32nd Parliament, 1st Session


















The House met at 2 p.m.



Mr. T. P. Reid: Perhaps I could rise on a point of order, Mr. Speaker. In response to question 92 on the Order Paper, placed by me on May 13, 1981, the minister responsible, the member for Dufferin-Simcoe (Mr. McCague), tabled on July 3, 1981, a list of all public opinion polls that the government had commissioned between March 11, 1980, and February 1, 1981, and their costs.

At that time, the minister stated that copies of these polls would be tabled individually by the ministers involved. The minister also indicated on May 19, 1981, that the information would be made available by approximately mid-June 1981.

My point of order, Mr. Speaker, is that to date only nine of the total of 25 polls have been tabled. Two of the polls tabled include only every other page. These were polls conducted by the Ministry of Energy, interestingly enough. Finally, it seems that some of the ministers involved have tabled old polls, taken in 1974, 1975 and 1976, to avoid tabling the ones I had specifically asked for.

Mr. Speaker, I ask you to ensure that the polls outstanding be tabled immediately.

Mr. Speaker: Thank you.

Mr. Smith: Is there going to be a statement? Is there going to be a reply to that?

Mr. T. P. Reid: Mr. Speaker, maybe we could hear from the government House leader, who is supposed to orchestrate these things.

Hon. Mr. Wells: Mr. Speaker, I think the point raised by my friend is an interesting one, and I will be happy to look into it. I know the answer tabled was the answer the government presented. It is the intention of all my colleagues who had various ministries to table the polls that were conducted. I was not aware that some of them had not been tabled. I will be glad to check and find out when the others will be tabled.



Mr. Smith: Mr. Speaker, I have a question for the Minister of Energy. The Treasurer (Mr. F. S. Miller) informed this House some time ago that although the Suncor purchase would not produce jobs or additional oil for Ontario, it was a good business deal in his view.

The minister was present in our caucus room today when we heard from the experts who supposedly had endorsed the deal. Therefore, he knows the experts pointed out to us that, given the cost of money for the deal and given their estimates of what can be hoped for by way of return in total, both capital gain and dividends over 25 years, their general hope was that, although we would lose money for a few years, it would even out and become a break-even deal over 25 years unless, perchance, we discovered oil such as in the Hibernia field. Those were their words.

Will the minister please answer the question that is now on the lips of everyone who attended that meeting today? In a province that is short of money and has so many pressing needs in terms of industry and the various services the government is to provide, why did the government enter a deal in which we are going to lose money for several years and in which the best hope we have, barring some fabulous oil discovery, will be to break even over 25 years?

Hon. Mr. Welch: Mr. Speaker, I think it would be helpful if we clarified some of the preamble before we get to the questions. It is unfortunate that the Leader of the Opposition (Mr. Smith) found it convenient to leave the caucus this morning before the people who had been invited had the opportunity to respond to the invitation of the --

Mr. Barlow: He had a press conference.


Mr. Speaker: Order.

Hon. Mr. Welch: For the record, the chairman of that particular caucus, gentleman that he is, had indicated before we adjourned that the Leader of the Opposition had one further question --

Mr. Smith: They answered all my questions. I listened to the rest. This is not responsive to my question. The question is, why did we buy the company?

Mr. Speaker: Order.

Hon. Mr. Welch: He indicated that, following the final question of the Leader of the Opposition, those who were there on the invitation of the Liberal Party would be given the opportunity to do some summing up and to have some opportunity of clarification. When we reached that point, the Leader of the Opposition found it convenient to stand up and say, "I do not have any further time," and walk out of the room. I think that should be understood. Obviously there was an appointment some place to expand on the matter.

Mr. Smith: They had answered my questions.


Mr. Speaker: Order.

Hon. Mr. Welch: Fortunately, some of us stayed behind, including members of the media, and were provided with an opportunity to get some further clarification. If the Leader of the Opposition had remained, he would have had the opportunity to get some clarification made with respect to the very figures he is using.

He will recall that during his questioning, and I thought very relevant questions were asked during the course of that session with the Leader of the Opposition's party and his colleagues, he was told the advisers to the Ontario Energy Corporation had incorporated into their recommended valuation -- that is, the fair price to be paid for 25 per cent of the shares of Suncor -- that there would be an average rate of return of between 15 per cent and 20 per cent.

Suncor's proven and probable reserves were built into that valuation, and it did not include new findings. Indeed, built into that was the present oil pricing agreement between the governments of Canada and Alberta, but it did not necessarily go on to reflect what would happen after 1986. I am sorry; the valuation did, in fact, carry with it some assumption with respect to that escalation. Therefore, the new finds to which the Leader of the Opposition makes reference are not included as part of the 15 or 20 per cent, only the proven and the probable ones; so the 15 to 20 per cent is there and is in place now.

2:10 p.m.

One has to see this investment in terms of the energy policy of this province. Indeed, we announced a year ago, as part of the energy policy initiatives of this government, that we were instructing the Ontario Energy Corporation to seek opportunities to become involved in the Canadianization process.

We live in a province that has very little oil and gas. It is therefore essential that we address the needs of this very large consuming province, which depends, as it will for some time, on hydrocarbons for part of its energy requirements -- indeed, for 65 per cent of its energy requirements. We wanted to be there to facilitate the Canadianization of a particular company, which would then attract the incentive grants that would allow it to open up these lands with their proven and probable reserves and therefore address the whole question of supply.

We pointed out at that time that out of every dollar invested in oil and gas in this country about 42 cents will accrue to Ontario, and we could go on to spell out in a very real and positive way what that means with respect to the size of the investments that it is anticipated will have to be made in order for Canada to become self-sufficient in crude oil.

Although a substantial percentage of the investments that are being talked about now will be in Alberta, we must not lose sight of the spinoffs to this province, particularly the refinery and retail operations of the company we are talking about. This is in Ontario's interest, because it is Ontario's contribution to the national target of crude oil self-sufficiency. We are moving on a number of fronts, and this has to be seen as very important for the economic well-being of this province.

It is unfortunate that we were not given the opportunity to share all this information, because it might have disturbed the quick summary the member was very anxious to leave as a lingering last comment on the meeting.

Mr. Smith: Since the minister has now confirmed the accuracy of the quick summary I presented, namely, that the government has spent $650 million it has had to borrow at a long-term rate of between 17 and 18 per cent -- at least, that is what they thought it would be, and it may well be that over the years -- since the government has done that to achieve a return that is estimated to be somewhere around 15 per cent and might, if we are lucky, go as high as 20; since we can expect, therefore, to lose money for the next several difficult years in Ontario, in the hope that we will break even over the course of about 25 years, unless they discover new oil; and since the minister is saying that this speculative venture is based entirely --

Mr. Speaker: Question.

Mr. Smith: Mr. Speaker, after the amount of time you gave the minister to describe the goings-on in our caucus meeting, you will let me ask a question.

When even breaking even on this deal will depend on whether the price of oil from the tar sands goes to about $110 to $120 a barrel within 10 years, the only reason he spent $650 million he did not have is that he thought the oil under the ground which Suncor happens to have leases on would otherwise not be discovered.

Is that what he is saying to the people of Ontario, that he has spent $650 million of our money plus interest in a deal in which we will be lucky to break even over 25 years? We are going to lose money when we most need it just because he thinks the oil in the ground that Suncor leases would not otherwise be discovered. Is that what he is saying?

Hon. Mr. Welch: I rise in response to this supplementary question simply to point out that the conclusion that is reached as far as breaking even is concerned is the opinion of the Leader of the Opposition.

Mr. Smith: It's the opinion of the experts. The experts told us that.

Mr. Speaker: Order.

Hon. Mr. Welch: We are saying that built into the assumptions that were used to make this calculation was the 15 to 20 per cent return. The new finds to which the honourable member makes reference will then appreciate that figure, and so will go beyond it, subject to that.

Mr. Smith: You have to hope we strike oil, to pray that we strike oil.

Hon. Mr. Welch: The Leader of the Opposition has to see this investment in the context of the energy policy and the objectives and targets with respect to that policy. This country is dedicated to crude oil self-sufficiency by 1990. The Canadianization process is part of that. And to stimulate exploration --

Mr. Smith: Were paying $650 million for a speculation. It's the worst disgrace I've ever seen here.

Mr. Speaker: Order.

Mr. Sargent: Supplementary, Mr. Speaker --

Hon. Mr. Welch: Well, I have not finished the answer yet.

Mr. Riddell: We of the farm community call that heifer dust.

Mr. Ruston: Close the hospitals --

Mr. Speaker: Order. The minister is responding to a supplementary from the Leader of the Opposition.

Hon. Mr. Welch: To stimulate exploration and to take advantage of those generous grants being provided by the government of Canada under the national energy program, there are certain criteria that have to be met. This province and the people of Ontario are prepared to make that investment today with respect to crude oil supply against the background of that policy. The people of Ontario are going to require that. This is a long-term investment. Indeed, I remind the Leader of the Opposition that if he and his party had been in power in this province 18 years ago we would still be burning oil for electricity and expanded coal. It takes some vision and some leadership in this area, and that is why we are involved in it.

Mr. Riddell: You make a lot of noise for a pipsqueak.

Hon. Mr. Davis: You guys would have told Marconi to go peddle his fish.

Mr. Speaker: Order.

Hon. Mr. Davis: You used to quote Mel Hurtig.

Mr. Speaker: Order.

Mr. Cassidy: Mr. Speaker, it has already been established that the province one way or the other will have to borrow $650 million, and we know from the briefing today that there is a substantial carrying cost on this investment which will go on for quite a number of years.

Will the minister explain why it is that when Suncor and Sun Oil had been to 15 other places looking for a Canadian buyer for a substantial part of the company -- when they were desperate to find a buyer -- no effort was made by the Ontario government to get any commitment from Suncor with respect to investment in this province?

Can he explain why there was no effort with respect to procurement within in this province, with respect to job creation within this province, with respect to research and development within this province or even with respect to the dividend policy the company was going to carry out'? Why did he seek to get so little when he is putting so much into the deal?

Mr. Smith: And he's for the deal. Imagine if he were against it.

Mr. Speaker: Order.

Hon. Mr. Welch: Just one or two observations, Mr. Speaker: The visit this morning with the caucus of the third party was a pleasant experience --

Mr. Smith: Oh, I'm sure it was.

Mr. Ruston: The minister is paying for 30 NDP members, he should know.

Mr. Speaker: Order. Will the minister just respond to the question, please?

Hon. Mr. Welch: It was a pleasant experience because of the courtesies that were extended. Even the minister was made to feel welcome and, indeed, was expected at the first meeting --

Mr. Smith: When Malcolm Rowan starts telling the truth, I will treat him graciously.

Hon. Mr. Davis: Are you saying Tom Kierans is not telling the truth? Say that outside.

Mr. Smith: I did say it outside.

Hon. Mr. Davis: That Tommy Kierans isn't telling the truth?

Mr. Smith: No. Rowan.

Mr. Speaker: Order, please. The Minister of Energy has the floor responding to the member for Ottawa Centre (Mr. Cassidy). Will the Leader of the Opposition and the Premier please contain themselves?

Hon. Mr. Welch: There is no question with respect to the differential, with respect to the cost and with respect to earnings as they are represented both in cash dividends and reinvested earnings. As we pointed out during the course of the discussion this morning, we expect those lines will cross, although it was very difficult to predict the year in which they would actually cross.

As was explained this morning, we found this company an ideal candidate with respect to our policy decision in so far as Canadianization was concerned. It was almost wholly American-owned and it had extensive holdings as far as the frontier and the Arctic were concerned. Third, it had some experience already with respect to synthetic oil development and a fairly significant retail operation in Ontario along with its refinery in Sarnia. We felt it was a good candidate from the standpoint of our negotiations.

2:20 p.m.

The honourable member knows that the Ontario Energy Corporation will have representation on the board and will bring whatever influence it can to bear with respect to a number of issues. We have to keep in mind that we have not bought control and we are not managing the company; but we feel quite satisfied that, in keeping with good corporate citizenship in this province, the company will be persuaded to discharge its responsibilities along those particular lines.

Mr. T. P. Reid: Mr. Speaker, in regard to the process: In view of the fact that these negotiations took place and direction was given by the government last fall before the election of March 19 took place, does the minister not think his party owed it to the people of Ontario to tell them that one of the promises we heard so much about was that we were going to spend $650 million in buying an oil company -- probably the largest expenditure the government has ever made, with the exception of Ontario Hydro -- and that the priority of the government was to do that rather than to put that money into industry, social services, hospitals and education? Does the minister not think he owes the people that amount of truth?

Hon. Mr. Welch: Mr. Speaker, I think it is very important to keep the calendar in mind. Members of the opposition were told this morning during the caucus presentations that the negotiations with Suncor did not start until May, and the honourable member is talking about consultation with the people in March. He is talking in terms of a policy decision by this government, which was underlined and enunciated in October 1980; and we talked about that a great deal. In fact, we talked about the energy initiatives of this province. One of the reasons the people of this province have confidence in this administration --

Mr. T. P. Reid: You didn't tell the people you were going to spend $650 million on an oil company, or else you wouldn't be here.

Hon. Mr. Welch: How could they be told in March when we did not enter into the agreement until October of this year?

Mr. Smith: It's the craziest deal I have ever heard of.

Mr. Speaker: Order.

Mr. Smith: We will not break even unless we find a Hibernia. What a ridiculous way to use money.


Mr. Smith: Mr. Speaker, I have a question for the Minister of Health. The minister and I were on the radio this morning at different times, and I heard him say he is very proud, as I am, of the fact that in the recent past Ontario hospitals have always admitted patients to available beds, regardless of the patient's ability to pay; if the patient did not have coverage, he could still get into a semi-private bed. The minister must surely be aware that this was because, among other things, it was no skin off the nose of the hospital to do so; it did not lose anything by so doing.

Since the minister has introduced a new program specifically because he believes incentives will change the behaviour of the hospitals, why has he now introduced a system of incentives whereby the hospitals will be penalized every time they admit a nonpaying patient into a semi-private bed? Is it the intention of the government to compensate the hospitals each time such a patient is admitted to a semi-private bed?

Hon. Mr. Timbrell: Mr. Speaker, if one looked at it that way, I suppose one could argue the hospitals were penalized because under the existing arrangements, which have been in force for several decades, the government takes back 65 per cent of the preferred accommodation revenue and the hospitals retain the 35 per cent balance. So one could argue they were penalized.

Mr. Smith: There was no substantive revenue involved.

Hon. Mr. Timbrell: They were penalized because there was no revenue. I am just following the member's argument. One could argue that. I would like to put on the record the fact that people have been admitted to whatever beds were available, regardless of whether they had third-party insurance, semi-private or private, for two reasons: first, in this province no physician in any hospital would turn anybody away for lack of that coverage and, second, it is in the law that they must admit people.

Let me quote two sections of the law that specifically apply. First, quoting from the Public Hospitals Act, section 17 states: "Where (a) a person has been admitted to a hospital by a physician pursuant to the regulations and (b) such person requires the level or type of hospital care for which the hospital is approved by the regulations, the hospital shall accept such person as a patient."

Second, in relation to that and to this concern let me quote to the member section 37 of the regulations under the Health Insurance Act: "Subject to section 39(a), the in-patient services to which an insured person is entitled without charge other than the prescribed premium are all of the following services:" -- the first one is the most important -- "accommodation and meals at the standard or public ward level..."

Nobody ever has been and nobody ever will be turned away from a hospital in this province on admission by a physician because he does not have third-party insurance.

Mr. Smith: Given that the minister ought to know something about the way in which incentives work in hospitals, since his whole program is based on the belief that giving an incentive will change the hospitals' behaviour, does the minister not recognize that there will now be an incentive for the hospitals essentially to convert more beds to semi-private care, thus reducing the number of beds that are freely available for the ordinary citizens who cannot afford it?

He is going to cause an increase in premiums for insurance, of course, because of the increase in user fees that this involves. But, more than that, there is going to be an incentive for the hospitals to keep patients in the semi-private beds rather than to free them up, because of the danger that they will be occupied by standard, nonpaying patients.

If the hospitals' budgets are now to depend on these kinds of additional fees, he is going to put them in a spot where they will be forced to emphasize two-class medicine instead of the original idea, which was to eliminate class distinctions in medicine. Why is the government going back to the medicine of the 1950s when they have come so far since then?

Mr. Speaker: Just before the minister responds, I would ask all the private members to restrict their conversations in the House. If they want to carry on conversations, they should please go outside the House.

Hon. Mr. Timbrell: Mr. Speaker, the point, of course, is not to return to the medicine of the 1950s; nobody is talking about that. We are talking about making sure that the medicine of the 1980s is of a standard we want and at a price we can afford. Totally aside from the traditional operating practices of the hospitals, which would be not to turn anybody away, I have already read into the record the parts of the law that require them to admit those persons whom their physicians have indicated should be admitted to whatever bed is available.

Mr. Smith: They are waiting for electives; you know that.

Hon. Mr. Timbrell: Excuse me. I listened to the member's question.

To make the point even further, in the 1980-81 operating year slightly less than 52 per cent of the beds in the public hospitals were designated as standard ward beds, but more than 68 per cent of the bed utilization was at the standard ward rate. People are routinely being admitted to hospitals and, if a ward bed is not available, they are being put into private or semi-private rooms and are not being charged for it if they do not have the coverage.

What is more, let me tell the member that in five years in this portfolio I cannot ever recall once receiving a letter from a private citizen in this province complaining that he was turned away, or from a physician complaining that his patient was turned away, because he did not have third-party insurance. I have had dozens of letters, if not hundreds, from people who have said, "I have Blue Cross, London Life, whatever -- extended health coverage. I was admitted to hospital, and they did not put me in a semi-private room; they did not put me in the private room for which I have third-party coverage. They put me in a ward." That happens, not the other.

Mr. McClellan: Mr. Speaker, now that the Minister of Health has redefined our hospitals as businesses to operate on free enterprise principles and to finance their deficits through the sale of hospital beds to sick people, which is the essence of the speech he made the other day, will he tell us how many standard ward beds he anticipates will be alienated and diverted to private and semi-private use for sale? And how much money does the minister expect hospitals to raise through the sale of beds?

Hon. Mr. Timbrell: Mr. Speaker, I do not intend to get into a rhetorical kind of debate. I just want to deal with the facts; and I will restate the facts.

The law is very clear: Nobody ever has been and nobody ever will be turned away from a hospital in this province on admission by a physician for lack of a piece of paper that says he has semi-private or private coverage. That simply has never happened. The law is in place to make sure that it will never happen.

2:30 p.m.

