Legislative Assembly of Ontario

L107 - Mon 3 Feb 1986 / Lun 3 fév 1986

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

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The House resumed at 8 p.m.

HEALTH CARE ACCESSIBILITY ACT (CONTINUED)

Resuming the debate on the motion for second reading of Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act.

Mr. Rowe: I am pleased to rise this evening and join in this debate on Bill 94, a bill that will play an important role in the life of just about every resident in the province. This bill should be under attack by every person concerned with our wellbeing.

With such an important bill dealing with the life and the death of so many, I have to wonder why this government has arbitrarily decided to disrupt the harmonious rendering of health care in Ontario. The Minister of Health (Mr. Elston) must surely be aware by now that our health care system in Ontario is ranked among the best in the world and perhaps the very best in the world.

If one takes a moment to think about the title of this bill, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act, it is an all-time first in the professional field for possibly the freest of lands in the world. I wonder who will be next under the present government. Will it be the lawyers? Could it be the farmers? As my friend the member for Simcoe East (Mr. McLean) points out, they do not need to worry about regulating their income, taking zero from zero leaves zero.

Surely the minister must realize the proposed changes in our health system have put this program in jeopardy. Surely he can assess the damage done to health care programs when they were totally nationalized under socialist regimes around the world. Let me give him a couple of graphic examples.

Britain's totally socialistic health care program may appeal to the present Liberal government. It has had a quarter of a century of experience with the national health scheme. What a boon it was to be to the country when implemented, but it was no boon to Britain. It was a boon to nations such as Canada because it stimulated the exodus from Britain of huge numbers of British-trained graduates. They did not all come to this country; some went to the United States, Australia and many other countries in the free world.

The nationalization of Britain's health care system, in turn, stimulated the influx of many medical graduates. They came from as far away as India. They were eager to join the National Health Service. Since all this has come about, my doctor friends tell me the system has degenerated to a point where a full 85 per cent of elective surgery is done by private surgeons in private hospitals. Otherwise, a patient could wait five years to have a hernia repaired. Imagine waiting five years for a hernia repair. It is a horrendous pain to go through.

I will point out a few of the pitfalls in this situation. These private hospitals in Britain do not have the same safeguards as the national ones do. Patients take a chance. When they have the operation done in a national hospital, they are at the mercy of the system.

Surgery is risky to a degree under any circumstances, but we should strive to eliminate all the elements of chance as much as possible. That is something this bill does not do. With the unrest of the doctors in the world today, this will not alleviate and spare any percentage of chance.

Those patients take the chance rather than wait for proper medical care. Until now every resident or citizen of this province has been entitled to equally superior health care. They have had the freedom to choose their doctors, even those who extra bill. These were in the minority. They accepted patients at the regular OHIP rate. The patients had the freedom to choose their doctors and the doctors had the freedom to bill those they felt could bear the traffic of a higher tariff.

I suggest to the opposite side that this is called free enterprise. That is what this province was built on and I hope will continue to be built on in the future.

While we are on the topic of money, members should be aware that Britain currently spends more on health care than does Canada. My doctor friends tell me almost every other western nation does. Australia recognized the problems of the British system. It modelled its system after Canada's. However, government meddling and new regulations in the field of medicine resulted in imposed fee settlements.

What happens next, we ask? The Australians abandoned their system and instead provided a market for private medical insurance. These insurance companies have provided a variety of policies and coverage, on the whole less costly even than OHIP. There is still universal access and government-subsidized premiums for those who need them.

We in this Conservative Party do not criticize merely for the sake of criticizing. We have some workable solutions.

Mr. Barlow: Tell us the solution.

Mr. Rowe: I will. I want members to know they are not simplistic solutions that can be glibly proffered, such as those offered by certain parties in the heat of an election campaign. We all remember the election campaign. This government, painted as inexperienced by the Canadian Chamber of Commerce, may learn quickly that being in government means going beyond the popular and the expedient.

8:10 p.m.

There comes a time early in the real, cool light of dawn, and I suggest for the members opposite that is far before they are ever out of bed, when a reasonable and responsible government must balance the legitimate interests and opinions of various groups in our society before it throws itself into a frenzy of knee-jerk reactions. Consultation as opposed to confrontation is another lesson a new government such as this must weigh. Our medical professionals would appreciate an opportunity for consultation with the minister and his government.

I realize, with all due respect, that the minister may feel more obligated to listen to the rantings of the third party than to the rational voice of the people; that is understandable. However, the doctors have an axe to grind. They have chosen their profession and they have worked for success and for a lifestyle. For the most part, they deserve the prestige they have earned. Residents of this province have come to rely on the high degree of professionalism our doctors have rendered.

I feel I am speaking for many of my constituents in the riding of Simcoe Centre when I say I do not relish the thought of assembly-line surgery. A simple appendectomy in the Soviet Union is an ordeal. Just ask the federal member of Parliament for Simcoe South, my colleague Ron Stewart. Over there on a trade mission some six months ago, Ron took a terrible attack of appendicitis. They finally got him into the hospital and they wanted to take out his gall bladder. What kind of medical system is that?

Upon going into the waiting room, the federal member noticed that the hospital was generally in bad repair. The window was broken. He sat on a cot for examination that he told me he was sure was out of the Second World War. This is the kind of health care they are subjected to in that part of the world. This is the kind of health care that we as legislators of this province must ensure does not come to pass in Ontario.

One of the doctors came to him and said, "We are here to take out your gall bladder." The federal member said, "No, I believe it is my appendix." After they had argued for a while, one would have thought there was a two-for-one sale, that they would take them both out at the same time. The federal member was not very excited about losing both.

Reluctantly, he gave in to the appendicitis operation. He shared with me some of the details of the operation he recalled just before going under. He said he looked up and remembered seeing seven or eight light bulbs in a socket that would hold nine or 10, the balance of them being burnt out, and the doctors were ready to operate. That is the kind of health care system I want to talk about. It is the kind of degenerating mess that this province could find itself in years down the road if we are not careful.

Last Friday I spoke to a group of people at an old folks' home in my riding of Simcoe Centre and I asked them, "What do you think of banning extra billing?" Amazingly, these people said to me that in all the course of their lives they had always respected doctors as being great professional men, much as the member for Stormont, Dundas and Glengarry (Mr. Villeneuve) said a few weeks ago when he talked of the great medical men in his riding, and there have been many.

Mr. Sterling: Name them.

Mr. Rowe: There were too many to name. They asked me, "Why does this government want to fight with the doctors?" I told them I had no idea why they really wanted to fight with the doctors, but I too shared their concern and was worried about what might happen.

They told me no doctor who had ever extra billed them had ever pressed them for collection. A very few who were extra billed and could afford to pay paid their bills and did not argue. They gave the doctor his due.

They also asked me, "Why does the present government want to confront every medical man in the profession and put in jeopardy a health care system that we in this province have lived with and loved for many years?" I was at a loss for words. I could not explain why this present government wanted to continue this course of self-destruction. I could only say it must be for crass political reasons that this government wanted to attack the present system. If the government creates a huge situation of unrest with the doctors, the medical services that flow out from them to all these seniors and homes are bound to be affected. That is a sad state of affairs.

The government has expounded on the $50 million it is going to save. What happens when the Ontario Medical Association finally sits down around the table and decides whether this extra billing ban will indeed take place? One does not take it out of one pocket and expect to get away with it without replacing it in another. Let us not live in a fool's paradise. All the members of this fine chamber know the doctors are going to get their pound of flesh. One cannot blame them. They are happy in the system the way it is, but they will not put up with this kind of legislation.

I suggest that before this is over the $50 million saved by the Treasury in transfer payments from the federal government could indeed be $100 million or $150 million in increased fees that will eventually result from this terrible legislation. The sad part of this whole issue is that the people driving on the roads in Ontario tonight who feel they will save on their Ontario health insurance plan premiums because of the $50 million that will be realized through the federal transfer of payments to this province will be disappointed the most. The people who can least afford a huge increase in OHIP premiums will be the ones this present callous Liberal -- socialist government is going to disappoint by legislation such as this. They are the people who will bear the brunt and carry the worst of it.

My colleagues across the House will have to answer in the next election to the people of Ontario who have to pay these huge increases. They are the members who should sit up and listen now. They should sit down with the doctors around the bargaining table and not continue to fight with every one of them in Ontario.

The fundamental issue in the new scheme of things is not the smokescreen of extra billing that the Liberal Party has initiated. Hospital facilities and facilities for health care are an issue we in this party and the people of Ontario could applaud. In my riding of Simcoe Centre, through the efforts of the Progressive Conservative Party, we were well on our way to building a new regional hospital to serve Barrie and the surrounding area.

The real issue in the health care field today is not the banning of extra billing. It is the lack of adequate, up-to-date facilities for the people of this province, specifically the residents of Simcoe Centre, Simcoe East and Dufferin-Simcoe.

8:20 p.m.

Interjections.

Mr. Rowe: I hear some great chatter to my far left.

Mr. Villeneuve: The far left.

