Report continued from volume A.
1814
EXPENDITURE CONTROL PLAN STATUTE LAW AMENDMENT ACT, 1993 / LOI DE 1993 MODIFIANT DES LOIS EN CE QUI CONCERNE LE PLAN DE CONTRÔLE DES DÉPENSES
Resuming the adjourned debate on the motion for second reading of Bill 50, An Act to implement the Government's expenditure control plan and, in that connection, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act / Loi visant à mettre en oeuvre le Plan de contrôle des dépenses du gouvernement et modifiant la Loi sur l'assurance-santé et la Loi sur l'arbitrage des conflits de travail dans les hôpitaux.
The Acting Speaker (Mr Noble Villeneuve): The honourable member for Simcoe West had the floor when last this bill was debated.
Mr Jim Wilson (Simcoe West): I'm pleased to have the opportunity for the next half-hour to resume the debate where I left off yesterday with respect to the NDP's Bill 50. It's entitled An Act to implement the Government's expenditure control plan and, in that connection, to amend the Health Insurance Act and the Hospital Labour Disputes Arbitration Act.
I began and ended my remarks yesterday on the theme of Dr Ruth Grier and Bob Rae and whether or not the people of this province trust the NDP to manage the health care system. In the estimates committee which just concluded some 15 minutes ago downstairs in one of the committee rooms, we had the minister responding to some of my concerns with respect to Bill 50, in particular the example of the delisting or limiting of psychoanalysis. It was an interesting discussion with the minister, where she began telling me that she didn't want to play physician; that she didn't think it was the role of government to decide when patients will receive treatment, to what extent that treatment will be, how often the treatment will be received, where that treatment will be received and by whom that treatment will be delivered.
She emphatically told me she didn't think that was necessarily the role of government, yet Bill 50 does exactly that. As I recorded yesterday, in a letter from the College of Physicians and Surgeons, Michael Dixon, the registrar there, made it very clear that this legislation for the first time in Ontario places the government, Bob Rae and company, between the patient and his or her physician. Bob Rae and company, as a result of this draconian power grab, Bill 50, will determine when, where, how and by whom medical treatments, medical processes will be delivered and received by patients.
Furthermore, this bill goes on to do a number of other things. It goes on to give broad powers for the government to determine what medically necessary treatments a physician or other health care professional in this province may deliver.
I guess my major complaint has been twofold: One is that if the government, the NDP, were in opposition today, I'm sure they'd be clinging from the rafters in this building and screaming at a Liberal or a Conservative government, whichever it would be, telling us that we had no business controlling physicians' lives to this extent, that we had no business denying patients of Ontario the right to medically necessary services.
To go back to the estimates committee, it's interesting, the minister telling me that she had no intention of determining herself or having her cabinet colleagues determine which services are medically necessary and should be insured under OHIP and which services should be delisted or not insured or paid for under the medicare plan. Yet a few minutes later, with respect to psychoanalysis, she indicated that the government had already made the determination that it was a non-medically necessary service and that is why it went to the Ontario Medical Association and the joint management committee and, as part of the government's proposal in the expenditure control plan, indicated to the medical community that it should be delisting or certainly limiting psychoanalysis in this province.
I understand now why there is a tremendous amount of confusion out there in the public when on one hand the minister says she doesn't want to determine whether or not a treatment is medically necessary, that she doesn't want to unilaterally do that but wants to do that in cooperation with the medical community, with health care practitioners, but on the other hand she has predetermined a number of cases with respect to eye examinations and psychoanalysis. The government has unilaterally predetermined that those may not be medically necessary, and that has been its negotiating position with the OMA.
It's unbelievable. That's a complete contradiction of statements by the minister. As I say, it's absolutely incredible, and it's completely understandable why there is mass confusion out there. On one hand, she doesn't want to play Dr Ruth; on the other hand, she does.
As I said in my remarks yesterday, I hope it's the end of the days of the NDP pretending that they're holier than thou. We've seen that in a number of issues. This House was just examining the casino gambling issue, where the NDP was totally opposed to casino gambling while it was in opposition. They certainly were opposed to this type of draconian legislation, Bill 50.
The intent of my remaining remarks today is to simply ensure that the public understands that this is the end of medicare as we know it in this province and that the NDP government and Bob Rae are doing that to the people of this province without any input from the public. It's the lazy, hazy days of summer right now. They're hoping the public doesn't pay attention to this debate or to the passage of this legislation. The government will use its majority to pass Bill 50 in spite of the objections of the medical community, in spite of the objections of every person, every citizen, every taxpayer I've talked to with respect to this. I've not had anyone come up to me saying they want Bill 50.
1820
The minister says in her statements in this Legislature that Bill 50 is just a clarification of the powers already given to government in the Health Insurance Act. That is just absolutely bunk. It is not simply a clarification of the powers. This represents a huge power grab by the NDP government to determine what is medically necessary, to determine how physicians will deliver that service, to determine where and when and by whom those services will be delivered.
I think the public deserves to be heard with respect to this important issue, because that's not the way medicare was managed in the past. That is not the way the Ontario Conservative Party developed the medicare system. This is simply the government's expenditure control plan. We have seen the social contract, where the government has hit all health care professionals, nurses, hospital workers extremely hard with no really overall comprehensive plan in place in terms of management of the system.
Then we see Bill 50, the expenditure control plan, where the government says: "We haven't got time to talk to the public. We haven't got time at all. We're the New Democratic Party. We're Big Brother. We know how to do it. Trust us. We're going to cut your services through the cabinet process behind closed doors." Bob Rae won't be around in two years to fully appreciate the consequences of the passage of this legislation.
The Ontario PC Party will be voting against Bill 50. We think it's a tremendously draconian piece of legislation and one that would have driven the NDP absolutely crazy when they were in opposition. I'm sure they would have used every procedural trick in the book to try and prevent this debate had they been in opposition.
It's unfortunate that long gone are the days of the filibuster, when Mr Kormos, the member for Welland-Thorold, put that party on the map with respect to the auto insurance issue with his 17-hour filibuster. I suspect if the NDP were on the opposition benches today, they would be doing exactly the same thing with respect to Bill 50, because I dare say Bill 50 is the most significant and most serious piece of legislation that we've debated in this House.
It's unfortunate, and I've discovered through the committee process and speaking with a number of the NDP, that they don't understand what the implications of Bill 50 are. Because it's so serious, their own government, the minister and the Premier have come out and said that Bill 50 is simply a fail-safe mechanism if we don't get the $1.6 billion out of the health care system in terms of savings that the expenditure control plan calls for. They simply try to assure their backbenchers by saying: "Well, it's a fail-safe. We probably won't ever have to use it, pending the outcome of the negotiations with the OMA."
This is more than a fail-safe. Regardless of the outcome of the negotiations with the OMA, this power grab, this ability to decide everything in terms of medically assured services, in terms of physicians' services, in terms of payments to physicians, in terms of payments to all of those health care practitioners who bill OHIP, this power will remain on the books and it will be able to be used by successive governments.
I sure hope that when the NDP are kicked out of office -- I'm confident now that they're at 16% in the polls, they will be kicked out of office in two years --
Mr Chris Stockwell (Etobicoke West): That's 13%.
Mr Jim Wilson: They're at 13% in the polls? We've seen a dramatic drop over the past 24 hours since I read the 16% poll.
But I sure hope that the next government takes an opportunity to undo what Bill 50 is doing to the people of Ontario. I suspect there will be delistings in medically necessary services. The government will unilaterally decide what those services are. It's already decided what those services are in terms of psychoanalysis and eye testing and a few other examples.
I guess what's worrying about Bill 50 is its massive powers across the board. The bill is written in such a general way that really the NDP could do anything. Yesterday I brought forward examples from the medical community saying that the NDP, at some point in the future, may decide that if you're not looking after yourself well enough and you need a medically necessary procedure -- they may determine that because you don't look after yourself well enough, you haven't done enough preventive medicine in your own life, you won't be entitled to a medically necessary service down the road. That is the extent of the power that is contained in this bill, and it must not be downplayed in any sense.
I want to read from a letter of February 1, 1993, that was sent to an individual in the province by the former Minister of Health, Frances Lankin. In that letter she assured this particular person who was worried about the delisting or limiting of psychoanalysis that that would not be the case and that the government had received recommendations suggesting that it not delist or limit psychoanalysis, that the status quo would remain. I'll read the important paragraph. It says:
"A number of items that are not insured by some other provinces, including psychoanalysis, have been reviewed by a subcommittee of the JMC." That's the joint management committee, the government and the OMA. "Other forms of psychotherapy were not reviewed. This subcommittee has recommended to me that psychoanalysis be maintained within the fee schedule and that separate fee codes be developed to allow the ministry to more closely monitor the efficacy of and access to psychoanalytic services."
To me, that reads that the government will not move ahead and delist psychoanalysis or limit it in any way, yet in the committee hearings today with the minister, I could get no such assurance. Yet the previous minister sent out a number of these form letters to people who had written her earlier this year indicating that that was not the government's intention.
With respect to the overall feeling of the province, and particularly seniors in my riding of Simcoe West, I want to read the following letter by R. Brighty of Tottenham. It's dated July 1, 1993, and it's entitled "Open Letter to Bob Rae and Ruth Grier." It was contained in the Record Sentinel and the Times of July 7, 1993. It reads:
"There's a timeworn trick which has been used by every despot from time immemorial. A sure-fire way to cover one's errors, omissions and deficiencies is to divide the possible critics and set one against the other, but then, I don't have to tell you -- you already deserve congratulations for your efficiency in this practice.
"In common with most Canadians I have concluded that development of this art is a prerequisite for politicians in general, but I stand in awe of your polished technique in its execution. In particular, I refer to your adroit footwork in your suggested (partly already implemented) 'streamlining' of the Ontario health system.
"You have brought seniors, 'gays,' low-income young families and other groups into direct confrontation with each other, effectively masking your own guilt in the gross mismanagement of resources. I, as a senior, believe emphatically that we should not be confronting each other -- we should jointly be confronting you." He's referring to Bob Rae and Ruth Grier and the NDP government.
"The closure of hospitals, hospital facilities and services, and the removal of many drugs from the government-supported list cannot be justified by claims of reduced available funds while past government practices are maintained and continue to drain our dwindling resources.
"Your party" -- and that's referring to the NDP -- "has, in my opinion, recklessly squandered our money on projects and programs which are non-essential, non-productive and, in many cases, actually harmful to our economy. Your lack of precautions against fraudulent use of the health scheme in the past, against overprescription by doctors, in fact against all abuses of the system, has been reprehensible.
"Your persistent implementation of the 'official' bilingualism program in a province which overwhelmingly neither wants nor needs it is a criminal waste of millions of taxpayers' dollars.
"I have paid into the health system since its inception, have paid taxes, provincial and federal, for almost 40 years, and now exist upon old age security and Canada pension payments. Having invested in a few RRSPs and having paid off our mortgage, I and my wife are in a far better position than many seniors.