Secondly, I anticipate that the changes probably will be very small and will come in over a protracted period of time. I do not think this is seen, even by the hospitals, as a major move. The major move for the hospitals is that for the first time in any jurisdiction in Canada, to my knowledge, we are turning around the budgeting process of hospitals so that the incentive now is there to operate with a surplus and not to spend up to the budget line as of midnight March 31.

Mr. McClellan: That's right. Sell the beds. Specials on appendectomies this week.

Mr. Smith: I suggested that six years ago; this is a different matter.

Mr. Speaker: Order.

Hon. Mr. Timbrell: They are to operate with a surplus, and if they do, they can keep that money in the hospital for patient services which, after all, is what it is all about. That is what the whole set of new policies is all about; it is to make sure that we maximize the considerable amount of money, which is being spent for patient care.

Yesterday, I pointed out to the Ontario Hospital Association convention that more than 30 per cent of the money that is being spent on hospital services is going into the administration and nonpatient care area of hospital operation. Clearly, that is an area they have to look at to make economies that will free up money for additional patient care. That is the whole point of it.

Mr. Sweeney: Mr. Speaker, the minister has already indicated that the experience of the past few years has shown there has not been any incentive for the hospitals to divert people who cannot afford the more expensive facilities. Surely the minister realizes that, with the incentive he is now going to put in, that practice will turn completely around. The minister knows there are a large number of people in the province who have to wait for a long time to get into the hospital for certain kinds of elective surgery.

What kind of monitoring system is the minister going to put in place to assure us and to assure people outside of the Legislature that, whether or not a person can afford third-party coverage, he is going to get an equal chance and that the hospitals will not use the incentive to give preference to those people who have third-party coverage as opposed to those who do not?

Hon. Mr. Timbrell: Mr. Speaker, the fact is that laws are in place to cover that. Second, the member may be sure that the first time any admissions clerk asks if a person has London Life, Blue Cross, Green Shield -- something that says he can pay for the semi-private room -- and denies somebody admission --

Mr. Sweeney: You just go to the bottom of the list.

Hon. Mr. Timbrell: No. They do not go to the bottom of the list. Admission to every hospital in this province is based on medical need. If the honourable member has a greater medical need than the member to his right, he will be admitted first. If not, he will wait for him.

Mr. Cassidy: It's based on your wallet now.

Mr. Smith: For electives, they will call the others first.

Mr. Sweeney: It is to their advantage to call the others first.

Mr. Speaker: Order, please. I want to point out to all honourable members that we have spent half the question period on two questions, interesting as they were, with long questions and even longer answers. I ask for the co-operation of all members in proceeding with dispatch, if we can.

Mr. Cassidy: Mr. Speaker, this is a very urgent and difficult issue, because the government is proposing to put the profit motive in where profit motive does not belong, in terms of hospital care for ordinary Ontarians.

I want to direct a question to the Premier, because the Premier made a speech at the Ontario Hospital Association on Monday which was almost a replica of the speech made on Wednesday by the Minister of Health and in which the Premier said quite specifically he wanted to see a business-oriented system of hospital management.

Is the Premier not aware that since 1958 Ontario has been part of a national hospital insurance scheme which, when it was set up, was to be comprehensive, was to have uniform terms and conditions, was to get away from any kind of means testing and was not to have any kind of user charges? Is the Premier not aware that Ontario will now be violating its commitments under the national health care scheme and jeopardizing Ontario's right to have shared funding from the federal government as far as hospital insurance is concerned?

Hon. Mr. Davis: Mr. Speaker, I will try to abide by your admonition. The answer to the honourable member's question is no.

Mr. Cassidy: The Premier is not taking the question seriously. That is billions of dollars of revenue as far as this province is concerned.

Is the Premier aware that by giving hospitals in upper-income communities the right to charge what the traffic will bear, to raise the fees on their beds for private and semi-private care, to increase the number of semi-private and private beds, while hospitals in areas like Windsor, Chapleau and other communities that do not have a large number of people on the upper-income level will not be able to do so, we will be getting in this province a two-class system of health care?

Those upper-income communities will have Cadillac care, while the hospitals in places like Windsor will have to struggle to maintain any kind of a basic standard. Why is the government doing that?

Hon. Mr. Davis: My very short answer, once again, is that is not what will happen.

Mr. Smith: Mr. Speaker, given what we have seen of the basis of the Suncor deal, is the Premier at all surprised that he now heads a government that wants to see a business attitude in the hospital sector, but apparently not in the business sector?

Hon. Mr. Davis: Mr. Speaker, I may have to give a little lengthier answer to this. I recall the Leader of the Opposition some two or three years ago, in debating expenditures in the area of health, talking for greater efficiency and better management. That really is all the minister was saying. Certainly all I said was that we should be as efficient and as businesslike as possible in the operation and administration of the hospitals. I have news for the Leader of the Opposition: I think the majority of people agree with that, including those in the medical field themselves.

With respect to the second part of his question, I do not even know how relevant it was, and, since he is not listening, I will not endeavour to answer it.

Mr. McClellan: Mr. Speaker, I would just like to ask the Premier if he really believes the prices for private and semi-private beds in our hospitals in Ontario should be based on what the traffic will bear?

Hon. Mr. Davis: Mr. Speaker, I do not think it is a question of using the phrase, "what the traffic will bear." I think, really, we are saying a reasonable amount.

Mr. Cassidy: In fact, what happens is, if the doctor says the patient needs to get in, it will be the hospital administrator who decides whether the patient can afford to get into the bed.

Mr. Speaker: New question.

Mr. Cassidy: Mr. Speaker, my second question is also for the Premier. In the Hall commission report which came out a year or so ago Mr. Justice Hall, who was the father of the medicare system in our country, said, and I quote, "Accessibility is also made more difficult to some by the imposition of so-called authorized hospital ward charges."

He also said, and I quote, "This policy and practice of imposing hospital ward charges is an application of the user-pay concept, which is contrary to the principle and spirit of the national health care program advocated by the royal commission in 1964 and legislated into being in 1966." Could the Premier kindly give to the House a definition of what he considers to be user fees?

Hon. Mr. Davis: Mr. Speaker, the honourable member had a very long preamble to a very short question. I would take nothing away from Mr. Justice Hall. I have never regarded him as being the sole father of the health care system in Canada, but I would certainly give him some measure of credit.

I would only say to the honourable member, when he quotes that particular section, my recollection is that refers to a general fee for all hospital beds, not the question of a preferred fee. I draw a distinction between a user fee that has application to everyone, which we might call a deterrent fee, and the fees that had been traditionally charged for semi-private or private accommodation. That has been a part of the system here for generations. No one is changing that system.

Mr. Cassidy: The Premier seems to misunderstand what his Minister of Health announced two days after the Premier's speech to the Ontario Hospital Association on Monday, because on Wednesday what the minister said was that hospitals will be free to charge extra for semi-private and private rooms on 60, 70, 80, 95 per cent of the beds. As long as one ward bed is available in the hospital, it would appear the requirement to have some standard care available is actually being met.

2:40 p.m.

On Monday, the Premier said and I quote, "For the present, despite press reports, we have rejected new user fees for hospitals as a revenue-producing step." On Wednesday, the Minister of Health and the Premier were surely aware what the policy was to be. The Minister of Health announced a new user fee for hospitals with the increase in charges on private and semi-private care and the expansion of the number of beds.

My question is this: Why did the Premier lie to the Ontario Hospital Association in making that speech on Monday?

Mr. Speaker: Order. The member for Ottawa Centre knows full well that language is unparliamentary and is not allowed in this chamber. Will he please withdraw it?

Mr. Cassidy: Mr. Speaker, it is very seldom we get to this position in this House, but on Monday the Premier lied to the Ontario Hospital Association --

Mr. Speaker: Order. I am well aware. Everybody is well aware. I am asking you to withdraw your remarks.

Mr. Cassidy: I am sorry. I will not, Mr. Speaker. The Premier lied to the hospital association. Let him explain --


Mr. Speaker: Order. Did I hear the member for Ottawa Centre correctly?

Mr. Cassidy: As a matter of fact, Mr. Speaker, you did. The Premier lied on Monday when he said to the hospital --

Mr. Speaker: Order. It is with regret that I must name the honourable member and ask him to withdraw for the rest of the day.


Mr. Sargent: On a point of order, Mr. Speaker --

Mr. Speaker: Order. It is not debatable. The Sergeant at Arms.

Mr. Cassidy was escorted from the chamber by the Sergeant at Arms.


Mr. Speaker: Order. A new question, the member for Huron-Middlesex.


Mr. Riddell: Mr. Speaker, I have a question for the Minister of Agriculture and Food, who hopefully greeted the dawn knowing he had a farm to return to this weekend. The minister should think about that -- a farm to return to this weekend. In view of the frustration and the desperation being felt in Ontario's farm community as a result of the financial crisis facing the farmers, will the minister now indicate to us what specific aid programs he intends to introduce that will benefit all our farmers?

I do not wish the minister to get up and talk about the beef industry or about that segment. Will he tell us what programs he will introduce that will benefit all our farmers and get them out of this financial trouble and will --

Mr. Speaker: Order. Will the member please ask his question?

Mr. Riddell: I have asked what aid the minister will render. Second, will he institute an immediate moratorium on farm foreclosures until the government comes in with assistance programs as recommended by the emergency task force on agriculture?

Hon. Mr. Henderson: Mr. Speaker, I am sure the honourable member was here on Tuesday afternoon of this week when I announced the cow-calf program. He is not proud of that but we are proud of it over here.

We understand the member. He is much like his leader. He just does not want to know the truth.

On Tuesday I announced that my deputy, the provincial Treasurer's deputy, Mr. Ralph Barrie, president of the Ontario Federation of Agriculture, and Mr. Everett Biggs will be on a committee along with a prominent farmer in this province to study the Biggs report and report to us.

Mr. Sargent: Mr. Speaker, in view of the minister's disgraceful performance --


Mr. Speaker: Question.

Mr. Sargent: As a preamble to what I am going to say -- you allow everybody else; why not me? -- in view of the fact that agriculture is facing disaster how does the minister tell the farmers of Ontario, when Quebec is spending $300 million for mortgage foreclosure protection, that his boss is planning to buy a plane that has leather-covered toilet seats, a plane that is going to cost us $4,000 an hour every hour it flies, on the basis of 500 hours a year, in interest alone, not talking about the other factors?

Will he tell me whether he made it perfectly clear to the bankers he talked to -- because the uncaring and defensive attitude they have taken is unacceptable to us in Ontario and to the farmers in this audience today -- that he will require these lending institutions to give advance notification before any foreclosure, and that he will work -- before Christmas, according to his deputy minister -- to set up a fund to put a moratorium on foreclosures in the agriculture industry? Will he do that?

Hon. Mr. Henderson: Mr. Speaker, about three weeks before the federal budget came down, the task force made a special trip to Ottawa to tell the federal government of the problem and to ask the federal government, the government that has the jurisdiction to do it, to consider just what the honourable member for Grey-Bruce is asking. They could not do it. When I met with the women from Grey-Bruce last Tuesday night --

Mr. Sargent: I know what they told you.

Hon. Mr. Henderson: Tell me what they told me. They told me it was the monetary policies of the government of Canada --


Mr. Speaker: Order. Will the minister just respond to the question, please?

Hon. Mr. Henderson: Yes, Mr. Speaker.

Mr. Riddell: What did you tell the bankers on Monday?

Mr. Speaker: Order. The minister is responding to a question from the member for Grey-Bruce.

Hon. Mr. Henderson: Mr. Speaker, these ladies told me it was high interest that was causing the problem. They told me they could afford to pay the 12 per cent interest which they originally considered, and they told me it was the monetary policies of the government of Canada that created all their problems. They told me the government would not listen to them; they have lost faith in them completely.

Mr. MacDonald: Mr. Speaker, we all know the Liberals in Ottawa are not doing their job. When is the minister going to pass in this House a bill that will give --


Mr. Speaker: Order. Will you escort that gentleman out of the chamber, please?

2:50 p.m.


Mr. Speaker: Order. Would the opposition members please allow the member for York South to ask his question? You have had your opportunity to ask questions.

Mr. MacDonald: I have a question for the Minister of Agriculture and Food, but he is not listening.


Mr. Speaker: Order. Will the member for Huron-Middlesex (Mr. Riddell) please be quiet?


Mr. Speaker: I would point out to the member for Huron-Middlesex that he had his opportunity to ask a question and now it is the turn of the member for York South.

Mr. MacDonald: Thank you, Mr. Speaker. I would say to the minister we know that the Liberals in Ottawa are not doing their job, so my question to him is: Will he pass in this House a bill comparable to the one that was introduced by my colleague the member for Riverdale (Mr. Renwick) last year, which would institute a moratorium for a period of one year? Will he pass that in this House and quit passing the buck to Ottawa?

Hon. Mr. Henderson: Mr. Speaker, I have tried to answer the honourable members but they apparently do not really want to know the true facts. They keep talking around in circles.


Mr. Speaker: Will the honourable members allow the minister to reply please?

Hon. Mr. Henderson: The honourable members know full well that that particular recommendation was made to the government of Canada. The committee felt the government of Canada was the government with such authority if it wished to act.


Mr. Speaker: Would the member for Algoma (Mr. Wildman) please contain himself and allow the minister to reply?

Hon. Mr. Henderson: Mr. Speaker, I have asked the committee to get together next Monday. I do not think we could ask a group of people to get together much quicker than that. This is one of the recommendations that committee will study.


Mr. Watson: Point of privilege, Mr. Speaker: I do not see why we should have to face those lights if there are no television cameras in the House.

Mr. Speaker: Obviously they are responding immediately.


Mr. Speaker: Order.


Mr. Mancini: Mr. Speaker, I have a question for the Minister of Government Services. Is the minister aware that his department is undertaking a significant land survey project in the township of Colchester South and that his department is sending four crews of four persons each to spend approximately two months in the area? Why would the minister undertake to send surveyors from Toronto at substantial cost to his ministry when the work could be done much cheaper and more efficiently by the local Essex county surveyors?

Hon. Mr. Wiseman: Mr. Speaker, a couple of members have been interested in this. The member for Windsor-Riverside (Mr. Cooke) has written to me and I believe one other honourable member from the area has written as well.

I think the honourable member who asked the question should know this is a job that has not been funded at the present time, it is in the preliminary stages and what Government Services surveyors are doing is going out and doing this preliminary work until such time as it is funded.

I think the honourable member should realize as well these five surveying firms who have written to the Essex county chapter of the Association of Ontario Land Surveyors have, in the last three years, had 29 jobs totalling about $40,000. Our guidelines for that are not changing. It is just in the preliminary stages and they have asked us to go in and do this. The honourable member mentioned all these crews for two months. I am not aware of that, and I am sure that would be a major project to have that many men working for that length of time.

Mr. Mancini: Is the minister not aware of the serious shortfall of work in the Essex county area for land surveyors? Does he realize the Essex county survey industry has had to reduce its total employment by a full 76 per cent, reducing its numbers from 83 to 22? In view of that, and the fact that the surveyors in the county can do the work in the immediate area at a much cheaper rate than having crews sent in from Toronto, could I have the assurance from the minister that if there is going to be a significant undertaking in the township of Colchester South he will ensure the work is done by the local surveyor industry?

Hon. Mr. Wiseman: Mr. Speaker, if the honourable member listened to my answer to the question, I said it was preliminary. There is no reason for me to believe, if it goes ahead and we get the funding for it, we will not carry on in the same manner as we have in the past. The surveyors and architects and so on are having problems all over.

But if he listened to the previous answer he would find these five surveyors who have asked for this have been successful in 29 different jobs for a total of $40,000. He asks if we will go ahead. I have no reason to believe we will not carry on in the same manner as we have in the past.


Mr. Wildman: Mr. Speaker, I have a question for the Minister of Labour. Will the proposed regulation on coke ovens under the Occupational Health and Safety Act protect only workers working in coke ovens full time, and not cover other workers who work in and around coke oven operations from time to time?

Hon. Mr. Elgie: Mr. Speaker, there was an open public meeting on the issue of the coke oven regulation about two months ago. The ministry staff are reviewing the comments that were submitted and the final draft of that coke oven emission standard has not yet been given to me for my approval, so I cannot answer the honourable member directly. If he wants me to bring him up to date on the present status I will be pleased to find that information and contact him.

Mr. Wildman: Is the minister aware this matter was not raised at the public meeting? Does he realize the Steelworkers' Local 2251 in Sault Ste. Marie was notified in mid-November that the ministry intended to remove section 3, subsections 2 and 3, from the regulations so that there would be two laws for different workers working in the same operation?

Hon. Mr. Elgie: As I said, if the honourable member wants me to bring him up to date on the present status of that regulation I will be pleased to get in touch with him about it.

Mr. Mackenzie: Mr. Speaker, given what is happening to the standards for noise -- the increase -- and for lead emissions and now for coke oven emissions, are we seeing a deliberate and systematic downgrading of the few toxic substances that we finally got on the list? Is there a downgrading of the standards we are looking for in this province?

Hon. Mr. Elgie: Mr. Speaker, I do not know if the honourable member disagrees with it, but what we are seeing is an open, public, consultative process about the designation of substances within this province. This degree of openness and consultation is not happening anywhere else. The member knows very well the regulations we are reaching --

Mr. Mackenzie: We are getting worse standards than they have in the US. You are just destroying workers' protection in the province.

Mr. Speaker: Order.

3 p.m.


Mr. Bradley: Mr. Speaker, I have a question for the Minister of Industry and Tourism. The government of Ontario has been considering the location of its auto parts technology centre for a number of months now. In view of the downturn in the automotive industry at the present time and the keen competition that we get from offshore, in view of the fact that the minister has indicated that an announcement is relatively near on this, in view of the fact that the Niagara Peninsula has all of the facilities and desire to have the automotive technology centre located there and has the support of the municipalities in that area, could the minister indicate when he is going to make the announcement and if he will be announcing that it is going to be in the Niagara region?

Hon. Mr. Grossman: Mr. Speaker, I am delighted to see the support for the Board of Industrial Leadership and Development program and specifically the auto parts technology centre, coming from that party after so long.

I also presume that since the honourable member wants it for the Niagara area where his riding is located, he will acknowledge the job creation aspect of the auto parts technology centre. Perhaps he will tell his colleagues about that, since every day they stand up and say BILD is not going to do anything or create any jobs.

Having established that, may I say I welcome him to the debate, since my colleague the Minister of Energy (Mr. Welch), his parliamentary assistant, the member for Lincoln (Mr. Andrewes) and the excellent member for Chatham-Kent (Mr. Watson) have all been speaking to me at length, putting forward the prospects for their communities and have played a major role in putting together the excellent presentations from all of those areas. Indeed, they were excellent.