Mr. Rowe: It is about as left as one could get. If one has a dog chasing one's sheep, one does not shoot all the sheep to solve the problem of the dog.

In my riding there are hardworking men and women who have given of themselves, their time and their resources to work for a new hospital in our area. These are men and women like John Brennan, Andrea Porter, Ray Tash, George Dangerfield, Walter Tardiff, Ray Gariepy and William Caldwell -- the list goes on. These people are all now wondering why this government persists in using the smokescreen of extra billing to take away from the real issue, the issue of health care facilities in this great province.

These people are not fooled by the smokescreen the present government is attempting to create. Men like Ed Harper, Bruce Peacock, Mark Scarfe, Ron Gilbert and Rayner McCullough, all of whom are directors of our hospital, are most aware of the desperate need for a new hospital in Barrie. They are not fooled by this attempt to cloud the issue.

I am disturbed that this Liberal government is taking advantage of the political climate to introduce a bill to ban extra billing and thus refusing to deal with the real fundamental issue. That is the issue of health care and the lack thereof in this province.

I invite the Health minister to come to the emergency ward of the Royal Victoria Hospital just as a visitor, not for a permanent stay. I invite him to talk to some of the 17 patients who are waiting on cots in the hallways to be examined by doctors in the emergency ward. Lives may have been endangered and certainly human dignity is suffering every day of the week. The minister should ask these patients if extra billing is foremost in their minds as they lie there waiting for a hospital room.

We have assembly lines in North America. I envision the medical and surgical tactics the present government espouses as being similar to those in Detroit and Windsor in the automotive industry. I will take the professional surgeon as we know him or her today in Ontario. The minister is welcome to take the blue collar, assembly-line operation; however, the people in my riding say, "Thanks, but no thanks; we will stay with the present system."

I am not favouring the position of the medical profession over the primary goal of great health care programs, not under any circumstances. This is what the minister has put in jeopardy. I realize it is incumbent on him with his third-party-crutch support to label my party as one that stands for big business and the professionals. I understand and that is part of the game, but let me share some concerns I have and some that have been expressed in letters written to me about the present legislation as proposed.

Let me share some concerns of a medical doctor in my riding, Dr. Matsalla, BA, MD, FRCS(C). He writes to the Minister of Health, and I am sure the minister has this letter stacked up with thousands of others, and says:

"Firstly, I bill my patients according to the Ontario Medical Association schedule of fees." He does not extra bill. "All patients have access to my services regardless of financial status, in fact, only approximately 50 to 60 per cent are billed according to the OMA schedule of fees.

"No patient has ever been turned away from my office, and each has had complete access to my service." It is important that this be on the record.

"Secondly, accessibility to the government-provided hospitals is a major problem. Royal Victoria Hospital in Barrie is not accessible to the patients of Barrie and Simcoe county. Why? Because the government has dilly-dallied on the provision of a new hospital and its services to the community."

"On any given day, urgent emergency patients are lining the halls of the emergency department, frequently waiting more than 24 hours for a bed."

Mr. Haggerty: Meanwhile, hospital beds have been closed by the previous government over here.

Mr. Rowe: Let us not continue to talk about the past record. It amazes me how the present members can sit there, masquerading on one side of the coin as the government and floundering away their woes on the other side, blaming us for everything that has ever happened.

The letter goes on to state: "Operating-room facilities are outdated and inadequate for the needed specialty care required for the patients of Simcoe county." Urgent operations of a diagnostic nature, e. g. , "cancer of the throat and lung are delayed due to no beds, no operating-room space, and a lack of staff due to inadequate funding by the government of Ontario.

"Any idiot recognizes that accessibility is not due to extra billing by doctors but due to the completely inadequate self-motivated, misdirected, perpetually delayed political process."

The final paragraph says, "I suggest you reconsider your off-based priorities on health care in this province, and redirect your energies to the needed co-operation of government and doctors for the optimum conveyance of health care in our great province."

To me, that is the crux of the whole problem today: underfunding of the present situation and taking away from that by creating a huge smokescreen in what is in political terms popular today by saying ban extra billing.

I have another letter I would like to read into the record. I will quote just the first part of this great letter I received from one Mr. and Mrs. A. D. Miller from Gilford, Ontario.

"We are writing at this time to express our most vehement opposition to the proposed legislation which will ban extra billing by Ontario's doctors. This arbitrary, draconian piece of socialist nonsense will result in a steady deterioration in the quality of medical care available in this province, as the best doctors leave and the ones who remain become increasingly frustrated and indifferent. The current status of socialized medicine in Britain, where unions more and more are insisting on private medical coverage, is a clear example of what we can expect in Ontario."

An opportunity bulletin that I have in my hand was sent to Ontario doctors. It is rather amazing to learn how fast the other side of the border realizes what a quagmire we are getting ourselves into in Ontario. Family practice on this opportunity bulletin: Texas, solo 1.5 million service area near Dallas, board certified, guaranteed net income; California, solo with coverage 50,000 service area, San Francisco area MD, guaranteed net income.

The list goes on: Kentucky, Florida, North Carolina, Indiana, Kansas, Utah, Ohio, Texas, Illinois and Mississippi. It is an unbelievable shopping list from our American counterparts, who are smart enough to realize the desperate situation we in Ontario are going to find ourselves in with doctors if we do not sit up, take note and think about this legislation.

8:30 p.m.

One of our great bone specialists in Barrie, who puts little children back together again after severe accidents, is Dr. T. Porter. He shared with me some of his terrible experiences. Here is a man who may make a great income in a year. He probably works 15 hours a day, 360 days a year. He has a standing offer from the state of California to relocate in the Los Angeles area. He would be paid a guaranteed US$300,000 a year if he simply went down to work in the United States of America.

It is a sad state of affairs when our health system gets to the point where they start coming across the border by letter and by phone. This, by the way, was a phone call received between Christmas and New Year's, which this doctor shared with me.

He said: "It is hard to turn down, but I am a Canadian first and foremost. I love the province of Ontario. We have created the best economic climate here in this province that we have anywhere in the Dominion, and I want to stay and practise medicine. I have a family. I have three boys. I enjoy this province and this country. I do not want to be forced to become an American citizen."

That is what it is all about. It is forcing professional men with years and years of experience, men who save lives, men who put people back together again every day of the week, to leave. They do not want any thanks. They do not want any pats on the back from the Minister of Health or the Premier (Mr. Peterson). They simply want to be left alone to practise what they do best: it is called saving lives and helping people in need in the medical system today.

We have all heard of E. D. Myers, president of the Ontario Medical Association. In his letter to the Premier he states:

"We expressed great eagerness to participate in a fundamental reconsideration of how health care is delivered to the people of Ontario and how it is funded. We further agreed that in the context of such a study, physicians' billing practices should be a part of the exercise. We suggested further that while a study was under way we would assist you in ensuring that the financially disadvantaged were exempt from any direct charges by physicians."

When one takes a moment to read that, one really wonders whether there is any sense of caring on the other side of this great chamber at all. Indeed, one has to surmise that political expediency is the only answer, the objective on the other side of this chamber and of the little red rump to my far left. I wonder whether that is not the overall gain. It is not health care, it is not the wellbeing of the people of this province; it is simply a chance to jump at what they see as a politically favourable climate.

He goes on to say:

"In the final analysis, you refused to hold back legislation on the opt-out question pending such a study. In short, it was you, not we, who refused to negotiate."

I honestly suggest that the record will show in time to come that it was the government, not the medical profession, that refused to co-operate.

Letters are coming in from people all over the riding saying, "I definitely agree with the statement made by the president of the medical staff." In one of my colleagues' ridings, at Orillia Soldiers' Memorial Hospital, Dr. Pritt Pallopson writes, "The doctors' concern is not about money; it is about freedom." It is a fundamental freedom that goes back a long way.

The members will notice that at least one of these letters mentioned the government's draconian measures. The members should ask themselves, "Where have I heard that term in this regard?" With little investigation they will realize that came from a colleague across the House, the member for Humber (Mr. Henderson), a member of the Liberal Party and a gentleman who enjoyed for a time a sojourn in my riding of Simcoe Centre.

One may ask, "What is this voice of reason doing in the Liberal Party of Ontario?" Who knows? He may be asking himself that same question today. I imagine he asked it yesterday, the day before and the day before that. He knows he would be most welcome in the Conservative Party, a party made up entirely of men and women of reason. The member for Humber would fit in and would be welcome.

As I mentioned previously, we are a party of reason and compassion. That did not happen by mistake. It amazes me how some of the members on the other side of the House seem to think we just stumbled on to this. They will find out as they go along in the course of the next few weeks, months and years, for as long as this so-called agreement lasts, that reason and compassion are something one learns and something one does not take for granted. It is for that reason I thank the member for Humber for his rational approach to this matter.

I can understand that his having a seat on the government side of the House could not be more appropriate or more urgently needed than it is today. There is a real need for the member for Humber's services over there. If the government continues its present course, the need will grow larger and larger as time goes on.

