows that when this bill passes, the medical profession is going to go downhill instead of our having the best medical service in the world right here in Ontario.
During the first two weeks in March, my wife and I were in Venezuela. I happened to be talking to a doctor there. He asked me where I was from, and I said, "I am from Ontario." He said: "I want to congratulate the doctors in Ontario. Ontario has the best doctors in the world, and we would love to have some specialists come to Venezuela to teach some of our younger doctors going into the medical field."
Mr. Wiseman: Do not say that too loudly. Some of them will move down there.
9:20 a.m.
Mr. Sheppard: I know some will move there, because they cannot stand what the Liberal government is doing to the medical profession here in Ontario.
When one member on that side of the House gets up and supports the Conservative Party on this side, the Liberals must know there is something wrong with their thinking in wanting to pass this bill at one o'clock today. I commend the member for Humber (Mr. Henderson) for the stand he has taken, because I know he must be getting a razzing from some of his colleagues, especially in the anteroom.
When the bill passes today, it will be just the beginning. My friend the member for Cambridge (Mr. Barlow) mentioned a few minutes ago that doctors will probably be legislated back to work. The Premier said no, but we will have to wait and see. Nevertheless, the doctors are the first, then it will be the lawyers and then the chiropractors, etc. I would like to know when the government is going to call Bill 54 and Bill 55, because the pharmacists in my riding are very concerned. They are afraid they will be dropped.
Mr. Speaker: Perhaps the member could wait until the next question period to ask that.
Mr. Sheppard: Thank you, Mr. Speaker. I will, if time permits. I will not ask it today.
I think the doctors are going to regroup when this bill passes today at one o'clock. They will regroup in a way similar to that of the Ontario Teachers' Federation. I wonder whether this party to my left will support it, because it supports the federation. What I mean by the doctors regrouping --
Mr. Hayes: The member is encouraging that, is he?
Mr. Sheppard: I have asked a couple of doctors this question: when a doctor gets out of medical school, why should he get the same money as a doctor with 25 years' experience? I think doctors will regroup and have a pay schedule that will be stronger than ever when they come back to negotiate with the government.
Interjections.
Mr. Speaker: Order.
Mr. Sheppard: I would like to congratulate the member for York Mills (Miss Stephenson) on the splendid way in which she, along with the member for Lincoln (Mr. Andrewes), put across our amendments. They have done an excellent job. I see our party has left some flowers on the desk of the member for York Mills. I am sure she will be in later to carry on to help our leader sum up the few remaining remarks before this bill is passed at one o'clock today.
I have had phone calls from doctors and patients in my riding for and against, but until now I have received a lot more than the member for Algoma (Mr. Wildman). I have received as many as 30 phone calls in one day; they were not all for the doctors and they were not all against, but I have received several phone calls. Patients in the riding of Northumberland are very concerned. Several of them said the sooner it is over, the better. All I can say is that I will be glad when the vote is over at one o'clock this afternoon.
Mr. McClellan: I want to ask the member, in regard to the burning question my friend the member for Scarborough Centre (Mr. Davis) raised, whether he knows what the Bible has to say about extra billing. I am looking at Acts, chapter 8, and the story of Simon the famous magician in Samaria who went to St. Peter to ask if he would sell him his gifts and his skills and his prophetic powers. This is what the Bible has to say about the religious equivalent of extra billing:
"And when Simon saw that through laying on of the apostles' hands the Holy Ghost was given, he offered them money, saying, Give me also this power, that on whomsoever I lay hands, he may receive the Holy Ghost. But Peter said unto him, Thy money perish with thee, because thou hast thought the gift of God may be purchased with money. Thou hast neither part nor lot in this matter....Repent therefore of this thy wickedness, and pray God, if perhaps the thought of thine heart may be forgiven thee. For I perceive that thou art in the gall of bitterness, and in the bond of iniquity."`
Are the Conservatives in the gall of bitterness or in the bond of iniquity?
Mr. Davis: To comment on the member's remarks which relate to my colleague's remarks just a second ago, if one is going to quote the Scriptures, one ought to be sure one knows what one is saying. He suggests it is gall and bitterness, but I suggest the essence of that little parable he read was that the gifts are free gifts from God.
Mr. McClellan: Which should not be sold for money.
Mr. Davis: It has very little to do with extra billing, but in free services of the doctors that are given to people there is an equality the member might like to look at.
Mr. Ward: I have one question of the member for Northumberland. I believe he may have made a factual error when he indicated that his party still has more seats than the government. I want to know whether he is counting Ottawa South and Cochrane South as one seat or two, because I understand the members are job sharing, and whether he is including Don Mills as an opposition seat.
Hon. Mr. Riddell: I have sat and listened to Conservative members stand up and read letters from people who support the doctors' cause. I have to remind my Tory friends that the people of Ontario sent 76 of the 125 members to this Legislature after the last election to bring about an end to extra billing. I fail to understand why the remaining Tories are prepared to jeopardize their positions in this House by speaking against public opinion. I do not understand that.
9:30 a.m.
sMr. Taylor: In response to these remarks, let me make it clear that extra billing was not an issue in my riding during the last election. Not a single doctor in my riding has opted out of OHIP. However, the doctors are now suffering a crisis of confidence in this government and in the system. They are concerned about that hidden agenda, and we are not talking money. We know money is not the issue. If one is in the plan, the rules about what one can bill are clear. The legislation is saying that if one is not in the plan, we give the freedom to opt out, but if one does so, one is still governed by the rules of that plan with respect to billing.
That is eliminating a marketplace for these professional services. They can see, down the road, that the policy of the New Democratic Party -- and it is open about it -- will ensure that doctors become salaried people and civil servants. The state will usurp the role of the physician with respect to the relationship between patient and doctor. There is that concern. What we see today is an expression by reasonable people of fear of what lies down the road. That is why it is important for the government not to be so adamant in its position and to invite a mediator.
Mr. Sheppard: The member for Wentworth North (Mr. Ward) wanted to know whether I knew how many members were in the House. All he has to do is look at the chart in front of him and he will realize the Conservative Party has two more seats than his party over there. I would ask him whether he can read or write. I am sure he can or he would not be here.
The Minister of Agriculture and Food (Mr. Riddell) wanted to know why I was reading the letter into the record. Perhaps he did not hear it, but that doctor was supporting the government, because he is going to make more money and have the weekends off when this bill passes today at 1 p.m. I suggest the Minister of Agriculture and Food should pick up Hansard and read what I read into the record from the letter I received from the doctor in my riding.
Ms. Caplan: I rise to enter this debate, which I believe is one of the most fundamental which will be facing this province and this country. Many things have been said and many of them eloquently, but they bear repeating.
It is my view that this should be a nonpartisan issue. When we speak of the principle, we must remember it was dealt with in 1984, unanimously, in the federal Parliament with the passing of the Canada Health Act. Before that, in 1962, this country made a fundamental decision to have medical care and facilities available to all of its citizens in a system whereby we had a partnership.
In this public system of medical care, the taxpayers have lived up to their commitment. In Ontario, the taxpayers have fulfilled that commitment with public hospitals, public research facilities, public institutions which educate and training facilities. All of those have been funded by taxpayers' dollars, given the commitment they made back in 1962, which was reaffirmed by unanimous vote in the federal Parliament in 1984.
That is when this principle was dealt with. What we are discussing now and have been discussing for the past year has not been that principle, because that was established. What we have been discussing for this past year is how to comply and conform with the law of the land, which penalizes those taxpayers who do not have the support of their Legislature to conform with the law of the land, and which says that for Ontario, that bill to the taxpayers is $1 million per week. As the members have heard from the Minister of Health (Mr. Elston) and from the other speakers who have spoken, that bill to date has risen to over $100 million. That could do a great deal to buoy up our medical facilities to give us even greater medical care.
The issue is not freedom. There are many freedom issues which can and should be discussed in the future: the freedom for a professional to practise where he or she likes; the freedom to prescribe and treat patients; the freedom to choose where that professional will practise; and the freedom to offer services to those whom that professional wishes to offer services.
This bill speaks only to the issue of compliance with the federal law of this land. I remind members that this law was unanimous in the federal Parliament.
Let us look at what we had prior to 1962. We had private insurance for those who could afford it; we had a welfare system for those who truly were in need and could not afford it; and we had bankruptcy for those who could not afford medical services, who did not have private insurance and who were not on welfare.
We moved away from that in 1962. We moved to a system where we said that everyone --
Mr. Andrewes: It is too early in the morning.
Ms. Caplan: It is early in the morning.
We moved to a system that said we did not want a system for the rich and a system for the poor. We did not want a system where people should have to face bankruptcy or embarrassment because they could not go for the treatment they required in their time of need. The taxpayers and the people of this province have lived up to that, and 30 per cent of our recent provincial budget is dedicated to health care. Almost $10 billion in this fiscal year will be committed to that system. That does not include the money going to our medical schools and our research and training facilities.
I support very strongly our medical professionals in their desire for freedom, as I believe does everyone in this Legislature and in this province. This bill has nothing whatsoever to do with infringing on those freedoms. It speaks to the principles that no one should have to pay more for medical services than the fee schedule established. We have already heard many speakers speak to that principle. That is not a principle of freedom. That is a principle of the marketplace, to which the previous speaker spoke. The marketplace has no place in our medical system and our medical facility because that breeds exactly the system we had prior to 1962. It says people should have to pay more, if the market will bear.
This bill recognizes that, in my view, and I believe in the view of the majority of the people in this House who represent the majority of the people of this province. We believe no one should have to pay more. That is the underlying principle of the Canada Health Act of 1984.
This bill fulfils the commitment that was made in that federal Parliament. It fulfils the commitment and the promise that was made in 1962. I understand the fears. I understand and I am concerned for those professionals who have been poorly advised about what this bill means, who have been led to believe that in some way this does impinge on their freedom. It does not. It speaks only to the financial issue that no one should have to pay more for medical care than insured services. It does not speak to the freedom to practise. It does not speak to the freedom to prescribe.
Mr. Davis: But it will down the road.
9:40 a.m.
Ms. Caplan: The Minister of Health in this province has said unequivocally that there is no hidden agenda. Those who are stirring those fears, those who are raising that spectre are doing a disservice to the professionals.
On this historic day I believe it is time for all responsible and honourable members of this House to come together in fairness; to recognize and to say to the profession what this bill says; to put aside partisan political concerns; to give effect to a bill that addresses only that principle, the principle established in 1984, which had been begun in 1982; to examine this bill calmly and, as the Attorney General (Mr. Scott) so eloquently said, to show the medical professionals that it does not do or say more than that, as we have said time and again during the past year.
Let us look at that negotiation process. Our government began on the basis of saying to the medical profession, to the OMA, its leadership and representatives: "It is our desire to end the practice of extra billing. It is our desire to comply with the Canada Health Act. It is our desire to work with you to find a way to do this. However, we must do this within the principle of that act, which is that no one should have to pay more."
We presented a 10-point proposal to the OMA. We said: "We believe these are some of the freedom issues about which you are concerned. If there are more issues of concern to you, bring them forward and we can discuss them as we determine together how we can accomplish compliance with the federal act."
This is not a time to inflame the passions that have arisen during the past year because of unfounded fears. I believe the time has come for all members of this House together to help to moderate, to assure, to say to the professionals: "We value and respect your services. We want to comply with the Canada Health Act. We are not in any way looking to impinge upon your freedoms as professionals."
My concern for that profession is that through this process, through the passions that have been inflamed -- I believe unjustifiably -- the way the profession sees itself and the way the public will see the profession are in danger. That is why I say this is a nonpartisan issue. It is time, as it was in 1984, for all members of this House to come together to moderate, to de-escalate and to say, "Let us work together to continue to have" -- and I believe we will have, because of the commitment of the taxpayers of this province to ensure it -- "fair and adequate compensation and to look at those parts of the plan that perhaps need some adjustment because they are not perfect." Nothing in this world is perfect.
This bill complies with the Canada Health Act. That is its only purpose and its only intention. I implore all members of this House to act responsibly to reassure our medical professionals that this is what this bill says and nothing more, and to join together in the same spirit of co-operation as in that federal Parliament in 1984 to build a medical system, to continue to build on the foundations of what is looked upon around the world as one of the finest systems of medical care not only in North America, not only in Canada but also around the world; and it will continue so because of the commitment of these taxpayers and the commitment of the members of this assembly.
This bill complies with the law of the land. This bill represents the will of the people as it stood in 1984 and as it stood in 1962. There is no hidden agenda. This bill is just. It represents our commitment, made loudly and clearly in the last election. This bill represents an opportunity for all of us in this House to say to our medical professionals calmly, rationally and moderately: "Let us continue to work together in the spirit we have in the past. Let us recognize that this principle was dealt with in 1984 and let us work together."
We have a historic opportunity. We have seen the movement across this country to comply, and seven provinces have already complied with the federal law. I believe every responsible and honourable member of this House should take the opportunity to work together to help in the implementation of this bill, which conforms with the law of the land, to ensure that the stature of that dignified and fine profession and of our medical system are enhanced as we build for the future.
I felt it was important to speak to this because I believe much has been said unjustly to inflame. We have been talking about this all night. We have been talking about it for a year.
Mr. Davis: Has the member been here all night?
Ms. Caplan: I was here until 12:30 a.m. and it was very late. I know the members went all night and that there were members who listened and spoke right through the night on this historic, important and fundamental piece of legislation.
We are all law-abiding citizens. We have a federal law that says this is the law of the land. We have this opportunity to join together calmly and rationally. The time has come to moderate the passions and to assure the doctors that there is no intention for them not to be well compensated, that there is no hidden agenda and that they have the respect they so well deserve from their patients and from the members of this Legislature.
As I conclude, I call on all members of this House to encourage that consensus to come forward in Ontario, which is not only a land of bounty and promise, but also a province that is law-abiding, one that says, "We recognize the powers of Parliament, the law of the land and our duty to comply with that law."
There should be no fear of the unknown. All members of this House should speak to the members of the profession whom they know and show them what this bill actually says. This bill deals with money; it does not deal with freedom. We have treated our doctors well in the past and we will treat them well in the future. They have nothing to fear. This bill represents the will of the majority of the people of this country and this province and it should be done.
9:50 a.m.
Miss Stephenson: I should like to clarify one point I heard the honourable member make in the early part of her presentation, namely, that in 1962 Canada decided there would be no such thing as extra billing. I remind the member that was the year of the confrontation in Saskatchewan. The introduction of the national health insurance or medicare program was in 1968. In 1962, Tommy Douglas recognized the need for the kind of safety valve which has been present in Ontario since the inception of medicare and, in fact, was written into the first law of Saskatchewan after the confrontation.
One of the things that troubles me is that the member, a member of that government which has spent all its time denigrating physicians and destroying their confidence in the government, is now expecting the rest of us to do its work to allow the physicians to trust government.