May I say to the honourable member that one of the reasons it has taken longer than I anticipated to make this decision is because my colleagues have done such an excellent job in putting forward their presentations that it has become a very difficult job to pick one. However, we should have a decision very shortly and I know the honourable member, my three colleagues and all of the members of this House will join me in rejoicing at the selection of the ultimate site.

Mr. Bradley: In view of the fact that we have extreme difficulty in the automotive industry at the present time and that people in the Niagara region have had difficulty with unemployment and have looked to the future of the automotive industry and the fact that we have to be keenly competitive and we want to see this get under way as soon as possible; in view of those facts and in view of the representations the minister has received from other members in the peninsula in addition to myself, in view of the fact he has trotted out money across other parts of the province, in view of the fact he is giving it out anyway, is he prepared to give a commitment this afternoon that he will give it to this particular part of the province which is so deserving?

Hon. Mr. Grossman: I can assure the member that his part of the province, particularly because of the excellent work over so many years of the member for Brock (Mr. Welch), knows that this government never forgets that part of this province. They know that our financial commitment is there. There have been grants under the employment development fund, BILD, and the Ontario Development Corporation to that part of the province. Whether the centre ends there or not, I can assure everyone in the Niagara Peninsula that they will --

Mr. Bradley: The question is, can I announce it?

Hon. Mr. Grossman: Can the member announce it? Go ahead this afternoon. It will have no relevance or credibility, but he is used to that.

Let me say if he follows my colleague's schedule for the next few weeks, it may give him a hint.

Mr. Swart: Mr. Speaker, is the minister aware that just recently Brock University indicated it had some land it would be only too glad to have used for this purpose? Is it not true that there is a real advantage in having this adjacent to a university? Would this perhaps tip the scales in seeing that this comes to the Niagara Peninsula, particularly near Brock?

Hon. Mr. Grossman: You might say that of literally all the areas in question. I can think, for example, of the Cambridge situation where my colleague has arranged with the municipality of Cambridge to make some land available in the event we build the microelectronics facility there.

I can think of all my colleagues from the Ottawa area who have arranged several alternatives for an Ottawa site as well as my colleagues from the peninsula and Chatham who have also made land available through their municipalities for the siting of these centres.

They are so sought after for the job creation they will bring to this province that the municipalities are anxious to make land available. Therefore I can answer the member quickly and shortly. Yes, we are aware of it and almost all the municipalities have made some land available.


Mr. Foulds: Mr. Speaker, I have a question for the Premier. Has the Premier been made aware of the formation of the save the Can-Car committee in Thunder Bay, a committee of city council? Has he been made aware of a resolution passed by that committee requesting a meeting between city council representatives, members of that committee, the Premier himself and cabinet ministers with regard to the decision of the Urban Transportation Development Corporation not to award the contract to Can-Car but go into a joint venture with TIW Industries? If he is aware, can he tell us when that meeting will take place?

Hon. Mr. Davis: Mr. Speaker, the distinguished member for Fort William (Mr. Hennessy) has been very much on top of this subject. I believe he has already had some discussions with the minister, the ministry and UTDC. I expect those discussions will continue.



Mr. Gillies from the standing committee on social development reported the following resolutions:

That supply in the following amounts and to defray the expenses of the Ministry of Health be granted to Her Majesty for the fiscal year ending March 31, 1982:

Ministry administration program, $45,661,000; institutional health services program, $2,6- 13,907,000; community health services program, $144,114,000; health insurance program, $1,469,550,000.

That supply in the following supplementary amount and to defray the expenses of the Ministry of Health be granted to Her Majesty for the fiscal year ending March 31, 1982:

Institutional health services program, $121,112,600.

Mr. Speaker: Order. Before proceeding with that, I would ask again that all honourable members refrain from private conversations in the chamber.

Mr. Gillies from the standing committee on social development presented the committee's report and moved its adoption.

Your committee begs to report the following bills without amendment:

Bill Pr24, An Act respecting the Greater Niagara General Hospital;

Bill Pr38, An Act to incorporate Emmanuel Bible College.

Your committee would recommend that the fees, less the actual cost of printing, be remitted on Bill Pr24, An Act respecting The Greater Niagara General Hospital and on Bill Pr38, An Act to incorporate Emmanuel Bible College.

Motion agreed to.


Mr. Treleaven from the standing committee on the administration of justice presented the committee's report and moved its adoption.

Your committee begs to report the following bill without amendment:

Bill Pr41, An Act to revive The Atlas Hotel Company Limited.

Motion agreed to.

Mr. Speaker: Motions.

Mr. McClellan: Pursuant to standing order 63(a), in the absence of Mr. Cassidy, I move, seconded by Mr. Foulds --

3:10 p.m.

Mr. Speaker: Order. This is not the appropriate time to move that.

Mr. McClellan: With respect, Mr. Speaker, I am submitting to the table a motion of no confidence pursuant to standing order 63. I would hope the House would give me the courtesy of giving notice orally to the House of the motion.

Mr. Speaker: No.

Mr. McClellan: It is a precedent that was --

Mr. Speaker: No, that is out of order. It is just presented to the table, with all respect.

Mr. McClellan: The precedent was established a few weeks ago by the member for York South (Mr. MacDonald). I intend to obey the Speaker's ruling, but I simply want to say on a point of order that the precedent was established of reading notices of motion when the member for York South --

Mr. Speaker: No. Order.

Mr. Stokes: It was a precedent, but a wrong one.

Mr. Speaker: Right, which just goes to prove you can be dead right as well as dead wrong -- or something.



Hon. Mr. Baetz: Mr. Speaker, I move, seconded by Mr. Grossman, that leave be given to introduce a bill entitled An Act to incorporate the George R. Gardiner Museum of Ceramic Art and that the same be now read the first time.

Mr. Speaker, may I make a short explanatory note? George Ryerson Gardiner of Toronto, a well-established and highly respected member of the business and financial community, owns one of the world's most important private collections of ceramic art. This internationally acclaimed collection --


Mr. Speaker: Order. In introducing a bill, I have to have a copy and submit it to the House and then you make your statement afterwards.

Hon. Mr. Baetz moved, seconded by Hon. Mr. Grossman, first reading of Bill 183, An Act to incorporate the George R. Gardiner Museum of Ceramic Art.

Mr. Renwick: Mr. Speaker, you will recall the other day that I raised a question on a point of order on item (b) of standing order 32. I asked whether it is the appropriate procedure before the motion is put on the first reading of a bill for the mover of the bill, if he chooses, to exercise his right to make a brief explanation of the purpose of the bill before the motion is actually put to the chamber.

Mr. Speaker: Yes, I remember that very well and it is a permissive section, as I pointed out. I do not disagree with it. If the minister cares to make a statement at this time, prior to the question being put, he may do so.

Hon. Mr. Baetz: Mr. Speaker, George Ryerson Gardiner of Toronto, a well-established and highly respected member of the business and financial community, owns one of the world's most important private collections of ceramic art. This internationally acclaimed collection, regarded by experts as the finest in North America, consists of more than 1,000 porcelain and other ceramic objects, most of them originating in England and continental Europe between the fifteenth and eighteenth centuries. It has cost Mr. Gardiner approximately $10 million to assemble and its current value far exceeds that amount.

Mr. Gardiner wants to make this outstanding collection available to the public. He is, therefore, undertaking to spend a minimum of $2.5 million to build the George R. Gardiner Museum of Ceramic Art in Toronto opposite the Royal Ontario Museum. The Gardiner museum will be located on the grounds of Victoria University and is being created with the full collaboration of the university. Mr. Gardiner is also undertaking to set up an endowment fund with donations up to $4 million if necessary to provide income for all the operations of the museum.

The government believes there is a major public benefit to be gained from having this remarkable collection in a public place. Therefore, I am pleased to introduce this legislation to facilitate that very worthy objective.

Motion agreed to.


Mr. Smith moved, seconded by Mr. Breithaupt, pursuant to standing order 34, that the business of the House be set aside in order to debate a matter of urgent public importance, that being the imposition of two-class health care in Ontario announced outside the Legislature by the Minister of Health (Mr. Timbrell), whereby supplementary hospital insurance will become a necessity, even longer waiting periods will be imposed on ordinary citizens and user fees are to he entrenched, thus further eroding universal medicare.

Mr. Speaker: Pursuant to standing order 34, the member has up to five minutes to state his case.

Mr. Smith: Mr. Speaker, I have been in the field of medicine, going back to my university days, some 23 years or so. One of the motivating factors for me in that field has been to eliminate the two-class system of medicine that existed when I first started as a medical student.

I remember only too well the lineups to which clinic patients were subjected while those who could afford it could come to their appointments at an appointed hour. But the rest of the people, including my family, would frequently have to wait in line from 2 p.m. to be seen possibly at 4:30 or 5 p.m.

I remember when one of my very close relatives wanted to see a leading specialist in town because of a very severe condition in the inner ear. She was told that his fee happened to be high and that if she could not pay it she could damn well go to the clinic and be seen by somebody there.

I remember too well what two-class medicine meant, and I have struggled for my entire professional and political life against two-class medicine. I know something about health care delivery. I have taught the subject. I do not object at all when the minister says hospitals will be allowed to keep any leftover money from their budget. In fact, I made that recommendation six years ago. I said, "Why penalize the efficient hospitals and reward the inefficient?" I see nothing wrong with that.

But I am particularly distressed to see us revert in Ontario to a situation where hospitals that are hard-up for money are told that if they want to get the money they need to continue operation they ought to transfer standard beds into a category of user-pay beds. To me there is not the slightest indication the transfer of beds into the semi-private and private categories is warranted as a matter of government policy at this time -- except, presumably, as an effort to raise additional revenue.

Hospitals are going to be put in a position where not only are they going to have to transform ordinary standard beds into semi-private beds but they are probably also going to have to actually cut down on the number of beds. In some instances, depending on the architecture of the situation, it will not be enough just to designate certain beds as semiprivate. It will be necessary to change the spatial arrangements if they want to benefit from this great opportunity provided them by the government to make additional revenue.

Lest the minister shake his head, as he is doing now, to the point where it might fall off, I might point out to him there are several hospital experts who said exactly that this very morning. Hospitals are now going to find themselves with an incentive --

Hon. Mr. Timbrell: Do you think the medical staff would let that happen?

Mr. Smith: I certainly think the medical staff will put their patients on waiting lists for elective surgery. I believe the patients will be called to be told there might be a bed for them for their cardiac bypass or whatever. I believe they will be told the bed that exists is a semi-private bed, and they will be asked if they have coverage or not?

3:20 p.m.

I believe the law will be taken to apply only to emergency cases, and I believe fully that the incentive being given to hospitals will be utilized in a way that will cause them to do a few things. First they will keep their semi-private paying patients in longer -- watch, that is going to happen for sure. They will keep their semi-private patients in longer because of the additional money it is going to mean to them. Second, I believe it means ordinary citizens are going to be disadvantaged on waiting lists. I am convinced of this.

The minister seems to think the Premier did not tell a falsehood or in some way mislead the people of Ontario. The government have been playing the press like a violin. First, the Treasury says, "user fees." Then the Minister of Health says, "user fees." Then the Premier gets a headline for saying nothing other than, "There will not be user fees." He gets on the front page of all the papers. Then along comes the minister the next day to say, "Well, they are fees paid by users, but that is not the same as a user fee." Unfortunately, by then, the great headline of our great benefactor has already been inserted in the public memory.

Free enterprise does not belong in hospitals, for goodness' sake. What choice does a customer have in a hospital? If the surgeon tells him he needs an operation, he is not going to say, "I will take the no-frills job." As a consequence of this we are heading for two-class medicine once again, something we do not have to do. It is not worth it for the small amount of money the government is going to get. I wish the minister would reconsider, and we should debate that today.

Mr. McClellan: Mr. Speaker, I rise to support wholeheartedly the motion for an emergency debate on this most critical issue today. Our health system has been under assault from the Conservative government for the last five years. There have been bed cuts since 1978 that have seriously reduced the capacity of our hospitals to provide medical services. There have been monetary constraints on our medical budgets that have seriously inhibited the capacity of our health system to care for our people, and now the government comes in with yet another body blow.

I have been expecting it ever since the minister warned on September 11 of this year he intended to impose "modest user fees." He said that in his Ottawa Kiwanis speech. There are two issues. One has been dealt with by the Leader of the Opposition. That was with respect to the establishment of two-class medicine in Ontario. We are already well along that road.

We have a huge number of doctors, particularly specialists, who have opted out in many communities across this province. We have patient streaming, which permits doctors who have opted out to stream their second-class patients into the hospitals. They are seen in the hospitals and the bills are sent directly to the Ontario health insurance plan. Now we have the proposal announced yesterday.

There are two aspects though -- not just the deterioration of access and the quality of care. The second aspect, surely, has to be the cynical, cowardly and duplicitous way in which this government went about announcing its change of policy. I have never seen anything as sordid in the course of the last six years during which I have sat in this House as the duplicity with which this government skirted around the question of imposing user fees and then brought them in disguise through the back door.

Does the minister deny these are user fees? The Premier said on Monday we would have no new user fees in our hospitals to increase revenue. Less than 48 hours later his Minister of Health repudiated the policy in the very same forum where the Premier had made the original promise. What kind of gentlemen are these? The standing orders prohibit me from saying what kind of gentlemen these are.

Mr. Smith: It did not prevent your leader from saying it.

Mr. McClellan: It needed to be said. There is nothing in the standing orders, I may say, that requires me to believe these gentlemen. I leave it at that.

The Minister of Health has announced a major change in policy and it is important we debate that change today. We will have an opportunity when our motion of no confidence is called next week to vote on that change of policy. It is a critical change. It reintroduces the notion of free enterprise into the delivery of health care in our hospitals.

The Minister of Health said in his Ontario Hospital Association speech, "We are in the business of health." He talks about emulating some private sector thinking. He talks about the bottom line. He talks about retention of net earnings. Net earnings from what? Net earnings from what commodity? Net earnings from the sale of hospital beds to sick people. Those are the profits the Minister of Health talked about on page six of his speech. He can shake his head and deny it but that is precisely what he is talking about.

He is talking about permitting our hospitals to convert standard ward beds which are covered under medical insurance to private and semiprivate beds and to sell those beds to the general public for whatever the traffic will bear. There is no nice way to put it. That is precisely his policy, to sell those beds for whatever the traffic will bear or through coinsurance, if one can afford coinsurance.

The hospitals are expected to solve their deficit problems, estimated this year at $100 million, through the sale of hospital beds to sick people. They can keep the revenue at 100 per cent. That policy is simply despicable. Any government that would undermine the principle of our medical insurance program so thoroughly is unworthy of the respect, not only of the people in this assembly but of anybody in this province.

Hon. Mr. Timbrell: Mr. Speaker, during the course of question period, with the questions raised by members opposite and asked of myself and the leader of the government, we addressed directly the motion which is before us. May I address myself to the Leader of the Opposition (Mr. Smith). Many of us have unpleasant memories of those days prior to the introduction of universal hospital insurance when Mr. Frost was Premier of the province and Mr. Diefenbaker was Prime Minister of the country. I have been happy for five years to have been associated with, and been a party to making that system broader, more accessible and as cost- effective as possible.

Since 1958 to the present day and into the future, every single bed in every public hospital in this province is an insured bed. I quoted during the course of question period two relevant sections of the Public Hospitals Act and the regulations under the Health Insurance Act. The law is clear, even putting aside the fact we have in our hospitals today men and women as administrators and physicians who by their practices and oaths -- never mind the law; put that aside for a moment -- ensure that those who need the hospital care get it.

Every bed is an insured bed. If one needs to be admitted, one will be admitted. If one does not have third-party insurance and there are no standard ward beds in the hospital when one has to be admitted, one will be admitted in the future as in the past to whichever bed is available. If one does not have third-party coverage one does not pay. The member knows that to be the case.

I submit we have answered this motion in the course of question period today. What is more, it would appear if there is to be a no-confidence debate a week from now, we will have an opportunity to debate it even further. In that case I would submit, Mr. Speaker, this motion is not appropriate today. There will be further opportunities during the course of the no- confidence debate.

But should you find it is appropriate, we will be pleased to put the facts on the record yet again, to show that this system is not being eroded, this system is not being turned back. We will show this system is being made more cost-effective to do that for which it was intended -- to supply as much to the patients of this province in terms of health services as the health ministry budget can buy.

3:30 p.m.

Mr. Speaker: I have been listening carefully and with great interest to this debate and I do find the motion in order. It is, indeed, of public importance, and therefore I shall put the question to the House. Shall the debate proceed?

Motion agreed to.


Mr. Smith: Mr. Speaker, I have already alluded to my major concern about this change in policy on the part of the government, the idea that we are moving backwards to the shades of the 1950s, moving backwards towards two-class medicine. The Minister of Health seems to feel, however, that although he has told the hospitals they can gain and keep a lot of revenue out of reclassifying beds for semi-private patients, and out of removing the ceiling on what can be charged for those beds, that will not affect people at all.

He seems to feel that people who cannot afford insurance, people who cannot afford to pay these fees, will none the less, somehow or other, be admitted to those beds, even though that may mean a loss of enormous revenues to hospitals that are hard-pressed for money. He is simply not being realistic, if he honestly believes what he is saying. I have to assume he is being honest with himself, even if not entirely with us at all times. If he really believes hospitals operate that way he does not know very much about how they operate.

There will be a tremendous incentive on the part of the hospitals to make sure these newly classified beds are doing the job they are intended to do, that is, to bring in revenue. Why would the hospitals go through the difficulty of classifying the beds, if they then are going to sit there and not bring in the revenue, especially now that the enormous amount of revenue this will generate becomes so important to the hospitals, and government has stated it is not going to meet the funding needs of hospitals as they might otherwise hope? It seems to me we are going to find that hospitals that go to the trouble of reclassifying beds are going to expect to get additional revenue from those beds. That means, very simply, that people are going to have to buy insurance they do not now require, if they hope to be able to get into the majority of these beds

If they do not buy insurance, if the minister is saying to the people of Ontario: "Don't bother buying insurance. It does not matter. You will get in equally to any bed, of any kind. It is just a lottery. It just depends on what bed is available when you happen to come along. Do not bother to buy insurance. You will not be charged," then the minister should come out and state that openly. In that case everybody will get rid of insurance if they honestly believe it will be of no advantage at all to them in getting into these newly classified beds. If they ought not to have insurance, then the minister should say so.

Then what is going to happen? If I go in without insurance and somebody looks at my annual income and decides I can pay, am I going to have to pay? Or is the mere fact that I do not have insurance coverage going to be sufficient to prevent me from having to pay? I expect I would have to pay. Would the minister agree with that?