One cannot take on all the people all the time simply to prove and show that one is going to accomplish something, that one is to going to tell the people of Ontario and show the people of Ontario that, by golly, one has acted, done something and really made some moves. Indeed one might, but for every step forward I warn the present government that it may be taking five, six or seven steps backwards.

I have a letter I shall share with the House in regard to the dispute with the government. It is from Dr. Philpott. It encloses a letter written January 21, 1986, from Dr. Myers, president of the Ontario Medical Association, to the Premier and explains: "There have been private negotiations going on between the provincial government and the OMA on billing practices as well as global funding of health care in Ontario. Both sides have agreed the study should be carried out. Mr. Peterson refuses to hold back the legislation until this is carried out." As Dr. Myers says in short: "It was you, not we, who refused."

Surely we in this chamber, and surely this government, in history have spent much more than $50 million and never regretted spending that money. Surely we have spent $50 million and more on far more foolish things, on far more things that do not affect the lives of the individuals of this province now, tomorrow and in the future.

The present government should take a moment, sit back, and honestly ask whether it thinks the $50 million it is saving today in extra billing will really be $50 million in savings in a year, two years or three years down the road when the OMA sits down to renegotiate its fees.

8:40 p.m.

It does not take a blind man to see that in only a few short years the cost of medical care to everyone in Ontario, be he wealthy or a pauper, will skyrocket. We cannot play with the system for ever and not expect to suffer the consequences.

The letter from the office of the president, Dr. Myers, to the Premier goes on expressing great concern and wanting to participate in fundamental reconsideration of how health care is delivered to the people of Ontario and how it is funded. He goes on to say that he further agreed, in the context of such a study, that physicians' billing practices should be part of the exercise.

The medical association is willing to do almost anything to stop short of entering into such a terrible piece of legislation.

As has been stated earlier in the House by my colleagues, the doctors do not want confrontation. They do not want to cause health care in this province to suffer. They actually want to sit down and negotiate, to talk with the present government.

Mr. McFadden: Why do they not talk?

Mr. Rowe: They are trying to talk. Unfortunately, in order to have a reasonable, intelligent conversation, one must have two parties. If the present government continues its no-talk attitude there will be no dialogue.

Dr. Myers goes on, "We further agreed, and suggested if a study was under way we would assist you in ensuring that the financially disadvantaged were exempt from any direct charges by physicians." When the president of an association such as this guarantees that the financially disadvantaged will be exempt from any direct charges by physicians, I wonder what the whole context of this bill is all about.

One must wonder about this whole situation when the doctors say they are not going to charge anybody who cannot afford to pay. "If the financially disadvantaged cannot pay, we will not charge. Let us put the thing on the table, set it to the side and we will discuss it."

One must wonder exactly why this government is in such a great hurry to get this bill through the Legislature.

Mr. Leluk: There is an election coming.

Mr. Rowe: Maybe it is an election. Maybe they want to walk out to the average man on the street and say, "We banned extra billing." God help that poor man two or three years down the road if he ends up paying a lot more for the same service, or probably less service. Then he will wonder if it was a wise move to ban extra billing.

Dr. Myers goes on: "The OMA now publicly presents you with the offer we made in private. The people of Ontario cannot afford a war between physicians and government. The stakes are too high."

On Friday of last week I talked to many older constituents in my riding. They are constituents who well remember the days when they had no money to pay the family doctor who dropped in to visit, who called to treat their sick children. They had no money, and the doctor knew that.

Did the doctor say: "I am sorry. I cannot look after your child since you cannot pay me"? In the history of this province that has never happened, to anyone's knowledge. The medical man, the doctor, has always been and will continue to be a professional. He renders his service knowing it is service above self, somewhat like the Rotary Club I belong to in the great city of Barrie, whose motto is "Service above self."

I charge the present government to put that same motto to themselves, "Service above self." They might find it is time to stop and think about the idea of service above self, because we are playing a game of health care roulette in this province by continuing along the slippery slopes of socialism that we are on now. I can see problems.

On Friday I spoke to 165 senior citizens in a home, all of whom were on fixed, low incomes, and all of whom were at least twice my age, some three times my age. It was an experience for a young man such as myself to speak to them and listen to their questions. In the end, not one single person could see the wisdom in banning extra billing and everyone concurred with my thoughts: we cannot rob Peter to pay Paul; eventually, someone has to pay.

They could see through the smokescreen of the present government. With age comes wisdom. If 165 seniors at a home in the riding of Simcoe Centre can see through it, the present government had better be careful because there will be more from ridings all around the province. It has not addressed the real, fundamental issue of health care; which is not taking on the doctors. It will come back to haunt the present government.

In closing, let me wish the present government and its far-left friends much good luck in their proposal. Politically speaking, they will need it. I am convinced that by the time 17,000 doctors in Ontario speak to 17,000 patients every few minutes, the real message, the real problem, the real word will get out. I warn the government that it can play a lot of games and fool a lot of people but when it starts to fool with the health care of individuals, beware the ides of March for they will come back to haunt it.

Thank you for allowing me to take part in this most important debate.

Mr. Jackson: I am pleased to rise tonight to offer a few concerns on Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act. That is a long and unwieldy title but at least it has the virtue of being accurate, something that cannot be said about its short title, the Health Care Accessibility Act.

The figures are there with respect to accessibility to health care providers. Only about 12 per cent of all doctors in Ontario are opted out of the provincial health insurance plan. They are primarily members of specific medical specialities. They are primarily in locations as specified by the Minister of Health. Less than five per cent of doctors' claims involve some form of extra billing.

8:50 p.m.

Given these figures, any reasonable person would be hard pressed to declare that a state of crisis existed which was sufficient to warrant an attack on an entire profession. Any reasonable person might be tempted to suggest there may be specific problems to address, specific areas to negotiate and specific concerns that a reasonable person, dealing in good faith with other reasonable people, could resolve.

However, that reasonable person would find no one to talk to in this Liberal government. I should amend that. He would find no one to talk to on the benches to my left, but might find one man of reason remaining among the rest of the Liberal-NDP government across the way. We applaud the member for Humber.

Apparently there is still one man there who recognizes there must be reasonable ways to resolve this alleged crisis, ways that do not unfairly brand all doctors in this province as criminals whose sense of social responsibility is as thin as their wallets are thick. There is apparently one man who can see that there must be ways we can solve the health care crisis and still treat our doctors as the caring professionals that we, and the people of this province not blinded by the rhetoric of the left, know they are.

We applaud reason wherever it is found, particularly when it must stand alone against all the weight irrationality can bring to bear. If there is a crisis in health care, is it reasonable to suggest it is there because a few doctors in a few places extra bill a few patients?

Is it reasonable to assume that by a blanket condemnation of the doctors of this province as rapacious criminals we will have greater accessibility to health care in this province? Or can we, by negotiating problem areas and dealing with the lack of facilities in a fair and reasonable manner, achieve what this bill purports to do?

This bill purports to give accessibility to the health care system. It does so by stigmatizing the providers of health care and turning them into civil servants so that presumably all the problems will disappear. But will they? Will the banning of extra billing provide accessibility to the people of Halton waiting for health care facilities? Will it help the 27 people on waiting lists for chronic care beds; the 249 waiting for extended care beds; the 23 waiting for residential care?

If extra billing is banned, will the 20 per cent of the Joseph Brant Memorial Hospital's acute care beds now used by patients waiting for chronic care facilities be freed up for the people who need them? Can the people now waiting six months for speech therapy at Joseph Brant hospital say, "I will have accessibility because no one's doctor is allowed to extra bill"?

Joseph Brant hospital will get a four per cent increase in operating funds, but I am told it needs 5.3 per cent just to hold the line. Will the end of extra billing mean the automatic end of financial problems for all our health care facilities?

Can the people who need opthalmologic outpatient care be guaranteed access because there is no more extra billing? What of those waiting for outpatient respirology or cancer programs? The list goes on, and not just at Joseph Brant.

Bill 94 purports to be the Health Care Accessibility Act. Where is the accessibility? This government makes a great noise about its commitment to health care accessibility. Where was that commitment last July, when it took this opposition so long to wring from the new Premier the promise that the one per cent increase we had given hospitals would not be jeopardized? It meant $330,000 to Joseph Brant hospital, but it took the concerted efforts of this opposition to ensure the government did not walk away from its health care commitment.

Where is the commitment from this government for health care accessibility for our senior citizens?

Last week, this government reannounced the Progressive Conservative program for integrated homemaker and other support services. It is a good program. We thought so last June when it was introduced. Seven and a half months of inaction by this government certainly have not alleviated that need; indeed, it may have aggravated it somewhat. We look forward to seeing some commitment from this government in the field of health care.

Last April the Progressive Conservative government, realizing that there were senior citizens who needed nursing home beds, announced an allocation of 4,500 beds in the province, up to 90 of those in Halton and a further 207 in neighbouring Hamilton-Wentworth. A government with a commitment to accessibility would have acted on those. They are needed and our senior citizens are waiting for them.

However, rather than deal with the urgent need of our senior citizens, this government prefers to deal with the wants of its accord. A ban on billing above Ontario health insurance plan rates is wanted by the accord. The nursing home beds are needed by the senior citizens. Bill 94 shows where the priority of this government really lies.