"Yet I still feel the 'pinch' of now having to pay for many essential drugs while you people pass out grants to 'gay' 'arts' organizations, propose spending further millions of dollars for 'further education,' programs to prepare the untrained to compete with the trained for jobs which do not exist, and erect bilingual road signs on roads where only English is needed.
"Sir, Madam, I have paid my dues! And so have thousands of other seniors who, I hope and trust, will express their dissatisfaction and outrage at your incompetence at the next provincial election.
"May I wish you a happy Canada Day -- as little as you deserve it."
1830
That's a fairly strong letter, an open letter to the Premier and to Ruth Grier, from R. Brighty, a good constituent of mine from Tottenham, who is expressing in a very forceful way the frustration of seniors in this province.
I tell you, Speaker, if the frustration is high now, it's going to be higher with the passage of Bill 50 and its implementation by this government, because this government, which at one time pretended to have a corner on compassion, this government, the NDP, which above all other people in the province claimed to understand the needs and concerns of Ontarians, this government, which said it would never do anything even resembling the contents of Bill 50, has done a complete flip-flop, betrayed the seniors and all the people of this province and is involved in a tremendous power grab to set unilaterally the medical services that will be received by the people of this province.
I tell the people of this province that with the passage of this legislation, it is the end of medicare as we know it, and I say that to the federal government, because it's going into a federal election and there will be federal party leaders on the Liberal and NDP side, and on the Conservative side, indicating that medicare is well in this country, indicating that there are no user fees in this country. I ask the federal government to wake up to the reality of what's happening in Ontario under Bob Rae's government. There are user fees in the system; there are millions of dollars of user fees in the system. What we must do is have a debate on where those fees should be appropriately placed in the system.
Downstairs in the standing committee on estimates we're continuing to have an argument between parties on whether user fees exist. I say, my party says and every citizen in this province who has to pay out of pocket some $150 million in new money this year that residents of long-term care facilities will pay to live in those long-term care facilities -- the government calls it copayments. The government calls it accommodation costs. The people of this province call that an out-ofpocket expense, and that is a user fee.
We still in this province send poor people and street people bills for ambulance services to the tune of about $180, which this government, by the way, through regulation increased shortly after coming to office. We still send bills to people for all kinds of services within our health care system.
Yet the debate, unfortunately, when you get on the campaign trail, seems to surround, do we have user fees or not have user fees? Ask anyone who's absolutely with it in this province, and that's every taxpayer in this province, other than the NDP and some other people in other parties. There are user fees that people pay out of pocket for what they consider to be medically necessary services, such as ambulance rides. It comes as a complete shock to people that they're sent a bill for those ambulance rides, and a very steep bill.
I say we have to stop sending poor people, lowincome people, bills for ambulance services, bills for many other medical services, and we have to stop lying to people, we have to elevate the debate past whether or not user fees exist and we have to have the courage, as politicians, to go to the public, admit that there are hundreds of millions of dollars of user fees in the system now and ask people what they want to pay for, what they don't want to pay for, what they want their taxes to pay for, and the same debate must occur with Bill 50 with regard to medically necessary services.
The government must not be allowed to get away with this draconian power grab which says that Big Brother NDP knows best.
There's no room in this bill for consumer input. There's no room in this legislation, because it gives the cabinet regulatory authority to make unilateral decisions regarding your health care, regarding what services you're going to receive as a taxpayer in this province, as a resident of this province. There is no input for consumers.
We will have four weeks of committee hearings and we will do our best, during these summer days, to get as many people and residents of the province of Ontario to appear before that committee. But if it's like the long-term care changes, Bill 101, there's a lot the government didn't tell us.
The government didn't tell us in Bill 101 with respect to user fees that those fees would apply in an extremely draconian way for those people in semi-private and private accommodation. Yes, there's always been a differential between the ward rate, the semi-private and the private rate in a nursing home or home for the aged or charitable home. That government, on many, many occasions, made it very clear that all seniors residing in long-term care facilities -- nursing homes, charitable homes, municipal homes for the aged -- would be income tested.
We found out, now that they've brought in their long-term care reforms, $150 million in new user fees, additional fees on the backs of seniors, that those seniors, essentially stuck now in semi-private and private accommodations, will not be income tested. Thousands and thousands of seniors are being left out of the income test. I sat through a month of committee hearings, asked that question specifically to bureaucrats, to the minister, to ministry officials, and not once did the government ever come forward with that piece of information.
At one of my nursing homes in Alliston, the Good Samaritan Nursing Home, there is now a waiting list to get into ward accommodation, because the families can't afford the new rates in semi-private and private, where they're not entitled to an automatic income test to see whether they can afford the new user fees brought in by the NDP. That was misinformation by this government. It was misinformation and I use it as an example of how the public can't trust this government.
What the name of the game is in Bill 50 is Bob Rae, Ruth Grier, the cabinet and the NDP members saying: "Trust us. We know how to run your medical system. We'll do it. We'll do it behind closed doors. We don't particularly want to talk to the public." There's no room here for consumer input. They will decide what services, when, how, where and by whom you will receive those services.
The result has been that even though the bill hasn't passed, but with the anti-doctor, anti-professional attitude of this government -- I read yesterday from Dr Wong from Windsor and a number of other physicians who have pointed out that it isn't necessarily the medical system itself that's driving them to the United States or out of this province. It's the attitude and the political reverberations that are coming from the government. It's the sour political mood in this province.
We see it in the business sector, where firms have certainly left this province in an unprecedented way since this government came to office, and we see it now in the medical and health care community, where they are leaving this province, where they are finding other endeavours to keep themselves busy and to earn a living, and where in places like the village of Beeton in my riding it is almost impossible to attract new physicians.
Not only do we have the expenditure control plan, Bill 50, which reduces fees to physicians; we have the social contract. We all agree you have to cut costs, but the NDP at one time stood for consumer input. We hear a lot about stakeholders, but we don't hear the government listening. We don't see them acting on what they hear from the public. I plead with the government to withdraw Bill 50, to start over and to listen to the people of this province.
The Speaker (Hon David Warner): I thank the honourable member for Simcoe West for his contribution to this debate and invite questions and/or comments.
Mr George Mammoliti (Yorkview): I've sat here for the last half-hour anyway today and some of the member's speech yesterday. While I can't respond to a number of things, because of course I get only two minutes to respond, I'd like to touch on one particular area.
But before I touch on that particular area, I want to talk about the recommendations the member has made. You ask, what? What recommendations? No recommendations. What has this member talked about for the last hour and a half? The member has criticized, has done nothing but criticize. No constructive recommendations, and if I'm wrong, please tell me. I don't think I'm wrong. I did leave yesterday for a short period and I may have missed some recommendations that the member made, but I doubt it. I don't think he's made any. I'd like to criticize him for not giving us some constructive recommendations to deal with his concerns, as opposed to just saying: "Scrap it. Forget it. It's no good."
Yesterday, he talked about a doctor leaving the province and going to the United States. What appals me is that he's asking this Legislature to be sympathetic towards a doctor who's going to the United States not because he feels -- in my opinion, anyway, from what I've heard -- that the system is in jeopardy, not because he cares for his patients, perhaps, but because he has some political views that are frustrating to him. I'm assuming that this doctor is a him and I'm also assuming that this doctor is going to stay in the United States once he gets there. I have a problem with somebody coming into this Legislature and asking all of us as members to be sympathetic towards somebody who feels a little uncomfortable because of the government of the day and moves away for a couple of years --
The Speaker: The member's time has expired.
Mr Mammoliti: -- and then wants everybody to feel sympathetic and accept him back into the province whenever he feels fit.
1840
Mrs Irene Mathyssen (Middlesex): I too listened very carefully, and I feel compelled to comment on some of what I heard from the member opposite.
I would like to begin by saying that it is true that doctors do leave the province of Ontario. In fact, the average over the last 10 or so years has been about 200 doctors a year.
I'd like to tell you that of those doctors who leave, about 80% of them return to Ontario. They return for a number of reasons, one of which is the exorbitant cost of malpractice insurance that doctors are faced with in the United States; second, and I think more important, is because the private insurance industry, which finances health care in the United States, to a large degree, dictates protocol to those doctors. They're very intrusive in a way that would never be accepted here in Ontario, intrusive to the point where the restrictions create problems for doctors and patients.
For example, the insurance companies will only allow women to remain in hospital for two days if they're in having a baby, or if a patient goes in for gall bladder surgery, five days is the amount the insurance company permits a doctor to keep his patient in that facility. Very clearly, you've got insurance companies dictating hospital policy, and we would never accept that in Ontario.
I'd like to also mention that the Health Insurance Act in this province has always placed limitations. For example, your yearly checkup is supposed to be yearly; however, any person needing medical care has no restrictions placed on that need.
In terms of the limitations in the Health Insurance Act, those guidelines and recommendations coming from the joint management committee are done in an atmosphere of negotiations. There's nothing unilateral from the government. It is done by negotiations so that our health care will last.
Mr Bob Huget (Sarnia): I have listened very closely to the remarks of the member from the third party over the last couple of days, and I would have to say that although I didn't catch his full speech today, it certainly appeared to be, at the close of his speech, less abusive and insulting than it was yesterday, so I think perhaps we're making some progress.
I would have to say that for my constituents, the issue is not one of doctor-bashing or an attitude against doctors in the province; it's an issue of preserving a very important system. It's clear to me and clear to many of my constituents that there is a responsibility, and it's a shared responsibility, to ensure that we in fact are able to salvage a very important system in Canada and certainly in Ontario.
Health care is an issue that I think goes far beyond the buttonholing and labelling of individuals, the stereotyping of individuals. Frankly, I take offence at the member from the third party, who would suggest that we have an attitude problem with doctors in the province. I consider that to be nothing more than stretching it quite a bit and fearmongering at best.
Frankly, I think members of my caucus understand that all of us have a responsibility to deal responsibly with a very important system, and that's health care. We expect doctors to take a share of controlling expenditures, we expect patients to take a share of controlling expenditures, and we expect government to take a share of controlling expenditures.
Certainly, I have never heard, nor do I profess to claim, that any one sector has all the answers, certainly not doctors, certainly not patients and certainly not government by itself. All I know is that without the concerted effort of all who participate in the health care system, be they patients, doctors or government, which administers it, without significant cost-cutting efforts and expenditure control efforts, the system itself is in jeopardy.
My constituents tell me they want health care and they want medicare in this province, and we're working to salvage just that.
The Speaker: The honourable member for Simcoe West has up to two minutes for his reply.
Mr Jim Wilson: It's interesting in the responses from the NDP government members that what they believe is what they believe, but it isn't reality.
The member for Middlesex says that insurance companies will dictate protocols, will then be in essence running -- what did she say exactly? -- "insurance companies dictating health care in Ontario. We would never accept that in Ontario." Well, the member for Middlesex has clearly never read Bill 50.
I read from two letters yesterday from people in the know, who made it very clear that that's exactly what you're doing. I also read from Bill Clinton, who comments that he's trying to move away from that in the United States. I made the point very clearly: Isn't it ironic that Ontario is moving towards the US system? When you delist psychoanalysis, or when you delist the unemployed truck driver who can't get a note to renew his driver's licence and has to pay $75 to $150 out of his pocket, or when you delist eye care, you then are in the hands of private insurers. They dictate the protocols, they tell the physicians and health care professionals how to deliver those services.