Under those circumstances then we have to have a means test. What we are going to find, more and more, is that hospitals are going to be in a position where more beds have become private beds, more people are subjected to means tests, more people have to have insurance, more --


Mr. Smith: Are they going to have to pay the semi-private rate if they are in a semi-private room? If they are not going to pay it, on what criterion will they not pay it? If they are not covered it is one thing; otherwise it is a means test. Let us be honest. Let us not kid around.

Hon. Mr. Timbrell: Never let the facts get in the way.

Mr. Smith: Do not be stupid. Do not be ridiculous. If a patient is sitting in a semi-private bed he is going to be charged a lot of dough. He is either going to pay it or not. If he is covered by insurance, the insurance will pay. If not, is he going to be able to get away without paying it? Even if he is rich? Would the minister answer that question?

Hon. Mr. Timbrell: I did.

Mr. Smith: What is the answer? Yes?

Hon. Mr. Timbrell: I did answer it in question period.

Mr. Speaker: Mr. Smith, will you proceed with your speech, please?


Mr. Speaker: Order. Address your remarks to me.

Mr. Smith: Mr. Speaker, either there will be means tests or else people will abandon their insurance as being of no value. It is one or the other.

Furthermore, there is the way in which this government has gone about this situation, allegedly because there is no money for health. But I ask you, Mr. Speaker, to consider --

Hon. Mr. Timbrell: Mr. Speaker, on a point of order.

Mr. Smith: I am not going to let the minister stand up now. I am sorry. He would not answer my question.


The Deputy Speaker: I recognize the Minister of Health on a point of order.

Mr. McClellan: There is nothing out of order. Sit down and wait your turn.

The Deputy Speaker: I have recognized the Minister of Health on a point of order, and I have the floor.

Mr. Smith: There is nothing out of order.

The Deputy Speaker: I have not heard the point yet.

Hon. Mr. Timbrell: Mr. Speaker, on a point of order: The honourable member, with respect, continues to ignore the fact that the government has put $651 million more --

The Deputy Speaker: What is your point of order?

Hon. Mr. Timbrell: -- into the hospitals in the last two years. He cannot ignore that.

The Deputy Speaker: All right. The minister will have a chance to respond.

Mr. Smith: That is not a point of order. I hope you recognize that, Mr. Speaker.

The fact is the minister wants to introduce free enterprise into the hospital system. He is going to fight the battle for health in the parking lots of the hospitals of the province. Surely he cannot be serious about this. It is all very well to suggest that parking fees go up or some other nickels and dimes be obtained. Why he would want to charge people who come to visit their sick relatives more money I cannot imagine.

But let us imagine that he thinks this is going to produce a lot of revenue. I doubt it, but let us say that he goes ahead and does it and this is his great new free enterprise thrust. Surely he recognizes that free enterprise has nothing to do with obtaining hospital beds. Surely he recognizes that free enterprise should not be brought into health care itself.

What kind of free enterprise system is it where a customer is told by his doctor that he needs an operation? Can he shop around elsewhere? If the doctor happens to be certified and accredited at a certain hospital and that is the only place he can do the operation is the patient supposed to say: "No, I am sorry. That hospital is too expensive. I am going to shop around for a cheaper hospital." Is that what the minister really wants to see in Ontario? Does that make sense?

If the doctor is offering an operation is the patient supposed to say: "I will take the no-frills operation. I do not want the leading kind of nylon or catgut; I will take the ordinary stuff, which may not have a lifetime guarantee but will at least do me for a couple of years," the way you buy batteries at Canadian Tire?

Can the minister honestly imagine that free enterprise has the slightest place in the hospitals of Ontario? How can he be so ridiculous as to want to go back to a system where the person who is buying it is not a customer with a free choice? The free enterprise system is not the system that is involved when you need an operation; it is closer to dealing with the godfather: they make you an offer you cannot refuse.

You do not have a choice, Mr. Speaker. You go in and have the operation and pray to God you are going to recover. You do not have the choice to start shopping for other doctors who might have fancier scalpels or better advertising or charge less money for their hospital beds.

Hon. Mr. Timbrell: Nobody is talking about that.

Mr. Smith: That is what the minister is talking about. Look at what he said the other day. He said, "Let us call deficits for what they are: overspending." Gee, the Treasurer of Ontario (Mr. F. S. Miller) does not call them that. He calls them a net cash requirement; he does not call them overspending.

Let us call hospital deficits for what they are: underfunding by the niggardly government of the Premier (Mr. Davis), which over the years --

Hon. Mr. Timbrell: Thirty per cent increase in two years is niggardly?

Mr. Smith: Sure, the last two years they funded them properly around election time. Yes, the last two years we know about. But what about the five years before that? The government funded them under the rate of inflation year after year, and now they want the patients, and the people who park their cars while visiting the patients, to pay for it. That is who has to pay for it now.

If I had not had those Suncor experts in my caucus room this morning I might be a little less incensed about this. But to go to the patients of Ontario and tell them we are going to move back towards two-class medicare when in fact the entire $100 million is simply the interest alone on the stupid Suncor deal, during which we have to pray that we strike oil somewhere, and when in fact that $100 million is available and the government can get it by just not signing this ridiculous deal.

It seems to me at this point there is reason for people to be angry. Why should the patients of Ontario have to pay for the government to buy the Suncor shares? That is exactly what is happening -- and do not think that people are too stupid to understand that. They will understand it.

3:40 p.m.

The minister goes on to say these are not really user fees. The leader of the New Democratic Party was thrown out of the House for saying the Premier lied. Mr. Cassidy was 100 per cent correct. In point of fact --

Hon. Mr. Timbrell: You can go too.

Mr. Smith: I will go when I am finished and when I feel like going. The minister will not tell me when I can go. But I will say this --

Hon. Mr. Bernier: In February you will be gone forever.

The Acting Speaker (Mr. Cousens): Order.

Mr. Smith: They say these fees are not user fees. When they are fees to be paid by users, what in heaven's name are they if they are not user fees? The people who are using hospitals either have to pay it directly or via their insurance premiums. It is one or the other. He says they are not new user fees. Of course they are new fees. They did not exist the day before yesterday. They now exist. They are new user fees. What the hell else are they? He should not think he can play games with the English language and get away with that.

Unfortunately, the Premier did get his big headlines in the Star as being against user fees. I only hope the same readers now see the duplicity with which this government has dealt with the people. I only wish that before March 19 the government had told the people they intended to go into a crazy scheme of buying an oil company, where if they are lucky they will break even by the end of the century, and that they intended to introduce user fees on the patients of Ontario.

The Acting Speaker: The honourable member's time has elapsed. The member has used his allocation of time that was allowed. Thank you.

Mr. McClellan: Mr. Speaker, I am beginning to understand why the government's slogan during the election was, "Keep the promise." It was kind of like a practising alcoholic saying: "Don't drink, don't drink."

The government stands as naked on this issue as on anything I have ever seen. The promise delivered at the Ontario Hospital Association lasted barely 48 hours. The Minister of Health's commitments to the standing committee on social development lasted less than a day. Yet the government sits there confident, smug, arrogant and totally duplicitous with respect to this issue.

I think it is important during this debate to try to set out a little bit of the background leading up to this change of policy that was announced on Wednesday. One of the things the government has been saying is that there are no cutbacks in the number of hospital beds, and that, in fact, the government has increased the overall number of hospital beds across Ontario.

In case the Minister of Health wants to deny that he ever said that, I refer to Hansard of June 18, 1981, where the minister said: "Let me take the member back to February 7, 1978." He went on to describe the new policy that would impose acute care guidelines of 3.5 beds per 1,000 in the southern part of Ontario and four beds per 1,000 in northern Ontario.

Then he said, and I have underlined this: "As a result of this process, the total number of beds dedicated to health care has gone up." Then he goes on to criticize my leader as follows: "He has not acknowledged that in the course of this period" -- that is from February 1978 to June 1981 -- "the total number of beds in the system has gone up."

Then we have the figures that the Ministry of Health finally submitted to the social development committee on Monday or Tuesday of this week. Lo and behold, we find the total number of beds from March 31, 1978, to August 1981 has actually declined by the number of 208. During this period of time --

Hon. Mr. Timbrell: What the member is saying is not true.

Mr. McClellan: The minister will have his chance to speak if he will just hold his tongue for a few more minutes. I can count and I can count the minister's figures and I can count the figures of the Ministry of Community and Social Services just as well as the minister can.

The total number of hospital beds in Ontario has declined by 208. The number of acute care beds that the minister has excised from the system since December 1978 is 2,405. Nobody is surprised to see overcrowding in our hospital corridors, to see elective surgery postponed or to see crisis after crisis described in the province's newspapers from one end of Ontario to the other.

It is a result of this government's stupid constraint program which has led to a cutback in the absolute number of hospital beds and to a staggering cutback of -- I misspoke myself. Let me correct that -- 2,488 active treatment beds. The net loss, as I say, in the last two years is 208 beds.

In September, the Minister of Health was boasting he had established 6,800 new chronic and extended care beds. This week he conceded that figure was wrong. The minister likes to play games with the number of beds in Ontario just as the Premier likes to play games with respect to this province's health care policy.

The Premier said on Monday, and let me again read his exact words from page 13 of his speech, "For the present, despite press reports, we have rejected new user fees for hospitals as a revenue producing step."

I can read that forwards, backwards and sideways. What it says is, "We have rejected new user fees for hospitals as a revenue producing step." Forty-eight hours later that policy was repudiated by the Minister of Health, as I said a moment ago, in precisely the same forum, the Ontario Hospital Association's convention.

The Minister of Health instructed the hospitals through their trustees and administrators to solve their deficit problems by raising money through the sale of hospital beds. He made that possible by lifting the ceiling on private and semi-private beds, by lifting the restriction and permitting hospitals for the first time to convert standard ward beds to private and semi-private beds.

I am trying to make the point this has not been done in a vacuum. It is done within the context of bed cuts, particularly of active treatment beds, and it is done within the context of a budget freeze which has kept the growth of the health dollar's purchasing power below the rate of inflation. The growth in the health budget sounds impressive. That 68 per cent figure is very impressive until one remembers that as of this month the consumer price index has increased 66.9 per cent. The minister knows as well as anybody else that by the end of fiscal 1981-82 it will have exceeded the minister's 68 per cent figure.

We have a situation of crisis now compounded by the new policy. We can anticipate with absolute clarity the effects of the new policy. First, there is the philosophical distastefulness of the policy. We have now enshrined one level of care for the poor under medicare and another level for the affluent under the minister's new policy of free enterprise beds, sold at the going market rate by our hospitals to raise essential operating revenue.

There are all kinds of interesting speculations as to how the price of a hospital bed is going to get set now that the minister seems to have washed his hands. Are they going to tie beds to the rate of motel and hotel beds in a given community? Do they intend to have discount days? Will there be bargain prices on holiday weekends? Do they have special rates for children under 12? How do they intend to let the market settle the price of a hospital bed now that the minister has embraced the principles of the free market, the business world and the profit sector for our hospitals?

3:50 p.m.

I hope the minister will tell us when bespeaks how he expects the market mechanism to work as it relates to the price of private and semi-private beds. How many standard ward beds will be alienated from their present uses under medicare to the new for-sale category of beds? He says 52 per cent of our hospital beds are dedicated to medicare coverage. How many does he anticipate will be alienated?

It is more upsetting than I can communicate to see the development of more and more class orientation, class bias in our medicare system. Medicare is increasingly becoming a charity service available for poor, low and middle income people, those who cannot afford to pay either the per diems under the new for-sale categories or for private insurance, or co-insurance, whatever one wants to call it. The result is a destruction of universal medicare as we have come to know it over the course of the past 15 years. There is no other way to describe the significance of this policy change. It is a signal of the end of universal medicare.

Hon. Mr. Timbrell: Mr. Speaker, I welcome the opportunity, during the brief time allotted, to elaborate on the new policies I outlined to the annual meeting of the Ontario Hospital Association yesterday. Let me begin by saying we on this side of the House believe Ontario's health care system is one of the best, if not the best, in the world. Our goal in introducing these new policies is to improve it even further. This goal will be achieved through the introduction of the very practical and innovative shifts in direction we are initiating.

I understand, and I have heard it here today, that some, although not all, of the members opposite claim to be aghast at my statement that we need a larger measure of private sector thinking across the public sector today. While I will not in such a brief time argue philosophy with them today, let me simply say that by emulating some of the principles that have served Canadian society so well, we can indeed have an even better health system.

I am not talking about some form of reprivatization of our system or turning the clock back 30 years. I am talking about employing tried and true management techniques to ensure that tax dollars are used in the most effective manner possible. This new approach will tap the dynamic spirit of local initiative that has impelled our progress in the provision of health services for decades. Now it will fuel a drive for improved health care.

The system I spoke of yesterday has four elements: (1) retention of net earnings by hospitals; (2) new opportunities for hospitals to maximize revenues; (3) strategies for minimizing expenditures; and (4) an end to hospital deficits. Hospitals will now be permitted to retain any surplus revenues over their expenditures for use within hospital operations, for new programs, for new equipment, for capital projects or for other purposes -- in short, for enhanced patient care.

Some members have referred to this as the profit motive. I have not used the word "profit." When one uses the word "profit" one envisages a business operation where at the end of the year, if the operation is in the black, somebody takes that money and puts it in his own pocket. What we are talking about is encouraging the hospitals to find every possible way to provide services in the most cost effective way so that, if indeed they do and should end the year with a surplus, that money can then be ploughed right back into the system for patient services, which is, after all, what it is all about.

Mr. Smith: You will probably penalize them for it in next year's budget.

Hon. Mr. Timbrell: As a matter of fact, that was the one thing we guaranteed we would not do.

Hospital managers in the past have had no such incentive to underspend their budgets. Indeed the member for Hamilton West, as a representative of the Ontario Hospital Association, has on occasion urged this change of policy, so I am sure that is one aspect he and they wholeheartedly endorse, because this situation is going to change.

As a second component of the new approach, the government will expand the revenue sources open to the hospitals. For example, the rates hospitals may charge for private and semi-private accommodation will no longer be strictly controlled. Hospitals will be able to set their own prices for preferred accommodation based on their local conditions. Furthermore, with the approval of the ministry, they will have the flexibility to raise the proportion of preferred accommodation of their beds.

I want to re-emphasize here that this change in no way imperils access to standard ward hospital beds.

Mr. Smith: There just might not be any.

Mr. Foulds: That's right.

Hon. Mr. Timbrell: That is not right. If an individual needs a private or semi-private room for a medical condition, that room will continue to be provided, as in the past, at the standard ward rate.

Let me reiterate that every single bed in the Ontario hospital system is an insured bed. In these more relaxed surroundings than during question period, I want to quote again the two very relevant parts of the law of Ontario that pertain to this situation and which I submit, to members on all sides and to the public, should answer the concerns which have been raised. First, quoting from the regulations of the Health Insurance Act, section 37:

"Subject to section 39(a), the inpatient services to which an insured person is entitled without charge, other than the prescribed premium, are all of the following services: (1) accommodation and meals at the standard or public ward level."

Related to that, enforcing and reinforcing that, I quote from section 17 of the Public Hospitals Act, which states:

"Where, (a) a person has been admitted to a hospital by a physician pursuant to the regulations; and (b) such person requires the level or type of hospital care for which the hospital is approved by the regulations, the hospital shall accept such person as a patient."

I repeat that every hospital bed in this province is an insured bed. No one will be denied access for lack of co-insurance for preferred accommodation.

Mr. Smith: Oh nonsense, they'll be on waiting lists and you know it.

Hon. Mr. Timbrell: If that was going to happen it would have been happening since 1950.

Mr. Smith: No, because the incentive is immediate now.

Hon. Mr. Timbrell: If the member looks at the facts and figures I gave him today, I submit to him that if that was going to happen it would have happened before now. It has not happened. It is not going to happen because of the way our physicians --

Mr. Smith: It will happen. Mark my words.

Hon. Mr. Timbrell: -- and our hospital administrators run our hospitals. It is not going to happen because of the law. What is more, if the member is right, if somebody should try to do it, we will collectively come down on them like the hammers of hell and enforce the law.

I submit to the honourable member that is not going to be necessary because the kind of practices which the honourable members opposite have suggested will occur are not going to occur. If they were going to occur, they would have happened in the last 23 years and they have not.

We think these new policies of the retention of earnings and opening up of new avenues for revenue will create major new opportunities for hospital managers to maximize revenues to spend on improved health care. That is the whole point of the exercise. Many hospitals have shown entrepreneurship in ancillary service areas and many new ideas will occur to the innovative administrator and boards. I am sure many patients will welcome new amenities to make their hospital stays even more pleasant. That to me is a significant point.

Given that our goal is continued high quality care, I think these changes can and will lead to both better service and to better programs; in short, to better care.

As a third initiative, the minister will promote strategies for raising productivity in the institutional sector, which will help hospitals to control their costs and to generate earnings which can be fully retained. This is not the case in the way the ministry has supervised the budgets of hospitals now and in the past.

The most significant aspect of this new plan falls in this category and it has been somewhat overlooked by the media and so I want to make it clear to my colleagues in the House. Put simply, rationalization of services among hospitals will now take a quantum leap forward since hospitals can retain the savings to use on better health programs. As members know, we have promoted, and I believe with the support of both parties opposite, the elimination of unnecessary duplications in the health system by encouraging, for example, the amalgamation of two nearby and underused obstetrical units.

4 p.m.

The result has been better programs and savings, but the incentive was not there in the past for hospitals to aggressively pursue this avenue since quite often, if not usually, savings were shared, if not taken back entirely by the ministry. That has changed. We will see increased sharing of services and pooling of resources with the savings channelled fully into new and improved health services by the hospitals involved.

I will stop here and tell the honourable members of an encounter yesterday, where the administrators of two hospitals in a town in northern Ontario came up to my assistant deputy minister and said: "Look, you know we have talked from time to time about the possibilities of merger and rationalization of our hospitals. With this change of policy, we see that is something we can do because we will save between $1 million and $3 million a year."

Mr. Smith: This is free enterprise. You certainly do not want to merge them. You want competition. This sounds mandatory, but you like free enterprise.

Hon. Mr. Timbrell: You are not interested in that, apparently. Let me tell you, Mr. Speaker. You appear to be interested.

These administrators said that by merging and rationalizing services in that town, maintaining all existing services and, in fact, improving them, they could save between $1 million and $3 million a year which, under this new policy, they will keep right to the last red cent, and all of which will be ploughed back into new, improved regional health services in that northern Ontario city. That is our first tangible evidence, only hours after my speech, that it is going to work. The taxpayers --

The Acting Speaker: The honourable member has exhausted the time available for his presentation.