Mr. McClellan: I wanted to respond to the comments by the member for York Mills (Miss Stephenson) about Tommy Douglas. It is true that extra billing was part of the original medicare plan in 1962.
Mr. Gregory: The member should be addressing himself to the member for Oriole (Ms. Caplan). He is out of order.
Mr. McClellan: Questions and comments are part of debate.
The Acting Speaker (Mr. Morin): Order.
Mr. McClellan: Tommy Douglas spent the last four or five years of his life fighting against extra billing, and he was responsible for the Canada Health Act as was no other Canadian. It is an insult to his memory that the member for York Mills has introduced this into the debate.
Mr. Mancini: I want to take this opportunity to congratulate the member for Oriole on a well done speech. In the small period of the last 20 minutes of the time she used, she said more than we have heard from the entire Conservative Party through this all-night session. She made more salient points, was more to the point and more willing to deal with the basis of Bill 94 than the whole Conservative Party has been during this entire debate.
Mr. Davis: He is now in Hansard. The member should sit down.
Mr. Mancini: I enjoy the interjections from the reverend member, who is always interesting in this Legislature.
The member for Oriole stated very plainly what Bill 94 does and the intention of this Legislature. More important, she explained very clearly the consequences of the Canada Health Act, which the Conservative Party continues to refuse to acknowledge. The Canada Health Act was passed by every member of Parliament sitting in the House of Commons in 1984. That includes the Honourable Jake Epp, who made comments today against extra billing, and the Right Honourable Brian Mulroney, who said health care is a sacred trust.
Have those members forgotten what happened in the Parliament of Canada? Do they not understand what the Canada Health Act is? Do they disagree entirely with the Right Honourable Brian Mulroney and all his ministers of the crown? If members disagree, let them stand up, say so and be counted. They should not put forward their specious arguments about freedom. It has nothing to do with freedom.
The Acting Speaker: The member's time has expired.
Mr. Jackson: I would like to respond to the member's comments as well.
I am taken by a statement made by Frederick the Great, who, incidentally, died 200 years ago. However, it is appropriate to the statements the previous speaker and our Premier (Mr. Peterson) have made. Frederick the Great said: "My people and I have come to an agreement which satisfies us both. They are to say what they please, and I am to do what I please." That, I submit, sums up the entire position of this government. It sums up the entire position of the Minister of Health.
I take great exception to the member making reference to compliance with the Canada Health Act, as though the Liberals would prostrate themselves before the federal government. In this province, one cannot pick and choose the issues that one will champion in Ottawa and those on which one will turn one's back.
I submit that the Canada Health Act is open to a degree of negotiation which this government is afraid to tackle and even afraid to attempt. Nowhere is there an effort. Nowhere has there been an effort by the Minister of Health to examine the formula and to reduce the amount of the penalty. Nowhere is there an attempt by the minister to look at an extension or a compromise agreement.
Even the Attorney General, in legal opinions given when he was in a fee-receiving capacity -- his professional wisdom was worth quite a bit of money at that time -- advised the Canadian Medical Association and, through it, the Ontario Medical Association of the legal significance and status of that bill. I object strenuously to the member's reference and I would ask her to respond to why the government would not negotiate but instead would prostrate itself before this federal bill.
Ms. Caplan: First, I will respond to the member for York Mills. It is important to note that in this past year and during this debate not one member of this government -- not the Premier, nor the Minister of Health -- has in any way attempted to denigrate the position of our physicians. In fact, the opposite is true. We have spoken to their professionalism and we have asked them to join us time and time again to work with us to come into compliance with the Canada Health Act to ensure that no one will have to pay more than the fee schedule. That was denied. The opportunities are available as we proceed into the future.
I will respond as well to the member for Burlington South (Mr. Jackson). The Canada Health Act is clear. It was supported by the federal Parliament without one dissenting vote. It has been supported time and again by the members of that Legislature and by the Conservative government in Ottawa at this time.
Miss Stephenson: The member's friend the Attorney General says it is unconstitutional.
The Acting Speaker: Order.
Ms. Caplan: Further, the act penalizes those provinces that do not comply. We have an obligation on behalf of the taxpayers of this province to comply. We have an obligation on behalf of our constituents who supported the bills in 1962, in 1968 and in 1984. The time has come for us to temper our remarks to build moderation and consensus as we move forward in this great province.
Mr. Andrewes: I am delighted that the member for Oriole (Ms. Caplan) chose this moment to introduce the topic of history and of this province's involvement in medical health programs, because it gives me an opportunity to respond to some of her comments and to put this debate into some perspective. The member will have to realize that over the years --
She is not staying?
Ms. Caplan: I will be happy to stay.
Mr. Andrewes: The member will appreciate after my comments that the initiatives taken for health care programs in this country were not taken by the government of Canada; they were taken by the provinces. The government of Canada was forced into trailing on the activities of the provinces over the years, and it was indeed --
Mr. Foulds: Name names.
Mr. Andrewes: Sure. I will give Tommy Douglas full credit for what he did, but I also want to give people such as Leslie Frost and John Robarts full credit for what they did.
I want to make it perfectly clear at the outset that the passage of this bill at one o'clock today will not end the doctors' strike. I only follow in the comments of the government House leader, who, in appealing to the member for Ottawa Centre (Ms. Gigantes) not to inflame and enrage this debate, recognizes that the passage of Bill 94 will not end the strike.
I want to take a few moments to review some of the history. In January 1943, in a throne speech, the then Liberal government in Ottawa headed by the notorious and memorable Prime Minister of the day, Mackenzie King, commonly known as Willie to his friends --
Mr. O'Connor: And his dog.
Mr. Andrewes: And his dog and his memoirs and all the other things that go with Willie. In that throne speech the federal Liberal government introduced a comprehensive scheme of social insurance. It proposed that scheme should be worked out at once, as a scheme that would constitute a charter for social security for the whole of Canada. The throne speech also announced the government's intention to appoint a committee of the House to consider these matters and to submit for study and consideration the establishment of a national system of health insurance.
Over the 10 years prior to this announcement, an advisory committee on health insurance had come to an agreement with organized medicine not only on the principle of health insurance but also on the details of a national and model provincial bill. Although it may come as a surprise to those of my Liberal and New Democratic Party colleagues who are in attendance, the Canadian Medical Association approved the adoption of the principle of health insurance and favoured a health insurance plan that would secure the development and provision of the highest standard of health services. The co-operation the government received from the medical profession was eroded over the years by successive federal Liberal governments.
In July 1943, the special committee submitted its report to the health minister of the day, Mr. Mackenzie, who sought the support of the Prime Minister and reminded him of the contents of the throne speech. In a letter to the Prime Minister in 1943, Mr. Mackenzie had this to say:
"There is no doubt that our government is unpopular. That is very largely the result of inescapable war conditions. The restrictions that have been found necessary are generally hated by the people. It is not Toryism under its new guise that is killing us. It is the unnatural, unliberal regimentation we have been constrained to adopt and, worse still, to defend. This situation, I fear, cannot be corrected until the armistice.
"What are the other causes? What of the use of socialism all across Canada? It was for years a British Columbia and Saskatchewan freak, but it is now definitely a national political menace. Why?"
These words are no less relevant today as we look into the intervention into our private lives by this provincial government, intervention into the freedom of a self-regulating profession with no guarantee that health care will become more accessible, but every indication that the health care system in this province will deteriorate. The other day I saw a bumper sticker which summed up the situation we have before us today. It said, "If you love the post office, you are going to just love state medicine."
In any event, in November 1943, Mr. Mackenzie appointed a committee on health insurance finance to re-examine the financing question. The committee recognized that health insurance would be expensive, entailing a large federal contribution. The committee stated in its report, "It seems clear that the provinces cannot finance health insurance themselves and that a purely national scheme is at present considered constitutionally and politically impractical."
The committee then concluded with a recommendation. It was, without doubt, the most extreme suggestion for federal intervention in provincial administration. It would overcome the inherent difficulties of the dominion financing provincial schemes if the dominion, as a condition of making grants to the provinces for health insurance, was permitted to appoint one or more nominees of the dominion government to the provincial health insurance commission. In addition, the federal health grants would be available only if the provinces introduced health insurance. The old leverage game had begun.
Only 40 years later, the Trudeau Liberal government was to hold the provinces for ransom with the provision in the Canada Health Act providing for the holdback of federal transfer funds unless the provinces did its bidding by banning extra billing. The old leverage game continues.
Both 40 years ago and at the time of the introduction of the Canada Health Act, the provinces fought the federal government's intervention into their constitutional right to manage their own health care system. In 1943, the provinces stressed that each province should be permitted to introduce each benefit in its own time as it became feasible to do so and should also be permitted to raise the funds in any way it saw fit.
In 1945, the country saw a federal election where health insurance became a major public concern. The Liberals obtained a very slim majority and immediately set the date for a dominion-provincial conference for the summer of 1945. The major topic for that conference was the taxation powers of the dominion and the provinces for a whole range of social programs, including a health insurance scheme.
As a result of the federal Liberal government's unwillingness to negotiate in good faith with the provinces and reach a compromise, the dominion-provincial conference collapsed and the health insurance proposals went into limbo. The collapse of the conference could only be attributed to the fact that the federal government's offer had been bound up with the proposals for the transfer of major tax fields to the federal Treasury and that the federal health grants would be available only if all the provinces introduced health insurance at the same time.
Ten years later, in 1955, after Saskatchewan had decided to go it alone in the area of health and hospital insurance, there was another federal-provincial conference with almost the same political players as in 1945; only their roles had changed. Prime Minister St. Laurent, who had been the Minister of Justice in 1945, and Premier Frost from Ontario, who had been the provincial Treasurer in 1945, took their places at the discussion table. In the 10 years between 1945 and 1955, Saskatchewan had introduced a universal provincial hospital services plan. Two years later, British Columbia introduced a similar program and Alberta, if members can imagine, introduced a provincially subsidized municipal hospital insurance plan.
In June 1949, the Canadian Medical Association, after years of frustrating discussions with the government of Canada, completely abandoned its 1943 policy of endorsing governmental health programs by announcing a new policy favouring the extension of voluntary plans to cover all Canadians, with governments paying the premiums for those unable to pay them themselves. In 1952, almost 5.5 million Canadians were insured for hospital benefits through voluntary plans and commercial insurance and nearly 4 million were insured for medical and surgical benefits.
10:10 a.m.
As I said, the federal-provincial conference reconvened in October 1955 and its primary purpose was to reach a consensus on a revised formula for tax agreements. Health insurance was a separate item. It was Premier Frost of Ontario who reminded the federal government that this lack of initiative on its part was leading to a hotchpotch of provincial programs in the health field. At the conclusion of this conference, the Prime Minister announced the appointment of a special committee on health insurance, the federal-provincial Joint Committee on Health Insurance.
In the meantime, Ontario moved ahead to prepare its own legislation to introduce a hospital insurance program. On March 5, 1956, An Act to establish the Hospital Services Commission of Ontario received first reading. There were three primary functions to this proposal: first, to ensure the development throughout the province of a balanced and integrated system of hospitals and related health facilities; second, to administer the hospitals act; and third, to administer a plan of hospital care insurance for the whole province.
In 1957, the Ontario government introduced its proposal for a comprehensive hospital services program to be implemented by January 1959. The two-year lapse was to permit the enrolment of the people of Ontario in this plan. Upon its implementation, Premier Frost was able to announce that 91 per cent of the population of Ontario was enrolled in the plan, and by the end of 1960 that percentage had risen to 95.
Since a number of the provinces had moved forward, the federal government had no choice but to bring forward its legislation. It was slow to get into the act, but quick to use the lever. In April 1957, Bill 320, the Hospital Insurance and Diagnostic Services Act, was unanimously adopted and on May 1, 1957, the national hospital insurance program became law.
The next major act of the health insurance scenario opened on July 19, 1965. Lester Pearson had replaced Louis St. Laurent, and Frost had been replaced by Robarts. The intentions of the Pearson government were set out in the 1965 throne speech, which said, "My government will, at an early date, meet with the governments of the provinces in order to discuss with them the ways in which federal and provincial action can most effectively contribute to programs that will provide health services to Canadians on a comprehensive basis." The decision for medicare had been made, buoyed by the Hall commission report. A federal-provincial conference was called to discuss health services for all Canadians.
As I said previously, the CMA had not only declared a policy favouring the principle of health insurance in 1943, but also in 1949 the association filled the vacuum created by the failure of the federal government to act on its proposals and the profession sponsored a number of prepayment plans. This same association continued to support health insurance for everyone, but the route it proposed would be one that limited the role of government to the subsidization of premiums for those who could not afford to make their own payments to the voluntary agencies.
In 1966, in consultation and in co-operation with the medical profession, the Robarts government in Ontario established the Ontario medical services insurance plan to insure individuals and to subsidize those who could not afford the physician-sponsored or commercial insurance plan. With 585,000 covered by OMSIP in 1966 and 6,000,000 people insured through voluntary methods, 95.5 per cent of Ontarians had some form of protection without a universal government program.
However, on July 1, 1968, medicare finally became law, although there was no minimum requirement of all provinces having to opt into the program at once. Federal health grants to provinces were tied to that province opting into the federal program -- the old leverage game once again. Ontario had no choice, and on July 1, 1969, the province opted into the federal plan. The national plan was born because of the power of the federal purse, notwithstanding the many constitutional arguments that the whole policy was outside the federal government's constitutional jurisdiction. The arrangement was considered by many provinces to be coercive political blackmail.
The scenario of federal interference in the delivery of provincial health care began in the 1980s with the introduction of the Canada Health Act. The setting was all too familiar; only the actors had changed. Mr. Trudeau was the Prime Minister, Mr. Davis was the Premier of Ontario and, unlike the hospital insurance and medicare debates, where there was at least the appearance of provincial consultation, there was no consultation with the provincial governments in the drafting of the act.
The Canada Health Act was passed containing financial clauses that would force provincial governments to interfere in the patient-doctor relationship and to ban extra billing, a right that had been given to the medical profession some 20 years earlier. That legislation and the bill before us now have proved to create such acrimony between the government and the medical profession that many believe it has begun the decline of the quality of health care in the province and the likelihood of a two-tiered system of health care akin to that of Britain.
I refer the members of the Liberal Party and the New Democratic Party to the Taylor report of August 31, 1954, commissioned by Mr. Frost. This report analysed the economics of hospital and medical care in Ontario and concluded, among other things, that medical and hospital services flourish best in an environment of freedom, including freedom from bureaucratic control.
I am ignoring the interjections, Mr. Speaker, because we have heard them all before.
No one will disagree that the establishment of a publicly funded health care system, as we know it in this country and in this province, is one of the great achievements of our society. The concept that every Ontarian is entitled to a comprehensive range of health care services without reference to ability to pay is deeply ingrained in our national identity.