That's exactly the point. I'm glad the member for Middlesex recognized it, although she didn't recognize it in the mirror: She recognized that somebody else was doing that, but not the NDP. That is the problem with the NDP.
The member for Sarnia says that I seem to believe that the NDP has an attitude problem. It's not only me who believes the NDP has an attitude problem; all the people I've talked to about this legislation, I'm sure the vast majority if not all the people who will appear before the committee hearings on this legislation, will agree that the NDP has an attitude problem. That's the attitude problem: You continue to believe stuff you invented in the Dark Ages, and it isn't true. The reason to have debates in this Legislature is for us to try to bring you into reality.
The member for Yorkview still owes Dr Wong an apology. Yesterday, the member for Yorkview said, "He can go to the US and he can stay there, as far as I'm concerned." Dr Wong is not alone. Hundreds of physicians have gone to the US. We are subsidizing the US health care system at $2 million per physician, and that is wrong.
The Speaker: The member's time has expired. Is there further debate on this bill?
Mr D. James Henderson (Etobicoke-Humber): In arguing for reform of legislative assemblies in Canada, I have often made the point that an elected member must divide his accountability and his sense of duty between constituents, party and caucus, and personal conscience. I'm very pleased to speak about Bill 50 because it is an area in which all three of my legislative accountabilities propel me in exactly the same direction. This is bad legislation. It represents a power grab that would make Genghis Khan and Attila the Hun look like Neville Chamberlain, and it is an alarming precedent for health care in Ontario and in Canada.
A little over three months ago we learned of the government's expenditure control plan, which proposed $4 billion in cuts to ministries within the government. This expenditure control plan was but one prong of the government's intended approach to cut $8 billion from the projected $17-billion deficit anticipated for 1993-94. A number of us who take an interest in health care matters saw the writing on the wall when we heard that the Ministry of Health was targeted for about $1 billion in cuts.
The necessity for major restraint is clear. Any responsible legislative member shares this government's determination to get its fiscal house in order. We may worry a little that the government created some of the fiscal disorder it seeks to redress with its first budget proposing that Ontario and the Ontario government spend its way out of the then current recession. We knew that was faulty thinking. It is about as faulty as an individual or a family in debt proposing to spend their way out of indebtedness. You can borrow more and more, but that only leaves you with a larger and larger debt which may have to be paid off during times of greater fiscal stringency when the repayment of the debt is even harder.
So we saw the storm clouds back in 1990 and 1991 when we heard the government talking about spending its way out of the recession. Nevertheless, we are with the government now, philosophically at least, as indeed the government is in some measure with us philosophically. I think that all three political parties at Queen's Park know that spending cuts are necessary and that somehow or other revenues must be increased by getting Ontarians back to work and creating jobs within our province.
We do not quarrel with the need to cut spending. Especially, we rejoice when we hear New Democrats talk about the need to cut spending, because that perhaps does not come easily to some of them ideologically. New Democrats, many people think, are the party of bigger government, and bigger governments spend more. It is a happy day when New Democrats rise in the Legislature to talk about the need for cuts in spending to reduce the provincial deficit.
1850
So we are with the government philosophically in what it is setting out to do. We are not with you instrumentally, because we think that the Social Contract Act was a badly flawed bill which at best is deferring debt for a three-year period and will leave the next government of this province facing fiscal chaos in three years' time.
But Bill 50, an act to implement the government's expenditure control plan, is even worse. Bill 50 is a terrifying piece of legislation. Even Genghis Khan and Attila the Hun are shaking in their graves today.
Bill 50 will allow the government to decide which medical services will not be insured and will allow the government to pre-emptively delist from the OHIP schedule of benefits, without negotiation or consultation with the clinical authorities, medical and nursing and others, who know what is really going on in health care at the level of care of individual patients and who understand clinical treatment.
Bill 50 will allow the government to limit how much will be paid for a particular service according to the age, specialty or location of a practising physician. Bill 50 will allow the government to say that having your appendix out in Toronto is worth half as much as having your appendix out in Kapuskasing, or a quarter as much.
Worst of all, Bill 50 allows the government to refuse to pay for a medically necessary service offered by a licensed physician. The government may decide under Bill 50 how often an individual may receive a medical service in a given period of time and may arbitrarily dictate, without regard to the medical need of the patient, how and when and how often that is going to occur.
Bill 50 will allow government bureaucrats to decide how many times a doctor may perform a particular service under the plan, again without regard to the medical need of an individual patient. Bill 50 will allow government bureaucrats to say how often a particular health facility or clinic can perform a certain service without regard to how many patients are requesting that service and without regard to the medical need of those patients.
In other words, government bureaucrats will be able to decide what services OHIP will pay for, how often it will pay for them, in what areas of the province it will pay for them, in what health care facility it will pay for them and by whom they must be administered. These draconian powers will cancel a patient's right to receive medical care as we know that right today.
What could this mean in practice? It could mean that coronary artery bypass surgery for people who are at risk of heart attacks or who have had heart attacks may not be available to patients over a certain age. It may mean that renal dialysis, a life-sustaining treatment for patients with chronic renal failure, chronic kidney failure, may not be permitted for patients over a certain age. It may mean that a child with health care problems will be permitted only one physical examination in a six- or 12-month period. Further examinations will be deemed redundant and will not be allowed under the OHIP schedule of benefits.
These changes may also mean that cancer patients may be permitted treatment only to a certain level of expenditure. They may mean that patients with illnesses which are life-threatening and carry a serious prognosis may be limited as to the cost of treatments that will be permitted to them, according to the prognosis of their illness. Patients with cancer or chronically disabling neurological illnesses who are not expected to make a complete recovery may find that the government bureaucrats, not their doctor, will decide how much treatment they are entitled to, given the unfavourable statistical outlook of their illness.
It is even possible that patients whose illnesses are prone to recur at regular intervals will find that they are permitted only one or two or a specified number of recurrences for treatment under the provincial health plan.
All this is terrifying and should occasion the most vigorous and powerful coordinated resistance among patients, health care advocates and clinical practitioners, including doctors and others in the province of Ontario.
Bill 50 was introduced without prior consultation or input from health care practitioners, especially not from doctors. Surely such a draconian piece of legislation with such far-reaching implications should at least be discussed with physicians and other clinical specialists, clinically trained people, before it is brought forward for legislative debate in this assembly. Surely in the field of health care our legislation has to make clinical as well as political and fiscal sense before it is brought forward for enactment.
There is a difference between legislation in the field of health care and legislation in many other areas. When ill-advised legislation is brought forward and passed in the field of health care, people die. It isn't just a matter of some fiscal disarray or program difficulty -- people actually die. Surely the joint management committee of the Ministry of Health and the Ontario Medical Association, along with similar bodies coordinating dialogue between the ministry and such professions as psychology, nursing, chiropractic, social work and a variety of other fields, should have had an opportunity to inject a clinical point of view into the discussion for the need for fiscal restraint in health care matters in Ontario. The joint management committee of the Ontario Medical Association and the Ministry of Health was set up for precisely such a purpose.
I hope it is very clear that I am opposed to this legislation. Any decision to limit or curtail treatment must be made in consultation with doctors and other health care practitioners who understand the implication of that treatment and its withholding at the level of the care of a particular individual person.
Recently there has been some discussion of limiting the number of hours of psychotherapy which patients will be permitted to receive under Ontario's health care plan. During those discussions and in the light of several documents emanating from the Ministry of Health, it became very clear that the bureaucrats and politicians involved in these decisions did not understand even some of the very most basic fundamentals of the nature of psychotherapeutic treatment. I could tell you some alarming stories about that, Mr Speaker, but I will limit myself to only two references.
A so-called backgrounder put forward by the Ministry of Health on the subject of psychotherapy and psychoanalysis was full, and I mean full, of errors. When I say errors, I don't mean differences of viewpoint or attitudinal differences; I mean frank, bald errors, things that were stated that did not exist and things that were stated in such a distorted way that they showed a total lack of understanding on the part of officials of the Ministry of Health. That such a decision to curtail treatment should be made by people with that degree of ignorance of the subject matter of their decision is indeed alarming.
I think this is a good example of the menace posed by this bill, because as the members for Halton Centre and Simcoe West have observed, the ministry is threatening to delist psychoanalysis as an insured benefit in Ontario, despite the fact that the OMA-ministry joint committee, the OMA, the college, the chairmen of psychiatry in the various universities in the province of Ontario and, most important of all, the patients have been adamant that psychoanalysis is a medically necessary treatment.
I know, as a physician, that some psychiatric illnesses respond well to medication and hospital treatment, but many do not. Many people whose lives are wrecked by the mental torment of psychological origin need and want the painstaking reconstruction and renewal that can be offered by psychoanalytic treatment.
1900
What bureaucrat, what politician wishes to take it upon himself or herself to deny that anchorstone of our health care system? I mean the universal access to medically necessary treatment that we have guaranteed to the people of Ontario. What bureaucrat, what politician wants the right to deny that patient that medically necessary treatment? I speak with some personal experience in this area, and I am deeply troubled by what the ministry is proposing in this bill.
Second, a very senior cabinet minister within the NDP government was quoted as having said to a patient who was terrified about the curtailment of her psychotherapy coverage that she should trying taking a medication called Prozac instead. That a politician or a bureaucrat would offer such a clinical judgement and a piece of clinical advice is alarming, not so much for its effect in this instance on that patient, because the patient was wise enough to dismiss the advice as a piece of political absurdity and certainly clinical absurdity, but rather because of the fact that politicians and bureaucrats are presuming to offer such counsel. That really does reflect their profound ignorance of the nature of clinical diagnosis and treatment, let alone the nature of the psychotherapeutic treatment they are seeking to curtail.
Bureaucrats should never be making medical decisions about what services are deemed to be essential or how often they can be received. Only doctors and other health care professionals with clinical training are qualified to make those kinds of decisions at the level of individual suffering people.
Government expenditures should not be reduced in this way without a very thorough analysis of what the cuts will do to individual people in Ontario. There is no place for slash-and-burn cost reductions in the health care of Ontarians and Canadians. If we do that, believe me, people are going to die. It is just not an acceptable form of cost reduction when we compromise the health and lives of Ontarians in the course of saving dollars.
I oppose this legislation as well because the government has not been forthcoming in explaining how it has determined which communities in Ontario are deemed to be underserviced and whether its approach to determining that nebulous notion of underserviced communities has validity. Rumour has it that the government figures used to determine whether the city of Sudbury, incidentally my home town, was underserviced counted as active practitioners several family doctors who are deceased.
This is an example of ignoring illness and death taken to its logical extreme, and I do not commend this kind of thinking to anyone, let alone to my friends in Sudbury. A government that is bringing forward legislation like Bill 50 would have to find a way to ignore illness and death in order to collectively sleep at night, but I don't recommend it.
Finally, the government should not be attempting to discriminate against availability according to the age of the patient or according to the age of the practitioner without thorough discussion with the appropriate patient representatives and professional bodies.