Mr. Van Horne: Mr. Speaker, I would lean on your last few words in which you indicated the honourable member had exhausted his time. I would like to add he has exhausted our patience, and I can use that word in both meanings.

The minister, my leader and also the critic for the New Democrats have all indicated the health system in Ontario has developed over the last decade or two into something of which we can be proud. We are not quarrelling with that today. What we are submitting is that this new plan of the minister is going to take the health care system in Ontario back to where it was about 1950 or 1960 and we do not want to see that happen.

That is why the debate is on today. That is the point we are trying to make. The minister has mentioned the use of management techniques by the various hospital administrators, techniques which he is submitting in this proposal have the objectives basically of the retention of net earnings by hospitals, new opportunities for hospitals to maximize revenues, strategy for minimizing expenditures and an end to hospital deficits.

These are the four elements he refers to. If one sits and analyses these words and these four points, when one compares the possible result of trying to address these four points with whatever management techniques this government has been able to display over the last few decades, I would submit the hospital administrators are going to be hard pressed to improve their lot very much.

We do not know, for example, what the net saving of the program will be. During the past day, the parties on this side of the House have been trying to assess what dollar figure might come into play. The figure of a possible $20 million to $30 million possible saving has come up from some of our research people. When one compares that to what we know is the possible outside number of a $100 million deficit, we have to submit that attempt does not really put even a dent in the deficit situation the hospitals are facing.

So the wonderful management techniques of the government surely cannot be an example for our hospital administrators. What they are left with is the avenue, to quote the minister's words again, of getting into such things as jacking up the prices for the rates they have for their semi-private and private beds or jacking up the price of a parking space.

My leader referred to that, wondering how benevolent the minister shows himself to be by charging an extra tariff on someone going to visit a friend or relative in the hospital. Even with nickel-and-diming through parking fees and through putting up the price of food in the cafeteria or making the hospital laundry available for Sally the Vampire's Motel down the street, or whatever other business might want to come and share the hospital facility, even such nickel-and-dime management as the minister is suggesting will not help our hospitals.

I am really dismayed at this retrograde step. The Ontario health care system is based on a foundation of universal availability. When one takes the opportunity to assess what the government is bringing in, one would have to say that cornerstone, that foundation, will be damaged severely, and only time will tell. That is the prediction I would make and that my colleagues are making. That foundation will have a huge crack in it.

I made reference earlier to going back to where we were 10 or 15 years ago. We made some calls this morning and talked with various people in the consulting business as it relates to hospitals. One of the persons we talked to gave us this example. Ten years ago, the old Mount Sinai Hospital had its tenth floor reserved for private patients. Interns were not allowed on that floor nor were teaching staff. It was run like a hotel. People we talked to this morning pointed out there were other situations in hospitals in other parts of Toronto, let alone other parts of Ontario. Reference was made to similar floors reserved totally for private patients at St. Michael's, the Wellesley and Women's College hospitals, to name only a few.

What we fear, the reason for us being here to debate this issue now, is that the hospitals will be encouraged by this government's action to revert to that, and we do not want to see it. The minister can stand all day long and quote the law to assure us and anyone else who might care to listen that beds will be available. Sure, they will be available. Where? On a cot in the hall? The minister can shake his head about the cot in the hall. My oldest daughter, when she had her appendix out a couple of years back, spent the first day and a half on a cot in the hall.

I have another question to ask the minister. We have heard about the ratio of beds to citizens in a community. We know the minister and his colleagues have a determination to see the ratio be 3.5 beds per 1,000. We know a lot of hospitals have objected to that, and a lot of them say it is virtually impossible for them to live within that kind of ratio. I submit what the minister is proposing now will encourage hospitals to get into that situation of 3.5 per 1,000.

I see other problems. I see the problem of the poor getting poorer. We have no idea of the exact number of people who are without insurance or without the ability to pay extra, but we understand it is somewhere in the neighbourhood of a quarter of our population.

4:10 p.m.

With that quarter of our population, those who do not have any way of being covered for semi-private or private, our understanding is that the vast majority of those people will not be able to afford to go out and buy additional insurance to get any extra coverage. What we have, again, is a case of the poor getting poorer.

I do not think there is any need to dwell on that. I think we have to get away from that for just a moment and take a look at what the government really is doing. I would submit to the minister that he had the opportunity to announce this during this last two weeks, during which time the estimates of the Ministry of Health were considered, that process wherein we review not only the moneys the minister spends but the policies he has.

We talked, each of us on the opposition side, about the sorry situation in which hospitals find themselves. We talked about hospital deficits. We received assurances from the minister and the Premier we would not see a user fee. He said he would not sneak it in, and yet he announces this rather major change in direction at a meeting outside of this chamber, at a meeting of the hospital association people.

He can call it not sneaking but I submit it is almost like the attack on Pearl Harbour. The only thing wrong is that his timing is off by a couple of days. This is a retrograde step. We are upset with it. I doubt whether our words today will have any bearing on changing his determination, but I want to finish my statement by saying I want the minister to be very sure that what he is doing is setting health care in Ontario back to where it was 20 years ago.

Mr. R. F. Johnston: Mr. Speaker, in the other leadership contest that has yet to be announced -- for the Tory leadership -- it is well known that the Minister of Health is one of the prospective candidates. This is one heck of a way to launch his bid for the Premiership, by destroying the health system in Ontario as he goes along.

Hon. Mr. Timbrell: That is a little overstated.

Mr. R. F. Johnston: It is not an overstatement at all. Look at what we have in Ontario. Medicare, a concept which is supposed to be giving universal access to medical health facilities for people in this province, has been totally eroded.

Mr. Boudria: It was invented by the Liberals.

Mr. R. F. Johnston: That is a great distortion, as the member for Prescott-Russell (Mr. Boudria) knows. It started because of the great work of Tommy Douglas in Saskatchewan.

We in this province are one of only three provinces to have premiums -- an extra tax on people which is unfair to those with less income. We now have chronic care copayment -- and before the minister leaps up to say we supported him on that, we did not, and he should not distort the issue. That makes it possible for senior citizens to lose their homes because they have to pay for their partner's stay in chronic care facilities. We have doctors who not only can get 14 per cent increases, but then can also opt out and charge 40 to 60 per cent more, and therefore in many communities force people not to have access to them -- a double standard.

We have extra charges all over the place. What we have is a total lack of public responsibility by this government and an attempt to turn it back on to the people of the province to pick up their lack of responsibility.

I would remind members of what the Minister of Education (Miss Stephenson) says about the cutbacks in education, if I can draw a parallel, at the post-secondary education level. She does not take responsibility for the underfunding there. She says the alumni should pay. Why did the minister not consider a levy on ex-patients? Is that not a good idea? Why do we not get ex-patients to pay a certain amount a year in return for the fine care they received in our health care system? Why did he neglect that? The rest of all the things he has here are not the concern of a minister of health care. They are a minister of accounting's concern. They are Reaganistic, they are Neanderthal, they are a throwback to another age. I guess that is what his leadership bid for the Tory Party will be all about.

What we have is a major introduction of free enterprise into the health business. It began in the nursing home field: the feeling that we can deal with our elderly by making them the victims of people who want to make a profit out of health care. Now we are moving into a business orientation in how we should run our hospitals. We run into concepts like maximizing revenues, minimizing expenditures, retention of net earnings, cost effectiveness and hospitals that show entrepreneurship. That is the tone of the minister's statement. My God, it is an accountant's dream; it is an accountant's approach to health care. It has nothing to do with caring and it has nothing to do with health. The minister should be ashamed of it.

First the Premier says, 48 hours before the minister spoke, there would be no new user fees for hospitals as a revenue-producing step. Then the minister explains how our hospitals can maximize revenues by imposing this new fee for service, this new user fee. And we have to admit it is new; we have not had this before. Certainly there was a cost for private and semi-private care that was over and above that which was insured by the public system; we all admit that is the case.

But hospitals have never had the option of deciding how many beds they would be able to devote to private and semi-private care. Hospitals in this province have never had the wonderful open-ended mandate to raise it as high as the market will bear. And the incentive to raise it as high as the market will bear is obvious: The minister's statement says 100 per cent of anything over the amount now shared by the province and the hospitals in terms of private and semi-private care may be retained by the hospital. My God, why not just go for the ceiling? Why not go for as much as one can get out of people? Surely that is what this is doing. Surely that is what this new user fee is all about.

The notion now is that somehow we can move away from the past policy of a 50 per cent guarantee of ward spaces. Now they are saying, "Oh, you hospitals, it is up to you to make the decisions on that, and as long as we do not get too much flak there will be no problems at all." Even if they do get flak the minister has given us no indication of how he is going to step down with the hammer of hell, or whatever it was he indicated he would be willing to do.

This whole approach of maximizing revenues is becoming the major thrust for hospitals. But that should not be the major thrust for hospitals. Good care is what the major thrust for hospitals should be, not maximizing revenues, not figuring out what extra fees they can charge people to get more revenues.

I have questions for the minister. I do not know why he decided to speak first. I wish he had spoken last to answer some of them. Just how many beds is the minister going to allow a hospital to convert to semi-private and private care? What percentage will be his cutoff? How is he going to determine when hospitals have gone too far? How high a cost is he going to find unacceptable? How high a cost must there be before he says, "This is absolutely unfair"?

Is it all going to be based on what the market will bear? Is he just going to let it go until there are enough complaints because they do not seem to be able to fill their beds? Is this going to have an effect on the total number of beds in hospitals? Is there going to be any reason for hospitals that get rid of a certain number of ward beds in order to create private and semi-private beds to add extra ward beds? When they take over a ward, obviously, they are going to lose beds in the process.

4:20 p.m.

It is not likely that we have a plethora of hospital beds in the province that are sitting there empty at this moment. My honourable colleague from Bellwoods (Mr. McClellan) has pointed out that in the wonderful juggling of statistics the Minister of Health has been doing in the last number of years about hospital beds, there are actually 208 fewer hospital beds.

Hon. Mr. Timbrell: As of when?

Mr. R. F. Johnston: This year.

Mr. McClellan: From 1978 to 1981.

Hon. Mr. Timbrell: When in 1981?

Mr. McClellan: August 31.

Hon. Mr. Timbrell: No, wrong.

Mr. McClellan: I am not wrong.

Hon. Mr. Timbrell: You are.

Mr. R. F. Johnston: Oh my God. There we go. This is exactly what we run into with him. This dickering around with figures. We get triple announcements of beds that are going in. We have essentially 2,000 fewer acute-care beds. We already have problems with ward space now and he is going to get rid of more.

Do we not have problems in terms of people sleeping in the hallways? No? Oh, I am surprised. That is not the information I get from people in my constituency. Do we not have long delays in terms of getting elective surgery? No? Oh no, there is no problem getting elective surgery in Metropolitan Toronto now is there. A person in my riding has been waiting for three months. That is going to get worse because of this -- the minister knows it is. It just has to.

What about the elderly people who need a cataract operation or some other kind of operation which is not an emergency, and they are not in some kind of a group plan which gives them semi-private care? Their doctor is not going to send them into the hospital. Their doctor is going to tell them to wait for a nice space. That is very clear.

The Deputy Speaker: One minute.

Mr. R. F. Johnston: My leader, before he was thrown out for telling the truth, pointed out there are classes of people and there are going to be whole towns like Windsor with huge welfare rates to which this system is just going to be totally impossible. It will be a field day for private insurers. Unionists will have to carry extra costs for their plans, or if they are not going to have to carry extra costs, they are going to have to bargain it somehow and lose it on their wages.

Or, they are going to have to take the minister's advice and say: "Why bother to take it out at all, because I can get a space any time I want," if we are to believe the minister. It is just total garbage.

What we have is the beginning of a two-class system for health care. This is the broad edge of the wedge being shoved into the people of Ontario.

The Deputy Speaker: Time.

Mr. R. F. Johnston: Mr. Speaker, to sum up. This minister is destroying the health care system. This minister should go no farther than his present position. He should not be running for the leadership of his party; he should be resigning his post in shame.

Mr. Jones: Mr. Speaker, listening to the contributions made on the government's initiatives in hospital care I feel an important point needs to be added to this mix. I am referring to the wider context of the federal-provincial fiscal arrangements.

We have all had an opportunity by now to review the main parts of the MacEachen budget address of November 12. If members do not think it relates to this they are sadly not aware of how economics work as they flow to the health care system of this province and the other provinces.

It seems to me --

Mr. Grande: Do you remember 1976?

Mr. Mackenzie: The disgrace to this House.

Mr. Grande: Do you remember that, 1976?

Mr. Jones: You bet I do.

The Deputy Speaker: Order. The member for Mississauga North has the floor.

Mr. Jones: It is quite clear our Treasurer (Mr. F. S. Miller) was accurate in his description of federal cutbacks to the provinces when he described them as unreasonable and unfair. As a consequence of the federal proposals we heard on November 12 Ontario will lose more than $250 million in the 1982-83 year and this will rise to almost $500 million during the 1986-87 year, a total loss to this province that will amount to almost $1.2 billion over that period.

On top of those financial constraints imposed by Ottawa, the federal Minister of Health and Welfare has also indicated an intention to inflict undefined terms and conditions on health programs after Mr. MacEachen has had his cuts. So it becomes very clear to me that the greatest threat to preserving the health care system intact in this province is Ottawa itself.

But we in Ontario are not without alternatives and many of them are unattractive to us and to the taxpaying citizens of this province. Again, however, it was the Treasurer who pointed out some of the defences we have against an uncertain future are innovation, creativity, research, discovery, competition and enterprise. The Minister of Health's announcements of yesterday are all of those things. But I will return to that in a moment.

First I think it is important for us to review the background to the imaginative steps that have been taken by the Ministry of Health yesterday. Traditionally, there has been a long period of federal-provincial negotiations leading up to a revised fiscal arrangement. The reason for these lengthy discussions is the extreme importance of federal transfers in provincial budgets. They take up almost 50 per cent of the budget revenue in some provinces.

The largest of these transfers and the one which concerns us is the established program funding, or EPF, enacted in 1977. Before EPF, as a point of history and vital to the debate today, the federal and provincial governments participated in three separate cost-sharing agreements for hospital insurance, medicare, and post-secondary education.

Each of these three began as an open-ended agreement from the federal government to match about 50 per cent of provincial costs. But you will recall there was a problem. Costs went up and that escalation alarmed the federal government. We saw ceilings on contributions, first in post-secondary education and then on medicare. That ceiling on medicare was quite severe.

Undoubtedly ceilings would have been placed on hospital insurance too, except that existing legislation prevented that action. To overcome that legislation Ottawa gave the required five-year notice to terminate this agreement. The provinces did not think much of these pre-EPF agreements either. And here we are seeing the signal that at the end of the five years they are not necessarily going to be renewed.

Those federal ceilings on the two agreements were artificial and crude, and the provinces were not free to design the range of health care services and education programs they wanted because of the narrow range of things Ottawa agreed to help finance. For instance, Ottawa would not share the costs of nursing home care and other lower-cost alternatives to hospital care. All the problems resulted in negotiations in 1976 that converted these three cost-sharing programs to the block funding arrangements of EPF or established program funding.

From the beginning, EPF was hailed as a giant step forward. It clarified and untangled the responsibilities of the two levels of government. It represented a long-term arrangement that fulfilled the major federal objectives of tying provincial transfers to previous growth of the economy which made their transfer outlays more predictable. It provided equal per capita transfers to all provinces.

As far as the provinces were concerned, EPF offered flexibility so we could determine our own spending priorities and direction of our health care services. When one gets a little, one has to give a little. It was clearly understood that this new EPF arrangement passed considerable fiscal risk on to the provinces. When this arrangement was established in 1977 the federal government said it was to offer a greater degree of permanence and stability to health as well as to post-secondary education funding. To reflect this, there is no requirement that the EPF arrangement expire or be amended during the upcoming round of fiscal renegotiations.

Prime Minister Trudeau spoke at a federal- provincial conference in 1976 and on the subject of EPF said notice of termination would not be taken, or be given, lightly. I want to underline this: EPF was not supposed to change over the next five-year period covered by the renegotiation of federal-provincial cost sharing.

4:30 p.m.

This brings us to the issue that is giving all of us many sleepless nights -- the issue in this debate today. It is certainly a big part of it. Recently, as members know, there have been strong tremors that make us believe Ottawa wants to upset that applecart. Ottawa may want to make major structural changes in EPF; the evidence is rather clear and convincing.

Mr. MacEachen announced his intention in last fall's budget to achieve new savings of some $1.5 billion from transfers to provinces over the next two years. That intention was repeated at hearings of the parliamentary task force on federal-provincial fiscal arrangements by Mr. MacEachen and his senior federal civil servants. That echo has gone on. They have indicated that Ottawa might seek to phase in just such cuts gradually.

Mr. Breaugh: It seems to me to be a long way away from the hospital bed issue. Are you ever going to get there? One would almost think you were afraid to get on that. When do we get to hospitals? When are you going to make the connection?

Mr. Jones: It certainly relates. If the member opposite does not think $1.2 billion that comes right out of EPF and constitutes the removal of the revenue guarantees, then I do not quite understand how he got to the role of health critic. He understands clearly how the two relate.

For example, the Minister of National Health and Welfare, Miss Bégin, told the parliament task force she would recommend to the federal cabinet that a ban on extra billings be a condition provinces must fulfil in order to receive the full allotment of EPF transfers. Miss Bégin is taking what we consider to be a philosophical position as there is no compelling evidence that current opting out is harmful. Others will disagree. Her position was also rejected by all provinces except Saskatchewan, to be sure.

The Deputy Speaker: One minute.

Mr. Jones: As we have all been told by Ottawa, the federal government wants to raise its visibility across the land by blowing more trumpets about its role in various programs. We see it rather clearly.

Mr. Wrye: She wants you to spend some money; spend a few dollars for a change.

Mr. Jones: I can understand why the Liberals are particularly sensitive about it. The Liberal members talked about it at their recent gathering and acknowledged that EPF cuts were going to have an adverse effect on health care in this province.


Mr. Jones: The member should not deny it today for convenience in the debate. It is at least $1.5 billion in cuts. He should not be so silly. I heard the debate on Suncor earlier. When we talk about that amount of money, that is 40 days in the health care system of this province.

The Deputy Speaker: Time.

Mr. Jones: I remind the House, Mr. Speaker, as I take my seat, that as Justice Emmett Hall said, there is no evidence the provinces are diverting funds from the health care expenditure field, as we have heard in allegations leading up to this EPF cut. The cut has caused our minister to bring forward initiatives, proposed here, to ensure we continue to have the maximum health care programs the people of this province have always enjoyed.

