[ Page 4905 ]

CONTENTS

Routine Proceedings

Oral Questions

Mines inspectors. Mr. Segarty –– 4906

Dismissal of Bruce Donald. Mr. Macdonald –– 4906

Ombudsman's complaint on behalf of residents of Daisy Lake. Mr. Barrett –– 4907

Ombudsman investigation into electoral redistribution inquiry. Mr. Macdonald –– 4907

Colenutt case. Mr. Macdonald –– 4908

Abbotsford veterinary laboratory. Mrs. Wallace –– 4908

Committee of Supply: Ministry of Municipal Affairs estimates. (Hon. Mr. Vander Zalm)

On vote 156: minister's office –– 4909

Medical Services Plan Act, 1981 (Bill 16). Second reading.

Hon. Mr. Nielsen –– 4909

Mr. Cocke –– 4912

Hon. Mr. Bennett –– 4916

Mr. Hall –– 4917

Hon. Mr. Gardom –– 4919

Mr. Nicolson –– 4919

Hon. Mrs. Jordan –– 4920

Mr. Levi –– 4922

Hon. Mr. Vander Zalm –– 4923

Mr. Kin –– 4924

Hon. Mr. Nielsen –– 4925

Medical Services Plan Act, 1981 (Bill 16). Committee stage.

On section 6.

Mr. Cocke –– 4926

On the amendment to section 6.

Mr. King –– 4926

Mr. Gabelmann –– 4927

Tabling Documents British Columbia Railway annual report, 1980.

Hon. Mr. Phillips –– 4 9217

Ministry of Consumer and Corporate Affairs annual report I'm the year ending March 31, 1980.

Hon. Mr. Hyndman –– 4927

WEDNESDAY, APRIL 1, 1981

The House met at 2 p.m.

Prayers.

HON. MR. CURTIS: In the House today, in the gallery and in the precinct on a tour are students from the great constituency of Saanich and the Islands. It is the Islands portion which is represented today with students from Gulf Islands Secondary School accompanied by Mr. Bergstrome. Would the House make them welcome.

MR. LEA: With us today in the gallery is an ex-member of this House who served both as an MLA and cabinet minister and served the public of this province for many years. I'd ask you to welcome Dan Campbell.

MR. HOWARD: We could give him a thousand cheers of welcome, Mr. Speaker.

Anyhow, I'd like the House to join with me today in welcoming to Victoria a young gentleman from the community of Kitimat, Doug Panton.

Oral Questions

MR. MACDONALD: I don't see the Attorney-General (Hon. Mr. Williams). On a point of order, it seems to me that a minister of the Crown should be in his place, not in the precincts where he cannot be subjected to questions, particularly at the present time. I'd like a ruling on that. What's the use of a question period incorporated in the rules when the Attorney-General, who has now committed an act of serious public consequence, does not appear to be responsible for his actions?

MR. SPEAKER: The member knows full well not only the rules but the practice of the House. I would suggest that perhaps during the 15 minutes allotted for question period the minister whom the member wishes to question will likely be here. Perhaps he could reserve his question until that time.

MR. LEA: As I understand it, Mr. Speaker, your ruling....

MR. SPEAKER: It's not a ruling.

MR. LEA: ...is that members of the cabinet do not have to be in the House during question period. Is that correct?

MR. SPEAKER: The hon. member knows the rules and practices of the House.

MR. LEA: Are you ruling that they don't have to be in here?

MR. SPEAKER: The member knows the rulings, standing orders and practices of this House. They do not require a ruling, and to insist on a ruling is an abuse of the forms of the House. We're in question period and time is fleeting.

MR. LEA: We're not in question period yet, are we?

MR. LAUK: On a point of order, according to the standing orders of this House every member is required to be subject to the service of this House and in attendance of this House when the House is in session. Therefore I ask the Speaker to summon the missing cabinet ministers to their chairs.

MR. SPEAKER: The member knows full well that the Chair does not have the authority to summon people to this chamber. Up until this time the interpretation of the rule has been that members who are in the precinct are considered to be in attendance of the House. I notice, hon. members, that there are empty seats on both sides of the House, and I would recommend we continue with what have been the practices of this House to this day.