I am fervently opposed to Bill 50 for all these reasons and will certainly vote against it. As a representative of the people of Etobicoke-Humber, I am opposed to it. As a member of the Liberal caucus of this assembly, I am opposed to it. As an individual, as a physician, as a parent and as a citizen, I am opposed to it. I am opposed to bureaucrats and politicians dictating matters that will undermine what will determine the availability of health care for individual Ontarians.
That prerogative to discuss and debate what treatment is going to be available, what treatment is appropriate for a particular person, is the prerogative of health care professionals. Health professionals in Ontario are among the finest in the world. They, not bureaucrats and not politicians, should be the ones deciding what kind of treatment is offered to a particular patient afflicted with a particular kind of suffering.
I have heard that the government is very determined to proceed with this legislation, but I hope that some cooler and wiser heads will prevail before this bill comes to a further vote. Genghis Khan and Attila the Hun achieved their own kind of infamy. Now let's let them rest.
I ask the government to back up on this one. Take a second look at this one. Genghis Khan and Attila the Hun are turning over in their graves. Let the voices of sober second thought prevail a little on Bill 50. Defeat it, lift it, withdraw it, amend it beyond recognition. Do whatever you have to do and save whatever face you have to save in the course of doing it, but don't pass this bill in the form or anything like the form that it now exists.
I know that the Minister of Health is a caring, committed, hardworking legislator. She and I go back longer than perhaps either of us would care to admit. I first knew her about a quarter of a century ago in the course of her work in Lakeshore when I was working as a physician in Lakeshore. I know she means well. I suspect she has got some bad advice or some bad directives in the preparation of this bill.
I would like to ask her to resist that advice and to resist those directives. I would like to ask her to wrestle with her conscience a little more on this bill. I know she would not want to ride roughshod over the rights of patients in Ontario. I know she would not want to compromise clinical excellence in the way that this bill is surely going to do.
Ontarians are fine people. Our patients don't deserve to be treated in this way. Please reconsider, Madam Minister. The people of Ontario deserve no less.
The Speaker: I thank the honourable member for Etobicoke-Humber for his contribution to the debate and invite questions and/or comments.
Mr Frank Miclash (Kenora): I would just like to congratulate the member for his comments. I must say that we not only heard from a member of the Legislature but a professional in the field, and a professional who's very close to the patients here in Ontario. I think the member brings forth some very good points on the actual scariness, if I could term it that way, of this particular legislation.
He indicates that now we're going to have politicians and bureaucrats decide, and I think what makes it even a little bit more scary is that these are going to be NDP politicians and the bureaucrats hired by these politicians, as was given in the example earlier today by one of the members asking a question. For any medical advice to come from anybody but a professional such as the doctor in the House or any other professional across the province, I think can be fairly scary, and people have to stand up and take note.
As the member has indicated, we know that the minister is a very caring person and a person who I know will take another close look at this legislation and take a look at where it can be made to fit into what we know today as being a world-class health system here in the province of Ontario. We have been known around the world as a very high quality place when it comes to living conditions. I tell you, if this legislation is to go forth, as the member has indicated, this could actually bring down those standards in terms of medical care throughout the province.
You really wonder when you take a look at places across the province -- and I speak of places within my riding, Ear Falls, Red Lake -- about having any kind of a question at all in terms of whether they should be underserviced or not. I just cannot believe it. The minister could not have been to any part of this province when she could actually say that.
Again, I do hope the minister takes particular note of a member of the Legislature; not only that, but a professional very close to the health care system in Ontario.
The Speaker: The member for Etobicoke-Humber has up to two minutes for his reply.
1910
Mr Henderson: I won't need two minutes. I want to make only a couple of observations.
Ever since universal health care came into the province of Ontario, clinical people in Ontario have been frightened. They've said that whatever step was taken to move us towards a universal, comprehensive, government-sponsored plan was but the thin edge of the wedge, and that we would end up with a bureaucrat-driven, politically driven health care system instead of a health care system that was driven by the clinical needs of people.
For the most part, I have not felt that so-called medicare in Ontario has been like that. I think we have moved forward to guarantee accessibility and to set up a comprehensive plan in a way that for the most part has not compromised clinical excellence, has not done any harm to the good things that were achieved in health care prior to the 1960s when medicare came into the province of Ontario.
I think that's changing now. I think this bill, perhaps following on a couple of others that came a little earlier in the last few years, really is demoralizing clinicians, and demoralized clinicians do not do good work.
I was very pleased, as I was speaking, to notice that there was a kind of transition from the lively chatter that so often greets us when we stand in this assembly and try to offer reflective and serious comments on some piece of legislation. There was a transition from lively chatter to quietness. I only want to express the hope that this quietness reflected thought, and that indeed some further sober second thought will go into further consideration of this piece of legislation.
The Speaker: I again thank the honourable member for Etobicoke-Humber for his contribution and invite any further debate.
Mr Robert W. Runciman (Leeds-Grenville): I appreciate the opportunity to participate in the debate on Bill 50. Someone from across the floor, when the previous speaker was commenting on the decorum in the House, said, "They're all afraid of physicians." I won't identify who said that, but I think there's a lot of truth to that, having been around this place for 12 and a half years. In some respects they are, if not individually, collectively a somewhat influential force -- perhaps not as much as they'd like to be, obviously, given this legislation and some of the pieces of legislation we've seen brought forward in earlier years, in earlier governments.
My party, the Progressive Conservative Party, is opposing this legislation. I relate this to Bill 48. Of course we did support in principle the goals of Bill 48. With Bill 50, we feel that as a responsible opposition we have to flatly reject what we consider to be an ill-conceived initiative on the part of the government to save dollars to the detriment of the health care system.
Any cost restraint measures aimed at the health sector must allow us to preserve the system, not dismantle it, and the Progressive Conservative Party will not be able to support Bill 50 because it holds this potential.
Through Bill 50, the government is seeking sweeping and unilateral powers to limit, reduce or restrict health services across the province. Under Bill 50, bureaucrats in essence become the chief medical officers of health by being able to determine who gets what treatment and how often they're able to receive it.
I'm not going to speak at length or in detail of our concerns about this legislation because our critic, Jim Wilson, the member for Simcoe West, has done an outstanding job in this House detailing how members of the Progressive Conservative Party feel in terms of the specifics of this legislation.
Interjection.
Mr Runciman: I want to say that I was approached by one of the whips of the NDP in terms of exercising restraint and not calling quorums so that members of the NDP could eat their dinners during this evening's sitting, but I'm now being heckled or hassled by the member for Cochrane North. We're going to be loath to continue that agreement, that exercise in decorum, if we have to deal with that sort of effort at upsetting opposition members from getting their views on the record in what is indeed a very limited debate, based on agreements between the leaders of all three parties.
I said we're concerned with the principle of this legislation and what the government's attempting to do. We're not doing this for any political gain, I can assure you of that, because based on the experience of this party, most of us who were around here in 1986 anyway, in terms of counting on physicians and their ability to judge their friends, our experience has been less than a positive one.
If you look back to 1986 and the extra-billing legislation brought in by the NDP-Liberal accord, the Conservative Party was the only party to oppose that on principle. We felt it was wrong for health care in this province and we believe that has been borne out by the history of what's transpired since that ill-fated legislation passed by the NDP-Liberal accord.
But I can also recall for you the results of the 1987 election. Certainly, from a Conservative perspective, there wasn't a physician in sight during that 1987 election. We dropped from 50 seats to 16, so I don't think anyone could accuse the Progressive Conservative Party of taking a position in opposition to this kind of legislation, which the medical community also opposes, for political reasons. We're doing it simply because we believe it's bad for the province of Ontario and it's bad in the long term for the health care system that we all have to live with or try to live with.
I want to talk a bit about some of the problems that exist in terms of the medical community and governments and the public. The previous speaker, who is a doctor -- a practising psychiatrist, I understand -- made reference to universality and the onset of medicare. I think some of the problems in terms of the public perception of the medical profession started to develop with the growth of universality and easy access to medical treatment and the fee-for-service process under which doctors operate with the Canadian medical care service.
I can go back to my early days when doctors in my community made house calls, when doctors were certainly held in esteem in the community, made a reasonably good income, worked very long hours, were very much involved in a host of areas and were always there to help, were always there when they were needed. I'm not saying that many doctors are not like that now -- I'm sure there are many -- but I think to a significant extent people look into the communities now and see doctors, for the most part, who refuse to make house calls, who are by far the better-off members of most communities.
I can look at my own community. When we look at riverfront properties, who drives the best cars in the community, who belongs to the squash clubs, who has the finest memberships and so on in golf clubs, we can bet dollars to doughnuts that it's members of the medical community. I think they have all, for the most part -- I can't use that word "all"; I'm sure there are exceptions to this. But the perception out there with the public is that they've done very well indeed through the process of universal medicare and the so-called free medical services provided to Ontario and Canadian residents.
They have, for the most part, not done anything to deal with that growing perception and the fact that there are so many people who have very little sympathy for the concerns on which doctors now are spending, through the OMA, $3.3 million in an advertising campaign to try to get their message across that they believe Bill 50 is a bad piece of legislation and is going to hurt all of us over the next number of years.
1920
The $3.3 million, I gather, comes from a special assessment on physicians of $200, and there may be other elements of that $3.3 million, but of course the argument can be made that all of those dollars are public dollars and that in effect it's an indirect form of taxation that's paying for an advertising campaign which I think is falling on deaf ears. Really, very few people are paying attention to the advertising the OMA is putting out. I suppose it's providing employment to advertising consultants and public affairs specialists, and in that sense, it's good. But I think it again reinforces the message that physicians believe they are above the fray and that they're going to, through some magic potion -- that $3.3 million indirectly taken out of taxpayers' pockets is going to pay for the overthrow of this government. I simply don't think that's the case. Those funds could be used for much better purposes.
We could even look at the total budget of the OMA and raise questions about that, and maybe at some future date I will. I know we are all going through a salary reduction process in this place. Staff, all public servants, are going through it. I know there is a negotiating process under way with the medical profession.
I suspect if you take a look at salary increases, staff increases, at the OMA level, that probably is on a par with what's happened in the public service during the Liberal-NDP days, when the public service was fattened; I think, during the Liberal days anyway, 8,000 new civil servants, and I don't know how much the growth was during the three-year tenure up to this point with the NDP government, but I suspect you'll see comparable growth at the OMA.
Their revenue in 1991 was $16.3 million. One element of that was $2.5 million in retroactive dues which were part of the OMA entering into this agreement with the NDP government. This in effect was a modified Rand formula, which all of the unionists in the room will understand, whereby an individual doesn't become a member of the union but is obligated to pay dues to that organization. In this case, there are something like 26,000 physicians in the province, apparently; I'm told 23,000 of them are members of OMA and about 3,000 have decided not to join, for a variety of reasons, but they're still compelled, still obligated under this agreement, to pay dues. I think that was a significant carrot in respect to the OMA entering into this accord with the NDP, or, as Barbara Amiel described it, "getting into bed with the crocodiles." I think she was dead on. I agree with Ms Amiel on that. I agree with a lot of things she's said in the past. There are a great many things about Ms Amiel that I find appealing.