When we consider changes in our health care system, I believe the government has a responsibility to proceed in a spirit of co-operation and mutual respect with the deliverers of our health care services. Government has a responsibility to negotiate and bargain in good faith, not to dig in its heels to make a point. Nobody wins in that situation and, more important, the public interest is not served. Everybody loses.
The functioning of our health care system, however, cannot be described simply as another government activity. Government plays an essential role in financing, managing and insuring health care delivery. How well government is able to fulfil these responsibilities ultimately depends upon our complex and interlocking relationships with a great number of health care providers and institutions and with a host of health-related organizations and associations.
By definition, in nature, health care is an activity of profoundly human dimensions, and this quality permeates every aspect of our health care system. Health care can work effectively only when there is consensus and agreement among the key players and participants in the health care system. Both sides must be ready to seek accommodation, compromise and a broad area of agreement if we are to be successful in this task.
10:20 a.m.
We have had publicly funded medical care in this country for 20 years and a hospital insurance program for 40 years. Access to quality health care has been enjoyed in this province for many years. It is the government's responsibility to see that it does not become captive or hostage in a doctor-government dispute. Surely after 20 years of experience with medicare, we have more collective wisdom than to believe that extra billing is a threat to the accessibility of our health care system.
The health care services of doctors are crucial to the successful operation and function of our health care system and, therefore, we must be sensitive to their concerns and be prepared to listen and negotiate in good faith on those matters relating to the practice of their profession.
The proportion of opted-out physicians in Ontario has been steadily declining over the past few years from a peak of 18 per cent in March 1979, to 14.3 per cent in January 1984, to the present 12 per cent. It is important to note that when the number of opted-out physicians in this province was at its peak, at a level of 18 per cent, it was the now Premier of the province, the member for London Centre (Mr. Peterson), and the Liberal caucus that did not support or advocate a ban on extra billing.
About three per cent of all Ontarians are extra billed. The size of this perceived problem is very small. I believe that most would agree that since such a small percentage of people are affected, the government should be able to work out a solution. What is happening is that the Liberal government of Ontario is using a hammer to kill a fly. In doing so, it has missed the target and mortally wounded those who are helpless participants in the program.
The doctors have put forward a compromise solution. They have agreed to support legislation that would ban extra billing of seniors, people on public assistance and people requiring emergency care. The Liberal government did not move from its original non-negotiable position that extra billing would be banned with or without the co-operation of doctors. Today we see the results of this hard line. Doctors are unavailable to their patients and a number of emergency wards in this province are closed indefinitely. There is health care inaccessibility.
I want to remind the Premier that hard cases often make bad law. Hard positions and simplistic solutions never work. Government and, in particular, leadership is about resolving political problems, not creating them. On this issue, I believe that the Liberal government, propped up by the New Democrats, has created a problem of the greatest order.
The passing of Bill 94 will not solve the problem and will only serve to inflame it. The government has succeeded in creating acrimony in the medical profession and a feeling of distrust between patients and their doctors. It has succeeded in forcing the medical profession to withdraw their services indefinitely. It has succeeded in substantially confusing the issue for the public.
This Liberal government has shown it does not understand what the words "compromise," "negotiate," and "leadership" mean. An essential ingredient in our health care system in the past has been government's co-operative relationship with the providers of care and the public. Surely negotiation and mediation, rather than ultimatum, is the route to a lasting resolution on any health care issue that comes before this House.
From my perspective there are some major and important challenges now confronting health care in Ontario. The growing demand for more and more health care services, our costly dependence on institutional and curative forms of care, the potential benefits and the threat of huge cost escalation in the explosive growth of medical high-technology, the need for more co-operation and consultation among the now highly structured and defined health care professions, our manpower and service needs to care for a growing elderly population and a growing incidence of degenerative diseases, the need for more lifestyle education and disease-preventive activities are just some of the issues that must be faced.
We must be prepared to deal with these issues now if the health care system we know is to be enjoyed by future Ontarians. Bill 94 does not respond to these issues, just as the Canada Health Act did not. The bill addresses an issue which affects three per cent of our medical services. It does not address any of the health care issues I just mentioned. If this bill is passed, which no doubt it will be, without due regard for the integrity and professional freedom of our doctors, our primary deliverers of care, we will have missed an opportunity to work with this group in shaping and guiding the future of our health care system in Ontario.
The Acting Speaker (Mr. Morin): Ms. E. J. Smith moves that the House agree to divide the time equally among the three parties from 10:05 a.m. to 1 p.m.
Motion agreed to.
The Acting Speaker: Ms. E. J. Smith moves that the House agree to waive the 10-minute comment-and-question period following each speech.
Motion agreed to.
Mr. Foulds: Today is, indeed, an historic day in Ontario. It is one in which some of us will take pride and some of us will not. There is no use avoiding the fact that it is a day that will have caused some division.
As a member of the New Democratic Party, I rise with a great deal of pride to support the passage of Bill 94, which bans extra billing. I do so because of the heritage of this party and the commitment it has made since its inception to publicly funded health insurance, medicare, for the people of Canada.
This bill needs to be passed for two simple reasons. First, it needs to be brought into law so we no longer have charity medicine in Ontario. It needs to be brought into law so every person who is at the centre of the health care system, the patient, has the right to the best care available in the province on equal terms and conditions. It needs to be brought into law so people do not have to beg for treatment at prices they can afford.
That leads me to the second reason. Why are the concessions the OMA has offered the Conservative Party not enough? They are not enough because they do not cover the working poor in this province. They do not cover the people who, through no fault of their own, have jobs at minimum wage or barely above it and receive no government assistance. Those people would have to beg their doctors to be forgiven from extra billing. It would be at the individual doctor's discretion. Most doctors have no idea of the actual incomes of most of their patients. Most doctors do not know.
Mr. Pierce: Only the NDP knows.
10:30 a.m.
Mr. Foulds: I remind the member for Rainy River (Mr. Pierce), my friend from the northwest who is supporting extra billing, which discriminates particularly against people in our region, that doctors have no special insight into the financial conditions of their patients. They have special insight into the medical conditions of their patients, but not into their financial conditions.
I remind this House it is to our shame that we have a taxation system, both in this country and in this province, under which people who earn above the minimum wage but below the poverty line still pay taxes and most of them have to pay medicare premiums because they are not covered by group or company plans.
I want to deal with the next question. The Conservative Party has argued for as long as I can remember, but particularly in the past two weeks, that this bill should be put out for mediation. I want to reiterate the comments of my colleague the member for Ottawa Centre (Ms. Gigantes). There are many things that can be negotiated, but the bill cannot be negotiated. It cannot be negotiated because it does only one very simple thing: It eliminates extra billing. It is the determination of the government party, the determination of the majority of members of this Legislature and the determination of the majority of people in Ontario that extra billing should be banned.
Let me outline what can be negotiated and what should be subject to negotiations with the OMA or any new association that a number of doctors may want to form after their experience with the OMA in the past few weeks. The scale of fees can be negotiated, and if some specialties are being underpaid, that can be negotiated. The process of payment can be negotiated or mediated, as can the form of payment. We can also negotiate more community clinics across the province, fees for service, a form of salary or the per capita idea. All those things are subject to negotiation.
Mr. Wildman: Merit.
Mr. Foulds: My colleague the member for Algoma reminds me that even so-called merit pay can be put in the fee schedule, but extra billing of the patient, the person who receives the treatment, is not for negotiation.
What needs to be done in the situation in which we now find ourselves? We do find ourselves, as the government House leader and Treasurer (Mr. Nixon) pointed out, in a difficult situation because there are some doctors out there who are angry and frustrated. In a few moments I want to get to the reason for that anger and frustration and how we can perhaps deal with it.
As a society and as a parliament, we need to recognize the skills, the professionalism and the dedication of most of our medical practitioners, but we also need to recognize the very same skills in all the other people associated with the delivery of health care. It is not only the medical doctor who is the deliverer of health care in this province. Midwives and nurses are also deliverers of health care.
The professional people I feel sorriest for in the present circumstances are nurses in this province, who are receiving all the patients on the first line of the emergency ward. If there are no doctors available and they can help, they are put in an extremely difficult position. One of the things we should look at in future is legislation that gives nurses who are properly and practically trained more authority for the delivery of health care in our province. We need to do that with every other professional associated with the health care system. That does not in any way diminish the rightful role of the medical practitioners, the doctors, but it will free them to use their specialty skills. It will free them from mundane tasks with which they need not be concerned. That is the other part of the health care system that we need to pay attention to: expanding the service and developing other models of delivery.
Finally, when it comes down to it, in a sense this debate is about responsibility. We have a responsibility to reflect the will of the people of Ontario. It has always been my strong view that we also have a responsibility in a democracy not to run roughshod over the interests of a minority, but the primary concern of both democracy and the health care system is not for the deliverers of the system but for the patients who are at the centre of the system. I think the point has been lost, by the Conservative Party and by certain representatives of the OMA, that the principal concern must always be the patient. That is what I come back to again and again.
The delivery of medicine, the delivery of health care is an awesome responsibility and our doctors have delivered that, by and large, in a responsible manner. I regret what has happened in the past few weeks. I must say frankly that some of that action, such as the closure of emergency wards and the threatened closure of intensive care wards, is irresponsible. The people who shut them down or have threatened to shut them down are not the members of the government party, the New Democratic Party, or even, God save them, the Conservative Party, but the people who are on the front lines. The people who have shut them down are the medical practitioners. I say, with great respect and with a great deal of reluctance, that has been an irresponsible act.
Why have we had that irresponsible act? I think we have had that irresponsible act because there has been a good deal of anger and hurt on the part of the medical profession. I think that has arisen for a couple of reasons.
First, the Conservative Party, particularly in the last 10 years of its administration, tragically underfunded the health care system and refused to put into place the kind of preventive medicine and the kind of delivery system that would have helped deliver more of a system at reduced costs.
Second, the official opposition has artificially inflamed the expectation of the medical profession about the passage of this bill. They knew the bill would pass and yet they gave the impression they were powerful enough to stop it. They are no longer powerful enough to stop it, particularly when they have stopped representing the patients of the province.
I get messages and phone calls in my riding office -- I do not think my riding is any different from the vast majority of ridings -- and those who are in support of the bill outnumber those who oppose the bill by eight to two. That is 80 per cent. I submit that my riding, with its ethnic mix and with its income mix, is probably more representative of the province as a whole than is the riding represented by the member for Mississauga South (Mrs. Marland). I even know people in her riding who are Conservatives who support the bill. They happen to be personal friends of mine.
10:40 a.m.
I want to say clearly that this bill does not in any way intervene in the professional responsibilities of the doctors. It does not intervene in any way in their medical practice. What it does is limit their economic practice. It limits their economic freedom. I admit that. It limits their freedom to charge more than their professional association has agreed to under the OHIP schedule.
That does not seem to be a great curtailment of freedom. It is a curtailment of freedom equal to that which prevents us from driving on the left-hand side of the road in this province; it is about the same.
Miss Stephenson: The member drives on the left-hand side all the time.
Mr. Foulds: That is a curtailment of freedom that produces the greatest good for the greatest number. The member for York Mills (Miss Stephenson) prefers that we phase it in so we only have trucks driving on the left-hand side of the road for a while. That is the analogy.
I want to conclude, because I have only four or five minutes remaining, with the charge that we are talking about socialized medicine in this bill. I wish we were talking about socialized medicine in this bill. I want to quote the words of the member for York South (Mr. Rae) on second reading of this bill because they have been taken out of context so often.
On February 11, the member for York South said: "Health is something else. It is not a commodity. It is not something to be traded on the open market. It is a basic human right that reflects our attitude to each other. That has to be the principle that is in place." That is the principle we in this party support. He further said: "There are those who say we are talking about the socialization of medicine. To those who say that, I say amen; we are talking about the socialization of medicine." The important part -- this is for the Tories -- is this, "We are saying that health is an individual and social right that is too fundamental to be left and treated as a commodity."
I want to quote Leslie Frost on private insurance to remind the members of the reasons Ontario ultimately began on this path. Mr. Frost said: "One of the great difficulties with private insurance is the fact that first, there is a time limit which does not take care of the catastrophes, and second, that some companies at least have been pretty free with the cancellation clauses in their policies. I have had that experience myself, you see." He mentioned that two of his individual policies had been terminated. "They insure you and then the minute there is some trouble, while they pay you benefits for that particular illness, there is a rider attached to your policy and that particular illness can never be covered again.
Then again when you reach a certain age, 60, you are cut off." What happened to Mr. Frost should never again happen to another citizen of this province.
I wanted to quote from the leader of the New Democratic Party at that time, Donald MacDonald, but I do not have time. He pointed out that the private insurance companies were making more than 56 per cent profit in relation to the benefits they were paying out on private insurance.
For those who say that socialized medicine is such a dastardly thing to introduce into Canada in the last half of the 20th century, I want to read the definition from the Concise Oxford Dictionary, surely a dictionary of international reputation that is not quarrelled with by anyone, including the Conservatives of this province. It says, "socialized medicine, provision of medical services for all from public funds." That is what socialized medicine is all about, and so that I am absolutely accurate: "hence socialization; act in sociable manner." What is wrong with acting in a sociable manner about medicare? What is wrong with acting in a sociable manner about health care in this province?
Finally, we do need to heal some of the wounds. We do need to bring the parties together in this province over this question.
I will end with a couple of quotations from Dr. Laurence J. Peter's Ideas For Our Times. There are a couple that I would not say but that he included in his book. He said: "When I got the bill for my surgery, I knew what those doctors were wearing the masks for." I would not say that, but someone called James H. Boren did. Another quotation he uses is, "A hospital should have a recovery room adjoining the cashier's office." Finally he said, "Financial ruin from medical bills is almost exclusively an American disease." Let us put an end to that American disease here in Ontario and here in Canada.
Finally, I want to quote from Hippocrates, the father of medicine, who said -- and I believe this with all my heart, as I believe most of the medical practitioners of this province do -- "Wherever the art of medicine is loved, there is also a love of humanity." Let us therefore look at the medical system, look at this bill and look at this society in that way. We will love the art of medicine, we will respect it and we will look at the delivery care system and, in doing so, we will also love humanity.
Ms. E. J. Smith: I would ask for the further agreement of the House to waive standing order 60 to permit the remarks of the leaders of the three parties to follow the reply of the Minister of Health (Mr. Elston).
Mr. Speaker: I hope all members are aware of standing order 60, in which it states that after the reply of a minister or of the parliamentary assistant who has moved third reading, as in this case, the debate is wound up. The member is asking for permission to waive that standing order so that the minister may reply for 10 minutes and the windups may follow. Is there agreement?
Agreed to.
Mr. Mancini: Since we are on time allocation --
Mr. Davis: Was this part of the agreement? Did we agree to this?