Mr. Conway: Thank you, Mr. Speaker. I want to offer some personal comments on the matter before us this afternoon. Before I do, I must say I regret the old standing order has not been reinforced that members ought not to be allowed to stand and read speeches. I think it is a comment on the view of this government, and unfortunately perhaps the view of this minister, with respect to the importance of this place that this speech would be offered hours after four, five, six, seven or eight legislative sessions concluded on the estimates of the Ministry of Health. It certainly sets in some perspective the role this government views the Legislature playing on some of these issues.

Mr. Wrye: Some people would call it arrogance.

Mr. Conway: I will not engage in the whole matter of the efficacy of the Premier's intervention on Monday at the Ontario Hospital Association convention. I learned my lesson painfully in the last election campaign about what to expect; I no longer have a very high expectation in some of these respects.

I must say it is a real concern to me that we have today the opportunity to discuss the speech made by the Minister of Health yesterday to the Ontario Hospital Association convention. There is no question in my mind that those of us who have had the opportunity to be here for the past number of years, I would say since about 1974 or 1975, are seeing the slow, studied, steady erosion and dismantling of our public health care system.


Mr. Conway: I have to dispute the Minister of Health's private interjection. There is little doubt in my mind that what he has offered here is yet another march towards the breaking down of a commitment entered into so very reluctantly by this Conservative administration some 20 years ago.

This afternoon I was reviewing briefly the book by Malcolm Taylor, entitled Health Insurance and Canadian Public Policy. I was reminded yet again of the kind of intransigent reluctance that characterized the bringing of the Conservative government of Ontario to the concept and to the public policy we have in terms of medicare in the public hospital insurance program. Certainly they are not going to have it said that their association with that public policy was any longer than absolutely necessary.

I have to agree entirely with the remarks of the member for Bellwoods (Mr. McClellan), of my colleague the Leader of the Opposition (Mr. Smith) and of the member for London North (Mr. Van Horne). I am rather amused and amazed when I hear what the member for Mississauga North (Mr. Jones) says in respect of what I heard days ago from his senior and, I think, rather more sensitive colleague the member for Mississauga South (Mr. Kennedy), who invited us in the committee to pay heed to some of the worries he was being faced with in Peel region.

The thing I find interesting about the speech is that through this minister the government has conceded to the powerful special interests that they are right and are going to be followed. The members who have been involved with the health debate, and certainly my colleague the member for Oshawa (Mr. Breaugh), will remember well the whole business not many years ago when those special interests were inviting the Legislature, the cabinet and the community at large to break the system down, to recognize that there would not and could not be sufficient dedication of public dollars and to let private money in. Private money is obviously being invited in, in a way that will seriously undermine the public hospital sector.

This afternoon I was discussing with a couple of administrators what they felt this change would involve. They view it as a very serious worry. Under these new conditions, they do not see any way whatsoever that they can deal with the service problems they are faced with in their respective communities. They are not happy. Who could be happy with quotes like this from page two of the minister's speech: "A deficit is going to be seen for what it is: a loss or overspending"?

How many of us who sat through hours, weeks and months of testimony in the last three or four years can honestly believe, on the basis of the evidence tendered, that the vast majority of hospital deficits in this province are the result of overspending? It seems to me the call from most of those people on the line is that it is a result of the rather arbitrary funding mechanisms, some of which have been shown to be ludicrous in the extreme.

I think particularly of the debate we had about the new active treatment bed ratios and how completely and grossly inadequate they were to meet the community needs in many parts of the province. It is my impression that the framework the government has set out in this paper will do nothing but aggravate the very conditions about which hospitals are so bitterly and properly complaining today.

4:40 p.m.

It has been said by many here today that the community should be involved. I will not bore you with the language of the minister, Mr. Speaker, but there are some rather interesting quotes in that respect, saying there should be more local decision-making and the community should be involved. It is not so many weeks ago that we sat in our places and had debated before us a rather controversial amendment to the Public Hospitals Act which gives the dictatorship at the Hepburn Block the effective trusteeship, if it so chooses to exercise it, over any public hospital in the entire province.

Iron-heel Timbrell, the man who but weeks ago stood in his place and said that through this new legislation, should the executive council decide an intervention into a local community's public hospital is going to be required, then there can be an intervention to take away that community control.

Now he comes back to say we are going to have greater community involvement. That is something of a contradiction, it seems to me, but I must say it is no greater a contradiction than listening to the baneful bleating of the member for Mississauga North, talking about the heinous activities of the federal government, on the one hand, and having listened over these many months and years to provincial Treasurers, most notably the current Treasurer, the member for Muskoka (Mr. F. S. Miller), inviting, enjoining, haranguing, harassing respective federal governments to get their house in order.

The member for Muskoka has stuck his chin so far out into the fast lane that the temptation to take a solid, four-square poke at it must have been almost irresistible for the federal Minister of Finance. I say that, making no judgement or comment about the efficacy of what the federal Minister of Finance was intending to do, save and except to say that it is nothing that the current Treasurer of this province did not repeatedly and regularly ask for.

How many times have we heard, in this chamber and elsewhere, on the one hand that the community concept is important, and on the other the steadfast reluctance of the government to fund to those community levels and responsibilities? We know that in a province as disparate and diverse as this, there are inequities in terms of socio-economic conditions; it was because of that very situation that we moved, under the guidance of many thoughtful and progressive people some 25 years ago, to a public policy that would put a standard across not only the province but also the country.

Now to be told that we are going to return to a broken-down, fractured health care delivery system is offensive to me. Added to which I want to say that the notion that there ought to be a private sector marketplace mentality exercised in this sector is just absurd; it is rendered more than absurd, it is rendered insulting, when it comes from the Minister of Health, who knows, not only on his own account but also on the account of some excellent advice I am sure he gets from within, that it is just not so.

This marks, I want to say in conclusion, another sad, sorry step down the slippery slope to a withdrawal from a public medical and hospital insurance program that I think will long remain an unfortunate and rather pitiful commentary on a government that lost touch with the real sensibilities of the people of Ontario.

Mr. Foulds: Mr. Speaker, one of the things we have to keep in mind in this debate is that we have perhaps the most single savage attack we have seen in a long time on the hospital system of this province and we have not a single cabinet minister in the House to defend the action of the Ministry of Health, including the minister himself.

I have been this route before. These arrogant, insensitive Tories that we see across the way, it only took them six months after the so-called realities of March 19 to start bullying and bashing the people of Ontario the way that they did in the early 1970s when they received their huge majority, which curled around on this side of the House.

What do we have? We have a government that deliberately attacks the most vulnerable people in our society. This is not new. It has been accentuated and has culminated because the minister and his Premier (Mr. Davis) have a majority at the present time.

It is worth remembering that in 1968, John Robarts, then the Premier of this province, called medicare "this Machiavellian scheme." That underlines the lack of commitment this Conservative government has had to a fully accessible, fully universal health care system. It is worth remembering the savage and continual attacks they have made, chipping away at our health care system over the last number of years.

Remember that in January 1979 we had cutbacks in hospital funding by this minister; in 1979-80, 900 hospital beds were cut back. The government was to impose a $9.80 penalty on chronic care and psychiatric patients who stayed more than 60 days. We had a 300 per cent increase in charges to users of ambulances. Health care wages, except for those of doctors, were effectively limited to 4.1 per cent.

Remember that the government arbitrarily chose its ratios of four beds per 1,000 in the north and 3.5 per 1,000 in the south. That meant we had the second lowest ratio of beds of any province in Canada. As well as that, in 1979 we were already paying the highest premiums in Canada.

By September 1980, members will remember that 16.6 per cent of all doctors in Ontario had opted out of the Ontario health insurance plan, and a whopping 26.4 per cent of specialists had opted out. That was the crisis of that day.

By the end of fiscal year 1979-80, Ontario's contribution as a percentage of the total Ontario health care budget had dropped from 59 per cent in 1975-76 to 46.1 per cent.

Then, by October 1980, an Ontario Hospital Association survey showed that 156 out of 199 reporting hospitals would be in a deficit position, totalling $71 million by March 1981. As of December 1980, the Ministry of Health had picked up only $16 million of that deficit for 39 hospitals.

They have played this game before, letting the hospitals get into a deficit situation, bailing them out a little bit and then doing this kind of thing. This year, in the spring budget, OHIP fees, already the highest in Canada, rose from $480 per family per year to a whopping $552. The Treasurer gets more in revenue from health care fees than he gets from our resource taxation. That is simply a wrong set of priorities.

Then the Minister of Health started his kite-flying. In June, he said, "Ontario residents may be required to pay part of their doctor and hospital bills directly if Ottawa slashes the funds it transfers to the provinces for health."

He said on September 11, 1981 to the Kiwanis, "We may have to contemplate raising additional funds from within the system itself including employing modest user charges, as has already developed in some other provinces." That is a tax on the sick.

What he has done in the last few days is he has introduced a two-tier hospital system. What is even more offensive to me is that they are doing this in a sense of what my leader called lying, which I will not repeat, but which my colleague the member for Bellwoods indicated is duplicity, dishonesty and bad faith. Frankly, I think he was being kind.

I do not know how else anybody could interpret the Premier's statement of Monday. I used to be an English teacher in high school, and for the life of me, when I see this, "For the present, despite press reports, we have rejected new user fees for hospitals as a revenue-producing step," I do not know how that squares with the minister's statement.

The Premier does not say, "We have rejected new user fees for ward care for hospitals." He does not say, "We have rejected new user fees for the lowest common denominator of hospital care." He says unequivocally, if he can say anything unequivocally, "We have rejected new user fees for hospitals as a revenue-producing step."

4:50 p.m.

Two days later, we had what I consider the most offensive statement I have heard from a Minister of Health in this province in my 10 years in this Legislature; and let me tell you, I have heard some pretty offensive statements.

Just look at the wording: "Creative hospital management is being stifled by the rigidity of the existing system." He uses terms like "financial flexibility," "increase in local accountability" and "private sector thinking." He says: "The improved system" -- note that -- "which I will introduce today will have as its linchpin the inclusion of a bottom line in hospital management. A deficit is going to be seen for what it is: a loss or overspending."

He talks about "the product we are working to create," and likewise says: "Hospital managers in the past have had no incentive to underspend their budgets. This situation is going to change." He says: "Many hospitals have shown entrepreneurship in ancillary service areas, such as parking lots and cafeteria services. Other money-making ideas will occur to the innovative administrator."

The imagination boggles. They are probably going to be encouraged to have hot dog stands. They are probably going to be encouraged to have little fairs in the parking lots to get additional revenue. They will be encouraged, perhaps, to put meters in the visitors' parking lot and in the doctors' special parking lot. Maybe they will be putting meters on the hospital beds so that if a person stays for a long time, there will be a surcharge on the amount of time he or she stays. There are all kinds of innovative ideas.

What is most offensive to us in this party is that this government will point its finger at the federal Liberals as being the makers of this catastrophe, and the federal Liberals will point back and say it is the provincial Conservatives' responsibility.

Frankly, I do not care whose responsibility it is, because to me the bottom line, if I may use that offensive term, is what will happen to the patient. Will the patient be better off in this system the minister has introduced?

The patient who will be better off is a patient, like the minister or myself, who may have extra plan coverage. The patient who will be better off is a patient who has insurance to take into account so that he or she can get semi-private or private care.

The patient who will not be better off is the patient who must pay his or her Ontario health insurance plan fee and have minimal care.

What we need in this province is the kind of government that will ensure that hospitals and schools and social service agencies get the kind of funding they deserve. The cabinet and the Conservative government would have to put on a bake sale or a tag day to get the money it needed for its unnecessary government jet, or Ontario Hydro would have to put on a bake sale or a tag day to build a nuclear plant it does not need. But this kind of doubletalk and doublethink by the minister is destroying the essential quality, the essential accessibility, the essential universality, of our health care system, which at all costs must be maintained.

Mr. Harris: Mr. Speaker, it is a pleasure for me to have this opportunity today to speak on this subject. I question whether it is an emergency situation, and obviously the Liberal Party does too, with six of them in the House. I think the Liberal Party numbers here during the debate probably signify that their party feels the same way. I have not seen the mover, a member of the Liberal Party, since he spoke. I do not believe our party said it was an emergency, and I do not believe it is. That is why I welcome the opportunity to speak on this subject, even though I do not believe it is an emergency.

A key element of the Ontario Hospital Association policy announcement made by the Minister of Health yesterday is rationalization in the health care system. By rationalization, I understand and I mean the sharing of services between hospitals. If gaps in local hospital services can be filled, overlaps eliminated and central service organizations established wherever possible, then costs can be controlled and money redirected to more effective uses to meet changing or growing health needs.

Rationalization also makes eminent good sense --

Mr. Wildman: I hate that phrase.

Mr. Harris: I am glad my friend said that, because I am going to use it quite frequently in my speech.

Mr. Wildman: You are going to use that a lot, are you?

Mr. Harris: That is what I am here for today. What is the point of having hospitals in the same, often small community offer identical medical services when, if one hospital takes a cardiac unit, for example, and the other perhaps builds a perinatal unit, the community is better served and more efficiency is achieved?

I want to stress that rationalization helps us to realize our goal of ever better patient care. Rationalization actually achieves at least two of the four major elements in the new business-oriented system outlined yesterday by the minister. I can understand why one party here does not want it to be business-oriented.

Rationalization offers new opportunities for hospitals to maximize revenues, and it is a strategy that minimizes expenditures. It means new money does not have to flow from the ministry. I think it means that money saved from amalgamating services can be used for other improvements and programs. I think it should be viewed as a double blessing.

There is no doubt in the government's mind either that the new program policy will make rationalization even more attractive to hospitals. With hospitals now being allowed to retain net earnings -- that is, any surplus of revenues over expenditures -- for use in their health care programs, we fully expect that rationalization will be promoted. I think all three parties ought to do their part to promote it.

Hospitals engage in the rationalization of nonmedical services in so-called hotel services, such as in sharing common laundry. At the moment, however, the rationalization of medical services saves us all -- hospitals, the government and therefore the taxpayers of this province -- the most money in co-operative hospital ventures. This is because of better utilization of some of the most expensive costs in the hospital, such as high technology.

The minister mentioned multi-unit management yesterday as an idea whose time has come. He urged hospitals to explore the possibility of sharing administrative and other support services with neighbouring institutions. When one considers that 30 per cent of the staff in the hospital sector is involved in operations other than direct patient care, then we have fruitful ground for a reassessment and a realignment.

I want to make a further point about the possibility of sharing administrative personnel, such as the accountants within hospital staff. I think a strong point can be made for this kind of rationalization when one remembers that upwards of 80 per cent of hospital service costs are wage-related. Those costs, incidentally, have been moving up at a rate greater than the general rate of inflation.

I realize that some hospitals use joint medical staff, and I am delighted to say that the two hospitals in my constituency, St. Joseph's General Hospital and the North Bay Civic Hospital, do just that. In fact, these North Bay hospitals were the forerunners of the rationalization process. The medical staff combined in 1967. They have shared a unified laboratory since the 1970s. Both offer acute care, of course, St. Joseph's specializing in neonatal obstetrics and the Civic in chronic care. They also have a central laundry.

5 p.m.

These two hospitals are moving in the direction of having one board and one corporate structure. A total merger is the ultimate rationalization. It has been estimated by one of the administrators of the North Bay hospitals that this ultimate rationalization they are working on will provide the same service with savings of $1 million to $3 million a year.

I believe keeping these health care funds in North Bay for improved services in other areas is good. That is one of the reasons I am supportive of the minister in the new initiatives. I think it is good news. It is logical. It makes sense. Maybe that is why some people in this Legislature want to question it. I know it will work.

I want to give other examples of rationalization at work in Ontario. In Brant county, major upgrading of the emergency services was made possible at Brantford General Hospital by the amalgamation of Brantford General's emergency department with that of nearby St. Joseph's Hospital.

In Ottawa-Carleton, an excellent example exists of the hotel type of support service rationalization. Six hospitals there have joined forces to create a central food purchasing and preparation facility. This is expected to save $500,000 a year, compared with the cost of operating six separate dietary departments.

Many hospitals find sharing obstetrical services useful. This has happened in Sault Ste. Marie, where General Hospital concentrates on obstetrics, leaving the Plummer Memorial Public Hospital to focus on psychiatric services.

Mr. Wrye: That is already happening everywhere.

Mr. Harris: No. I mentioned to my friend how well it was happening in Nipissing and that it is time some of these other hospitals started to look at it.

Mr. Wrye: Come on down to Windsor where we're really fat with cash.

Mr. Harris: Maybe the member could use some help from the hospitals in Nipissing down in Windsor.

Other hospitals prefer to co-operate on emergency services, and this is happening among four hospitals and other health care providers in Sudbury. District health councils can now play a decisive role in bringing about rationalization.

Mr. McClellan: Tell us about the price of beds.

Mr. Harris: Maybe next; I might have time yet.

District health councils serve as catalysts for change, pinpointing opportunities to streamline the local system and persuading the institutions involved in the act.

Rationalization can sometimes seem a painful and difficult process. It may be hard to convince someone with logical arguments and expert data if he thinks what one is advocating threatens his own wellbeing. Everybody favours fiscal restraint in principle but, when it comes to applying that policy to particular situations, those affected often change their minds.

The difficulties, however, can and are overcome through dedication and sensitivity of DHC members, hospital trustees and administrators to the needs of their local regions.

Mr. Wildman: But they are not logical, are they?

Mr. Harris: Some of them are, and some are like the member. I point out a recent procedural change the government has made that should improve the links between the views of the hospitals and those of the district health councils. Hospital board chairmen and administrators are now eligible for membership on district health councils which, as the members know, advise the Ministry of Health on programs or policy changes required in their areas.

The important point to remember with rationalization is that it is not a way of reducing services. It is a way of allocating them better to ensure they match the needs of the community. In view of the fact that needs are changing, we have to be increasingly adaptable. In a younger community, for example, it is quite apparent that we need more emphasis on paediatric and obstetrical services. In an area with a large ageing population, the priority is definitely on chronic care.

If new services are required, there are two ways of providing them. One can simply add on to the existing package of services, which requires more tax dollars, or rationalize areas where one has a surplus or duplication of services. This results in more available dollars and in an improved health care system.

Rationalization of hospital operations remains a key way that we in Ontario are able to ensure continued quality health care at a reasonable cost to all of our citizens.

Mr. Wrye: Mr. Speaker, I want to start by telling the House of an experience I had on Monday. I guess it turned out to be a dream. As I flew into Toronto on Monday morning, on my way up north on a tour of universities and colleges I have been doing, I picked up a Toronto Sun.

The first thing I saw was a story which indicated that the government was going to be bringing in user fees for hospital beds. I believe it was going to be $4 a day; that was what the report said. I said to a colleague who was going up north with me what an awful thing this was and what a disgrace this was, especially coming from a government which had enough money for an oil company.