The reality is that they're now paying the price to some degree for placing their trust in the NDP government and for becoming in effect a union and finding out that this government does not respect collective agreements. They fell for the carrot in 1991, and now, to some significant extent, they're starting to pay the price. What the long-term message is, I'm not sure, but I think there are problems out there that doctors have to come to grips with.
I want to quote a column from the Toronto Star of July 3, 1993, by Tom Walkom. He's talking about the critique of private-practice medicine:
"Because most charge a fee for each service rendered, doctors are virtually able to create their own business. If government limits their fees, doctors simply see more patients.
"So lucrative is medicine that the field has been flooded with new entrants. The ratio of doctors to population in Ontario has skyrocketed.
"Previous governments have tried to address this," and we know that.
Even though the government entered into agreement in 1991 in terms of trying to control health care spending, Michael Rachlis has pointed out that during that one year following the agreement, payments to doctors rose by a staggering 9%; 9% in the year following the agreement with the government.
So clearly there has not been a recognition among the profession in terms of the concerns of the public, of the government and, I would assume, all political parties in this province about that one element of health care costs and making efforts to get it under control, when you look at a 9% increase in one year, when you consider what was happening to the Ontario economy in the broader, bigger picture.
I have a couple of things I want to mention here as well and get them on the record. There are a number of things that can be done, and I want to put a few things on the record from a group called the College of Family Physicians, whom I have never heard of, really. This is an article written by Dr Gary Gibson, who is a family doctor in Cambridge and professor of family medicine at the University of Western Ontario. I want to put a few of the things he has to say on the record a little later, but I want to put a personal thing in here in respect to an experience I had a couple of months ago.
I went to a walk-in clinic in downtown Toronto because I was having problems and couldn't determine what it was; I thought I had the flu or something. The doctor there didn't know what the problem was, but he prescribed penicillin. He thought I had some sort of flu bug that wasn't going to go away, so he gave me some penicillin. Well, I took the penicillin, and it didn't help the problem; in fact, it seemed to aggravate it in terms of high temperature and so on.
So I ended up going back to this doctor. I was in quite a severe state. I had been under the weather for two or three weeks. I went back to this walk-in clinic, and the doctor gave me another rather cursory examination and said, "I have a new state-of-the-art medication I'm going to give you called Rocephin," a very powerful medication, state of the art.
So I took a shot of this and then went off on a weekend holiday and, still feeling rough, woke up the next day covered with a rash from head to toe. I was in the United States in Lake Placid. I'd had a bad drug reaction. I went to the emergency clinic in Lake Placid, in very bad shape, with a rash developing quickly over all of my body.
A fellow came in whom they'd addressed as "doctor," and within 45 minutes he found out what was wrong. He was very much concerned about the fact that this Canadian doctor had prescribed Rocephin without even knowing what my problem was. He showed some clinical evidence to prove that this has had some instances of causing death in the United States. This doctor had given me a shot of this in the butt and sent me on my way. A doctor in the United States -- I called him a doctor -- in 45 minutes they had found out what my problem was, and they corrected it very quickly.
Talking about OHIP, I got a bill a couple of weeks later. You know what that fellow charged me for the medical services? Forty-seven dollars. I found out later that this individual was not a physician. He was something called a physician's assistant. A physician's assistant can do practically anything. They are licensed to perform approximately 70% of the clinical procedures routinely performed by licensed general practitioners.
So we phoned Albany and the Department of Health in the United States just to get a little information on this program. It started in 1971. The program continues to expand in 1993 because of the need for more primary care practitioners. Now in the United States only a handful of states don't have physicians' assistants. Doctors support the program wholeheartedly because it allows for general health care to be more widely available, especially in more remote areas.
It is estimated that physicians' assistants can do 70% of the clinical procedures. PAs can do anything a doctor can do, but their supervising doctor is responsible for their actions. They can work in a speciality such as urology, but the majority of them mostly work in internal medicine, paediatrics, obstetrics and gynaecology. Their duty is to obtain complete medical histories, perform physical exams, order diagnostic lab tests and interpret the results, perform therapeutic procedures and respond to common emergencies. For example, a paediatrician uses a physician's assistant to screen out the colds and sniffles and the paediatrician is left with the more serious cases.
1930
The training is a four-year program, often with some college-level courses in science and clinical background experience, and often it's nurses who apply to upgrade to become physicians' assistants.
There are two reasons why it evolved. There was a great need for, as I said, primary care givers in New York state and there just weren't enough doctors to go around, and the need continues. I don't think we can make the argument in Ontario that there are not enough doctors to go around. There's an argument, and probably a pretty valid one, that we have 4,000 to 5,000 more doctors than we need in this province; at least some would make that case.
When you look at the average billings right now of a family doctor who bills OHIP, it's an average of $210,000 -- that's the figure I was given -- and an extra $250,000 to the health care system for drugs, tests and hospital stays, so it's close to a half-million dollars per doctor that it costs the health care system in Ontario. The cost of physicians' assistants: Currently in New York state they're earning between $45,000 to $50,000 per year.
It's good to see the Minister of Health in here, because I want to tell her I'm introducing a private member's resolution tomorrow calling on the government to look at the whole question of developing the concept of physicians' assistants in Ontario, because I think it could have a significant impact on health care costs in this province and certainly address some of your concerns and our concerns in respect to health care costs.
The physician's assistant I dealt with in Lake Placid could even prescribe medication. They have a significant range of responsibilities. I was most impressed with the individual treating me, unlike the guy wearing cowboy boots with a host of medallions who gave me a drug that was primarily untreated in the province of Ontario and has resulted in some deaths in the United States. That's the kind of treatment I got here in Ontario: give him a shot in the bum and kick him out the door and charge OHIP -- who knows? -- 200 or 300 bucks. I get down there and they charge me $47 and found out what was wrong with me in 45 minutes, after visiting a clinic here twice, and quite ill indeed.
Mr Mammoliti: Mail-order drugs.
Mr Runciman: Mail-order medication? That's an appropriate suggestion from one of the backbenchers of the NDP: mail-order medication. Mail-order health care treatment, I gather, is what he's suggesting.
Mr Mammoliti: Mail-order drugs.
Mr Runciman: Oh, mail-order drugs. I don't know. You'd better talk to the Minister of Health about that.
I mentioned that I wanted to put on the record a few comments of Dr Gary Gibson, the professor of family medicine at the University of Western Ontario. He's expressing concerns about the future and doctors choosing the appropriate way to go. I'm going to quote some of this.
"I despair that our provincial and national medical associations appear as lacking in insight and candour as the political leaders we criticize. The College of Family Physicians alone has been talking publicly about some of the real issues.
"We have a tremendously well-funded health care industry in Ontario (and Canada). Only the United States spends more on health care than we do; we spend more money per capita for doctors in Ontario than any other province and nearly double the level in the maritime provinces.
"And we waste enormous amounts of money on useless services, tests and treatments -- obscene amounts when compared to the medical resources available to most of humanity on this planet."
He talks about a whole range of concerns. He makes the point that most medical schools don't formally teach their students even to look at issues of cost-effectiveness, although he makes the point that Western does. In some of the examples where they have data: "Cholesterol testing and treatment is totally out of control in North America.... Looked at critically, the health benefit to most patients is very minimal or unproven. The costs are staggering. The long-term side-effects of the newer drugs are unknown."
He talks about the OMA's own study, showing that "more than $200 million in fees under Ontario's health insurance plan is paid annually for 'colds.' These are quick, easy visits for the doctors, often ending in an unnecessary prescription. Patient education on self-treatment is the only treatment needed."
He mentions: "Ultrasounds for normal, low-risk pregnancies are probably of no value at all, but we now average more than two per pregnancy in Ontario and the accepted standard of practice requires them to be done. Patients often insist on them. The cost is about $25 million a year.
"In parts of Europe, doctors don't give antibiotics for ear infections because there's so little difference in recovery time, and complications with treatment."
I said I was prescribed initially in my visit to a clinic in Toronto an antibiotic which did nothing but aggravate my problem, and then on my further return issued a new experimental antibiotic which caused a severe drug reaction. As I said in making reference to the easy dispensation of drugs, especially antibiotics, I can attest to the validity of this concern being expressed by Dr Gibson.
He mentions: "X-rays for minor injuries have been shown to be grossly overordered. Medico-legal concerns are the usual rationalization. But the medical profession should set the standard by example -- not the courts, not malpractice insurance companies and not patients.
"Routine mammography, with our current incomplete understanding of how breast cancer behaves, has been shown to be a value only from age 50 on, and probably needs to be done only every two years. Those who support younger and more frequent screening often have vested interests."
I can't comment. I know there has been some concern expressed about mammography testing just in the last few months, about its value and in fact the dangers it may indeed pose.
"Standard back and neck X-rays for strains and 'disc problems' are useless and unnecessary. Doctors know that, but they very often do them anyway. Patients expect them, physiotherapists expect them, courts expect them, the Workers' Compensation Board expects them.
"Most components of a traditional annual checkup are of no proven value, and checkups of well babies can be done by adequately trained nurses."
Again, the doctors are loath to delegate those kinds of responsibilities to anyone other than themselves, for who knows what reasons. If they're monetary, that could be one element. There could be other concerns; I'm not sure what they might be.
"The current fee schedule has doctors locked into outmoded practices."
He talks about walk-in medicine. I assume this is like the clinic I walked into down the street.
"'Walk-in medicine' creates very significant duplication of services. A large proportion of patients go to their own doctor the next day to be doublechecked. In some communities, family doctors encourage patients to go to walk-in centres or emergency departments out of hours."
Summing up, what Dr Gibson is saying is: "The entire mindset must change. Medical schools must routinely assess the true value and costs of new treatments and technologies.... Individual physicians must learn to make cost-effective decisions.... Patients must be taught what is good care and bad care, both for them as individuals and for society.... Governments must look beyond crude, bottom-line control measures.... Payment systems must encourage wise choices.
"We need effective incentives and motivations built into the system to achieve the needed shift, and we need leadership to achieve that. That is the profession's responsibility. Where is the leadership?"
Effectively, Dr Gibson is bemoaning the lack of leadership within the medical profession. He's not jumping at the throats of politicians or others; he's bemoaning the lack of leadership within the profession itself. Hopefully, these are the kinds of comments that the Minister of Health will pay heed to and perhaps even take the time if she hasn't already, to sit down with representatives of the College of Family Physicians and discuss their ideas and concerns, because they strike me as very valid. Certainly Dr Gibson is a respected professional, as I said earlier, a professor of family medicine at Western.
1940
Our critic, Jim Wilson from Simcoe West, has outlined most eloquently, most emphatically, most energetically, most enthusiastically, in a way only he can do, because he is so strongly wrapped up in health care issues, his genuine concern for the future of health care in this province.
As I said, we are not here to represent any political interest or the interests of any professional group. We're here because we believe Bill 50 is wrongheaded legislation. Over the long term, it's going to do more damage than good.
Obviously, in the views I've expressed today, I believe changes are necessary, and I am certainly one who believes that changes within the profession are very much called for. Over the years, I've been one who has on occasion expressed concerns about the profession.