Mr. McClellan: This was not part of the agreement. Carry on.
Mr. Mancini: Is the member for Bellwoods (Mr. McClellan) trying to help me out?
Since we are on time allocation, I ask the table officers to let me know when 10 minutes have expired.
We are near the conclusion of this historic debate, which has seen the Legislature sit round the clock, has seen some members of this Legislature talk for many hours at a time and has seen other members speak for only a few moments. We have in some way seen both sides of the issue with regard to Bill 94. We have seen the side that has been put forward by the government. We have tried to have our members rise and explain as clearly as possible what Bill 94 does.
10:50 a.m.
Anyone who has taken the time to read Bill 94, anyone who has been here in the Legislature to listen to the amendments that have been proposed by the minister and by other members, and anyone who has any experience at all in reading legislation put forward by the government and the opposition will know that Bill 94 does only thing: Bill 94 bans the practice of extra billing. That is the only thing Bill 94 does.
Bill 94 will not do what a small minority of doctors are saying it will do. Bill 94 will not do what a minority of the Legislature says it is going to do. I challenge any member of the Conservative Party to show me what clause or section in Bill 94 states, as they have said over these past number of days, that Bill 94 will prevent doctors from practising where they wish in Ontario. I would like the Conservative Party to show me where it states in Bill 94 that doctors would be limited in the patients they could see and in whom they could see. The claims that have been made by a small minority of the doctors and by the Conservative opposition really boggle the mind.
Just the other night, I had an opportunity to speak with the chief of staff at the Leamington District Memorial Hospital, Dr. McGirr. We had a conversation that lasted for more than one hour. I am proud to say the majority of the doctors in the Leamington area have decided to maintain all emergency services at the Leamington hospital. Dr. McGirr told me only a small number were closing their offices to people who needed care. I congratulate the doctors in the Leamington area for being compassionate and especially so in understanding what Bill 94 does. Dr. McGirr explained it to me very well over the phone.
He said, "Remo, we know what Bill 94 does; it bans extra billing." He went on to say that he understood the economic constraints in Quebec and he felt the government there was probably trying to save money in the wrong field, the health care field. He informed me also that what the Social Credit government, which is close to the Conservative Party, is doing in British Columbia is unfair. He stated that to me very clearly. He said it was unfair to have doctors graduate from medical school and then not give them a number with which to practise. Bill 94 does none of those things.
Mr. Davis: But it will.
Mr. Mancini: We hear again from the good reverend who continues to want to inflame the situation, who wants to continue to perpetuate ideas which do not exist. He said it again. The good reverend should know better. He said it again that Bill 94 would limit somehow how we are going to license doctors. I challenge the good reverend to find the section in Bill 94 that does that and I would be glad to meet with him after the House adjourns to talk about all those things his party claims it is going to do.
The only thing that has saddened me a great deal in this whole debate is the conduct of a small minority of doctors. It was put well this morning as I was reading the Toronto Star. I do not think I have read a story on this whole dispute as interesting as the one written by Gary Lautens which appeared this morning.
Interjections.
Mr. Mancini: I am going to ignore the interjections. My comments will be on the official record.
Mr. Speaker: All interjections are out of order.
Mr. Mancini: Mr. Lautens's headline says, "Where's the Coolness, the Dignity We Expect in MDs?" He goes on to state in his article: "It was, well, disappointing. You expect better. You expect dignity."
I am saddened that a small minority of doctors have put in question the dignity of the medical profession. I know from my own experience, from having dealt with my own doctor, Dr. John Greenaway. I may add, he and I have had the opportunity to have many conversations about the matter of extra billing. I say without hesitation that we disagree entirely on the matter, but he has always acted with dignity. He has always maintained the characteristics we expect of a medical professional. I congratulate Dr. Greenaway for being able to do that while at the same time being against what this government wants to do.
I am shocked when I read about a Dr. Sullovey, who actually glues the doors of other medical professionals, who walks into the practices of other doctors and intimidates them into closing their practices. We talk about freedom. I would like to talk to Dr. Sullovey about freedom.
It is sad that a small minority of doctors has put in question the reputation and the dignity of the vast majority of doctors. As members of this House, we know from personal experience the dignity and the good characteristics of our medical professionals.
The Conservative Party conveniently forgets about the Canada Health Act. I want to remind it about the Canada Health Act, which was passed unanimously by all three parties in the House of Commons. I want to remind members what the Honourable Jake Epp had to say. I want to quote to my Liberal colleagues and to the members of the House who are willing to listen. "`Our party would like to see user fees and extra billing eliminated,' said the Conservatives' health critic" -- now the Minister of Health and Welfare -- "Jake Epp during second reading. With those unequivocal words, the Conservatives joined the other parties in producing a rare display of unity in the House of Commons." That is what happened.
Mr. McFadden: What was the Premier (Mr. Peterson) saying two years ago?
Mr. Mancini: The member wants to know what the Premier said. Let me tell him what his leader has said in the past. Conveniently, I happen to have a story that appeared on May 29, 1982, in a paper that for some reasons the Ontario Tories do not seem to have favour with at present. The headline says, "Too Many Specialist Doctors Extra Billing, Grossman Says." The Leader of the Opposition said that.
Interjections.
Mr. Speaker: Order. I wish all honourable members would show respect to other members as well as to the member speaking.
11 a.m.
Mr. Mancini: The truth hurts, Mr. Speaker. This is my last comment. Since we have heard so much about mediation, what did the Leader of the Opposition (Mr. Grossman) tell the doctors on May 1, 1982, when he was negotiating? "Won't Talk For Ever, Grossman Tells MDs." That is what the member's leader said then. He was demanding a settlement. The Conservatives want us to talk for ever, but when their leader was in a position of responsibility, he said he would not talk for ever.
Mr. Jackson: I would like to respond.
Mr. Speaker: There will be no responses. That was agreed earlier by all members.
L'hon. M. Grandmaître: Je crois qu'il est très important pour un nouveau ministre de dire ce que la journée d'aujourd'hui représente, non seulement pour les commettants d'Ottawa Est mais pour tous les gens de la province de l'Ontario.
Je crois qu'il est grandement temps que les trois partis, que ce soit le Parti progressiste-conservateur ou le Nouveau Parti démocratique, aussi bien que le gouvernement, reconnaissent que le temps est venu de changer le système de santé de la province de l'Ontario au niveau de la surfacturation par les médecins.
Je dois avouer que mes amis d'Ottawa qui sont médecins et qui pratiquent la médecine depuis un certain nombre d'années n'apprécient pas tellement le vote d'aujourd'hui, excepté que je dois vous assurer, Monsieur le Président, que les démarches faites par le gouvernement vont certainement avoir des répercussions dans les années à venir et ces répercussions seront un meilleur service pour tous les Ontariens.
I know quite a few members would like to speak before the vote is taken. I want to reassure the House that in Ottawa East and Ottawa-Carleton, not only doctors but also other Ontarians have set their eyes on us today because this government is about to make history in this province by ensuring that a good medical system can be improved. That is what Bill 94 will do. It will improve the system and guarantee better services in the years to come.
It is time for all three parties to get together and resolve this impasse. All three parties have a responsibility to every citizen of this province to stand up and be counted and say what they have to say about a possibly good system or a system that can be improved. I urge everyone in this House to support Bill 94.
Miss Stephenson: The first thing I want to do on behalf of my party is to express sincere thanks to the staff of the assembly who for the first time in approximately 12 years have had to spend the entire night in this building without recourse to rest and restitution at home. Each one of us in the assembly today should express our thanks truly.
A great deal has been said about this bill, the process that led to it and all the things that have happened around it. I want to provide a concise report about the so-called negotiations and discussions that are said to have been held with the medical profession about Bill 94. The reputation the Premier (Mr. Peterson) is trying to establish for open government belies the experience the OMA has had.
The very first meeting was an informal one in late August between the Minister of Health (Mr. Elston) and the general secretary of the OMA. It was held in the latter's garden, because he happened to have his foot in a cast. Following that, there was a meeting of the president and the general secretary with the minister in mid-September. These were general discussions; there were no very direct or active negotiations about anything.
In late September, the executive committee of the OMA met with the minister, and the subject of the extra billing ban was raised. The position of the government was that it was willing to negotiate ways in which it could meet the concerns of the Canada Health Act, which needed negotiation with the physicians. There were no more discussions with the minister.
In October, the general secretary met with the Premier. The following week, the president met with the Premier. Because the two of them felt they were getting mixed messages, they requested a meeting of the senior negotiator, the president and the general secretary with the Premier so they would be together to hear the same things said by the Premier. At that meeting, there was discussion about what was going to be done in relation to the proposal to deal with the question of extra billing.
The member for Oriole (Ms. Caplan), parroted by the Minister of Municipal Affairs (Mr. Grandmaître), suggested this morning it was now necessary for all of us to come together in a spirit of co-operation, happiness and goodwill to sort out the problems with the doctors so that in some marvellous atmosphere the pieces the Premier talked about yesterday would be picked up.
It will be very difficult for the medical profession to feel in any way comfortable talking to the Premier ever again. At the meeting on October 31, 1985, the Premier said, "I am sick and tired of hearing about you f--ing doctors." I apologize. I never use that word. I suppose "fornicating" is the other word. I continue the quote, "You are overrated, overpaid, and I intend to do something about it." That is precisely the kind of attitude that has led the profession to be very suspicious about what Bill 94 does.
There were no other discussions between the government and the medical profession at all before Bill 94 was introduced on December 19. That was the end of the discussions.
After it was introduced, the Minister of Health suggested he was going to have meetings throughout the province, organized by the district health councils. He did that. I think he had seven or perhaps eight in all. The monitors who were there counted the bodies. If we subtract the flacks of the Liberal government and the members of the OMA who were there, there were about 12 to 14 people in attendance at each meeting who did not have a specific relationship to either the government or the OMA. That is the public consultation the minister held about Bill 94.
In March, because the OMA made conciliatory moves, the minister decided it was time to talk to the OMA and begin some silent negotiations, as they were called. Between March 6 and May 20, there were 11 dinner meetings in the presence of the Minister of Health and the Attorney General (Mr. Scott). From time to time, our peripatetic Premier attended as well. I gather those discussions were interesting, lubricated as they were with great French wine and good food.
However, no offer was made by the provincial government to do anything about negotiating this matter, which it knew was of grave concern to the medical profession. There was never a suggestion that it would introduce a mediator who might be able to bring the parties together to talk about the government's absolute commitment to total banning of extra billing, as opposed to the OMA's suggestion that limited permission of extra billing could solve the needs of the province related to the Canada Health Act. Arbitration or mediation was never suggested.
Nothing was offered by the government except a list of 10 proposals, one of which was interesting. It was danced before the profession by the Terpsichorean Attorney General, who provided the suggestion that it would be very nice if the $53 million per year, as calculated by the economists in the Ministry of Health, were provided for the pockets of the doctors if they would accept Bill 94. The OMA did not buy that; it simply said again that its principles were not for sale.
11:10 a.m.
When the OMA produced its package of proposals, which met almost all the government's concerns, or at least those it had heard in the public hearings, the government said that was not enough. What the government needed was an absolute, outright, total, guillotine -- which is a familiar word to this government -- ban on extra billing.
The OMA suggested very strongly that what was necessary in place of that confrontational attitude was the development of a salubrious atmosphere in which the profession plus the government as well as the other deliverers of health care and the public could come together to talk about the greatest challenge facing health care in Ontario at this time; that is, the difficult task of matching very rapidly growing needs with scarce resources so the quality of health care can be maintained in the province.
That requires an atmosphere that is relatively salutary to the discussions which must take place. However, they apparently did not understand that, because what we had in this House -- and I remind members there were no clause-by-clause discussions of this bill in committee. The suggestion that they have been held in committee is entirely erroneous. In fact, the public hearings were cut off. They were given a very brief date, and there were cases permitted after that cutoff date. The Ontario Public Service Employees Union was allowed to come in, although other groups that had applied at the same time as OPSEU were not permitted to come. Those public hearings were limited, and then there was the decision to bring the bill back to the House for this clause-by-clause debate.
I do not believe that even the most militant members of the government could suggest there has been undue delay of this bill in the House. What we have done is to try to provide rational arguments to attempt to produce the atmosphere the member for Oriole wants, an atmosphere of calm, concern and warm feelings which will permit the kinds of discussions about health care that need to be carried out.
Unhappily, we have not had that, because we have had carbon copies of the attitude of the Premier towards physicians mouthed by members on that side, but particularly by members of the third party. There has been continual denigration of the medical profession. The member for Oriole notwithstanding, remarks have been made about the most noble profession in Canada that no member of that profession should ever have to tolerate. She has not been here to hear it; unhappily, I have.
It is a sad day for this province, a black day, when the two parties have decided we must cut off debate, we must exercise the guillotine, we must wring the neck of the kind of creature that is attempting to bring some rationality into this discussion regarding Bill 94. It is sad when the government of the day decides it is going to conscript the profession into a relationship which, not only now but also in the future, will decrease the kind of total professional freedom an individual practitioner has.
The member for Essex South (Mr. Mancini) can ramble on all he wants. He knows nothing about this. He knows nothing about being a professional. He knows nothing about the practice of medicine, nor do most of the members of the NDP, who are willing to give us their advice constantly on how to practise medicine. Not one of them has ever practised medicine. What do they know about it? However, we heard the member for Etobicoke (Mr. Philip) telling us last night there was only one way to practise, and that was to be caring. The Lord knows that social consciousness was an inbred part of the medical profession before the NDP ever discovered it. It is still the singular characteristic of that profession.
It is a black, black day when we have prevarication, dissembling, distortion and all kinds of remarks coming from various sides of the House about what is going on as far as this situation is concerned. There is no doubt in my mind the profession in this province now believes there is no point in trusting a politician, because the profession believes politicians and government lie, cheat, distort, move in devious directions and deny what they have said they would do in the past.
There is no way that I, as a single member, or we, as 52 members together, are going to be able to heal the wound which this government and its cohorts have inflicted upon the relationship between the medical profession and the government of Ontario. It will take years to overcome it. It is a shame the people of the province have had to find out through this means that the Liberal government members are really socialists in gumboots. Their feet are loaded with mud, but they are socialists at heart. They want, as the socialists want, to reduce us all to equalized mediocrity in the delivery of health care in Ontario.
The medical profession will not let that happen. It will provide quality in spite of the government, but it will not do it with the same enthusiasm, with the same heart or with the same dedication it has in the past, because the government has cut it off at the knees. It does not realize it; it does not even understand what it has done. That is what worries me. With a little more sensitivity, a little more intellect and a little more thought on the government's part, we could have solved this problem without any confrontation at all, but it has caused the confrontation, and it is going to have to be responsible for the consequences.