In fact, in December this government's commitment to health care accessibility for our senior citizens was put quite bluntly by the Minister of Health. When asked in estimates about the 4,500 beds, he stated that they were under review. When pressed further he admitted, "We will not end up with the 4,500 beds announced in April." When questioned again by our Health critic he said, "It is pretty apparent there will be a reduction of the 4,500 beds."

The Halton District Health Council, in its accommodation study completed in October, stressed the need for accessibility and the need for more beds. The need is there; it is documented. Where is this accessibility in Bill 94? Where is the commitment of this government to do anything but stick to its accord regardless of the cost and the long-term consequences for the people of this province?

Dr. Grant Lawford, who has a practice in Burlington, wonders about the same question. He wrote to me and the Premier:

"Labelling the issues as health care accessibility and extra billing is truly a sham and a smokescreen to hide the government's shortage of health care dollars. Bill 94 will not resolve this shortage and will ultimately make quality health care inaccessible to the people of this province."

Bill 94 is so onerous and so far-reaching that I felt it necessary to go back to my constituents to see what they had written and said that could have led to such a piece of legislation. Sure enough, I have letters relating to problems of health care access.

There are people who could not get into programs they needed; there are people who could not get into chronic care beds because there are not enough; there are people with problems getting access to health care. However, there are no letters about problems in getting access to a doctor; there are no complaints about extra billing; there just are no complaints that would lead me to believe that this legislation is needed or even wanted by the people of Ontario.

We all have heard of the polls showing that the vast majority of people in Ontario want an end to extra billing, but I dare say that, given the opportunity, they would all like their lawyers' fees controlled at legal aid rates as well. It is human to say yes when something is offered free of charge.

9 p.m.

Perhaps the more worthwhile polling result is that an overwhelming majority of the people approve of the quality of care in the health care system in Ontario as it now exists. Perhaps those people responsible for wanting to push this legislation on to the doctors would do well to look also at the even more recent poll in the newspapers last week. It announced that close to one half of the adult population fears big government. They see it as a threat to their future.

This bill, this effort by the government to run roughshod over an entire profession, is one of the reasons people fear big government, and for good reason. "Who is next?" they wonder.

The people of Burlington are among those who fear this big government. They do not want to hear a knock at the door some midnight to be told, "You are next." They do not want to turn on the television and find their profession is being legislated and controlled.

I looked back to what the people of Burlington had to say about this alleged crisis in gaining access to doctors. Lorne German wrote to a Toronto newspaper recently. He said: "I suggest the Ontario government get off the doctors' backs. All it is is just a conspiracy to undermine our democracy."

Mr. German is a 67-year-old senior citizen, who is more concerned with preserving a system he believes in and appreciates than in listening to fairy stories about crises he knows he is not having.

I had another letter in which my colleagues might be interested. It was written by a doctor who has opted out of the Ontario health insurance plan. While he makes a number of comments, to which I will refer later, I was struck by one of his paragraphs. He writes:

"Early this week, my office received a call from an irate elderly senior citizen, who for obvious reasons was treated at no extra cost to herself, demanding to know what the difference was, having been previously unaware of the situation, so that she could forward a cheque for the difference to me even though she could obviously ill afford it. Despite her obvious intent to send along a cheque, it will be returned to her....It is nice to know there are a few independent-minded individuals in this day of government give away and take away everything to please the masses and therefore retain their votes simply to stay in power."

Distressing as it must be to those on my left, there remain in Ontario people who do not blindly follow the rhetoric of the free lunch and who realize there is still a place for freedom and the rights of the individual.

Perhaps members would be interested in hearing the belief of Irene Horne, who is not a doctor. She is one of the people of Burlington for whom this government says it is speaking. She says:

"I wish to make known to you my strong feelings regarding the intention of the Ontario government to introduce legislation to force doctors to practise within the limits of the present OHIP system.

"I feel that the government should not force itself into the relationship between the individual doctor and his or her patients. It seems to me if a doctor wishes to opt for practice outside the OHIP framework and if the patients of that doctor are willing to accept that decision, even if it involves extra billing, then no other parties need interfere in that relationship.

"For the past nine years, my family and I have been patients of Dr. Dennis Brodie of Burlington. Dr. Brodie has practised outside of OHIP for most of that time and we willingly paid a small extra price for the services of this excellent and caring professional. The extra time he takes to give clear explanations and reassurances has contributed significantly to our peace of mind regarding matters of health.

"It angers me greatly to think that this quality may be jeopardized by his being forced into a kind of practice of medicine where that time is no longer available.

"I value the kind of care we presently receive from this doctor and I wish to go on record as opposing legislation forcing our doctor into the OHIP mould. Surely there are better ways to search for solutions to problems in the health care field than this coercion of individuals."

Any reasonable person would agree with Mrs. Horne. There must be a better way of solving problems than the coercion of individuals, but we are not dealing with reasonable people. When reason conflicts with ideology, then reason, apparently, must take second place. Reasonable people negotiate. Ideologues impose solutions based on their single-minded view of the world. These ideologues work on the conceit that they and they alone speak for the people of this province; but for whom do they really speak?

Do they speak for Ray and Nancy Olexiuk? They wrote to the Premier as follows:

"As a taxpayer and a citizen of the province of Ontario, I am writing to voice my opinion regarding your proposed ban on extra billing. I would like to say we strongly oppose your government's position.

"The citizens of the province enjoy medical care second to none in the entire world and we resent the fact that legislation of the type your government is proposing will start to drive our medical doctors out of the country, but more important, you will soon be dictating where, when and by whom we will be given medical attention.

"I suggest to you that your government stop extra billing at the gas pumps and work harder to eliminate the deficit in the province so that each citizen will have some funds left to spend with his or her doctor of choice.

"Policies such as the one you propose should make true Liberals of days gone by roll over in their graves.

"You may think it politically expedient to appease your New Democrat socialist friends, but rest assured there will be another election day in the province and citizens will remember your strange bedfellows."

In letters and phone calls, the people of my riding say they do not want this legislation. Many say they are frightened by this unilateral, Big Brother move.

Certainly, the Liberal government does not speak for Oleg and Deirdre Gibb, who also wrote to the Premier. They said:

"I wish to protest in the strongest possible terms your proposed legislation regarding banning of extra billing by the doctors of our province.

"I feel this is a most regressive and repressive step and can do nothing but harm to the health care system as it exists at the moment.

"There are professional men and women with great pride in the services they offer. I can see nothing but harm coming if this legislation goes through. To make it a criminal offence to charge what a person thinks he or she is worth is nothing more than an insult to dignified people who work hard and long on our behalf.

"I have nothing but praise for the doctors with whom I have dealt over the years since the system came into effect and I would hate to see this change. I have paid over and above the OHIP rates on occasion and feel that this is often justified.

"I am sure that with goodwill on both sides a compromise can be reached regarding rates more in line with those set by the OMA, and I sincerely trust that this method will be used to avoid a most unfortunate confrontation between your government and the medical profession. There surely must be a better way of dealing with this matter than what I see in the offing. I do not feel that doctors are the greedy, money-hungry people they are often portrayed, and I am convinced most of them have only their patients' interests at heart. Something is radically wrong when I have to pay as much to have my dishwasher fixed as to have a baby under OHIP scales."

The people with whom I have been in touch speak to the need for the freedom of doctors and patients to make their decisions without coercion, without an imposed settlement. Their accessibility problem is not with the health care providers but with health care facilities.

9:10 p.m.

Another constituent of mine, Chris Robinson, wrote to a Toronto newspaper. He recently came from Britain. He saw the results of socialized medicine and he wrote very directly about what he feels about Bill 94. It is unfortunate that not a single member of the New Democratic Party is here at this moment. It would have been nice for them to hear about the decline, what they can look forward to, what may happen in Ontario and what is now happening in England. That is what Chris Robinson wrote about. He said:

"I escaped from Britain's declining National Health Service and was delighted to find superb medical care in Canada. When I find these snivelling leaders of our provincial government attempting to destroy this excellence for the sake of a few million dollars, I want to throw up, preferably all over the corridors of power at Queen's Park." This legislation will make civil servants of doctors just when we need a doctor the most.

Mrs. Elizabeth Keegan wrote to me just this morning; and again she wishes to register her strong disapproval of Bill 94. She feels it is the first step towards socialized medicine, and that one need only look at Britain to see how effective that will be. She said:

"More alarming, I view it as a threat to the basic freedom of choice that we as individual Canadians are supposed to enjoy. The government has no right to legislate how an individual will earn his or her income. It is my right to choose a doctor either in or out of OHIP. Since there are currently only about 12 per cent of doctors or physicians who practise extra billing, I would venture to say that we already have a very accessible health care system and one that enjoys a worldwide reputation for excellence at that. Why jeopardize a good thing?"