But at the same time I do not believe in the heavy-handed approach of this government and its predecessor, the Liberal government, and certainly not in what happened in 1986 with the ban of extra-billing. I think that just aggravated the problems and pushed us further along the road to socialized medicine in this province and had the effect certainly of driving specialists out of this province, as most of us feared it would have.
When you look at some of the world-class people who have moved to the United States -- I can't think of the name of the individual a year or two ago who was at the Hospital for Sick Children and moved to Texas, was provided with funds and a whole range of attractions which made it irresistible for the individual to stay in Ontario --
The Acting Speaker (Mr Dennis Drainville): I thank the honourable member for his participation in the debate.
Mr Runciman: Mr Speaker, thank you very much for listening to me. Again I want to express our concern, the Progressive Conservative Party's concern, about Bill 50 and where it will take this province.
The Acting Speaker: Questions and/or comments? The honourable minister.
Hon Mrs Grier (Minister of Health): I just want to comment on some aspects of the member for Leeds-Grenville's remarks. I certainly agreed with much of his analysis of the situation and certainly have appreciated his view that change was needed. I hope his recognition is that if we don't attempt to change the system, then we run the risk of the system becoming so overwhelming to everything else that government in this province does that we are unable as taxpayers to afford it.
I also very much appreciated his argument that the profession had to be part of the changes and had to be part of assistance in helping to protect the system.
I wanted to particularly comment on his descriptions of physicians' assistants in another jurisdiction and to say to him that I entirely concur with the philosophy that there are a lot of other professions within the health care system that have a rightful role to play and that, by being allowed to play that rightful role, can assist us to contain the costs and to also improve the quality of care.
While physicians' assistants are not something with which we've had experience in Ontario, nurse practitioners, who are very similar, are a profession or an extension of the nursing profession that I think we have come to understand in some communities, can play an extremely important role in assisting doctors and in preventing overuse of physicians, because the services that nurse practitioners provide are preventive, are educational and are for those who are well as opposed to treating those who are sick.
I regret that the member and his party object to Bill 50 and will not support it. Let me say to him that we view Bill 50 as a tool to enable us to make the changes that he agrees are necessary.
Mr Huget: Just very briefly, I too would like to congratulate the member for Leeds-Grenville on his very thoughtful speech. He and I don't agree on many issues, but I think we agree on the need for change as it relates to health care. In our society, in Canadian society, for too long we have assumed, and I think wrongly so, that spending more gets more, that spending more money necessarily gets better-quality health care. I believe that's not true now, nor was it true in the past.
I think there are some fundamental changes that we as a society will have to deal with when it comes to the funding of health care in our society. I sometimes get the feeling that people are afraid of change more than anything else. I think the issue of initiating change and initiating reform so that we can have a system that works well and survives causes as much anxiety as some of the change itself. I'm of the view that real change in health care and other areas will not take place until the cost of staying the same becomes higher than the cost of change. I believe we are now in a situation where the cost of staying the same is higher than the cost of change.
I look forward to the day when hospital administrators, nurses, professionals, politicians and consumers can sit in one room and agree on the need for all of us to change and work towards a sustainable system.
Mr Randy R. Hope (Chatham-Kent): As I listen to the member opposite talk about his experience in the United States, there is a serious question I wish to pose to him. As he talks about financial accountability and accountability to the taxpayers of this province, I would seriously ask the question to the member opposite, because I know when he was probably in the United States, as he went in there they were asking, "How are you paying for this, Visa or MasterCard?" Then, after having the work performed by the physician -- or the PA he referred to it as -- he went to the cashier and paid. There must have been a justification for the services that were done.
I'm wondering if the member, who I know was actively involved in the insurance issue, would not maybe agree that what we need to do is make sure that the services that are performed in the province of Ontario, the services that are rendered for an individual, must be verified by the individual before the insurance is paid for that individual. I'd just like his viewpoint to that effect.
Mrs Barbara Sullivan (Halton Centre): I was interested in hearing the remarks of the member for Leeds-Grenville as I found that on several occasions his content differed substantially from that which was being put forward by his colleague the third party critic for Health. I'm sure that within their own caucus they are going to want to iron out some of the differences in their points of view. I'm sure that the Ontario Medical Association will also be very interested in the lack of consistency in the direction that has been presented.
I think one of the aspects, however, which the member raised, through quotations from an article which described certain procedures and quoted, I believe, a physician who was making individual recommendations with respect to certain aspects of practice, including pregnancy screenings and so on, was one of the very problems with Bill 50, and that is the point of looking towards parliamentarians and ministry officials and the Minister of Health and cabinet to make decisions the basis of which ought to be made upon the recommendation of, and after complete clinical evaluation by, the medical profession itself. I think that relying on the kind of information that is transferred through newspaper articles to this place is wrong.
I do not believe the Minister of Health should have the power or any increased power to intervene or to determine what is medically necessary, and particularly to do that without consultation with the profession. To that extent I certainly disagree, particularly with the remarks of the member for Leeds-Grenville.
The Acting Speaker: The honourable member for Leeds-Grenville has two minutes to make a response.
Mr Runciman: In response to the last speaker, the Liberal Health critic, what she's talking about in terms of the proposed changes that I quoted in terms of a newspaper article: exactly. What the author was calling for was the involvement of physicians. It was a physician calling out for leadership within the medical community. He wasn't calling for politicians or others to make these kinds of decisions. He was calling out for leadership, and I was simply endorsing that call.
One of the government members mentioned getting a list of services provided. In my experience in the United States, indeed I did get a list of services prior to payment. In fact, when I left the hospital, I didn't have to pay. I just told them I was a Progressive Conservative and they trusted me. They sent me a bill and I paid by cheque two weeks later.
The other element I simply want to mention briefly: The Minister of Health drew an analogy between nurse practitioners and physicians' assistants. I appreciate what she's saying, but the reality is that nurse practitioners are very limited by the law in terms of what they can do. When you take a look at the comparable responsibilities of a physician's assistant, there's really a significant difference there.
As I said, I'm introducing a resolution tomorrow to encourage the government to take a look at this concept and the possibility of introducing it in Ontario, because I think it could not only have an impact on health care costs, but address the concerns in those remote areas that are not getting the service they require today.
1950
Mr Sean G. Conway (Renfrew North): I'm pleased to follow my friend from Brockville, from Leeds, who I thought made a very interesting set of comments. Part of the member's charm is his idiosyncratic quality. I thought he was true to that tradition today. While I certainly don't agree with everything he had to say, I thought there was a refreshing candour about some of his observations.
I'm pleased to have an opportunity to speak to the debate about Bill 50. I'm also pleased to see the current Minister of Health and a former Minister of Health and a few other people who know something about the Health department. As I listen to this debate, I'm reminded of one of the most interesting experiences I ever had in this assembly, and that was I guess now about 15 years ago participating under the able leadership of Dr Robert Elgie QC as a member of the select committee of this Legislature dealing with health care costs and financing. Fifteen years after we concluded those deliberations, I look to Bill 50 and I certainly see some of what was predicted now coming to pass.
I know the member for Ottawa Centre would be interested in this, if not in much else I have to say, but a few weeks ago I was privileged to be in an assembly hall in my community of Pembroke to hear the redoubtable Dr Jane Fulton of the University of Ottawa. She's becoming quite an international spokesperson on the subject of health care. I find her very interesting, very stimulating, extremely provocative. I would say on that night she was positively blistering in her comments about the establishment, which I think she would characterize as predominantly male and predominantly institutional. Boy, it was a very interesting presentation. I would recommend to all members, if they haven't had the opportunity to hear Jane Fulton on these subjects, that it's really very worthwhile.
Again, like the member from Brockville, part of her charm is her idiosyncratic personality. I left that meeting with a higher blood pressure than I thought I was capable of achieving, but it was very stimulating none the less.
Interjection.
Mr Conway: Pardon me?
Hon Mrs Grier: Worse than question period?
Mr Conway: Jane Fulton actually appeared one night about a year ago on a fabulous PBS forum on public health, I think at Harvard University, where she was debating, and I thought extremely successfully, a number of the principal luminaries in the world of managed care in Bill Clinton's America.
As I listen to people talk about what changes in Ontario might do in terms of forcing people out of this jurisdiction, there's no doubt that this pressure continues to be there. It's been there for as long as I've been in this assembly. I can remember periodic exoduses, if that's a word. It probably isn't. I'm failing my Latin.
Hon Mrs Grier: Exodi.
Mr Conway: Exodi. Pat, will you check that out?
Hon Evelyn Gigantes (Minister of Housing): Exits.
Mr Conway: Periodic exits of the profession over the course of the last number of years.
We do, I think, have to be concerned to ensure that in whatever change we seek to effect in health care programs and their delivery, we have as high a degree of support and participation from the leadership of the traditional professions. Though we might like to lash out at the medical profession, it is I think unreasonable for any of us to imagine that in Kent county or in Renfrew county or in Ottawa or in Etobicoke, we're going to be able to manage the kind of change that the member for Sarnia I think rightly points to as necessary without the active participation and support of the local medical associations, the nursing community and everyone else in the health care field.
I thought it interesting, in some of the public opinion research that was released recently -- I think it was the Environics data -- that this certainly does seem to be a very strongly held view in the Ontario community of 1993. They understand the need for change, but certainly in the health area, they fully expect that the medical profession is going to be involved in a very significant fashion.
I want to address my comments tonight to this Bill 50 from the point of view of someone who represents rural, small-town, eastern Ontario. As most of you know, my constituency is in the Ottawa Valley. Our principal community for health services is the city of Pembroke, but if the truth were told, our principal principal centre is the national capital. Most people in my constituency are referred either into the city of Pembroke, and if it is for any kind of major treatment or care, as often as not, that individual will find himself or herself being transferred down to the various facilities in the national capital.
There is no question that there are some problems we have to address, and I think it probably is a fair criticism of the incumbent government to say that some of these matters ought to have been addressed by earlier administrations. I can say without much fear of contradiction that in the area of, let us say, medical manpower, the marketplace is not working, that it hasn't been working for some time.
I don't think we can much longer allow a situation to obtain such as we have in the county of Renfrew. I wasn't able to confirm this today, but I think using the ministry criteria, our population of some 85,000, in a very large, rural, small-town community running from the town of Arnprior, ably represented by my friend from Lanark-Renfrew, all the way up to the Nipissing line just about 10 miles east of Mattawan, across to the Algonquin Park communities of Whitney and Barry's Bay, which is in the west part of Renfrew, has I think currently 1.5 psychiatrists, well, well below what is required. It is an ongoing scandal, quite frankly, for which the profession must accept a measure of responsibility and for which those of us in elected office must equally accept responsibility, and I accept my share.
I have listened for weeks and months and years to health care providers, hospital board members, hospital administrators and others say, "When are you going to do something about increasing the number of psychiatrists serving Renfrew county?" and the situation is getting worse, not better.
I would say to my friend the Minister of Health that I am, as one member, prepared now to consider more draconian action on these fronts than --
Hon Ms Gigantes: Directed, not draconian.