The medical profession will do its best for patients in all circumstances, no matter what the government does. This government is inept and should probably retire right now. None the less, I am sure the public of Ontario will be well served by its medical profession. It will not be well served by this government if it pursues the role it has chosen to follow right now.
Mr. D. S. Cooke: I guess it all depends on how one looks at it. The member for York Mills (Miss Stephenson) can describe this as a black day. Those of us in the New Democratic Party who have been fighting for this legislation for 16 years are very proud and think of this as a great day. As my colleague the member for Bellwoods (Mr. McClellan) said earlier in the day, at our convention, which began this morning, we will be honouring Tommy Douglas. It is fitting that on the day we will be honouring Tommy Douglas at our convention, we pass a banning of extra billing in Ontario.
Those of us who have been in the Legislature for a few years, and some in my caucus have been around here a lot longer than I, think of the fights that have been put up by Donald MacDonald, Stephen Lewis, Michael Cassidy and our present leader, the member for York South (Mr. Rae), and our Health critics. All of it now seems worth while: the cases we brought to the Legislature and the petition with 250,000 names collected by New Democrats all across this province to try to get the then Minister of Health, the member for Don Mills (Mr. Timbrell), to move.
I must confess that when I first asked a question on extra billing in 1978, I did not think this day would ever come. I am glad and proud to have been here all night with my caucus colleagues to make sure that, after one o'clock today, the patients of this province will no longer be extra billed.
I agree with one of the comments the Leader of the Opposition (Mr. Grossman) has made in the past week or so. He congratulated the New Democratic Party, saying we had a principled argument. He accepted that we had been principled and consistent all along the line. That is true. He described the government party, the Liberal Party, as not being terribly principled in doing this for political reasons. We accept that.
We accept that the realities of minority government are such that the New Democratic Party can and does play an extremely important role in bringing about progressive change. We accept that if there were not minority government and that if there were not an accord, we would not have this piece of legislation in Ontario.
11:20 a.m.
I do not accept that the Tory party has been terribly principled on this discussion. Right after May 2, when the Conservative Party was in a minority status, I remember reading the press reports of the then Minister of Health, the member for Cochrane South (Mr. Pope), who said extra billing was going to be reviewed by the Conservative Party. I remember the comments by the now leader of the official opposition, then the negotiator with our party to see whether we had anything in common so his party could remain the government in Ontario, that he was also willing to take a look at banning extra billing.
The Conservative Party has no right to claim it has been principled in this debate. The reality of the situation is that they are opposed to Bill 94 now because they are in opposition, but a year ago they were prepared to end extra billing if it meant they could stay in power.
In fact, on the first day of public hearings on Bill 94, the leader of the official opposition made a presentation in front of the committee in which he said he was prepared to bring in legislation that would ban extra billing in Ontario. His emphasis, however, was on patients having to request services at opted-in rates, and that is where we totally differentiate ourselves from the Conservative Party. We do not think patients should have to request charity medicine. We think they are entitled to health care without any discussion about finances, and that is the bottom line with our party.
One of the amendments put forward by the Liberal member for Humber (Mr. Henderson) and supported by the Conservative Party was the OMA position. The OMA position is that anyone over 65, anyone on general welfare assistance or workers' compensation and anyone who has premium assistance will not be extra billed. The bottom line is that the suggestion of the member for St. Andrew-St. Patrick (Mr. Grossman) on this matter was that we were going to give these little accessibility cards to people. Call them what one might -- charity cards, welfare cards -- the reality is that it was institutionalizing the two-tiered health care system the Conservative Party has supported so much during the past number of weeks.
At one o'clock this afternoon or thereabouts, this Legislature will vote to end charity medicine in Ontario and we will end the two-tiered health care system that has been developing. The Conservative Party says there is not a problem; there is not a lot of extra billing that goes on. The member for Don Mills will remember that when he was Minister of Health, the number of opted-out doctors got up to 18 or 19 per cent. The reality of the situation is that in good economic times the number of opted-out doctors will increase. It decreased because of the recession. That is why the number of doctors who were opted-out and extra billing decreased.
That the number is lower is also because of the debate that has been going on and the reality that extra billing is going to be ended. I have no illusion at all that if this bill were not passed and that if the Conservative Party still had a majority, with the economic situation improving in Ontario, the number of opted-out doctors in this province would rise dramatically, as would the number of extra bills submitted on an annual basis and the amount of money held back by the federal government.
We must examine some of the concerns the doctors have expressed to the committee and in the news media. Some of them are so much bunk that they need at least to be mentioned and the question asked, "What do they mean?" What does Bill 94 have to do with professional freedom? All Bill 94 says is that the OMA will have to sit down with OHIP and negotiate a fee schedule. That fee schedule will be adhered to by all practitioners in the province. What does that have to do with professional freedom?
We even suggested, and the Conservative Party voted against our amendment, that if there were a feeling that the fee schedule would be imposed unilaterally by government, we should have a system of negotiation. That system of negotiation should be the one that is there now, the joint committee process, with access to arbitration at the end of the process. That would mean there could be no way the government could unilaterally set the fee schedule. If the doctors felt negotiations were inadequate or unfair, they could go to binding arbitration, which would be imposed on the doctors and the government.
Unfortunately, the doctors want it both ways. They would like to have access to binding arbitration -- binding on the government but not binding on the OMA. That is the reality of it. They want to have their eggs in both baskets. They want to have the benefits of a negotiating process that has increased the fee schedule in this province by more than 50 per cent since the great deal that was signed by the member for St. Andrew-St. Patrick a few years ago. They still want to be able to extra bill another 30 or 40 per cent. We used to be told by previous Ministers of Health that they would not exceed the OMA fee schedule. We have had all sorts of cases that have been raised in this Legislature where not only have they gone the 30 per cent above the OHIP fee schedule to meet the OMA fee schedule, but they have gone far above the OMA fee schedule as well.
One of the agreements in this publication issued by the doctors yesterday, entitled Concessions offered by the Ontario Medical Association to Government in Context of Bill 94, is, "No patient receiving treatment of an emergency nature would be charged more than the OHIP rate." I thought that was in the deal that was struck by the former Minister of Health, the member for Don Mills, back in 1979. That was the deal that was read in the House by the then Minister of Health. It was never lived up to by the OMA. Why would we think this process could be ended by some negotiated, non-legislated agreement with the OMA when the one agreement that was supposed to have been reached in 1979 was never lived up to by the association?
Legislation was the only way we could go as a Legislature. The process has dragged on too long. One of the implications of the government party not proceeding with this legislation more quickly several weeks or months ago was that the government gave a false message to the doctors of this province. That message was, "Keep up the pressure; increase your sanctions, and government might collapse." Now we are where we are, with a major strike by doctors in Ontario.
When we were putting pressure on the government to proceed with the legislation and the Premier (Mr. Peterson) accused us of being too rigid, even draconian, we were using the argument that one cannot negotiate principle. It is interesting that in the past few days, when we were dealing with a Tory amendment on mediation, the Premier said, "You cannot negotiate principle." That is what we have been saying for several months. There was no reason this bill could not have been proceeded with and passed and been law several months ago. The government decides the legislative agenda; so be it, and here we are today. Better late than never, and we are proud to be part of this process.
11:30 a.m.
The Conservative position on negotiations has been totally and completely unrealistic. The last amendment we discussed on mediation was an agreement that would delay the proclamation of the bill for 90 days and set up some mediation process that would have a public fact-finder's process with the expectation that there was going to be a settlement. Does the Conservative Party think that mediation process was going to result in a settlement? It was a good political argument, but it was completely unrealistic.
What we have to do, when this legislation is passed at one o'clock, is to get on with pulling this all together again. Extra billing has been a symbolic as well as an important access issue. Because it has not been dealt with, it has prevented us from going on to other health care issues in the province. We have to pass this legislation today and then we have to get on with and tackle some of the other problems that exist in our health care system.
We have to start developing a multi-professional, multidisciplinary health care system in this province. We should not be so dependent on the illness approach to health care, which is what the medical model and the doctor approach to health care is. Doctors have an incredibly important role to play in our health care system. No one is denying that. However, there are other professionals, nurses, midwives, social workers, nurse practitioners and physiotherapists, all of whom have an incredibly important role to play as well, a role of equal importance to that played by the medical profession.
We have to start developing that process. We have to expand the community health centre system that has been drastically underfunded -- twelve centres, which have not been expanded -- and we have to develop and expand community-based services to senior citizens. That is the direction in which we have to go. After we have dealt with this incredibly important issue of access and extra billing today, we have to tackle the other important issues and improve the health care system of Ontario. It is no longer good enough to maintain the status quo. We have to move on and tackle the other health care issues that are so important.
This party wants to be part of that process. We have been a very important part of this process, the initiators of this process. All New Democrats are proud today of this legislation. The people of this province are proud of the legislators who are making this bold move, which will end at last one of the important barriers to universal and equal access to our health care system for all people in this province.
Ms. E. J. Smith: The time for t'is-t'ain't is over. For many years, the people of this province have expressed their high priority for health care for all the people of this province. They have expressed it in their willingness to pay high taxes for health care. They have expressed it in their charitable giving in many health causes such as the telethon two weeks ago for the Children's Hospital of Western Ontario. They express it from day to day in their personal lives with their compassion for family and neighbours. They expressed it recently in the unanimous three-party consent to the Canada Health Act. Today, on behalf of the people of Ontario, this House is reaffirming its dedication to good health care for all people.
Everybody in this province has always counted on the leadership of the doctors in this field, but the doctors are not alone. They are surrounded by others who care for the sick such as nurses, scientists, technicians and health care personnel at all levels. They are supported as well by all who involve themselves in the promotion of health, both physical and mental, such as public health workers, social workers, teachers and even parents.
Together, we are a team that has stated its priority for health care and that must work together to this most admirable end. We look with joy to the end of the internal strife we have seen. We count on the doctors once again to join hands with us and the many support systems of this province to work together for the common good of our people and to reaffirm their dedication, not only to care for the sick but also to preserve the healthy.
I am sure that each of us is proud to be part of this assembly today in taking this province, along with other provinces, one step further towards this. I personally am proud and happy to have this opportunity to address the assembly.
Mr. Ward: I stand here with tremendous pride that today marks the completion of a process in this province and in this country that began nearly a quarter of a century ago, the process of the evolution of universal health care.
More than two decades ago, the people of Ontario chose to move towards a system of health care in which no one would be barred because he or she was poor, elderly or a new immigrant, a system in which everyone was to have equal opportunity to the same quality of care, a system that perhaps we had come to take for granted. Let us make no mistake about it: The principle of equal opportunity to quality care and the practice of extra billing cannot coexist. I am proud to stand today in this Legislature to support the final step in establishing universally insured health care.
There is one element of this debate that I find particularly offensive in a very personal way. It is the constant comparisons to the British national health care system. I want the members to know that my father was employed by that system many years ago and that our family emigrated to this country. I suppose one of the reasons for making that decision at the time was the events in that country and the lack of commitment of that government to quality health care. I grew up with stories of the horrors of that system. It is one that firmly entrenches two-tier health care, one that is very similar to what was proposed in the so-called compromise.
We have a quality system of health care in this country, not because of the whim of the government of the day but because the people of this province demand that commitment.
I want to speak a little more about the suggestion of compromise. Too often in this Legislature over the course of the past 12 months, the official opposition has wanted to be on both sides of every issue. I do not believe anything is more indicative of that than this headline from the Toronto Star some years ago, "Too Many Specialist Doctors Extra Billing, Grossman Says." That speaks for itself.
The member for York Mills (Miss Stephenson) made reference to the fact that we could move a long way towards ending extra billing. However, it is a principle on which we cannot compromise. The elimination of 30 per cent of the extra billing in this province is, to me, no solution. Today, I received a copy of a resolution from the Blind Organization of Ontario With Self-help Tactics, BOOST, as it is known. Its resolution of June 13 addresses the issue of some of the suggestions of so-called compromise. The following resolution was passed unanimously:
"Whereas universal and equal access to quality health care is a fundamental right, and whereas the various exemptions/solutions suggested by the Ontario Medical Association are unacceptable to us and constitute a threat to the dignity of low-income Ontarians while interacting with their physicians, therefore be it resolved that BOOST call on the government of Ontario to proceed immediately and fully with enactment of legislation banning extra billing by doctors."
In this instance, there can be no compromise on a fundamental principle.
11:40 a.m.
The process that has brought us here today has not been an easy one. There have been 10 full months of debate. I participated on many occasions from one end of this province to the other with groups and individuals who were deeply concerned about this issue. One of the things that deeply impressed me was that there is one group in this province that knows what it was like before medicare. I refer to the last meeting I had in Welland. The member from that great riding was before a group of senior citizens. I might add it was somewhat less than six weeks ago. At that meeting, I was deeply impressed by the forceful presentation made by those seniors because they understood what it was like to live in this province before medicare. They understood what it was like to have to deal on a day-to-day basis, having to find the extra funds to pay for the necessary care they had to receive through no fault of their own.
We have had weeks of public hearings, more than 280 hours of debate in the House and in committee. I sat here throughout the night last night because I wanted to hear what special insights might be added to the debate at the last minute. I was mindful of the comments made by the Leader of the Opposition (Mr. Grossman) when the government moved to allocate time on this matter. For days, we have witnessed obvious stonewalling. Last night we could have heard some substantive new arguments and gained some insight. What did we hear? I sat for the better part of six hours while the member for Oxford (Mr. Treleaven) talked about his dog-haired blanket and assured us there was no problem because he had never encountered a problem with extra billing with one of his constituents before Bill 94.
I listened to that knowing full well that not long ago the member for Oxford had contacted the ministry out of concern for a constituent who had been extra billed a total of $1,200. He, or his constituency office, wanted to know whether this legislation would be retroactive so he could provide some relief to his constituent. He cannot have it both ways. The issue is clear and simple and the answer is to ban the practice of extra billing.
I believe those who suggest the issue is more than this are not acting responsibly. When the democratic will of this Legislature and the democratic will of the people of this province are thwarted by a party that chooses to provide tacit support to tactics such as a withdrawal of services that create fear and consternation, that is not a great day for this Legislature.
Miss Stephenson: On a point of order, Mr. Speaker: That is certainly an imputation of motive and he is entirely incorrect.
Hon. Mr. Nixon: What did she do in her speech?
Mr. Mancini: She has been imputing all kinds of things for days.
Miss Stephenson: I did not impute anything; I gave the facts.
The Acting Speaker (Mr. Morin): Order. This is a point of view.
Mr. Ward: It has been said that this is an issue of freedom. Indeed it is. It is the freedom of physicians to charge what the traffic will bear as opposed to the freedom of all the people of this province to access without financial barriers to the best available health care.