Most members in this House who have spoken so glowingly of the Saskatchewan system -- the perfect system allegedly in place there -- must have read with interest the recent Globe and Mail article about the doctors who won the right to opt out of that system. In fact, 80 per cent of the ophthalmologists in Regina wanted out last year. Perhaps there are flaws in paradise. Perhaps we in Ontario should be taking a second look at this legislation in order to preserve the rights doctors already have. Perhaps we should listen more closely to what the doctors are telling us.

Dr. Thomas Witton of Burlington wrote to me suggesting that although he is not in the habit of writing letters, "I cannot sit by and idly watch the introduction of the proposed Health Care Accessibility Act without some comment.

"As a medical practitioner of 35 years' standing, I find this legislation oppressive, disgusting and a personal insult to me and my colleagues who have given so much of ourselves to serve the public. The campaign of universal accessibility and free medical care to all is nothing but a political sham. I urge you to use every power at your disposal to reveal this deception to the public for what it really is, a bare-faced ploy to capture votes. Please consider all the ramifications of what is happening before you allow this obscene thing to become law."

Dr. William Johnston writes: "Without going into a long tirade, I feel it sufficient to point out to you that I cherish the right to practise as I choose. Being able to limit my practice, I spend more time, give more personal attention and, I feel, more fully satisfy the needs of my patients than I could under other circumstances. I enjoy this personal relationship with my patients."

His patients will lose that relationship under this legislation. Dr. Johnston will be forced into a new kind of practice, a state-run, state-governed practice that neither he nor his patients will find to their liking. All of this will be done under the guise of accessibility to health care.

Dr. Roger Nicholson tells me he is an opted-in physician and always has been. In a recent letter to the Minister of Health he stated:

"Your proposed act removes all negotiating power with the government from the medical profession, leaving them only with the option to strike. This option, of course, hurts the third party, our patients and your constituents. Do you, Mr. Minister, realize that this is what the Health Care Accessibility Act offers the people of Ontario? We have no reason to believe this government will treat physicians reasonably once this legislation is passed and we will have no bargaining power except withdrawal of service."

Dr. Standret writes with concern and conviction:

"Surely it is fundamental in a democratic society that government has no right to dictate the price of any man's labour and to punish him if he chooses to set his own fees. To me, this is the most significant issue concerning this bill as it encroaches on a fundamental freedom. Unfortunately, this fundamental freedom is not significant to the socialist NDP/Liberal alliance.

"The NDP/Liberal alliance claims that some people cannot afford to see an opted-out doctor. If that is a real problem, then let us work it out. In my own case, clergy and people who receive welfare or the old age supplement are provided with free medical care. This is the area where arrangements with OHIP can be made. The government could supply needy people with a special code in their insurance number; or use their present cards, which now allow them free drugs, free ambulance, etc.

"Let the government identify to me who is needy. They already know. Then they should obtain an agreement with the doctors wherein these individuals will receive free care. This must be fair. It must be fair to the needy and must be fair to the provider, in that being over 65, for example, is not an indication of need.

"Health care is provided by health care professionals and by the government. The two must work in harmony and not with antagonism. Our system works well now. It is underfunded, of course. Surely to God we don't want a British health care system here, but that will happen if Bill 94 passes."

This government seems to want to follow the dictum of Machiavelli who said, "One who deceives will always find someone who is willing to be deceived." They think if they can wrap up the problems of the health care system, blame them on a few doctors overbilling a few patients, everyone will believe that this legislation, the Health Care Accessibility Act, will ensure accessibility to the health care system.

Dr. Issenman writes with this very concern to the Minister of Health:

"As an opted-in physician, I have nothing to gain from extra billing. However, I strongly object to the destructive attitude which the Liberal government has displayed towards Ontario's medical system. As an independent practitioner, the physician is able to work as an advocate for the patient in obtaining services from government institutions. I can assure you that these institutions are often resistant to providing the necessary services to patients.

"OHIP works reasonably well, but only because there is an alternative. Without the threat of opting out, it would come to serve its bureaucratic masters in place of serving the patients. I say this as a physician who spends a fair amount of time trying to wring appropriate services and responses out of OHIP and other government bureaucracies such as the Ministry of Community and Social Services.

"Accordingly, I worry greatly at the willingness of the government to attack the medical care system for political expediency. I certainly support the physicians who are doing their best to resist legislation to ban extra billing and would personally go to the wall at any government attempt to ban a meaningful ability to opt out of the medical insurance system."

This government can certainly not deceive all the people. As I have pointed out, the people of Burlington recognize this bill for what it really is. They are not deceived. I read in the Burlington Post recently:

"It is a certainty that a majority of Ontario residents are far more concerned about the overall level of health care in this province than they are about a squabble between the health insurance program and the doctors over the amount doctors are paid."

9:20 p.m.

It was also the Burlington Post that pointed out, "The provincial government used the federal government's withholding of some $50 million in transfer payments as the reason for ending extra billing." However, it does not appear to have made any guarantee that the recovered $50 million will be used to improve health care in this province.

The government cannot make that guarantee because it knows it will cost far more than the $50 million just to compensate the doctors if it blindly goes ahead and passes this bill. That $50 million would allow only a 2.7 per cent increase in doctors' fees. The government must know a more realistic settlement will be in the $120 million range; and that just for compensation, not for the necessary increases in the health care field.

The people of Burlington are not willing to be deceived by this Liberal-NDP government and its spurious rationales for attacking a valued and respected segment of our society. The people are interested in ensuring access to quality health care.

As Dr. Larry Komer, a highly respected obstetrician says: "As an active participant in health care in this province I can honestly say the whole issue is more political than social or economic. Even though I am opted out of the health care plan, one third of my patients are still billed at the OHIP rate for reasons of need or compassion. Almost every physician I know who is opted out willingly does this. Therefore, I cannot see how universality is threatened and once again I think the physicians are in the middle of a political tug of war which at present is alienating the profession to government and taking our time and energies from what we really want to do, and that is to treat patients.

"Surprisingly, a large part of my practice is from outside of Burlington because of my experience in infertility. Patients routinely travel from Brantford, St. Catharines and even Peterborough to attend this practice. One of the reasons for this is that I can spend time with them and decrease the feelings of frustration and defuse some of their personal anxiety. The only way I can do this is to charge realistic fees; this demands being opted out. The patients certainly do not mind and would rather pay a little of their own money to have the time to be able to talk rather than be shuffled through the office.

"I have always stated, from the outset, that should this personal professional freedom be taken away from me, perhaps my only alternative would be to move to the United States to continue my practice. Perhaps many people in the community do not realize that many physicians with specialized areas of ability are still actively being recruited from the United States.

"As repugnant as this would be to me, it would have to be an option if the present legislation goes through unaltered."

Dr. Komer goes on to point out it is not mere idle threat; Burlington lost 20 per cent of its doctors in one period just a few years ago. From personal experience, I can say of the Liberal candidate who ran against me in the last election, his father has been a physician operating in Texas for the last seven or eight years.

I should perhaps remind the Minister of Health that these are the people of Burlington, residents of the region of Halton where, he says, the problems of accessibility are among the most acute.

When opening second reading the minister said: "If one is resident in Metropolitan Toronto, or in York, Halton, Peel, Peterborough, Simcoe, Wellington, Waterloo, Middlesex or Ottawa-Carleton counties, one may well have difficulty finding a physician in a particular specialty who does not extra bill. It is this clustering phenomenon, as it has been called, that constitutes the problem that our proposed legislation addresses."

We have heard what the people of Burlington think of this alleged problem. They do not believe in it. They will not be deceived into thinking that subjugating doctors will magically solve the problems of accessibility.

In ending this so-called cluster problem, the minister appears to have taken the cloister approach. The Liberals have retreated to their offices, communed with the NDP and delivered themselves of the pronouncement that extra billing must end and all doctors are to be treated as possible criminals. Would that all the world's problems could be so magically and simplistically eliminated.

I remind the minister that when speaking of Ontario's hospitals in December, he is quoted as saying, "Health care in the 1980s requires a sophisticated and creative approach to priority setting and tradeoffs." Is his Bill 94 an example of that sophistication and creativity? Is taking a sledgehammer to an entire profession, questioning its humanity and compassion and blaming it for the ills of the health care system the way Liberals approach sensitive issues with sophistication and creativity?

If there are a few doctors creating problems for some people in a few identified areas, is it sophisticated and creative to turn every doctor into a civil servant under penalty of a $10,000 fine? Would it not have been sophisticated and creative to sit down with the health care providers, with the health care facility groups, with all the groups involved in the health care field and say: "What we want is the best possible care for everyone in Ontario, at the best possible price, with the best possible equipment. We all have to have priorities. We will all have to have tradeoffs. Let us now negotiate"?

The doctors were willing to negotiate as long as the threat of Bill 94 was not directly in front of them. We have all seen Dr. Myers's letter, in which he writes:

"We expressed great eagerness to participate in a fundamental reconsideration of how health care is delivered to the people of Ontario and how it is funded. We further agreed that in the context of such a study, physicians' billing practices should be part of the exercise.

"We suggested further that while a study was under way we would assist you in ensuring that the financially disadvantaged were exempt from any direct charges by physicians."