I was up north all day and away from the car radio and television, and when I got back to my apartment here in Toronto late that evening and turned on the news I found out that the Premier of Ontario (Mr. Davis) had appeared in front of the Ontario Hospital Association and had rejected any new user fees for hospitals as a revenue producing step. I said. "Thank gosh. There must have been a terrible outcry, an almost instantaneous outcry, and the government has backed off." I was very pleased that the government had at the last moment come to its senses.

Its sensible approach lasted exactly 48 hours because, as we all know now, yesterday -- just one day ago -- the minister, apparently not having heard the Premier's message, got in his limousine and went downtown and announced that indeed there would be new user fees. I do not know how you rationalize the two; the Premier saying there would be none and then what happened when the minister made his speech yesterday to the Ontario Hospital Association.

I find myself wondering about the last speaker for the government side, the member for Nipissing (Mr. Harris). All fall, as the critic for the Ministry of Colleges and Universities, I have heard the word "rationalization." Every time you dig into what rationalization really means, it is kind of a Tory buzzword for cutbacks. That is what we have in this new proposal. We have cutbacks in services and it is just being done by another means. We have cutbacks in publicly financed services. We are now going to depend upon people to pay their own way. I suspect people have believed over the years that they were paying substantially enough money in terms of their own taxes and they are now being asked to do a little more.

What is terribly wrong about that is that it is just another step backward from the view which I thought we had all come to believe in; that decent health care, decent hospital care was a right and not a privilege. Now, once again, we are going to go back to a day when it will be a privilege.

A few minutes ago, the previous speaker for the government, the member for Mississauga North (Mr. Jones) spent most of the time in his prepared text -- carefully prepared by some ministry official or some government official, I presume -- talking about the established program funding cutbacks as if this has savaged the government, savaged its ability to provide any decent social programs for the people of Ontario.

Hon. Mr. Timbrell: Do you support the cutbacks?

Mr. Wrye: The EPF cutbacks, the cutbacks in the revenue guarantees will amount to exactly one to 1.2 per cent of all of the money they will spend in the next five years.

Hon. Mr. Timbrell: That is okay?

Mr. Wrye: We said very early on that we were not happy with it. We still deplore it.

Mr. Wildman: The parliamentary task force is against it, too.

Mr. Wrye: The parliamentary task force was against it. All parties were against it.

Hon. Mr. Timbrell: Are you against it?

Mr. Wrye: Yes. Despite that, this government which says, "We are going to have to cut back on social programs," has found not $1.2 billion or $1.3 billion to restore these programs; this government claims it has found $2.4 billion for an oil company and the minister is not concerned about that.

It is ironic, I guess, in a sense, that we should be here debating this emergency debate in the Legislature on the very day when the officials who had a great deal to do with Suncor came before us to try to explain this terrible business deal that will make the Tories the laughing stock of every business organization in this province. The fact that they claim they have enough money for Suncor but not for the health care system or for the universities is just ludicrous.

5:10 p.m.

Because we have bought an oil company, we are going to say to the sick who might want to go into semi-private or private coverage: "You will have to pay more. If you want to park in a parking lot, instead of 50 cents it will be $2.50. It does not matter whether you are one of the working poor or one of Windsor's 20 per cent unemployed, if somebody in your family happens to be sick, cough up a lot of extra money in terms of the parking lot." Maybe you have to stay for dinner because you have somebody in the family who is ill but, as the minister pointed out in his speech yesterday, that is another way to maximize some revenues.

As with the universities, I suspect this is just the starting point. They have backed off from the cost for hospital beds, the $4 proposal, but just for now. As this government moves forward in an effort to privatize the health care and hospital care industries, it will be asking the working men and women of Ontario, and indeed employers who pay for semi-private and private coverage in many union contracts, for example, to pay the difference.

It is interesting that within this speech the minister seemed to be putting the blame on hospitals for not having rationalized -- as my friend the member for Nipissing said, on hospital administrators for not having cut costs, and as my friend the member for Windsor-Walkerville (Mr. Newman) suggests, on too many people getting sick. I guess they are to blame too.

Mr. Newman: They are sick of the government.

Mr. Wrye: I guess they are. People are getting very sick of the government very quickly. I would venture to predict that this latest move will move us forward. The people are concerned that this arrogant government has completely lost touch with what its priorities ought to be. It is significant that the arrogance of this government can perhaps best be shown in two areas.

This very dramatic cutback in the policies we have had over the years for our health care system was not announced in a statement to the Ontario Legislature. It was not even announced on a day when the Legislature was sitting. I consider that to be more than sheer coincidence. It was announced on a Wednesday when the House was not sitting, so the minister would not have to screw up his courage and read this as a ministerial statement.

I find it significant that this breakthrough, if that is what this disgrace can be called, was announced just after the estimates of the Ministry of Health were completed. I think the minister ought to have the courage to go back and do a couple more hours of estimates so that both opposition parties could have a real opportunity to question him.

Rather than the speeches we are making this afternoon, we could question this speech on a line for line basis and get down to the nitty-gritty as to how hospitals like Hotel Dieu Hospital and Metropolitan General Hospital in Windsor, both of which have deficits of $1 million, will be able to reduce those deficits and, as the minister suggests, wipe them out without putting the cost of semi-private and private coverage totally out of the reach of anybody but the very rich or those who have contracts and are willing to forgo wage increases because of the sharp increase in benefit package.

Perhaps the minister suggests we are going to make do with increased costs of restaurants --

Mr. Speaker: The member's time has expired.

Mr. Wrye: -- or perhaps many, many other ways.

In closing, I would suggest that the minister should come back to the social development committee and talk for another three or four hours and justify this very dangerous precedent he announced yesterday.

Mr. Breaugh: Mr. Speaker, I am somewhat saddened by the debate this afternoon because I thought for a while this House, this Parliament and the people in this province had resolved the difficulties in hospital funding.

For example, I recall when the government decided it was a good thing to build hospitals in the early 1970s and in particular to cut ribbons. They built them all over the province. There seemed to be no end to available funds and there certainly was no end to the number of ministers present to cut ribbons, open new wards and do all of those things.

Having walked that side of the street extensively, somewhere around the middle of the 1970s they decided that having made all the political gain there was to be made in opening up new hospital institutions around Ontario, they did not like the reality of having to fund the system. They decided, and members might recall it was the now Treasurer (Mr. F. S. Miller), who was then Health minister, who said very dramatically, "We have too many hospitals and we are going to shut some down." He even had the audacity to go to the communities and announce these shutdowns, one by one.

But in the middle of that, I recall, little Frank got snowballed in several places and decided to chicken out.

Mr. McClellan: Including his own head.

Mr. Breaugh: Yes. He got a couple right where he deserved them. That probably has been a part of some of his problems.

But they decided to back off that, after that particular process proved to be so unsuccessful, perhaps because for once in its life this government told the public the truth about what it wanted to do. They committed an error of politics along the Tory lines, because the basic line is never really tell them what you are trying to do. Tell them anything else. Tell them what they want to hear. Go ahead and do it in the back room, but never tell the public up front just what exactly it is that the government intends to do. The former minister made that mistake, he paid the price and withdrew.

Subsequently, I recall in 1975, 1976, 1977 and on into 1978, the government of Ontario decided, through a variety of means, to cut back on hospital funding.

The first defence is never admit that there is a cutback under way. One always gets rather specious arguments about how many dollars one puts into a particular field in one year as opposed to how many one is putting in this year. One never attempts to really assess the realities of modern economics. One never attempts to really have a good clear argument about what the government is doing. One begins this process, and the Minister of Health is a master of this particular one, of trying to fudge the issue. Get lots of reports out, get lots of numbers out, and make the argument confusing enough so that the public does not perceive what is really going on.

I recall that process as well. That is kind of the second phase of cutbacks in the hospital system. I recall, too, petitions brought in and placed before this House. I recall the coalitions that were formed and I recall all of the emergency debates we had during those times and the things that we had out in front of the estimates.

I recall Darcy McKeough. The only time I ever saw that man turn tail and run was when he attempted to jack up the price of the Ontario health insurance plan premiums. Darcy and everybody else in that cabinet denied that is exactly what they were trying to do, denied that they really were trying to milk more money out of the sick in this province, but then gradually as the momentum of the process grew, they too withdrew that one.

Then the present minister went through his process as well. In a minority, things were a little different around here. In a minority, at least there was an opportunity to go before a committee of the Legislature and have the argument to give the public at large an opportunity to express problems, to give administrators, doctors, nurses and patients an opportunity to express an opinion.

But it is something which should be noted that in the middle of a majority, having had six or eight months to kind of get their teeth set on exactly what they wanted to do, just after the minister's estimates were finished, all of a sudden on Monday the Premier goes down to the hotel and announces, in a classic example of everything is just fine, that there will be no more user fees. He says, "We have discarded that idea," and on Wednesday, in a rather classic Tory move, he sends the little man in the Gucci jackboots down to announce that we may not be having more user fees, but we are substituting this program in its place.

5:20 p.m.

I recall that in a minority Parliament the opportunity was there for an expression of concern by members on all sides and by the public at large. I recall too that in a strange way, in a Globe and Mail editorial in the middle of July, the government announced it was going to provide more money. In that long series of debates that we had in here about how we do fund hospitals, we managed to get some small measure of truth out about that, and some measure of the problem as well.

I had an opportunity to go through the minister's announcement, and I must say there are some remarkable confessions as to what the Minister of Health in Ontario is all about. The minister said in his speech, and I will not quote it, but words to the effect that the ministry is in the health business. Well, that lines them up nicely with the pharmaceuticals. That lines them up nicely with the American suppliers. That lines them up nicely with all those private sector people who make a big buck off the people of this province, and that shows which camp he is in. It is nice and clear; there is no equivocation there.

I think he might regret that particular quote he stuck in the middle of his speech. The minister went through a long list of things in here which I think he is also going to regret and which certainly the rest of us are going to regret as well. He has set the pattern for hospital care in Ontario. He has made, in this pitch, a very soft and velvety approach which is basically an apartheid policy. Within our publicly funded institutions, the ones which you and I built, paid for and operate, Mr. Speaker, we are now going to have two classes of medicine, and we are going to take it from the stage where it is now and really embellish that. We are going to make sure that there is a Waldorf-Astoria approach.

The hospitals, looking for more money, desperate for funds, will grab on to that and they will decide there is a need to provide, not first-class care for patients, but good, up-front very fancy, luxury accommodation for those who can pay. The remainder will be stuck with a worsening problem. Those who are having difficulty finding space in our hospitals now will find the problem severely aggravated.

Quite frankly, I think those who have to work in our hospitals will find the problem aggravated severely as well, because for many of the doctors, nurses, orderlies and people who work in our hospitals now, the problem is severe. It is a funding problem. It is a problem of trying to provide a level of care that they know is not what it should be -- and now the minister has given a very neat solution to that problem.

What he is saying is, "Split it up. In that section of the hospital where total control of the funds can be retained and new funds generated, that high level of care can be provided." Certainly, if he is going to knock somebody an extra $100 a day for this kind of care he is proposing, that is where the hospital administrators will see a source of funding and they will be hot and heavy into that. Guess what is going to get neglected even worse than it is now? That is the level of care that is provided to the general public.

There is a perversion through all of this. There is a perversion that -- to take another little chunk of the minister's statement -- he is now saying if hospitals generate new funds and save money they will be able to keep that totally. I recall that repeatedly in the last three or four years around here we have gone at the minister about what does he do to a hospital which actually does become cost effective, which actually does in a sane and sensible way provide a rational service at less money. He grabs the money. He gives them back a quarter on the dollar, or something like that, but he grabs the main part of the savings.

I have noticed a slight shift in here, because now he is saying, "We will let you keep 100 per cent of whatever you have got there." He did not drop the other shoe very well though, because he said there will be consistent funding. That one is going to come back to haunt him. I bet what he will hear from hospital administrators around the province over the next three or four years is, "You have dropped that other shoe a little harder," as he takes away more and more of his provincial funding.

The notion that was put forward by the minister in his speech is a very dangerous idea and a perversion of what a medicare system is all about. The minister should not be surprised, but he should be very much ashamed; and the Premier, who said one thing on Monday and then sent his little jellybean assistant down on Wednesday to complete the dirty deal, ought to be even more ashamed.

Mr. Robinson: Mr. Speaker --

Mr. Breaugh: Are you wearing your Gucci jackboots?

Mr. Speaker: Order.

Mr. Robinson: No. I have my proletarian suit on today, I would remind the member for Oshawa.

Mr. Speaker, much of the debate today has focused on the quality of health care we enjoy in Ontario today. The Premier and others have frequently called ours the finest health care system in the world, and I believe they are right.

The extent and sophistication of the diagnostic and treatment facilities are still improving measurably year by year. The training and skills of doctors, nurses and other health care workers are better today than they have ever been.

I would like to review for the House some of the very obvious improvements that we have seen over the past few years. These improvements, I might add, are no tribute to the Leader of the Opposition (Mr. Smith) and others in his party whose announced policy in 1978 was to cut $50 million from the budget of the Ministry of Health. No, they are a tribute to this government, which instead of cutting health expenditures, as the Leader of the Opposition suggested, has continually increased its commitment to health care.

As the Premier recalled to the Ontario Hospital Association earlier this week, the budget of the Ministry of Health has grown by almost 68 per cent in the period since the Leader of the Opposition proposed to cut it. This year, for instance, we will spend about $5.7 billion on health care, which is more than the total budget of the government of Ontario 10 years ago.

These are mind-boggling figures. Even broken down on a per capita basis of $650 for every man, woman and child in Ontario, it is still staggering. Looked at another way, the volume of physicians' services increased by 20 per cent between 1974 and 1979, while the number of practising physicians increased by only 13 per cent. In the past five years, spending on the drug program has increased a whopping 185 per cent. This last year alone, we raised hospital funding by some 17 per cent, which is well above what any other sector of the government received and well above the rate of inflation.

I could go on and on in this vein for the balance of the afternoon. There simply has not been a single indicator of health care that has not increased and that has not experienced major increases during the past period. But I want to turn instead to some of the very innovative things that are happening in Ontario to give us a world-class health care system.

It sometimes takes dramatic events or well-known personalities from abroad to draw attention to the superior skills and unique facilities that draw them to Ontario's specialized hospitals for treatment, hospitals that we in this province enjoy routinely under the Ontario health insurance plan. For instance, over the past year we have developed one of the most comprehensive policies in Canada for the introduction of computerized axial tomography scanners, one of the most advanced of the new technological tools available to medicine.

For the benefit of all honourable members I should note that the CAT scanner was invented in Britain some nine years ago. It is a major breakthrough in diagnostic medicine. Its developers won a Nobel prize for it in 1979. Using a narrow X-ray beam, radiation detectors, computer printouts and visual displays, CAT scanners provide a cross-sectional view of bones, tissues and organs in minute detail. This slice image offers a perspective that conventional X-ray machines cannot match. Originally designed for head scans to diagnose neurological disorders, the hardware has evolved in recent years to provide scans of all parts of the body.

Scanners were initially introduced into teaching centres and specialized hospitals like the Princess Margaret Hospital in Toronto. Over the years we have reached the point where scanners are now available on the basis of one for every 300,000 referral population. This means that every major health centre in Ontario has access to the technology and it is available to everyone in Ontario who can benefit from it.

5:30 p.m.

There is also our fine air ambulance system program. If the Leader of the Opposition and others were to find themselves in Sault Ste. Marie again, they would discover this and other northern centres are serviced by a network of air ambulances that is attracting increasing interest from other health ministries in Canada and abroad. These ambulances, based in Sudbury, Timmins, Thunder Bay and Sioux Lookout, together with our underserviced area program, give citizens of remote and northern communities excellent local care and ready access to the specialists and specialized equipment of the major centres.

I would tell members about the increasing availability of ultrasound equipment and about the extension of home care, which is expanding at a phenomenal rate. I would talk about the improvements in the diagnostic capabilities of our labs, the specialized cardiac, burn, exotic disease and similar facilities being developed in our hospitals. I could talk about the significant improvement in chronic care facilities and the expansion of community services to help mental patients return to normal community life. I could use the entire afternoon just discussing the advantages in public health in this province in the past few decades, as more and more communicable diseases are brought under control.

One would have to be living in a vacuum if one did not recognize the enormous strides being taken by our health care system in this province. These strides are the result of the government's commitment to health care and our concern that the citizens of this province continue to enjoy the finest health care in the world. I had to wonder earlier in the afternoon if I should not attend a doctor today, because much of what the opposition shared with this House this afternoon has indeed been hard to swallow. That is why I could not sit quietly by in the House and listen to a lot of nonsense from members who, instead, should be joining in commending the ministry, the minister and this government for the wonderful health care system we provide today.

Mr. Mancini: Mr. Speaker, over these past few months, since the March 19 election, I have tried to rationalize in my own mind what makes a government seek re-election and what makes individual members of a particular party seek re-election. After having watched this Conservative majority in action since the March 19 election, I can conclude there is no rational reason why the Progressive Conservative Party of Ontario sought re-election.

We can go back to the budget that was immediately introduced after the House was convened in the month of April. We saw the Treasurer of Ontario (Mr. F. S. Miller) raise taxes by more than a billion dollars a year. We saw the imposition of the scurrilous ad valorem tax at the rate of 20 per cent. We saw the ability of this Legislature to implement economic policy somewhat diminished because of the fact it will never again have to introduce a bill to raise taxes on gasoline.

Further, we saw the members of this government enjoy the privilege of office by purchasing themselves a new executive luxury jet so they can stream across the skies in complete luxury. As my colleague the member for Grey-Bruce (Mr. Sargent) pointed out, whenever they have to go to the little boys' room, they can always be assured there will be leather seats there for them to use; $10.6 million for an executive luxury jet. Just the interest payments on that alone, at today's interest rates, are astonishing.

We saw this government then move forward with the purchase of a substantial portion of a major oil corporation, spending $650 million of the taxpayers' money, which we do not have. We were told today that $650 million would have to be borrowed at the rate of anywhere from 17 to 18.5 per cent, making the total cost of the Suncor deal approximately $2.4 billion. We could fund a lot of hospitals with $2.4 billion.

When one watches this government in action it is hard to find any good reason why they fought so hard to be re-elected. I would ask new members on the Conservative side, such as the members for Lakeshore (Mr. Kolyn) and Brantford (Mr. Gillies), why they fought so hard to get into the legislature. Was it to impose the ad valorem tax? Was it to help their party buy this new executive jet? Was it to help their party buy 25 per cent of Suncor as the economic situation in this province continues its nosedive and as industrial workers from Windsor, Chatham, Brantford, Toronto and elsewhere are laid off by the hundreds?