It is a sad day when I read in the newspaper that an honourable profession is described as a screaming throng. I do not believe that for a minute. I think of my own family physician, a man who for 20 years has served a small community, a man who in his spare time serves on the volunteer fire department so he can respond to accidents on the highway and to trauma situations. I will always view the profession in that context, in that regard. That man has never extra billed. He has a social conscience. He recognizes that he has been well rewarded for his efforts. My attitude towards the profession will not change.
I want to refer again to the article in today's Globe and Mail because I think it sums it up so concisely and so completely. "As often happens in these disputes, terms are thrown around with loose abandon. The striking doctors claim that their `freedom' is at stake. The only freedom truly at stake is that of charging what the market will bear, since no one is interfering with their freedom to choose a profession, to practise it where they will, to relate to patients as they choose or to extract from society on average the highest incomes."
No one has ever disputed those principles. What we do dispute and what we will continue to dispute -- I hope after today it will never happen again -- is people in this province being denied access to the best available care simply because they cannot afford it.
Hon. Mr. Elston: When we introduced Bill 94 just over six months ago, I said that the government had made a commitment to the people of the province to end extra billing. I also said at the time that we intended to honour that commitment. Today, we will fulfil that commitment to the people of this province. The province will join the majority of the provinces in the nation of Canada who now can say they comply with the federal legislation mandating that provinces which do not comply will be penalized.
We can go to the people of this province and say that we have fulfilled the requirements of the federal legislation and that we have removed the penalty that the federal government indicated would be levied; that is, for every dollar extra billed, a dollar would be withheld from our transfer payments, a dollar withheld from providing services and programs to the people of this province that the people deserve and have paid tax money to see established to meet the genuine needs in this province.
At the same time, we have provided the fulfilment of our commitment to the people that they will have a first-rate health care system that excludes the necessity of unrolling the wallets, the bank accounts and the credit ratings of anybody seeking medical care. I do not believe there is any more telling situation than the letters I have received from individuals who have felt constrained to seek necessary care when they were on fixed incomes or no incomes at all or were in fear of not having the income to allow them to be full participants in our medical care system.
Having arrived at the stage where we are able to fulfil and honour our commitment to the public and also honour our commitment under the Constitution of this country to comply with federal legislation, whether people agree or not with that legislation, we have taken a series of turns, a series of steps, a series of decisions that have not always been easy for us.
We have considered with the best judgement and the best advice possible how we might fulfil the mandate and still protect a system that I recognize is a first-rate system, that my colleagues recognize is a first-rate system and that everybody here recognizes is a first-rate system. We also recognize the need to ensure that no person in this province feels excluded from participating in that system.
11:50 a.m.
Over the past several months we have had discussions that have taken us into many areas of concern, areas that were not even addressed in our legislation. The legislation is quite straightforward. No one in this province will pay more for insured medical services than the schedule of benefits permits.
That is the bill, and yet we have run into questions of professional freedom, of availability of services and of access to services out of regions. There is no intent on the part of this government simply to pass this legislation and forget about those other issues. We will be working very hard to deal with answering the questions about freedom of the profession. We recognize it is a sensitive issue. We recognize that the need to supplement the services, programs and facilities in this province is real. It is something we heard during the course of our debate. We need to address the concerns about a lack of regional opportunities in providing medical services. It is a real issue. Needing to address the concerns about providing the assistance to further the ability of this province to stay on the leading edge of medical research is a real problem.
We heard all these items expressed to us during what has been almost the past 12 months and we heard them expressed with genuine sincerity, with feeling and with interest for the public of the province. How could we not have heard them? We had a series of forums around the province. We had a series of meetings. I have been to district meetings of the Ontario Medical Association and to district meetings of medical societies. We spent a lot of time talking to people about the issues raised by this bill.
To reinforce once more, the bill itself deals with only the question of extra billing. That is this bill. I do not know how many times I must repeat it but the public ought to be assured that it does not have to pay for those services. They ought to be assured they do not have to have a question in their minds that they will have to look to their wallets before they look to receiving first-class health care.
During the past several months I have been taken with the ability of the health care system in this province to adapt, to respond and to provide leadership in meeting the needs for change. If we reflect on the history of this great country during the past 25 or 30 years, we have seen the expansion and the advancement of the abilities of our health care system to provide care for the people of this province at a rate and in a style which none of us could have anticipated just a few short years before or, indeed, in the past 10 years. We are all struggling with the opportunities now presented to us by new technology, by new pieces of equipment which are allowing us to do with precision things never even thought of before to help the members of the public regain their health.
I want to make a commitment today to the profession.
Mr. Ashe: Withdraw the bill.
Hon. Mr. Elston: No, I will not withdraw the bill. The member for Durham West knows that. I am in the middle of telling the people of this province that my commitment is to building and continuing to build a first-class health system. Although the member laughs, there is no way I can respond in any more thorough fashion than to indicate my dedication to working to expand the capabilities of our health care system, to develop new techniques, to expand our research opportunities and to do all the things we have been doing in concert with the profession and other health care providers in this province for the last 30 years. The history of this country has been that we have been able, because of the opportunities provided by a commitment by the public of this country and the public of this province, to continue to build and expand our health care capabilities so everyone in this province will have access to first-class care.
During the past several months, we have spent countless hours on this issue, but we have also been working on other things, such as talking about the expansion of assistive devices, providing assistance for those with cleft lip and palate problems and providing transportation for medically necessary treatments out of northern Ontario. We have been working very hard on building a commitment to the regeneration of our capabilities with facilities under capital programs announced by the Treasurer (Mr. Nixon). Those types of initiatives indicate clearly the commitment of this government and this minister to ensuring that the health care capabilities of this province expand. My commitment to further work on those programs is clear and is confirmed again today.
In summing up, we are here today on a historic occasion. We join the majority of the provinces of Canada in underscoring our support for a commitment made by the Canadian Parliament to the people of Canada and made individually by the provinces when they instituted medical insurance programs. We underscore to the public that we stand to ensure that they will continue to have access to the first-class system of health care for which Ontario has become renowned.
During the past several weeks and months, I have been assisted by my colleagues. Obviously, there have been days when telephones have rung and calls have been made, and they have worked with the public answering the questions that have been raised by physicians and patients alike. I wish to express my considerable thanks, because it is not an easy process. As much as the minister has been at the centre of it, so have all my colleagues here in the House. All of us have had to do a lot of work with respect to this policy, despite party affiliation. For that work I thank all members. It is a new program.
My parliamentary assistant has been outstanding. In case anyone does not recognize the member for Wentworth North (Mr. Ward), he is my parliamentary assistant and I cannot think of a better person to help carry the load on this matter. In addition, the staff of the Ministry of Health have been outstanding, including the executive assistant, Mr. Ronson, and a list of several others. I will not forget any of them. They are with me today. I know the members opposite who are former ministers realize the stress that goes on for staff as well. These people have been outstanding, and I thank them.
Finally, I thank the Premier and members of cabinet for allowing me this opportunity.
12 noon
Mr. Rae: Before beginning my remarks, I would like to introduce to the assembly a member of the cabinet of Tommy Douglas in Saskatchewan who joins us today for this historic debate, Sandy Nicholson, who is now a citizen of Toronto.
This is indeed a historic day. For our party it is a day of celebration. It is a day of victory for the people of this province. It is yet another step along the way to the best health care system in the world, one that should belong not to any one profession or any group of people who work in the system but to all the people of the province.
That is why the battle about extra billing has to be seen in this great historic context. It has to be seen in the context not just of a battle that has taken a few years or a year or six months but of one that has been the work of working people all over this country who at different times and in different places have taken on a great cause.
In an economy that defines so much by what one can afford, in an economy that tends to define everything in terms of the cash nexus, in terms of the market relationship, those people have struggled for generations to make a basic social statement and to try to build an institution that is based on a different principle: That when it comes to health care, there should be no cash nexus, no marketplace. When it comes to health care there should be only one thing, a commitment to making sure everyone has an equal right to health and to access to a service that is there not as a business, not as a corporation, not as a profit-making institution but as a fully insured service for people.
That is what this historic battle has been about, not just for a year or two but for generations. It was fought in British Columbia, in Saskatchewan and across the country. There were sacrifices and battles. Let us not forget that the Ontario Medical Association and its equivalent in Saskatchewan were never in favour of the hospital insurance plan that went through. They resisted it and then they came to accept it. They were never in favour of it, and in 1962 they bitterly resisted it in the longest dispute between the medical profession and any government in the history of this country. They did not accept it then.
Today the Tory party was calling nostalgically for the good old days of Physicians' Services Inc. and private insurance. It was saying today that somehow medicare was, as described by Premier Robarts, a machiavellian plot foisted upon the people of Ontario. I say with great respect to my friends in the Tory party that theirs is a view which should be freely expressed, but let us not forget it is one that has been rejected decisively by the people of this province in favour of a system which is truly universal and accessible to all and which ensures that, no matter what one's income, one can get the best possible health care probably anywhere in the world right here in Ontario. That is the system we are fighting to maintain and defend and, by God, we are going to defend it and the gains that have been made.
It has been suggested that extra billing is not a problem. During the last number of years in the Legislature we have brought forward case after case in which people have been told at the last minute there was going to be an extra bill; of doctors who have joined together to form a group and who are sending out dunning letters to patients; of doctors who, when dunning letters do not work, then proceed to a credit agent. We have had situations time and again that we can raise. All members of this Legislature have had experiences. I suggest even Tory members have experienced the situation where people come in and ask: "What is this bill I have to pay? What is this bill for $200 or $400 or $600?"
When I hear the Ontario Medical Association say that extra billing is not a problem, all I can say is that their actions since the legislation came forward belie that initial statement. Apparently, the OMA admitted publicly, "Yes, there is a problem." Its solution, which I want to deal with very directly because it has been communicated to us once again by Dr. Moran, is that no patient over 65 would be extra billed, no patient in emergency would be extra billed and no patient receiving financial assistance from the government would be extra billed. Furthermore, it says it will guarantee that every citizen of Ontario will obtain medical services from an opted-in physician or from an opted-out physician at the choice of the patient.
I want to say this to the OMA -- I had a chance to say it before and I will say it again: If this scheme were accepted by any government in Ontario, it would mean two things: First, it would mean the institutionalization of charity medicine in the province for all time, and that is something this party will never accept in Ontario. People would have identification cards or there would be numbers on their backs to say: "Yes, I receive welfare. Yes, I am over 65. No, I am not over 65." Is that the kind of world the OMA wants to take us to?
Once charity medicine is institutionalized, the other thing that would happen is that the volume of extra billing that pertained to everybody else who did not have an access card or a card that was granted to him by the OMA would balloon and mushroom out of sight. Any objective observer of the way the health care system works would know and would recognize that hard and simple fact.
I do not regard the last proposal from the OMA as in any sense acceptable. I do not regard it as a solution and it is not a satisfactory so-called compromise. In fact, there is no compromise at all.
We have finally heard in language that I can only describe as the most extreme I have ever heard in my political career, and I think it is fair to say that I come from a party that has on occasion known extremes of language --
Let us hear a description of this bill for a moment, and let me say to the medical profession: This bill is not Russia. This bill is not fascism. This bill is not rape. This bill is not terrorism. This bill is not warfare. This bill is not a bomb and this bill is not conscription. What is this bill? It is a very simple statement, a simple requirement that the doctors' economic relationship be with the social insurer, not with the individual patient. That is what this bill is, and that is all it is.
There are those who say -- I hear it from the ranks of the Tories today and we have heard it from the OMA, and it is increasingly difficult to tell the difference between those two particularly vulnerable and dinosaur-like institutions in the province -- that this bill is a root and branch attack on professional freedom, on professional autonomy. That is true only if the definition of a profession is one that has to have a business-market relationship with the patient.
12:10 p.m.
I speak as the grandson of a doctor, as the brother-in-law of a doctor and as the nephew-in-law of a doctor. I happen to have a higher view of what professional autonomy is all about. I happen to have a higher view of what professional freedom is all about and I think it is perfectly possible to have professional freedom and professional autonomy and to have a social insurance program at the same time. Those who say we cannot have it are just flying in the face of facts.
Then there are those who say that if we ban extra billing, it will have an impact on a whole range of things in the health care service. I challenge the OMA, which has made this point. How will extra billing affect the number of nursing home beds available in Ontario? Tell me. I do not know how. Explain it to me. Does extra billing reduce the waiting period for physiotherapy? What is the connection between the two? I do not see that connection. Explain it to me. Does extra billing reduce the shortage of chronic care beds? Please explain to me how that is the case and how that happens. I do not see the connection and I do not think the province of Ontario sees it.
What is the connection between a ban on extra billing and the kind of payments available for first-class equipment in our hospitals? Explain that to me. I do not see it. I do not see how the question of underfunding for our health care system, which is a problem and an issue -- it was an issue under the Conservatives, it is an issue under the Liberals and, yes, the question of how we allocate dollars will be an issue under a New Democratic Party government as well, because the pot is not limitless. Every government has to make choices.
For the OMA to say that if it were responsible, there would be no cash limitations on what would be available to the health care system is a nonsensical statement. This bill does not cap incomes. It does not tell doctors where they can practise medicine. It does not cut back the number of nursing home beds in the province. It does not cut back the amount of payments for first-class equipment in our hospitals. It does not deal with the question of professional autonomy or where doctors can practise. It is not Russia. It is not rape. It is not fascism.
It is a simple statement: No doctor practising in Ontario can charge more than the amount negotiated between the OMA and the government of Ontario. Is that not a simple proposition? Is that not a fair proposition? Is it not a proposition that makes sense to all people who recognize that we need to move towards a health care system that is truly responsive, a health care system that deals with our problems, a health care system of which we can all be proud?
I have made this comment on many occasions, but I want to make it again today because it is of such importance. There has been much talk today and during the past number of days, weeks and months about the bad feeling in the profession. Statements have been made. For example, the member for York Mills (Miss Stephenson), who was a doctor herself, said this is a day that will create bad feelings among doctors to which we will not see an end for generations to come.
I suspect there are many patients and citizens who today have a very different view of the medical profession from the one they may have had two weeks, four weeks or six weeks ago. I suspect there are a great many angry patients. I suspect there are a great many people who wonder just how precious the doctor-patient relationship can be to the OMA if at will it can exercise its collective power and interfere in that relationship on an individual basis.
Just how precious can that doctor-patient relationship be to the OMA and to some of its more militant members when they are jamming up the doors of some of their brothers and sisters in the occupation of medicine who are trying to provide services to patients? Just how precious can that relationship be when one has the injection of this collective decision by the OMA that its members will be the ones to disrupt the individual relationship between the doctor and the patient?
Nothing in this bill disrupts the individual health care relationship between the doctor and the patient. Nothing in this bill affects the ability of a doctor to make whatever medical judgement he wishes -- not economic judgement, not social judgement, but medical judgement. Nothing in this bill does that, but much in what the OMA has done and much in what the OMA has chosen to do in the past number of weeks has interfered not only with the economic relationship, not only with the social relationship but also with the medical relationship, the access to individual care from an individual doctor.