Could this government and the Minister of Health, in the interests of sophistication and creativity, not have sat down with the doctors and discussed this openly; and perhaps discussed a ban on the direct billing of those who are financially disadvantaged and seniors based on need, as part of the professional conduct regulations?

We heard previously from Dr. Standret of Burlington, who made a similar suggestion and described how the system would operate. That would appear to be a possible solution to ensure universal access for the financially disadvantaged.

The Burlington Post also believes there can still be a negotiated settlement regarding this bill. It points out that there are people who cannot afford to pay for medical care:

"That, after all, is the reason OHIP was created in the first place," its editorial explains, adding, "Nor should the doctors be put in a position of having to judge the financial status of their patients. They have sufficient pressures on them with looking after the physical and mental health of the patients."

There are solutions, the paper says; both sides should be willing to negotiate.

We have seen the doctors doing just that. They have offered to put aspects of their billing up for negotiation. They have offered to ensure the financially disadvantaged are not charged above the OHIP rate; but as we heard from Dr. Myers: "In the final analysis, you refused to hold back legislation on the opt-out question pending such a study. In short, it was you, not we, who refused to negotiate."

Where is the sophistication and creativity in priority setting and tradeoffs to say extra billing is banned? Let us talk. What is there to trade off when the most important item is taken off the table before negotiations are even allowed? Even the members on the left should be able to see some problems with that kind of approach.

9:30 p.m.

When the health insurance plan was introduced, the doctors were given the ability to opt out as a right. It was negotiated into the contract. Perhaps the members on my left could advise us what happens in the collective bargaining process they are so eloquent in defending if an employer says he is taking out something that has been previously won in a contract. What would happen if a private sector boss were to call the union and say, "A lot of people in Ontario think your cost of living allowance is no longer relevant and you are making too much money"; or deal in this manner with any other bargained clause of a previous contract for that matter?

What would happen if the employer were to say, "Sorry, we have decided here in the board rooms that COLA, or whatever, is going to be eliminated from this and future contracts. Now let us sit down and negotiate"? Would the union negotiators show up? Would we hear rhetoric urging a strike? Would NDP members stand up for the workers or would they say the employer is right?

Why is the NDP not hollering about the concessions that doctors are being told they are going to have to make despite what has been written into the law? Does the NDP and its allies feel they can get away with things they would never allow a private sector employer to get away with? Do they feel the doctors would be too professional to strike, regardless of what is done to them?

Will they wait until the doctors have been bullied into submission, then stand up and welcome them into the ranks of the oppressed workers? Will they try, knowing that they and their pet government are the chief architects of the doctors' oppression?

I fear that for some short-term political pleasure the NDP is in for a long term of labour pain. They will have no one to blame but themselves when there are no obstetricians to help in what will be a most difficult electoral delivery.

To conclude, l cannot and will not support Bill 94. I will not be deceived that this can in any way guarantee accessibility to health care and I will not be party to an attempt to deceive the people of Ontario that it will.

I cannot support the attempt to subjugate the doctors of this province to take away their ability to bargain and to determine their worth in such an arbitrary and antidemocratic way. The citizens of this province, and the citizens of Burlington, deserve the right to retain their health care delivery system in all its excellence.

Mr. Leluk: I am very pleased to rise to speak on Bill 94, An Act regulating the Amounts that Persons may Charge for rendering Services that are Insured Services under the Health Insurance Act. The short title of this bill is the Health Care Accessibility Act. It provides for a complete ban on extra billing for all insured physicians' services, all insured dentistry services performed in hospitals and all optometry services. Under the proposed act these services are to be provided to all Ontarians at OHIP rates.

The minister stated that the government's intention is to preserve the principles of universality and accessibility in Ontario health care and to ensure that all patients have access to the physicians of their choice and that they are able to seek necessary health care free from any financial constraints. Let us look at the question of accessibility.

It may be true that some patients may not be able to obtain treatment services in certain areas of the province in certain fields of medical practice, except from physicians who extra bill. At present, however, only 12 per cent of Ontario's 17,000 physicians have chosen to opt out of OHIP. We have heard from several previous speakers that only five per cent of that percentage extra bill. This total has decreased since 1979, when 18 per cent of the physicians in this province were opted out. Many physicians who have opted out do not charge rates in excess of the OHIP rates. They are specialists who usually take the patient's ability to pay into account.

The option of opting out gives physicians a way to deal with problems in the OHIP fee schedule without endangering or withdrawing their services. As the Premier of this province used to say when he was the Leader of the Opposition, it provides a safety valve. The ability to opt out ensures that first-rate physicians will remain in Ontario. If physicians are denied this option, our world-class specialists, with all their skills and knowledge, are most likely to leave this province, and they will be the hardest to replace.

I know the Premier has said on occasion that he does not believe this will happen. I want to remind him of the some 12,000 Canadian-trained physicians who are currently practising in the United States of America because of the so-called brain drain. There is a very strong possibility that we will lose some of our finest world-class specialists and physicians, who will be very, very difficult to replace.

I want to remind the minister that physicians are not civil servants; they are self-employed professionals. When medicare was established some 18 years ago in this province, physicians agreed to medicare provided that they could retain the right to opt out of the plan. The government's honouring of this social contract is very important to the physicians of this province. There is a principle at stake here. The physicians are upset with this proposed legislation, referred to as the Health Care Accessibility Act, because they feel there is no service that is more accessible in this province than physicians' services.

The member for Humber made a very eloquent speech in these chambers on January 28. He is no newcomer to the health care system. He is a reputable physician who has worked in a general family practice and in a specialty practice, which is psychiatry. He has practised in community hospitals, in an academic teaching hospital, in three government hospitals, in a university clinic and in a university clinical institute.

9:40 p.m.

He has published widely and, as he indicated in his remarks in the House, his contributions have been cited, noted and honoured on six continents. I have come to respect this person not only as an individual but also as a member of the health profession, and I commend him for expressing his concerns as a professional in a very forthright and honest manner.

I know it is always difficult for members of this Legislature to differ with their colleagues, particularly government colleagues, on issues and policies, and it takes a great deal of courage to do so. It indicates to me the member for Humber's deep commitment to principle and to quality health care for the people of this province. I may be referring to some of his remarks from time to time this evening, not for the purpose of causing him embarrassment or to embarrass the Minister of Health, but because I feel very strongly about the comments made by the member for Humber with respect to the legislation currently before this House.

He has said that he knows the problems of practitioners and how those problems impede good work. He stated he believes he is as qualified as most people in Canada to know what does and does not succeed in health care service delivery. He stated that, to be fair, physicians' services are already equal to and more accessible than any other area of professional endeavour. The physicians argue that no one has been denied treatment because it was beyond his means. Despite extra billing, all Ontarians have access to the best available medical care at Ontario health insurance plan rates. What a shame that this government has stooped to Mackenzie King's tactic of divide and conquer in setting the community and its physicians against each other to serve its own political ends.

During the last provincial election, the leader of the official opposition at that time made a commitment to the people of this province that if that party formed the government it would do away with extra billing. The present legislation is part of the deal the current Premier and his government made with the third party for its support to put the Liberal minority in power at Queen's Park; there is no question about it.

Steps have been taken to ensure extra billing does not compromise accessibility to health care services in this province. A province-wide telephone system assists the public in locating opted-in doctors. There is a joint Ontario Medical Association-Ministry of Health committee that reviews patients' complaints about billing. Regulations under the Health Disciplines Act provide that physicians who extra bill must notify their patients in advance of treatment of the amount of the extra fee. Medicare was designed as a floor plan to ensure that everyone could afford adequate health care. The system now accomplishes that goal.

I would like to spend a minute talking about the present health care services we enjoy in this province. As a pharmacist and a member of the health care team, I think we are very fortunate to have the quality of health care we enjoy. Those of us in this chamber who have had the opportunity of travelling abroad and visiting other jurisdictions will attest to that fact. In my travels, I have taken the opportunity to visit hospital facilities and talk to physicians all over the world. We in Ontario are truly fortunate because we have a health care delivery system in this province that is the best in the world. We have world-class physicians, specialists and facilities. It is no wonder that people come here from all over the world. I do not want to say that they take advantage of our health care system, but they do come here because of it.

Recently, a young lad from Guyana who had a problem with his arm was operated on in one of our hospitals. We have had young people like Herbie from New York, who came here because he required a physician with special skills to treat a medical condition he had. People from all over the United States come here to the Shouldice Hospital, which specializes in certain types of surgery. People come here to avail themselves of our specialists, our orthopaedic surgeons, like Dr. Walter Bobechko at the Hospital for Sick Children, or Dr. James Bateman. These are people who are world renowned, who are known for their skills.

Unfortunately, we in this province take much for granted. I can recall that some years ago I visited Mexico. Being on my honeymoon at the time, I was enjoying a few drinks. I had too many frozen daiquiris and I froze my larynx.

Hon. Mr. Riddell: I hope the member did not drive.

Mr. Leluk: No, I was not driving.

Hon. Mr. Riddell: Good.