Mr Conway: Directed action. All right. I accept that amendment from the member for Ottawa Centre.
The people of Renfrew county have a right, I believe, in a public health care system which I support absolutely -- I am not one of these people who wants to get into managed care or some kind of brokered system of partially public and partially private. I think the commitment we made in this province and this country a generation ago to have, as a matter not just of social policy but of economic policy, a public health care system was a right policy and we should not retreat from that.
I think again, as the member for Sarnia observes, that what we developed in the era of Mike Pearson, John Robarts and Tommy Douglas a generation ago clearly is not necessarily what we are going to have in precisely that way to carry us into the 21st century. But I simply say, on behalf of the constituents I represent in the north part of Renfrew county and also on behalf of a lot of hardworking providers, that the deficiency that we have laboured under in certain areas of specialization -- I'll use psychiatry, because it's an obvious one and an important one -- must be addressed.
2000
I will support any action that this government or any government takes to correct a deficiency that is apparently part of the medical marketplace. I'm quite prepared to tell people more directly than I would have perhaps been prepared to tolerate 10 years ago that going to Pembroke or Eganville or Deep River or Renfrew to practise psychiatry is, in my view, not being assigned to purgatory or to some gulag. I don't think it is a punishment. I think those are wonderful -- I know they're wonderful communities. It is not that I think it; I know it.
Mr David Ramsay (Timiskaming): Beautiful places.
Mr Conway: Those are beautiful places, as my friend from Timiskaming says, and they have a right to expect a reasonable level of service that they have not been getting in some of these areas.
Where I differ, of course, with the current government is that good social democrats can't resist a very rigorous dose of social engineering. I will not walk with the minister as far as she might like me to walk down the road of that kind of engineering, though I am prepared to go farther, I suspect, than a number of my colleagues, because I have seen over 18 years some of the best efforts and the best wishes of Tory and Liberal administrations -- and one of them I was an active part of -- and we were not able to find a way to deal with some of these problems.
I say to the minister and through her and through this debate to the profession, that we had better find some mechanisms to deal with ongoing deficiencies in many of these areas of health specialty. They're not all physicians either, I might add.
The point was made here about nurse practitioners. There's been some interesting research. I might stand corrected, though I don't think I will be; I see Bob MacMillan here, and if anybody can correct me, he can. There was a study done I think not too long ago in some part of Canada where people were given an opportunity to "access" a nurse practitioner. As I remember that data, the consumers had a good encounter with the nurse practitioner and then said, "Where's the doctor?"
Hon Mrs Grier: Not all consumers.
Mr Conway: The minister says not all consumers, and that's probably true.
The time in this province when the nurse practitioner model worked best, as I remember it, was the period of the late 1960s and early 1970s when we had, as I remember the Elgie committee proceedings, a very marked shortage of doctors. We don't have a marked shortage of doctors today, and my guess is that as long as we have an overabundance of doctors poorly distributed, it's going to be very difficult to get the nurse practitioner program or anything like it off the ground.
So point number one on behalf of my constituents: We've got to do a better job as a matter of not just public policy but practical administration of more evenly distributing a number of these resources across the province.
Having said that, let me turn to another concern I have, and that is the underserviced area program. I can say some things here that will not be very popular in my own constituency; having enough seniority now, I guess I can expose myself to some criticism from my own constituency. I saw the government ads not too long ago about where one could go in my part of the province under the underserviced area program, and I thought: Boy, oh boy, this on the surface looks good but in reality it's not going to solve the problem.
One of the areas, for example, was Beachburg, a wonderful farm community 10 miles east of Pembroke. We've got a very considerable concentration of medical resources in and around Pembroke.
Mr Ramsay: Whitewater rafting.
Mr Conway: Whitewater rafting country. I'm not so sure that we need to use the instrument of the underserviced area program to put a person in Beachburg, though I want a person to go to Beachburg. That's 10 miles, a very easy 10 miles, from a very large medical hospital facility, in relative terms, in the city of Pembroke. And this is more interesting. My friend the member for Halton Centre probably won't like me saying this, but the other place that was on the list was the village of Whitney, in south Nipissing, which is in the township of Airy. My friend the Minister of Agriculture and Food knows what of I speak.
Hon Ms Gigantes: Whereof.
Mr Conway: Whereof I speak. That community has suffered through some very interesting experience over the last number of years with the underserviced area program. It's not the government's fault: Best efforts have been made to put and keep a solo practitioner in Whitney. I don't think, personally, the traditional way is going to work any more. Barry's Bay is the nearest hospital centre, and they've got some very real problems; in particular, like a lot of these smaller communities represented by people like the members from Cochrane South and Hastings, we're quickly seeing difficulties around emergency services in these small hospitals. You need, clearly, a roster of physicians available to keep those emergency services open and operating.
By the way, Minister, I think your expenditure control plan is going to have -- is already having -- a very significant impact on the way in which a lot of these small hospitals maintain emergency services. My guess is that the current arrangements in the two hospitals that I know well, the two small rural hospitals in my area, Deep River and Barry's Bay, are going to be in trouble very quickly.
I would be very interested, for example, looking at the Barry's Bay situation, which is a very rural hospital -- I personally would be interested now in looking at a program, maybe with the Queen's medical school or the Ottawa University medical school, to say, what would work up there?
What I think would work in a place like Barry's Bay, and this is speculation on my part, would be some kind of policy for young doctors, residents, coming out of Ottawa and Kingston, two hours in both cases, some kind of locum that is probably funded through the hospital and is tied into maybe a program operated by one of those two medical schools, whereby they are funded, together with the hospital, to provide an opportunity for young physicians to go up on a regular basis, but particularly on weekends in the fall, winter and spring, to maintain a basic level of service so that the regular docs can take some kind of relief. I'm going to make it a point in the next little while to go down to Queen's and Ottawa and talk to the deans of the medical schools just to see if I can put some flesh on this proposal.
Now, there will be people, I'm sure, who won't like the idea that they might be assigned to go up to Barry's Bay from Kingston on a rotational basis for a number of weekends. I don't think that's an unreasonable request to make at all. I think it should be properly funded, and it probably should be funded through the hospital and maybe the medical school, and I'm quite prepared to say on a salary basis. I have no problem with that.
But I'm terrified that we're going to end up with a program and a policy that's going to be targeted at larger centres and that these small rural hospitals that I represent are somehow going to fall through the cracks, because the situation in a place like Barry's Bay and Deep River is very, very different than in larger places like Chatham and even Pembroke.
Now back to the underserviced area program. My guess is that in an area like Whitney and Madawaska, where people rightly expect to have a level of medical service -- and I have no quarrel with that, but --
Mr Kimble Sutherland (Oxford): How about Palmer Rapids?
2010
Mr Conway: Palmer Rapids? That's a little different, my friend from Oxford, ably assisted by the member from Muskoka.
I want to say that I'm not interested in going back and pursuing programs and policies not designed by this government that failed, that just, for whatever complicated reasons, did not work.
The fact of the matter is, over the course of my 18 years in this assembly, we must have gone through six to eight young doctors who've gone into Whitney and they haven't stayed, for a lot of interesting reasons, not the least of which reasons are sociological. There were no other doctors there. There were other non-medical questions that came to bear.
I look at the situation there and say, "Yes, Whitney and Madawaska should certainly have an entitlement to a physician," and maybe more than a physician, a team of individuals, and there is some of that there now. But it seems to me that if we're going to assign someone there, we would probably be better to assign that person to the Barry's Bay hospital centre, because it's 30 miles to drive from Barry's Bay to Whitney.
My guess is that we're more likely to achieve most of what the villages of Whitney and Madawaska want, though not everything, and they're going to be angry at the local member for not supporting their ideal, which is an ideal I would like to imagine could work, but all of the evidence suggests that it hasn't worked in the past and is probably not going to work in the future.
Those people living in that part of south Nipissing do depend on the emergency services of the Barry's Bay hospital so that if we lose the emergency services there, it's going to have an effect on all of those surrounding communities.
The Bancroft situation's interesting and different because they've got a relationship with Belleville General. I can't speak to how well it's working. Somebody might educate me later.
My point is that as we look at the overall situation in these small communities, in these rural areas, I think we have to be realistic. We have to take heed of what has not worked in the past. We have to recognize the right of these people living in rural communities, in Renfrew or in Cochrane or in Kenora, to a good level of service and try to devise or reconfigure programs like the underserviced area program to more realistically accord with local conditions.
So when I see in the ad, Whitney, I say to myself, yes, but the Whitney situation can't be look at in isolation from the developing problems and opportunities of the Barry's Bay hospital centre. That's the point I want to make.
I'll tell you, living in these communities, we've got to make some choices. I think those of us in elected office, whether it's at the local board level or at the local political level or certainly myself as the local provincial member, I owe it to my constituents to be honest about the real choices and the funding that's going to be required to make those possible.
My sense is that people are willing to work with government, with elected people, if we are, quite frankly, a little more honest and candid than maybe we've been in the past on these kinds of subjects. Let me be honest, again most politicians, in my experience, this one included, have been terrified to deal frankly with some of the tough questions in the health care debate because we know that this is an area of enormous sensitivity, and the minister's facing a very tough decision around the drug benefit program.
You ask yourself, in 1993 who was it and on what policy grounds did we ever decide a generation ago that just because you were 65 years of age you had an automatic entitlement, a carte blanche, to free drugs? But we decided that. We decided that: not our government, not your government, another government. They decided that against some very powerful internal advice.
Hon Mrs Grier: Really?
Mr Conway: I know at least one of the people who gave it. But there was a very obvious political appeal to the offer.
Hon Mrs Grier: They could afford to.
Mr Conway: They could afford to, that's right. But I've got to tell you, I'm waiting for the day and if we adjourn on Thursday, probably about a week Monday, we will start to see more clearly the colour of Ruth Grier's cards. She's going to take 195 million bucks out of the drug benefit plan this year.
I only mention this because I remember about 12 or 14 years ago wily Willie Davis stuck his nose out of the tent one day and said he was going to take about, I don't know -- much, much less I can remember. He was going to tinker with the ODB and take much, much less than $195 million, and I've got to tell you, wily Willie Davis went back into the tent and he never, ever opened his mouth on the subject again, because I'll tell you, did he press a button.
It's 1993 and we've got different realities and we've got a very, very resourceful, powerful Minister of Health, who has got a much higher pain tolerance than Willie Davis.
Hon Mrs Grier: She also has some commitment and some principles.
Mr Conway: Well, you see --
Mr Gary Carr (Oakville South): Ruth Grier said that? Ruth Grier of all the members to say that.
Mrs Sullivan: Don't feed the bears.
Hon Mrs Grier: No, I was teasing the bears, not feeding them.
Mr Conway: Anyway, I want to talk again about hospitals, because it is very clear to me, again talking to a number of doctors in my area, that the expenditure control plan, wow, does it have some teeth that are going to bite into the way in which doctors relate to hospitals in rural communities. My guess is that we are just weeks away from a very significant impact on hospitals as a result of behaviour modification occasioned by the Ruth Grier expenditure control plan.