We are curious to know why they fought so hard to retain office. One would not want to become so cynical as to think the only reason they fought so hard and spent so much money to retain office was just to have the privilege of exercising executive authority, to be driven around in bright blue limousines and more or less to pretend to be in charge of an economy they seem to know so little about.

This attack on the health care system is something I am sure surprises even the 22 new members of the Conservative caucus, even though some of them are being forced to stand and read speeches which have been somewhat prepared for them. I am sure even they are surprised the health care system has now come under attack by the Conservative government of Ontario.

We are being told by the Minister of Health on the one hand that his government does not want to impose user fees but, on the other hand, he is telling the hospitals they must impose user fees. He is forcing the hospitals to create a two-tier level of service, one for the wealthy and one of the not-so-wealthy, one for the people who can afford semi-private and private care and one for the people who cannot.

We know the hospitals forced into this situation will eliminate ward beds and put more beds in the semi-private and private areas. We know that will make it more difficult for people who cannot afford to pay the price. It will make it more difficult for them to enter our hospitals. Hospitals like Hotel Dieu and Metropolitan General Hospital in Windsor, which are now under the severe load of at least a $1 million deficit in each hospital, are going to have difficult times ahead.

In my view, there is no other way but a reduction of services in the Windsor area as this program starts to take effect. The Minister of Health tells these hospitals they should become ingenious. He tells them they should think of ingenious methods of raising money. He says: "Charge more for semi-private and private beds. Charge more in parking fees. Charge more for the meals being served in the hospitals." I am surprised he has not asked them to hold a bake sale.

5:40 p.m.

It has always been our belief that medicare would be for all the people, that the health services here in Ontario would be second to none in the world. We have come to accept and to expect these services, not because the Conservative government is paying for them but because the Ontario taxpayers are paying the fees. I was quite surprised to hear the last speaker rattle off quite a number of things that are being done in the health care system as if he and his Conservative colleagues were paying for them.

We must not lose sight of who actually is paying the fees to support our health care system. Therefore, since all taxpayers are being asked to pay on a fair and equitable basis, according to their income, they should be treated as such when it is necessary for them to use the hospital services. No two-tier system should be allowed to grow. That is the basic point. All people pay as much as they can according to their earnings and they should not be forced into accepting a secondary type of health care service just because the government wishes to spend its money on executive jets and oil corporations, and not for sadly needed social services in our province.

Mr. Martel: Mr. Speaker, as I drove down the Don Valley Parkway yesterday coming back in, I heard the announcement by the minister. So help me I nearly hit seven cars, because I recalled the headline last Tuesday in the Toronto Star, "Davis Rules out User Fees For Hospital Beds." Old "smiling Bill" managed to dupe everyone. What did he say? He said: "For the present, despite reports, we have rejected new user fees for hospitals." They can call it whatever the hell they want, it is a user fee. There was "smiling Bill" at that convention on Monday, like the pompous ass he can be, pretending -- knowing that two days later his minister was going to announce what he announced yesterday.

My leader got thrown out today for calling the Premier a liar. I want to ask this House, what does one call someone who knowingly and deliberately dissembles? What does one call someone when he says one thing about no user fees on Monday, knowing full well that on Wednesday the Minister of Health is going to introduce a user fee? What does one call that? Dissembling? I have a better word for it, but the rules of this House say I cannot use it. He can do it and he can confuse or deliberately dissemble, get grand headlines and stand there, while somebody who calls a spade a spade gets thrown out.

It reminds me of what happened in Sudbury during the election. Some of the members were not around before the last election and there was a strike last fall of interns and residents. The Premier came to Sudbury. I remember Kay McNamara challenging him. At the Tory meeting she broke in on she asked, "Mr. Premier, how is it that doctors can strike?" He stood there and said, "They can't." Why were charges not laid against those doctors and interns as they were against the Canadian Union of Public Employees workers? He said in Sudbury they could not and he knew they could. They got away with it in December 1980.

The Minister of Health is now introducing a deliberate class system in hospitals -- first-class citizenship for those who can afford private or semi-private, and second-class citizenship for the rest.

I want to turn to the minister's statement because for gobbledegook I have never seen anything like it. What does he say? "A deficit is going to be seen for what it is, a loss or overspending." What a magnificent observation by the minister. That is a revelation if I ever saw one. What else does he say? "It will fuel a drive for new economic productivity in the health care Is that what the health care system is about? Is it to raise funds? We will see the hospitals now hiring new people to raise more money.

Hon. Mr. Timbrell: Read the part that says patient care is the prime reason for it all.

Mr. Martel: Yes, I have read the whole thing. It is going to be like the crisis centres for women. I am glad the minister --

Mr. Mackenzie: It is an utter disgrace and you know it.

Hon. Mr. Timbrell: Patient care is the prime reason and you know it.

Mr. Martel: They will spend half their time trying to raise money and not have the time to deliver health care. That is what the minister is doing. What else does the minister say? "Hospitals will be permitted to retain any surplus of revenue over expenditure for use within hospital operations for new programs, for new equipment, for capital building or for other purposes." Who in the hell is paying for it now? The taxpayers of Ontario and of this country. He is putting a user fee on it. They are already paying for those services. What is the matter with him?

Hon. Mr. Timbrell: There is nothing wrong with me.

Mr. Martel: I am going to come to what it is all about because those guys do not have any courage.

Hon. Mr. Timbrell: Did you read it?

Mr. Martel: I have read it.

What else does the minister say? "Likewise, hospital managers in the past have had no incentive to underspend their budget." Oh, they just went out wildly for the last five years, they have been spending like money is going out of style for the last five years. Staffs have been cut. They have just splurged, haven't they? The minister took a shot at every hospital administrator. I hope the hospital boards and the administrators have the courage to say to him, "You take your hospitals back. You take them back and you run them because we are getting out of the business. Let the province run them."

What kind of chintzy operation is it? What kind of chintzy operation --

Hon. Mr. Timbrell: That is in your green paper, as a matter of fact. That is what you advocate. That is your policy paper.

Mr. Martel: Those guys are something else. I would turn it all back to them. What kind of phoney, hypocritical program is this? What else does the minister say? "The rates hospitals may charge for private and semi-private accommodation will no longer be strictly controlled." We have now got preferred accommodation, a class system at its best. The Premier has got a class system now introduced into health care. Boy oh boy, those guys are something to believe.

"Of course, at the same time, we must continue to guarantee a ready supply of standard ward beds." He and I both know that is not going to happen. They are going to reduce the number of wards. Let me see, what does Chief Justice Hall say?

Hon. Mr. Timbrell: He was never chief justice.

Mr. Martel: He says, "This policy and practice of imposing hospital ward charges is an application of the user fee pay concept which is contrary to the principles and spirit of the national health program."

I know what the minister is going to say -- "We are not talking about wards." But we are going to move many of those ward beds into semi-private and private. When a person is sick he or she does not give a damn whether they have the money or not, he or she wants treatment and will pay for it.

Hon. Mr. Timbrell: And they will get the treatment.

Mr. Martel: Yes, they will get treatment when they can prove it is an emergency.

Hon. Mr. Timbrell: No, no; that's not the point at all.

Mr. Martel: Oh, no. That is what the fight will be every day from here on in. What hypocrisy. He has introduced a user fee. I am going to tell him about the sham of what he has done and what he is doing. Chief Justice Hall says not to do it. I hope Monique Bégin will have some courage to come down heavy on them. I hope she leans on those beggars like never before. She said, "Our belief is that the integrity of our national program should not be jeopardized by any financial barriers to health care. By that I mean extra billing." I hope she comes down heavy on him.

Hon. Mr. Timbrell: Do you?

Mr. Martel: Yes, I do, because this cannot be tolerated, cannot be allowed. It is a user fee; nothing else.

What he has done is what this Tory government has done so well in the past. If it is universities they get a bunch of Tories at the head of a university and they become the buffer between the government and the public. It is done in boards of education because they have so many candidates running there. They put the school board between the public and the government and the buffer becomes the school board. It becomes a fight between the school board and the teachers. In universities it is between the board and the university staff.

5:50 p.m.

It is the same thing in municipalities. This government is clever. The old, sly Premier did it also in health care. He now has a buffer. We cannot blame the Premier if fees go up for hospital beds. That is local autonomy. If those people in local autonomy want to raise the price of semi-private and private beds that is their fault. Do not bring the battle to the government of Ontario; they did it. Do not members over there believe in local autonomy? Not a bit, but we do. They use it whenever they can, and they are doing it again. The buffer is now the hospital administrators and the board.

As I wind up, I say I hope the boards in this province have enough integrity, enough morality and enough backbone to say to the Minister of Health, "We are not raising beds one cent for private or semi-private. You are going to fund it and in a fashion you have been trying to. You will have to have some controls but you are going to fund it and if you do not, here is your whole hospital system back, lock, stock and barrel."

I am afraid they will not because boards are dominated by the business establishment in this province. Members should look at the makeup of hospital boards -- all nice little Tories prepared to shaft the people out there to protect this government. It is a disgrace and the government knows it.

Mr. Gillies: I am pleased to have the opportunity to join in this very interesting -- and I think it is understating it to say exciting -- debate on this very important subject. I am indeed disturbed to hear so many misconstructions and wild constructions of various kinds that have been emanating from the members opposite.

I sat quietly and heard the member for Sudbury East a moment ago saying, "I hope Miss Bégin leans on you for all you are worth." That is not what his colleague, the member for Bellwoods (Mr. McClellan), said the other day when we were talking to the federal interns. He agreed with me. This is a very serious matter.

Mr. McClellan: On a point of privilege, Mr. Speaker. If the member wants to distort what I am saying, let it be on the record that it was before I was given the misinformation in the committee there would be no new user fees imposed.

Mr. Mackenzie: We have heard nothing but distortions today.

Mr. Gillies: Mr. Speaker, I do not feel I am distorting it at all. The member will agree it is a serious matter when the federal government cuts back to this extent on funding. Apparently his colleague does not agree with him. That is fine because every party has room for legitimate disagreement.

Earlier we also listened to some of the comments of the Leader of the Opposition. He said he agreed, somewhat grudgingly, that the movement being taken could increase somewhat the drive for efficiency of individual hospitals.

I have met I do not know how many times with the administration of the Brantford General Hospital. The administrator has told me repeatedly that is one of the more efficient hospitals. He has said to me, "Why should my efficient institution have to carry the load for those institutions that are less efficient?" It has been a constant complaint of that institution; I feel this inequity will be somewhat redressed by the measure being taken.

We hear our friends in the third party refute the position in their green paper a couple of years ago when they suggested hospitals should be returned to the direct control of the province. They did move in their 1978 convention towards regional boards. You cannot have it both ways.

We on this side of the floor believe in the autonomy of the hospital boards to run the business of their institutions within the guidelines set by the province. We believe in the responsibility of the hospital boards chosen by their communities and by the levels of government they represent to run efficient and well-run institutions in this province. And I believe that is what they are doing.

Health care is extremely important. Health care is the single largest expenditure of this government. The health care system in this province has been lauded world wide; it is a model system. It does not matter how much one spends: one cannot legislate good health; one cannot buy good health. One can encourage and foster a system that will lead to good health. That is exactly what we are doing in this province.

We have a fair and equitable system. There has been some suggestion from the members opposite that the move being taken here will somehow restrict access to the system. This is not true. We are not restricting access to the system.


Mr. Speaker: Order.

Mr. Gillies: The minister has said repeatedly in reply to the comments of the Leader of the Opposition if a person has to enter a hospital and if no public ward bed is available and he does not have third-party coverage he will get a semi-private or private room. He will get it.

The Leader of the Opposition interjected a couple of times. The minister said it repeatedly, and finally the Leader of the Opposition came up with the only answer he could have to the bald facts: he left the chamber. The Premier, the Minister of Health and some of my other colleagues have patiently and rationally explained their position on this matter all afternoon. The facts are these --


Mr. Speaker: Order.

Mr. Gillies: Some hospitals are letting their budgets run away from them. Their thinking seems to relate to an era when our economy was growing more rapidly than it is today, in spite of the best efforts of this government to do what it could to ensure the continued prosperity and wellbeing of the people.

In the face of international and national difficulties and uncertainties, Ontario's record of economic management is very good. The man in the street will say the fiscal record of this government is a good one. Members should ask the people in their ridings. They will tell them that in comparison with the federal government and in comparison with any number of other jurisdictions this is a well-run province.

Mr. Martel: Why don't you fight an election on this one?

Mr. Speaker: Order.

Mr. Gillies: The member for Essex South (Mr. Mancini) asked us in the back row of this party why we sought election to this chamber, and I will tell him. First, I sought election to this chamber to represent my people and my constituents. Second, I ran to support a party and a government that has a record of solid achievement: universal health care, a free and open society and a system of equitable justice. I ran for the party that believes in those things; I sit with the party that believes in those things, and I do not need the member for Essex South to ask me why I ran for election to this Legislature. I know why I ran. I am here and I am proud to be here. I would hazard a guess that I might be here just as long as the member opposite, if not longer.

Mr. Mancini: Why don't you carry out those principles then?

Mr. Speaker: Order.

Mr. Gillies: I was frankly quite shocked to see some of these budgetary figures. Until the late 1970s, hospital income and spending province-wide were in balance. Then in 1979-80 there was a $12-million deficit. In the last fiscal year the deficit grew to about $30 million. In this fiscal year the deficit is a staggering $100 million. Some seem to expect the money will come from some mythical slush fund, that it will just emanate from Queen's Park -- do not worry about it. As I said earlier, the more efficient institutions will carry the less efficient institutions on their backs.

Mr. Martel: Who was the government at that time? Was someone else responsible for that?

Mr. Speaker: Order.

6 p.m.

Mr. Gillies: That, let us face it, is not equitable. It is not right. Now there will be some tangible encouragement for the hospital boards to run their operations more efficiently and more properly. At this point in the evolution of our health care system, there is little assurance the budget overruns are directly related to the provision of better health care service.

I see we are coming to the close of the debate. In summary, I would say there are gross misconstructions being placed on the minister's actions and that he is trying to preserve the integrity of our health care system. He has done a good job of it for five years and he will continue to do so.

Mr. Martel: A point of order, Mr. Speaker: I believe the standing rules say there has to be a statement at approximately this time. The reason I raise the matter is there is some question of whether there will be a vote on the report of the select committee on pensions this evening. We should be in a position to announce whether there is going to be a vote or not. I do not see the House leader or the whip here to indicate what is going to occur this evening.

Mr. Speaker: We have not come to orders of the day yet, as you may recall.


Mr. Speaker: I beg to inform the House that in the name of Her Majesty the Queen, the Honourable the Lieutenant Governor has been pleased to assent to certain bills in his chambers.

Clerk of the House: The following are the titles of the bills to which His Honour has assented:

Bill 143, An Act to amend the Environmental Protection Act;

Bill 144, An Act to amend the Ontario Water Resources Act;

Bill 145, An Act to amend the Pesticides Act;

Bill 167, An Act to validate Certain Road Closings and Conveyances in the city of Ottawa;

Bill Pr9, An Act to revive Bankfield Consolidated Mines Limited;

Bill Pr15, An Act to revive the Burford Lions Club;

Bill Pr19, An Act to revive Jacinta Investments Limited;

Bill Pr25, An Act respecting the Township of North Dorchester;

Bill Pr31, An Act respecting the City of Kanata;

Bill Pr32, An Act respecting the Town of Bracebridge;

Bill Pr33, An Act respecting the Town of Gravenhurst;

Bill Pr34, An Act respecting the Town of Huntsville;

Bill Pr36, An Act respecting the Township of Chandos;

Bill Pr40, An Act respecting Tordom Corporation.

Mr. Speaker: Quite clearly, standing order 13 says, "Before the adjournment of the House on each Thursday during the session, the government House leader shall announce the business for the following week." We are not going to adjourn the House at this point. It being past six o'clock --

Mr. Martel: A point of order, Mr. Speaker: I am sorry. I do not want to belabour this but I have got to know what in God's name we are going to do tonight. There is a difference of opinion as to whether or not we are going to -- how are they going to let their caucus know if it is going to go to a vote tonight? That is the dilemma we are in.

Mr. Speaker: Order. I think the business of the House has been announced as far as --

Hon. Mr. Welch: Mr. Speaker, it is my understanding the government House leader is on his way to the House. I am at some disadvantage. Does the House leader for the third party know what the understanding was for tonight?

Mr. Martel: Mr. Speaker, if I might respond to that: At the House leaders' meeting, there was some discussion as to whether there were recommendations in the report. I could not recall the content of the report and I asked whether there were recommendations. We were advised there were no recommendations.

When there were no recommendations we agreed to carry on in a normal manner. But there are seven or eight recommendations. I have approached the House leader to try to find out how we are going to conduct the business this evening because, with the recommendations, it changes what the discussion was at the House leaders' meeting. I have been trying since about 3:30 p.m. to find out what was going to transpire.

Hon. Mr. Welch: Mr. Speaker, it is my understanding this debate is now completed according to the rules. Tonight, it was planned, as the honourable House leader for the New Democratic Party indicates and as I read here, to carry on a debate already started on this new report. Some people would like to know at this stage of the game whether there will be a vote tonight because it would influence whether they would come back --


Hon. Mr. Welch: I am sorry no one is here to answer that question.

Mr. Ruston: Mr. Speaker, on a point of order: It was my exact understanding at the House leaders' meeting this morning there would be a debate tonight, and at 10:30 the debate would be adjourned. Maybe someone else --


Mr. Martel: That is not quite -- it was agreed it would adjourn then, but that was under the assumption there were no recommendations in the report to be considered. But there are some seven recommendations. The House leader is now here and maybe we can get some indication.

Hon. Mr. Wells: Mr. Speaker, as I understand it, the matter of concern is what is going to happen at the end of the debate tonight. I cannot inform the House what is going to happen. While it is certainly not the concern of the members what the House leaders discuss at their private meetings, that in no way affects what the members will do. The order of business tonight is a debate on the pensions committee report, which will be called at eight o'clock and we will debate it.

At the present time I have been assessing the number of members who will be speaking. It could be there will be more speakers to speak on this very important report than will allow us to vote, but I do not know at this time. It is nobody's fault. We all went away from a meeting this morning -- and it is not really the Speaker's business -- believing there would not be a vote tonight. There was nobody asking for a vote tonight. That has to be made very clear. This whole business of whether there would be a vote tonight has come up subsequent to our House leaders' meeting this morning.

All I can say is that the order of business will be called. We will have to assess the length of the speeches and who has to speak. We are going to share the time equally, but all the members of the committee may wish to speak. I am sure my friend would not want to deprive them of having a chance to discuss it.

The House recessed at 6:08 p.m.