Mr. Leluk: Anyway, anyone who has ever had a frozen larynx will know that this is very painful. I know the Minister of Health does not quite know what I am talking about, but I am sure his medical colleague will tell him.

I called the house physician at the hotel and found that he was incapacitated himself. So I said: "What do I do? Here I am in a strange country. I need a doctor." Finally, after several telephone calls and complaints, the hotel management had a physician call me. I said, "I am in need of medical attention." The physician said: "You do not really need to see me. Why not just go down to the local pharmacy and pick up a bottle of Percodan and a bottle of tetracycline?" I know the minister's medical colleague will tell him that Percodan is a narcotic painkiller and tetracycline is an antibiotic.

I did. I went to the local pharmacy without a prescription. In this country one could not obtain Percodan without a prescription from a physician. When I arrived at the pharmacy I saw two young people dressed in white smocks standing behind a counter. I approached that counter and said, "I would like a bottle of Percodan and a bottle of tetracycline." The young lad reached behind him, took these bottles off the shelf and gave them to me, and I paid for them. There was no prescription label. They were given to me just as they were, directly from the manufacturer.

It is a good thing I am a pharmacist who understands something about these drugs; but what about the patient who might have visited that pharmacy and did not know anything about those drugs and did not know what he was getting? That is a very good example of the health care service that we do not enjoy in this country. We are very fortunate here.

9:50 p.m.

I want to talk about another incident. About 10 years ago my wife had two ruptured discs in her back. This is a very serious problem. I can recall her going to see an orthopaedic surgeon, who put her on painkillers and antispasmodic drugs because of the spasms she was having in her back and the excruciating pain she had because of those spasms. She went to see Dr. James Bateman at the Orthopaedic and Arthritic Hospital on Wellesley Street. After being on medication and in traction for about a week, he told her he would have to operate on her or she would be confined to a wheelchair for the rest of her life.

That is a very serious situation for a young person to face, knowing she could spend a good part of her life in a wheelchair. I remember her discussing this with me, saying: "I am afraid. I do not want to go in for surgery." I said to her: "We are fortunate to have the facilities and the quality of physicians, surgeons and specialists that we enjoy in this province. I am sure you will be in good hands."

She did go in for the surgery and spent nine weeks recovering in hospital, but today she is walking. She can do most things that most people can, such as work in the garden, and she is enjoying a good life.

While she was in the hospital, I used to visit her every day. I met a young couple there from the Bahamas. The wife had been in a serious car accident in the Bahamas. She had crushed a number of cervical discs in her neck and was in very bad shape. The Bahamas did not have the facilities, nor the quality of trained physicians and specialists that we enjoy in Ontario.

Her husband then decided to put her in a Miami hospital. The husband came up from the Bahamas to be with his wife during her ordeal, and he said to me: "She almost committed suicide in that hospital because the care was not the kind of care that we are getting here. She used to crawl on the floor on her hands and knees hoping she would die because of the pain and agony that she was experiencing.

Dr. Bateman operated on that young woman and in seven weeks, she left that hospital walking. I remember her husband saying to me, "Aren't you people here in this province fortunate that you have an OHIP system, a hospital insurance plan that will cover your costs for this type of surgery?" The cost to that couple for the surgery incurred and for the medical care was somewhere in the area of $14,000. He told me: "It was a bargain to see my wife up and walking about. We are going to enjoy life."

It causes me some concern that we in this province take for granted a health care system that was painstakingly built over a number of years to become the best health care delivery system anywhere in the world.

We have had people like Senator Ted Kennedy visit Queen's Park. I spoke to him. He was head of the Senate health committee and he came here with the express purpose of studying our OHIP system. He said to our caucus when he met with us, "This is one of the finest health care systems anywhere in the world." He only wished they had such a system in the United States.

I want to talk now about the method by which the Minister of Health brought this legislation into this House, not unlike the two pharmacy bills, Bills 54 and 55. There was no negotiation with the medical profession. The Premier had stated that the provincial government was firm in its commitment to ban extra billing. The only thing it was prepared to work out was the method of implementing the ban.

Representatives of the Ontario Medical Association met the Premier on several occasions during this past fall to discuss problems in the health care system. They agreed that the dilemma presented by increasing needs and scarce resources required urgent attention. They expressed a great eagerness to participate in a fundamental reconsideration of how health care is delivered to the people of Ontario and how it is funded.

They further agreed that in the context of such a study, physicians' billing practices should be part of that exercise. They suggested that while a study was under way, they could assist the Premier in ensuring the financially disadvantaged of this province were exempt from any direct charges by physicians.

What happened? In the final analysis, the Premier, through his Minister of Health, refused to hold back legislation on the opt-out question pending such a study. In short, it was this government and not the OMA that refused to negotiate.

It has to concern me, as a member of this Legislature, that on that side of the House, the Liberal member for Humber opposes this bill. He is a very qualified medical practitioner, who possesses those skills and that knowledge, and he has to stand in this Legislature and speak against this proposed legislation.

Mr. McLean: It is not hard to do.

Mr. Leluk: No, it is not hard to do, I agree, because it is ill-conceived and very poor legislation.

Mr. Barlow: Draconian is the term.

Mr. Leluk: Yes, I believe the member for Humber used that expression -- that it was draconian.

He said that as a professional who believes in professionalism, he cannot support this method. He says one cannot improve the health care system by seeming to alienate and demean the professionals one relies on to provide the services and leadership that help make the system work. That is exactly what this legislation does.

10 p.m.

He says further that "the apparent permanent civil conscription of virtually an entire profession in peacetime is a serious and disturbing matter. I feel conscience-bound to oppose it. I believe such a step" -- referring to the proposed legislation -- "to be unwise and I would argue that point just as vigorously for any other group as I would argue it for physicians."

I take it by that that he is probably referring to the pharmacists in this province, who are currently facing a similar situation with Bills 54 and 55.

Hon. Mr. Nixon: Did the member vote against that or not? I forget.

Mr. Leluk: The member for Brant-Oxford-Norfolk has to be kidding.

Mr. D. S. Cooke: The Conservative members did not vote against the pharmacy bills.

Mr. Leluk: Not yet.

Hon. Mr. Nixon: They have had second reading.

Mr. Leluk: That is all right. There is also a third reading.

It disturbs me that the Minister of Health is having difficulties with the pharmacy bills. In the standing committee on social development the other day, when representatives of the Ontario Pharmacists' Association appeared to make their presentation, they spent an entire afternoon discussing those two bills and their concerns with the proposed legislation. They had representatives there from Woods Gordon, a well-known firm, and their solicitor, Mr. Don Mills.

Despite their attempts to explain the difference between actual acquisition costs, as a method proposed for the costing of drugs under the Ontario drug benefit plan and Bill 55 in the free marketplace and the concept recommended by Dean John Gordon in his commission report, the minister had to struggle to try to come to grips with the difference. It has to concern me when a government has a minister who is having this much difficulty in trying to understand why certain legislation he has put forward is going to be detrimental to the health care of the people of this province.

The member for Brampton (Mr. Callahan), who I thought was very demeaning in his comments in this House about the profession of pharmacy, also has difficulties. It took him almost two months to come to grips with the difference between a pharmacist and a peanut vendor and a pill and a peanut. When that kind of mentality is exhibited by certain members on that side of the House, one has to be concerned for the welfare of the people of this province. Physicians may not be a popular group in our society these days, but that is not the issue before us. What is at issue is the health care of the people of this province and the democratic right of two people, as the member for Humber has stated, to negotiate a simple contractual agreement with each other, perhaps with certain safeguards provided by the state to guard against monopolistic fee-setting, but essentially at arm's length from the state.

The member says further that he is defending the people of Ontario from what he feels to be the threat of a weakening of the present health care system in this province. He is arguing for democracy and freedom. He says further, "Freedom is not negotiable."

We have not learned in this province and this country from the experiences of other jurisdictions. As we are moving towards socialized medicine in this province

Mr. Wildman: That is what we need.

Mr. Leluk: The member for Algoma will be like his colleagues in Britain who are trying to get into the other system.

Mr. Wildman: Margaret Thatcher has been in power there for 10 years, has she not? Why is she screwing things up so badly?

Mr. Leluk: Is that right? As I was saying, in Britain they now have socialized medicine.

Mr. Wildman: That is right, but Margaret Thatcher is in charge of it.

The Acting Speaker (Mr. Morin): Order.

Mr. Leluk: Our minister has stated he did not want to see --

Mr. Wildman: What we need is more Heseltines.

The Acting Speaker: Order.

Mr. Leluk: Thank you, Mr. Speaker. Our Minister of Health has said we do not want a two-tier system of medical care in this province, one for the financially disadvantaged and one for the so-called rich. However, that is exactly what we are going to have if the legislation passes in its present form. It will be a two-tier system. So we have not learned a thing from the experiences of other jurisdictions.

However, what do we currently have? We have a total breakdown of dialogue between the physicians and the government, which does not bode well, in my view, for the health care of the people of this province.