Now if the doctors I'm talking to do some of the things that they are threatening to do, I've got to tell you, we are going to very quickly find ourselves in an interesting situation in the province. But we're going to have to look at our hospital services.
I look to my own communities again. I live in Pembroke. We have two hospitals: the General Hospital and the Civic Hospital, five blocks apart. Wonderful facilities, well supported by the communities, but it's clear that the time is coming where, in a responsible way, we are going to have to refashion much of what goes on in those hospitals, not just because we probably should, but more importantly because of the fiscal reality. We just don't have the money to continue business as usual.
I'm under no illusion about what this is going to mean. As a former Minister of Education, people wanted to talk to me about the dual school system. But I look at all these communities that I know in the province where there are two hospitals, four hospitals. I said then what Bob Rae says now, and the only difference is that -- no, I won't say that.
I just want to make the point that we're going to have to make some tough decisions, and they're going to have to be taken not just by the government, in fact if they're going to be successful, they're going to have to be understood and supported at the local level. We've got a long way to go there because we've got a public debate that is driven by special interests. I don't care whether it's the Ontario Medical Association or CUPE or ONA or whomever else.
I go to meetings and I just want to tear my hair out because I would just like some facilitator to get up and tell the audience, "Here, generally speaking, is the unvarnished truth as best I can present it." But to have the president of CUPE or the president of the OMA local section come in and say, "Well, here's reality as we know it," is to really make a delicate situation more difficult.
We had in Barry's Bay last summer a meeting that I'll never forget because some of the representatives of government and the OMA showed up at a meeting that was attended by hundreds of people where the issue was inadequate resources for the hospital. Hughie Segal would kill me for telling this story, but Hughie's wife Donna, this fabulous, wonderful person, and it wasn't her fault, hitched a ride with somebody from the OMA and they arrived at this rural community in a block-long stretched limo that made me think that Earl McEwan had come to town.
That was the end of the meeting, because the first question at the meeting was, "Are you the people who got out of that car?" "Yes." "Ah, and we're supposed to now talk to you about the problems of financing our local hospital," and I'll tell you, it didn't get much better from there.
2020
Now, the point of that meeting: 400 or 500 people came out, a large crowd, and they wanted to be part of the solution. But we gave them very little in terms of what had gone on in that hospital in terms of funding. There was a great discussion about emergency services.
I'll end with this story. I was seven years of age, growing up in the little village of Barry's Bay when, violating the teacher's orders, I threw a snowball that November day at somebody who shouldn't have been interfered with, and when I fell, my leg ended up in Rafael Chapeski's balloon tire bicycle and was broken into more parts than I can imagine.
There was no hospital. But what happened to me as a seven-year-old was that one of my pals picked me up and put me on a bike. I was hauled home on the crossbars, squealing like I've never squealed in this place, as loud as I've been for 18 years. The doctor came and took a look at it and then my parents carted me off to the Pembroke General Hospital, 45 miles away. That was what the emergency services in my community were in 1958. Now, happily or otherwise, I survived that incident.
We need to have discussions, whether it's in Ottawa or in Barry's Bay, in Chatham, in Rexdale or in New Liskeard, about what is going on now, what is really going on in our hospitals.
Interjection: And what's that?
Mr Conway: Well, it's a hell of a lot different than a lot of people think, let me just say that -- including the local member, speaking for myself.
It's time we had an honest discussion about what is going on, what needs to change, and how in a participatory way we are going to make that change, because I've got to tell you, friends, we're all in this together. If we don't manage this file carefully, we are all going to sink under a real weight of public outrage and disgust.
The Acting Speaker: Questions and/or comments?
Mr Carr: I'm pleased to offer a few thoughts on the member's comments. I think his last points were the most valid, the ones about having the honest and candid debate. Of all the remarks, I think that's the truest. I really think that most people right now who are out there because of what is happening in the social contract don't realize what this bill does. I agree with the member that we need to have honest and candid debate.
I think it's starting to happen. He mentioned a couple of meetings in his riding. We've had a couple in ours as a result of some of the services being taken away from the Oakville-Trafalgar Memorial Hospital, and a tremendous number of people came out. Unfortunately, they don't come out until services are being cut; no one really knows until, all of a sudden, the services are cut.
I also agree with the member, and I don't think there are too many here who would not agree, that we don't have the money. I think back just two and a half short years ago, coming up on three years, when this government came in. I don't think they could have thought we'd be sitting here having debates on this type of bill, even as short as two -- first budget. But I think everybody realizes, the public realizes now, that we are out of money; we are broke.
So I appreciate the comments of the member. If the government takes one message, it is the honesty and the candid debate. I think it needs to happen, in spite of what the members might think. A member like the one who just finished speaking and the rest of us do want to have that debate; we want to be a part of the discussions. I really believe that a lot of people are not aware of what is going to happen to our health care system. We've taken it for granted, and with all the other problems out there in this day and age in the economy, people had better watch this bill very quickly.
I commend the member on his comments because, looking at this piece of legislation, I believe there needs to be hard debate on what we're doing with Bill 50.
Hon Mrs Grier: Having served in this House now for seven years with the member for Renfrew North, I hope he'll forgive me if I use a nursery rhyme to describe him: When he's good, he's very, very good, and when he's bad, he's horrid. Tonight he was very, very good, and I thank him for that constructive contribution to this debate.
Much of what he has said about the underserviced area program, about the need to involve the academic health science centres in meeting that long-standing problem, is precisely the direction I hope we can have some constructive discussion about and the direction that perhaps may lead us to some long-term structural changes that will enable us to deal with that problem as opposed to the quick fix or the financial fix, which, as he says, we can no longer afford to do.
But I want to say to him that in his analysis, the thing he failed to recognize is that there have been until now very few tools available to the Ministry of Health to make the kinds of changes that are being suggested; that the system has not been a system, and it hasn't been managed because there really isn't an ability to manage it.
As we work together -- and it is very much a non-partisan discussion out there in the communities and out there at the district health council level -- as we work to try to create a system and to manage it in the interests of everyone in all the great diversity of this province, Bill 50, as a tool, is one of the ways that both many in the profession, because of some of the abilities that Bill 50 gives us to implement the results of negotiations with the profession, some of which they will support -- but it is a tool that enables us to do many of the things that the member for Renfrew North and I agree need to be done.
Mrs Sullivan: I think the contribution from the member for Renfrew North has been a positive in this debate. I think some of the ideas he's put forward are the kinds of ideas that indeed could avoid the blunt instrument of Bill 50. Were the minister to take these kinds of ideas to heart, we wouldn't need this bill at all; in fact, I don't believe we do, and the bill should be withdrawn.
We know, and the member has ably pointed out, that there is a problem in providing physician coverage in many communities. Moosonee has no permanent physician. Rainy River, from June to July, has no doctor; there's a new one who may be arriving, but no one knows that for sure. The member has specifically spoken about Barry's Bay, where on weekends and evenings there is no coverage at the hospital, and the relationship between physicians who are located in Whitney and Barry's Bay is problematic.
The member from Renfrew talks about the possibility of a new relationship with medical schools to provide the kind of coverage needed in communities that otherwise would not have physician coverage. I point out that that has indeed occurred on an experimental and indeed a program level through Lakehead University and Laurentian University in the north, and there is no comparable relationship in southern Ontario for those rural and remote communities that do not have the physician coverage.
Unfortunately, many of the students who were coming to the end of their term in the Lakehead and Laurentian programs were indeed anxious to practise in the northern communities and were ready to take their place. The threat of being compensated, if they didn't pick the right community, however, at only 25% of the fee schedule gave them pause. That's the kind of power that would accrue to the minister under Bill 50, unilaterally. It's the kind of power that has no place in the health system.
Mr Runciman: I simply want to pose a couple of questions to the member for Renfrew North, whose comments I enjoyed. It's somewhat curious, to those of us in the Progressive Conservative Party, in any event, the position the Liberal Party is taking now in opposition to Bill 50. The Conservatives have been consistent in terms of their concerns about the interventionist approach of governments in respect to health care.
We just have to hark back to 1986, I believe, with the Liberal-NDP ban on extra-billing and the demonstrations that took place. The member for Renfrew North was an important player in the government of the day when those decisions were taken. It would be interesting to know what his views were. Certainly, he stayed within cabinet and supported the Liberal government and its friends in the NDP in respect to that ban, which had the effect, among others, as I said earlier, of driving some world-class specialists, surgeons, out of this province into the United States; that legislation, among other initiatives undertaken by the Liberal government.
I find it most interesting that he and his party are taking a position today -- I want to say that our position is one of principle in respect to this bill. We feel it's bad in terms of health care for this province. We have been consistent in that respect, going right back to 1986, in any event, in terms of our opposition, which certainly was of no political advantage to us; in fact, quite the opposite. We went against a great deal of political criticism. That was perhaps a factor in the results of the 1987 election, when the Progressive Conservatives suffered very badly at the polls. We felt it was the right thing to do and we stood up for it despite the political odds that were against us.
The Acting Speaker: The honourable member for Renfrew North has two minutes to make a response.
Mr Conway: My answer to the member from Leeds is very simply that I supported then, as I do now, very strongly the notion that there should be no extra-billing to any citizen of Canada for services that are insured and covered under the medical care act of Canada -- end of debate. That's my view. I feel very strongly. Our government took that position. Quite frankly, if you accept the tenets of medicare, I don't think you can have another position.
If you take the view that medicare was a mistake, and there were many in the right wing of the Conservative Party who have taken that view since 1963 and maintain it today, then clearly you can have another position. But I want to be clear: My position was then, as it is now, that for those services that are deemed to be insured under the medical care act of Canada there ought to be no extra charges.
I just want to say to my friends everywhere that we've all made our mistakes. I remember coming here 18 years ago just after Frank Miller went off on a unilateral Don Quixote mission up into western Ontario to close community hospitals. He had some rationale -- I don't doubt that he had some rationale -- but it blew up in his face; in fact, the miserable failure of that half-thought-out initiative complicated the life of Health ministers from that day forward. It set back some of the discussions and decisions we needed to have in those places for at least a decade.
To be sure, our government made its share of mistakes. My point, where I differ a bit with the minister, is that this isn't just a matter of finding the instruments. This is a matter of creating a public understanding and some sense of the common good that is going to allow us to make the change that is necessary and to allow spending to occur not just in health care but in key areas like education and training, where we have to improve our investments to start getting this economy moving again, to get more taxpayers out earning an income and helping us all with the good responsibilities we want to fund.
The Acting Speaker: It now being after 8:30 of the clock, this House stands adjourned until tomorrow at 1:30 of the clock.
Hon Howard Hampton (Minister of Natural Resources): Mr Speaker, I believe we have to deal with the business of the House for tomorrow.
The Acting Speaker: There is a business report? Okay.
BUSINESS OF THE HOUSE
Hon Mr Hampton (Minister of Natural Resources): Tomorrow we will deal with government notice of motion number 9; Bills 32 and 34 in committee of the whole House; Bill 8, resumed debate; and Bill 50, resumed debate.
The Acting Speaker (Mr Dennis Drainville): I thank the honourable minister. This House stands adjourned.
The House adjourned at 2033.