This bill has been described as many things and this debate has been described as many things. There are those of us who have been criticized because we have said that it is, in a sense, in good measure about a very practical matter in our economic life, and that is money.
I am under no illusions. I do not think anybody is. If a doctor has been extra billing for a long period of time and has developed an expectation that his income will be 30 per cent higher than the OHIP fee schedule, then I do not think anybody should be under an illusion that such a doctor is not going to be extremely annoyed at a government that says: "No, your income is not going to be that. It is going to change."
I have never for a moment suggested that the OMA and the government should not talk about money. Nobody in our party would object to the practical reality that if that is something members of the profession want to sit down and discuss, let them discuss it. There is no shame in a practical discussion with people about what level of remuneration or pay or income they will receive. There is nothing ignoble in that. It is a very practical matter. All of us have practical concerns about it from time to time ourselves. There is no shame in that.
What has happened is that the OMA has said: "We are not interested in negotiating that. We will not negotiate it." It has said: "We will not negotiate the question of professional freedom as it affects all the other items. We will not negotiate the question of capping of incomes. We will not negotiate the question of freedom to practise geographically. We will not negotiate all the ways in which we might protect ourselves practically as an association. We will not even discuss those things, because we are root and branch opposed to extra billing."
As somebody who has done a little bit of negotiating, I do not think the profession has been well served. I had a doctor come into my office two days ago and say he did not regard the OMA as any kind of a bargaining agent. For him, the OMA was an organization he had to join if he wanted to get cheap insurance. He said: "I am very annoyed with the government. I do not like what is being done, because it is affecting my practice and my ability to do some very special work I am doing at Women's College Hospital." I asked the doctor why in the name of goodness he would not sit down with the OMA and insist that this be part of its negotiation with the government of Ontario.
What government could possibly resist an argument from an eye doctor I heard on the radio the other day when I was on Radio Noon. He said, "The only reason I am extra billing is that it is the only way I can get the payments myself for the corneal transplants I want to do." What Minister of Health could possibly, in this current circumstance, not sit down with the OMA and say: "Let us talk about that, because it is part of a reasonable package we want to talk about. We will inject that money into the system if you will agree to stop extra billing"? That is what negotiation is all about.
Negotiation is not about a vested interest saying: "We will not discuss this. We will not deal with this, because we are root and branch opposed to extra billing." That is not wise. It is not even smart. It is not a good negotiating posture for any organization to take. It is a posture that says: "It is all or nothing. It is my way or the doorway."
No legislature of whatever stripe, whatever its makeup and however it may change in the future, could accept that kind of ultimatum from any group. No legislature could do that, and we cannot do it if we are serious about our job of protecting not the vested interest of any one group or any one profession but the interest of all the public, even if that means, as it has meant, making some tough decisions, making decisions that make sense for people.
There is no question that this bill is seen by the OMA and by a great many members of the medical profession as an attack on their power and their autonomy. It must be seen as that, because the rhetoric has been so overblown and so extreme. If the doctors' view of their role in the health care system is that they are always going to be at the pinnacle, the captain of the ship, making all the decisions, telling the government and the other partners in the health care system what to do as the sole purveyors of health care in the modern system, I say to them, "If that is your view and if it is your view that extra billing is connected with that, then yes, ending extra billing does affect your power within the system."
12:20 p.m.
Again, that is to see the process of negotiation and the process of partnership as a win/lose negotiation. I am not one of those who think this is the only way to negotiate.
Yes, it means a change, because we are saying to the medical profession that there is a partnership there that is waiting to be formed. There is a partnership there that is waiting to be formed with the other professionals who are working in the system.
I would dearly love it if the Ontario Medical Association would use its leverage and bargaining power to insist on a better health care system and not to insist on extra billing. Where have the full-page ads been on the crisis facing the health care system? When have we had thousands of doctors outside complaining not about an end to extra billing but about shortages in the health care system? When has there ever been a barrage of radio ads, a barrage of letters and a lobbying such as we have never seen before on behalf of really improving the health care system and the challenge we put to the OMA in our party?
The challenge was that if doctors want to be partners with the other people who are working in the health care system to build that system, then they should join in and get involved; but they should not expect a return to the 19th century, a return to the 18th century, a return to the world where the doctor was king and everybody else bowed down and let the world go on, where the doctors' market relationship was there and was there never to be changed. That is not realistic and that is not what the health care system of the future is going to look like.
The health care system of the future is going to be one in which the doctors, the government of the province and all the other professionals are going to be partners. It is a health care system that is going to be people-oriented and service-oriented, not profit-oriented. It is a health care system that is going to be service-oriented, people-oriented and community-oriented, not corporate-oriented and not business-oriented. That, my friends, is the way of the future in Ontario.
I am proud of today. I am proud of the role our party has played. I am proud of the fact we signed the accord that put this item on the agenda. I am proud of the fact we have goaded, pushed, cajoled and done everything in private and in public to see that this legislation got to this stage. I say to the House leader that we look forward to its proclamation today. We look forward to the official statement from the government of Ontario that, as of today, extra billing will be illegal in Ontario. It is a victory that is long overdue. It is a victory not just for the New Democratic Party, for the Liberal Party or for the Legislature; it is a victory for the people of Ontario. That is how it should be seen.
Mr. Grossman: In rising to speak on this bill I want to begin by saying that I have listened to many of the remarks from all sides of the House. I want to distinguish between them. At least, I want to distinguish between the remarks of the New Democratic Party, comments I do not share or agree with and many of which I find extreme, particularly those that suggest doctors are not as dedicated to full funding for their hospitals and other things as are politicians. That is categorically untrue.
I do want to say that I very much respect the New Democratic Party's position, much as I disagree with it. It is based on a consistent, reliable political philosophy of socialism. I think it is dead wrong, but I respect it because it is a legitimate view based upon a philosophy and a certain set of principles.
It is quite different, however, when we look at the government. I want to begin by reading a quote from the Premier (Mr. Peterson) in his first interview as leader of the Liberal Party. On February 28, 1982, he said: "It is so easy to kick the doctors. It is a temptation for all people in politics, but I tell you we will not win, the patients will lose, if we wholesale go around booting them and don't create a climate where they're reasonably comfortable." He went on to say, "You can legislate them all back into OHIP tomorrow, but I believe that will create far more stresses and lead to a deterioration in the quality of service if we do that."
If those words were right, and they were in 1982, they are far more accurate today. The leader of the Liberal Party cannot deny that he said that in 1982 or that he supported opting out when it was at 18 per cent in 1982, as opposed to the 11 per cent it is today. He cannot deny that events since then have proved the accuracy of those statements.
I want to deal briefly with some myths, because I know the Premier will have an opportunity to disabuse us of these when he speaks.
First, the argument is put forward that this bill is about accessibility. If it is about accessibility, why did the government not seek first to talk to the OMA and say, "Give us a fully accessible system or we will ban extra billing"? If the Premier ever put that proposition to the OMA, I invite him to say so this afternoon.
Second, there is a myth that doctors will go back to work if this legislation passes. Dr. Railton has said that is not so, many patients are worried that is not so, and last evening the government House leader said: "I am not among those who believe carnage of the bill will end the strike in the provision of medical services. I am not naïve." This bill will not end the strike.
Third, the view is put forward by the Premier that the public voted for this bill on May 2, 1985. If the government wants to take the position, because of the results of that election, that the public somehow voted for the banning of extra billing in voting New Democrat and Liberal, what about the elimination of OHIP premiums, which both those parties promised? What about the northern tax credit, which they have ignored? What about the equal pay legislation for women, on which they have dragged their feet? What about the $4 tax on meals they promised to eliminate? What about the $100-million job creation program they promised? My friends, what about the undertaking to tenants that their rents would be held at a four per cent increase? Did the public only vote for a ban on extra billing and not the others? What gave the Premier the opportunity to select from among these choices the one he believes the public voted for?
Fourth, the Premier argues that the public clearly supports this legislation. If that is his justification, I want to share with him some other public poll results. For example, 68 per cent of the Ontario public favour the death penalty, 90 per cent believe taxes are far too high and 80 per cent, I say to the Minister of Community and Social Services (Mr. Sweeney), believe there should be social-service cuts.
Mr. Mancini: Where did the member get those figures?
Mr. Grossman: From the polls the member's party has tabled.
I also say to the government that in the Goldfarb study of May 1986, 52 per cent of the public was opposed to separate school funding. Does this government believe that a simple poll of the public authorizes and justifies a piece of legislation? If so, what about all the other issues?
Fifth, there is the myth that the Canada Health Act money will go directly to hospitals. We dealt with that yesterday. I have a copy of the government's offer to the OMA. The Premier will be in the House shortly. I invite him to say categorically that paragraphs 2 and 4 of the government's proposal to the OMA in its famous 10-point program were not tantamount to $50 million -- all the Canada Health Act money coming back -- being handed to the doctors. If I am wrong in saying that, I invite the Premier categorically to say that $50 million was not offered to the doctors in paragraphs 2 and 4, so that Canada Health Act money will not come back into this province for hospitals.
12:30 p.m.
Sixth, the Premier has been asked by this party for days to negotiate, to bring in a mediator. His response was, "The Canada Health Act is not negotiable." When the Premier comes in here this afternoon, will he tell us he is doing this only because of the Canada Health Act? Is he telling us the reason he is banning extra billing in this province has nothing to do with the principle, has nothing to do with his campaign promise, has nothing to do, as the Minister of Health (Mr. Elston) says, with people paying to get health care and needing their wallets when they go to their doctors? Is he saying he is doing this only because of the Canada Health Act? If he is, let him say that this afternoon. If he is not, then let him not say he cannot negotiate because the Canada Health Act is non-negotiable.
Next, the Premier says, "Being Premier requires that one has to face up to these things." What about that myth? Did the Premier of Ontario face up to these things when he had 4,000 or 5,000 doctors on the front lawn of Queen's Park? No, he hid in his office and peeked between the drapes to see what was happening. He does not face up to it. Let him not use that excuse.
The Premier talks, and the Minister of Health talks all the time, about the tragedy and the determination of the government to make sure people do not need their wallets to get health care in this province. I want to ask the minister and the Premier, if they believe that, what about the $25 ambulance fee that is still in place in this province? What about the $25 upfront fee for the assistive devices program, to which the minister just announced an extension? Does he need his wallet to get those services? Of course he does. Why does the Premier not do something about those fees?
What about the copayment for nursing homes? What about the neonatal classes in hospitals for which one has to pay up front with one's wallet? What about chiropractic services and physiotherapist services? Are they not important health care services and does one not have to pay for them? One does.
Let us not hear about the myth that the government is determined to do something about the problem of having to pay for health care services. I have listed six examples. The government ignores all of them. In those examples, there are no exemptions; everyone pays, but this government ignores that.
Finally, the government argues the myth that doctors actually create an accessibility problem by extra billing. I am sending over a list to the Premier of all the opted-out physicians in London. I invite him today, instead of making blind statements in his remarks, bald and general statements about how bad extra billing is and about all the doctors who create an accessibility problem through extra billing, to stand up and name the doctors on that list in London who consciously or inadvertently create a problem of accessibility by extra billing. I invite the Premier to name the names of the doctors who are violators. Let us hear them. I do not believe he can.
I invite the Attorney General (Mr. Scott) to give us a list of doctors practising in his riding and in Metropolitan Toronto who consciously or inadvertently extra bill the wrong people. Name the names. Tell us where it is happening. I invite the Minister of Health who read out letters on television the other night to name the doctors. Tell us who they are. Stand up and be counted and do not hide behind a general statement about extra billing.
I want to say to the Premier that 360 days ago he inherited what the leader of the New Democratic Party has just called the world's finest health care system. That finest health care system took six Progressive Conservative Premiers, the doctors of this province and many other people 42 years to build. It has taken the present Premier of Ontario and his government 360 days to bring the world's finest health care system to its knees.
The Premier himself acknowledged that in an interview yesterday when in response to the question, "What is next?" he said, "Now we will try to pick up the pieces." He will try to pick up the pieces of what 360 days ago was the world's finest health care system which has now been brought to its knees. Now he has to pick up the pieces.
The leader of the New Democratic Party, the member for York South (Mr. Rae), said yesterday that the health care system does not belong to the doctors, it does not belong to anyone but the people. I want to share that sentiment with him and to remind the Premier that the health care system does not belong to the government either. It is only a trustee of the health care system. Its job as a trustee is to try to improve it, but most of all to protect it, most of all to look after it, most of all not to dismantle it.
Very clearly, the Premier has committed a breach of trust. The health care system was entrusted to him, and today it is on its knees. He has taken it to a situation where he is talking about picking up the pieces. He does not know whether hospitals are going to be open tomorrow or next week. Emergency wards are closed throughout the province. This is how he has looked after the trust he was left, the world's finest health care system, one year ago.
The Premier is fond of saying with a wink and a shrug: "We have the responsibility. We have the power." We know the government has the power. I have sat on those benches, and we know the easiest thing to do with power is to exercise it. The tougher thing is to refrain from exercising it from time to time. That is the true talent. We know he has the power. The question is whether he has the tolerance and the sensitivity. Does he have the maturity when a crisis strikes to stand down and say, "This is out of hand"?
I am not asking the Premier to say he put it out of hand, although I think that is the case. I am asking him to say: "There is an out-of-hand situation. It is out of control." The best thing to do is to say, "Even though I want my way as Premier, it is better to have peace and tranquillity out there for the time being," and stand it down. It is surely more important to do that than to push his way through to what he has the power to do, as he reminds us so often.
The public values its health care system highly. The Premier is doing irreparable harm to it. After today, the doctors, the hospitals and the patients of the province will not be the same, and neither will he.
What have we seen? For the first time in Ontario, after 360 days of the government having been given the job of protecting the finest health care system in the world, we have seen iron gates erected around the front of Queen's Park, the front of the parliament buildings. Why are they there? They are there to keep the doctors of this province from getting into this building during this debate. These barriers are erected against doctors at the very site on which the Premier was sworn in 360 days ago, pledging no walls and no barriers.
What we have is no hospitals, no emergency wards and no doctors. That is what he leaves for Ontario. The public of this province values its system. It wants harmony, conciliation and tolerance; it wants mutual respect and keeping people together.
The Premier has made the point others have, that from time to time, particularly a year and a half ago, we may not have met all those criteria on Bill 30, but the Premier has fractured every one of the criteria. He has brought a fine health care system to its knees. There was no tolerance and no conciliation. He does not have the political maturity to stand down and say: "We need some time. It does not matter whether I am right or wrong. We just need some time." That is what the public wants from the Premier. That is what it demands from him today.
12:40 p.m.