The complete failure of government, through its Minister of Health, and the Ontario Medical Association to find a basis for discussion on matters of mutual concern, including extra billing, exemplifies that breakdown in dialogue. What we have is each side blaming the other. As the member for Humber stated, "Surely the prescription for that breakdown is renewed efforts towards dialogue, not severe legislation."

The member for Humber went on to say he is worried as well "about unconscious bias and attitude in the shaping of this legislation." He said, "Physicians who represent the mainstream of clinical experience and wisdom are, one suspects, often not close to the drafting of policy and legislation to do with the health care of Ontario."

These are primarily the highly trained experts to whom we should listen very carefully. That is why I say I do not know who the Minister of Health is listening to on that side of the House, but he certainly does not seem to be listening to the member for Humber.

Mr. McLean: He is not even listening to the member for York West.

Mr. Leluk: No, he is not listening to me because it is all a fait accompli. They are just going through the exercise, just as they are with the pharmacy bills.

10:10 p.m.

"The only valid yardstick by which to measure the wisdom of health policy and legislation is the criterion of what is best for the people of Ontario," according to the member for Humber. "However, though health care is a political issue, we overlook at our peril that it is also and primarily a clinical issue by which people will live or die."

What do we have? We have the Premier now making gestures to the OMA and saying he is going to provide certain moneys for a special fund that could be administered by the Ontario Medical Association. This fund would be used to recognize, as he puts it, "excellence in physicians' services." He has also stated that he is possibly prepared to alter the penalty for extra billing, that it might be modified and that the government would be willing to discuss some of the system of merit payments for the more skilled and experienced doctors.

He now is starting to feel the crunch of a united profession that has told him it is not prepared to sit down and negotiate while the present legislation is in Orders and Notices. The doctors are willing to discuss concerns about access to medical care and some compromises are possible, but the proposed ban on extra billing is not acceptable to the medical profession in this province.

Mr. Wildman: Just to the majority of the people.

Mr. Leluk: I want to say to the member for Algoma that it will be those very same people who will suffer in the long run because they will not enjoy the quality of medical and pharmaceutical services or the high level of the health care delivery system they currently enjoy in this province. The member should ask people in Britain about the present health care system there. It is the consumer and the people of this province who will pay the price in the long run.

As the member for York Mills (Miss Stephenson) said in this House one day, what they have in Britain is assembly-line practice of medicine, where people line up in large numbers to see a physician on any given day. There is no way a physician can provide quality service to that many people.

It is not often I agree with the members of the third party, particularly with the member for Oshawa (Mr. Breaugh). He said in this House: "Let me make a comment or two about the minister. As long as I have known him, which is since he has been a member, he has never shown any signs to me of being as evil as the current ads in the newspapers portray him. I have always found the Minister of Health to be a very conscientious, hardworking person -- a little too serious for my taste, but to each his own."

I have to agree. I also believe the minister is conscientious and hardworking, but as the member for Oshawa said: "It seems to me the minister got bushwhacked by his staff. I believe there was a commonly and reasonably well understood problem and the minister probably said, `Give me something I can do that is my own initiative and is not part of the accord, some wrong that should be righted.'"

I believe there must be some truth in that. The minister is not really getting the right bill of goods. Possibly members of his senior staff are not giving him a straight bill of goods with respect to Bill 94 or Bills 54 and 55.

Where is the leadership of the Minister of Health? He requires input and he needs to be able to discuss these things with senior staff, but eventually it is the minister who has to make a decision with respect to policy. Why is there lack of leadership?

The member for Humber stated that rarely in the history of democracy has any legitimate profession been so curtailed by the state in its freedom to negotiate a simple contractual agreement with a client. He said that even government insurers rarely try to dictate the value of goods or services; rather they spell out the amount of coverage.

He does not believe it advisable to regulate, control and perhaps demean the providers of life-and-death clinical services to that degree. The measures and timing of the Health Care Accessibility Act are therefore, in his view, excessive and ill-advised. He said what I said earlier about the present health care system in Great Britain: "Experiments in other jurisdictions, whereby physicians have become employees of the state, have not fostered first-rate clinical care. When all the doctors in a particular society are controlled and accountable to the state, they are not able to do their best work."

Mr. Newman: Carried.

Mr. Leluk: Did the member for Windsor-Walkerville say time? Carried? He agrees with me. I am glad to see there is still some sense of reason on that side of the House.

He went on to say that "the Health Care Accessibility Act proposes to alter fundamentally a system that has stood the test of time for thousands of years. It has fostered development of a health care system which, though imperfect, is perhaps the finest and fairest in the world." Anyone in this House would agree there is always room for improvement, but we do have the finest health care delivery system of anywhere in the world. I dare anyone to say to the contrary.

10:20 p.m.

We face a total breakdown of dialogue between physicians and government, with the physicians unwilling to come back to negotiate with the Ministry of Health because of the principle at stake here. We have this impasse, and no solution is in view.

All members in this House believe in equality, universality, comprehensiveness and assured access to our health care delivery system. We almost have that now in health care in this province. We have excellence as well, as the member for Humber has stated. What the government should be doing is improving what we have currently in our system by negotiating with physicians, not through confrontation or through lack of discussion and consultation.

It seems the popular thing for the government of the day to do is to take on the pharmacists first, the physicians second, then the dentists and the optometrists. Who is going to be next? Will it be the chiropractors or the nursing profession?

Until this government came to power, a mood of co-operation existed between all health professions and the previous government. This government has deliberately chosen confrontation, not negotiation. There were some differences in the past, but the government always tried to avoid confrontation. It would appear that this government is looking for a fight, but confrontational politics is not good for Ontario's health care system.

One of the major points of contention in the proposed legislation is that there is no negotiating mechanism in this bill. The physicians in this province are not going to go begging the government of the day to trade such a mechanism. It is the government, through the Minister of Health, that must show the initiative in this regard.

I want to say a word about the penalty section in this legislation for physicians who contravene the proposed legislation with respect to extra billing and who will subsequently be charged and found guilty. The penalty of $10,000 is punitive and excessive. We are not dealing with criminals. We are dealing with a professional body of caring people who have been providing excellent health care and medicare to the people of this province.

I hope the minister will come to his senses, not only with respect to this particular legislation but with respect to the pharmacy bills currently before the House as well. It is unfortunate that we seem to be going through an exercise when it is obvious it is a fait accompli in that the legislation will pass because of the support the present government enjoys from its accord with the third party.

As I said earlier, it is the people in this province who will pay the price in the long run. They will not enjoy the quality of health care delivery services they are currently enjoying.

Before this legislation goes to the standing committee on social development, I hope the minister will reconsider this ill-advised legislation and that we will not perpetuate the confrontation that exists between the medical profession and the Ministry of Health. In the Toronto Sun dated January 30, I read that the physicians, through the Ontario Medical Association, have obtained the services of a high-profile civil liberties lawyer, Aubrey Golden. If and when it passes, they intend to test this legislation in the courts.

The article states Mr. Golden "told reporters, `I have never been so moved by the depth of feeling over an issue.'... The government, he said, is `lurching ahead' with the legislation without exploring other options because it is enshrined in the NDP-Liberal accord."

The article continues: "Failure to examine alternatives, he suggested, will work against the government in the court. `The courts will ask, is there no other way available to ensure that those who cannot afford to pay a doctor's fees have equal access to quality health care?'... Extra billing, he explained, is being used as a convenient political target to answer valid concerns about universal access to health care."

It goes on to say he will wait until this bill is passed before testing its validity in the courts and that the public will not tolerate doctor-bashing from the government.

I am at the end of my comments --

Mr. McFadden: Carry on a bit longer.

Hon. Mr. Nixon: Lay off.

Mr. Leluk: Let me say something about the Treasurer (Mr. Nixon) who just said --

Mr. Barlow: Bring the Treasurer into this.

Mr. Leluk: Let us bring the Treasurer into it. In an article in the Toronto Sun dated January 28, it says, "The Premier's plan to totally socialize health care in Ontario goes far beyond banning extra billing by physicians. The Treasurer showed that yesterday when he revived the Grit election promise to abolish Ontario health insurance plan premiums. He said he hopes to eliminate premiums within three to four years and get the money from somewhere else." I wonder where that somewhere else is: from the taxpayers of this province.

Interjection.

Mr. Leluk: That is right -- from the other pocket. This question of extra billing is nothing more than a red herring --

Hon. Mr. Nixon: It is a commie plot; that is what it is.

Mr. Leluk: It is a red herring because it is not the extra billing that is at issue and it is not depriving the majority of the people in this province of access to a very fine health care delivery system.

Mr. Barlow: Not so far.

Mr. Leluk: Not so far, but it will after the legislation passes.

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

Mr. Leluk: If I may, I will just finish with one sentence.

The $50 million in transfer payments that is currently being withheld by the Department of National Health and Welfare is only a pittance when one looks at the overall $1.6 billion raised annually through premiums. These pay less than 18 per cent of the $8.9 billion per year for the cost of funding the health care system in this province. What is really in question here is the underfunding of the current system: it is not the extra billing. We are talking about nickels and dimes.

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

The House adjourned at 10:31 p.m.