This morning I heard the Treasurer (Mr. Nixon) cautioning the member for Ottawa Centre (Ms. Gigantes) against using extreme words to criticize the doctors of this province. I was appalled at the hypocrisy of any member of the government saying that.
The Minister of Health said on March 5, 1986, that doctors were living in an ideological time warp. He said they were practising toll-gate health care and that the elderly are robbed of their dignity. He said the doctors were making shrill and unfounded statements.
The Premier himself said, "All doctors who extra bill their patients are not necessarily good physicians," and he said of my great, brave, sensitive, caring colleague the member for York Mills (Miss Stephenson), "She is living proof that opted-out doctors have nothing to do with any particular form of expertise." He told the doctors of this province, "Frankly, it is irrelevant to me whether on the front lawn of Queen's Park there are 10 or 10,000 or 100,000."
Let us not have any lectures from the Treasurer about using tough, mean-spirited words in regard to the doctors, not to mention the words that were read out in the House this morning by my colleague the member for York Mills, words used by the Premier that greatly inflamed an already dangerous situation.
I say to the Premier this is not a time for celebration. I know at the end of this closure motion, when he will have been unable to rebut any of the myths he has been putting forward, his colleagues will applaud, smile and celebrate. With television going live out of this chamber, I remind him that as he celebrates today, there are thousands of patients watching him from their hospital beds. They do not know whether their doctors are there today. Thousands of people in emergency wards will see him on television tonight celebrating and congratulating his colleagues on what they have done, while the patients have been unable to get medical care today. That is what he is going to celebrate at a few minutes after one o'clock this afternoon.
We know the Premier has the power. He reminds us all the time. The question is whether he has the good grace, the common sense and the maturity in this dangerous situation -- and he cannot call this "inconvenience" any longer; he is dealing with a dangerous situation -- to stand down and say that his political face is not as important as the health care system. Has he the good grace and the maturity and the judgement now to say that his determination to get his way is not as important as getting surgery conducted over the weekend and next week? Has he got that courage and good judgement? We know he has the power, but does he have the judgement and the maturity to exercise it?
We have fought only to get the Premier to put in a mediator. It may not work, but we know that the health care system is not working today. In 360 days, the Premier has dismantled and fractured a health care system. The wounds will not go away and the scars will never disappear. Somewhere during the next couple of weeks -- I hope and pray I am wrong when I say we are looking down a telescope towards tragedy. The Premier has created this situation and only he can solve this problem.
I tell the Premier this is not an inconvenience. He is sitting on a powder keg. There is a loaded cannon out there which he insists on firing. It will be fired at one o'clock this afternoon. He has breached a public trust. Now is the time to try to heal it before the entire system fractures.
The public of this province does not want its Premier to play poker in a game where he has dealt the cards and required the other party to come to the table to play those cards, when the stakes are the people of this province. Their health care and their safety are the stakes with which he is playing poker. This is the ultimate test of maturity, the ultimate test of being able to govern, not exercise power. We know the Premier has the power. He tells us all the time. But does he have the maturity, the understanding and the skill to bring this to a happy resolution?
In closing, when the Premier says the strike will come to an end and all the strife will disappear, I believe he is dead wrong. However, I and my party, who have fought so valiantly and bravely, pray he is right.
Hon. Mr. Peterson: Mr. Speaker, I confess to you at the outset today that I take little joy in this historic day. This assembly is going to put into place something I think is a great achievement but it is not a triumph. No decision this government has made has been more wrenching and it gives me no personal pleasure at all to see the turmoil and turbulence that has become part of our system in the past week or so.
It appears we are today at the end of one of the longest and fullest debates in this Legislature, certainly in my memory and perhaps even in the memory of my colleague the member for Brant-Oxford-Norfolk (Mr. Nixon). We have spent 38 days debating this bill, and since six o'clock last night we have added the equivalent of another six days of debate. Every single aspect of this bill has been discussed and considered by all members of this Legislature. Every single member has had an opportunity to express his or her views. We have heard a great deal of vocabulary, not only here but also outside the Legislature, that has been strong and sometimes, perhaps, exaggerated. We have heard charges and counter charges.
I do not believe this is the time to deal with those matters. This is an opportunity to reflect on what has happened and to reflect on the future as well. There were many discussions. I believe the committee had about 156 representations, and I could be wrong in that figure. Some people opposed the bill; some people were in favour of the bill. This issue has had public discussion, not only in this province but also nationally and in many of the other provinces. It is not a new issue; it is 20 years old. We in this party regard it as a logical extension of the principles to which other levels of government and, I suspect, all federal political parties are committed.
We sat down in good faith. My colleague the Minister of Health (Mr. Elston) sat down with the OMA for a long period of time and had many meetings, both formal and informal. They both conducted themselves in good faith. I was at some of those meetings, and they reached for a compromise. They were looking for a solution to the problem but, as sometimes happens in life, there was no compromise available in the circumstances.
12:50 p.m.
Now we have ended up with a difference of opinion, albeit a fundamental difference of opinion. I need not remind my colleagues opposite that this principle has been put into place in six of the other provinces -- presumably, now seven -- as well as the federal government. I also remind my colleagues opposite that we will be getting $100 million back in penalties that have been withheld from us by the federal government. That money will be going to the health care system which is so badly in need of those moneys.
Throughout this long debate there have been many issues discussed -- not just the specific issue in this bill, but the wider concerns as well: questions of the doctor-patient relationship, questions of the role of physicians, where they will practise, how they will practise and those matters.
I want to assure you, Mr. Speaker, as I assure my friends opposite, this bill is only what it says it is. There is no hidden agenda. This government has no plans beyond this bill. We respect the right of the physicians to carry on and practise where they choose, how they choose and what they think best. We have no desire to stand between a doctor and his patient. That is not the intention of this bill, even though the discussion on the whole matter has ranged much wider than this bill. This bill will result in one fundamental change and that change is that there will be equally accessible, universal, quality medicine for everybody in this province regardless of income. That is all this bill does.
There are a number of important points that have been made. Those points bear review and bear looking at. Today I propose again to my colleagues opposite that we address some of the questions and concerns that have been raised by the physicians. Some months ago, Dr. John Evans, the highly respected former president of the University of Toronto, was prepared to look at these long-term problems in the health care delivery system, including consideration of the status and trends in health care and options for future arrangements. In addition to the traditional things we have talked about, I believe we should add on the questions of professional freedoms, how they should practise, how they want to practise.
The terms of reference of the Evans committee, the independent look at the system, should have input from the Ontario Medical Association with respect to the terms of reference as well as with respect to the results. They should have an ongoing role in that review of our health care system. I hope they will take advantage of this offer to join in addressing the problems on their minds as well as the long-term problems of health care delivery in this province.
Some will describe this bill as a victory. I would not describe it in any way as a victory. I believe it is a victory for the principle of equal access to quality medicine, but I believe it is a defeat for no one. I recognize that the people who were opposed to this bill were well motivated. They were motivated by principle, but it happens in a democratic system that sometimes there are fundamental differences of opinion. It is only human to be angry when one's principles do not prevail. As one who has been in this Legislature for 10 years, and many of my colleagues have been here a long time, we have all fought those battles where we felt the principles were on our side, but ultimately we have to recognize the supremacy of this Legislature and take other avenues to fulfil our dreams or our hopes, or to advance our causes.
The OMA, which has fought this as a matter of commitment, a commitment I respect and I think I understand, will understand the political process that works in this province. I understand that in a press conference today the OMA has said it is going to launch a court challenge on Bill 94. I would say to you, Mr. Speaker, that is highly appropriate action in my view and I can assure you that we on this side will do everything we can to expedite that court challenge to prove to their satisfaction that the bill is constitutional.
Mr. O'Connor: That is not what the Attorney General (Mr. Scott) says.
Mr. Eves: Maybe the Attorney General can represent them. He agrees; or he used to.
Mr. Speaker: Order.
Hon. Mr. Peterson: All of us have a long-term responsibility to make sure quality care will be delivered to everyone. Personally, it has been the most difficult issue we have faced as a government. It will come as a surprise to some, but I hope not to many, that we are doing something we said we would do several months ago.
I believe the minister has advanced the cause in a sensitive, flexible and thoughtful way. It has been a difficult discussion but sometimes, as I said before, one cannot bend with every breeze like a straw in the wind. Here we are, today, with a fundamental difference of opinion between us and the medical profession.
It has been difficult for me personally. I have achieved no joy from this discussion. I think the same applies to everyone. It is a difficult situation, when serious people have violently conflicting points of view, to bring them together or to attempt to bring them together. But what the members have seen is the democratic process in action, working towards the end we think is constructive and will achieve the best results for the people of this province.
Mr. Shymko: What democratic process? Closure is called democracy?
Mr. Speaker: Order.
Hon. Mr. Peterson: When I speak for the people of the province, I believe it is our responsibility to speak for everyone. I think, in this discussion, we have done so.
That being said, I repeat that we have many matters that have to be addressed with the medical profession. I talked to Dr. Railton this morning. I told him we were prepared to sit down today, tomorrow, the next day, the day after, or at his pleasure, to discuss some of the wider issues, the questions of freedom of access, the questions of research --
Mr. Gillies: The Premier would not pick up the phone before, but now he will talk to them.
Mr. Speaker: Order.
Hon. Mr. Peterson: -- the questions that have been raised by the medical profession, to attempt to work together to find the long-term solution to the problems that prevail.
As we come to the end, on this historic day, I think it is helpful, in the long term, that perhaps we forget some of the rhetoric that has been employed on all sides of this discussion. I have heard extreme statements on all sides. I have heard rhetoric, perhaps overblown. A vocabulary has been chosen that was perhaps not appropriate in the circumstances.
But that is behind us now. The question is the future. Even though my friends opposite would like to predict doom and gloom, even though my friends opposite view this matter differently, I believe that the professional responsibilities of the physicians will prevail as, indeed, the higher instincts of the members of this House will prevail as we work together to build a world-class health care system that everyone in the province can enjoy.
Mr. Grossman: How hypocritical. That is the greatest hypocrisy I have ever seen in this House.
Mr. Speaker: Order.
Hon. Mr. Peterson: That is a perfect example of some of the rhetoric that has been employed in this chamber which is not constructive in finding the solutions we all desire. I believe there are solutions. I believe they can be found. As we come to a conclusion, with some two minutes to go on this day, I would have to say that I believe it is a victory for democracy, a victory for people to have access to quality medical care. It is a defeat for no one.
Mr. Grossman: Your member is leaving. You are embarrassing him.
Mr. Speaker: Order.
1 p.m.
Hon. Mr. Peterson: May I say in conclusion to you, sir, to my friends opposite and to the medical profession, I recognize that many people disagree with this bill, as many people disagree with many of the bills the government brings forward in this Legislature. Some people who are watching agree, some do not agree and some are unsure. But we all believe in one thing: we have great admiration for our medical profession, we believe in the importance of its role and it is a role we will support.
With the leadership demonstrated by the OMA, as well as by members of this Legislature, I believe we can go on together to build a quality health care system. Even though we have had this difficult discussion -- and it has happened in many other places in this country at many other times -- the importance of the future is too great to be diminished by partisan concerns at the moment.
1:13 p.m.
The House divided on Hon. Mr. Elston's motion for third reading of Bill 94, which was agreed to on the following vote:
Ayes
Bossy, Bradley, Breaugh, Bryden, Callahan, Caplan, Charlton, Conway, Cooke, D. R., Cooke, D. S., Cordiano, Curling, Eakins, Elston, Epp, Ferraro, Fontaine, Foulds, Fulton, Gigantes, Grande, Grandmaître, Grier, Hart, Hayes, Johnston, R. F., Kerrio, Keyes, Knight, Kwinter, Laughren, Lupusella;
Mackenzie, Mancini, Martel, McClellan, McGuigan, McKessock, Miller, G. L, Morin, Morin-Strom, Munro, Newman, Nixon, O'Neil, Offer, Peterson, Philip, Poirier, Polsinelli, Pouliot, Rae, Ramsay, Reville, Reycraft, Riddell, Ruprecht, Scott, Smith, D. W., Smith, E. J., Sorbara, South, Swart, Sweeney, Van Horne, Ward, Warner, Wildman, Wrye.
Nays
Andrewes, Ashe, Baetz, Barlow, Bennett, Bernier, Brandt, Cousens, Cureatz, Davis, Dean, Eves, Fish, Gillies, Gordon, Gregory, Grossman, Guindon, Harris, Hennessy, Jackson, Johnson, J. M., Lane, Leluk, Marland, McCaffrey, McCague, McFadden, McLean, Mitchell, O'Connor, Partington, Pierce, Pollock;
Rowe, Runciman, Sheppard, Shymko, Stephenson, B. M., Sterling, Stevenson, K. R., Taylor, Timbrell, Treleaven, Turner, Villeneuve, Wiseman.
Ayes 69; nays 47.
The Honourable the Lieutenant Governor of Ontario entered the chamber of the Legislative Assembly and took his seat upon the throne.
ROYAL ASSENT
Hon. Mr. Alexander: Pray be seated.
Mr. Speaker: May it please Your Honour, the Legislative Assembly of the province has, at its present sittings thereof, passed certain bills to which, in the name of and on behalf of the said Legislative Assembly, I respectfully request Your Honour's assent.
Assistant Clerk: The following are the titles of the bills to which Your Honour's assent is prayed:
Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act.
Bill Pr18, An Act respecting the Ontario Bible College and Ontario Theological Seminary.
Bill Pr31, An Act respecting the Brantford General Hospital.
Bill Pr42, An Act respecting the Waterloo-Guelph Regional Airport.
Bill Pr50, An Act respecting Renfrew Victoria Hospital.
Clerk of the House: In Her Majesty's name, the Honourable the Lieutenant Governor doth assent to these bills.
The Honourable the Lieutenant Governor was pleased to retire from the chamber.
BUSINESS OF THE HOUSE
Hon. Mr. Nixon: I want to indicate the business of the House for the coming week. On the afternoons of Monday, June 23; Tuesday, June 24; Wednesday, June 25, and Thursday, June 26, we will deal with the following items, as time permits:
Committee of the whole House and third reading of Bill 30, Education Amendment Act; interim supply motion, and the standing committee on the Ombudsman, report 14; second reading and committee of the whole, as required, of Bill 43, Shoreline Property Assistance Act; Bill 79, Municipal Amendment Act; Bill 11, Protection of Rental Housing Act; Bill 76, English and Wabigoon River Systems Mercury Contamination Settlement Agreement Act, and second reading of Bill 51, Residential Rent Regulation Act, and Bill 105, Public Service Pay Equity Act.
On Thursday morning, June 26, private members' business standing in the names of the member for Oakville (Mr. O'Connor) and the member for Lake Nipigon (Mr. Pouliot) will be taken into consideration.
The House adjourned at 1:28 p.m.