MR. LAUK: On a point of order, I refer Your Honour to standing orders 6, 7 and 8. I'll read them.

"6. The presence of at least ten members of the House, including Mr. Speaker, shall be necessary to constitute a meeting of the House....

"7. Whenever Mr. Speaker adjourns the House for want of a quorum, the time of the adjournment and the names of the members then present shall be inserted in the Journal.

"8. Every member is bound to attend the service of the House, unless leave of absence has been given him by the House."

It becomes particularly important during the 15-minute question period, when all members of the treasury bench should be in their places. We always did that when we were the government. [Laughter.] It’s true. Except when a minister was ill, we would all be present. I therefore commend that to you, Mr. Speaker, as the provision by which the Speaker has power to summon people to the attendance of the House.

MR. SPEAKER: The member knows the orders full well.

HON. MR. McCLELLAND: On a point of order, Mr. Speaker, I think the member has raised an important point. I think the member might provide to this House a written statement about where he was on March 11, 17, 19, 23 and 27.

MR. SPEAKER: Hon. members, these are not legitimate points of order.

MR. LAUK: Even though it's not a legitimate point of order, that minister, if he is implying that I was absent from the service of the House, has done a dishonourable act. I ask him to withdraw.

MR. SPEAKER: This is also not a point of order. I have reminded hon. members that time in question period is fleeting. Is there a member who has a question? I recognize the first member for Vancouver Centre; you have a question.

MR. LAUK: On a point of order, I ask the Speaker to demand that the minister withdraw any imputation that I was not fulfilling my duties under standing order 8 of the rules of the House.

MR. SPEAKER: Is there a question?

[ Page 4906 ]

MR. LAUK: I am asking for a withdrawal from the minister. Is the Speaker refusing my request as an hon. member?

MR. SPEAKER: I recognize the first member for Vancouver Centre on a point of order. Please state your point of order.

MR. LAUK: My point of order is that if the minister is imputing that I was absent from the service of the House by making the statement that he made, I'd ask him to withdraw that imputation.

MR. SPEAKER: The hon. Leader of the Opposition on a point of order.

MR. BARRETT: Mr. Speaker, you made the reference that question period time was fleeting. It is my understanding that the rules of this House are that when points of order are raised they are not subtracted from question period.

MR. SPEAKER: That is when the Chair has intervened and whenever a lengthy statement is made which is perhaps related to order in the House. I have asked on many occasions that the time which the Chair has taken not be counted as question period time. But, hon. members, the House can speak for itself. Is it the wish of the House that the time we have utilized up to this point in points of order not be taken from question period?

Leave not granted.

MR. BARRETT: On a point of order, it is not the prerogative of the Chair at any time to submit House rules to an arbitrary question of the House. Points of order raised are points of order time; they have nothing to do with question period. If you're ruling that points of order raised by any member of the House subtract from question period, it leaves open the whole question of the sanctity of question period. I would ask the Speaker to reserve decision on this and come back with a ruling please.

MR. SPEAKER: I will reserve decision. I will make this comment: to rule as the member has required leads to an abuse of question period itself. A question period could be distorted by continuous use of spurious points of order, and the purpose of question period could be destroyed. I do not think that that is the member's wish.

MR. BARRETT: Mr. Speaker, that is exactly the point I wish to make. There are rules governing spurious points of order. The point you made is that question period could be distorted by spurious points of order, but that is not the reason why it should cut into question period time; it is the exact reason why it shouldn't. That is the danger to question period that I'm addressing to the Chair.

MR. SPEAKER: I will reserve decision. I will bring a decision to the House, perhaps with a recommendation as to the procedure that should be used.

The second member for Vancouver East has a question.

MR. MACDONALD: On a point of order, Mr. Speaker.

SOME HON. MEMBERS: Oh, oh!

MR. MACDONALD: I don't think it's particularly funny that a question period should be cancelled, in effect, because we're practically through it. When this order of proceedings was called, I rose on a point of order, because the minister to whom the questions were to be directed was not in his place. Somebody may say that is a spurious point if they want to; nevertheless it was a point of order seriously made for the purpose of conducting public business and scrutinizing the activities of this government. It was a matter of substance. I wanted to ask the Attorney-General questions, and the only way I could do it was by raising a point of order. While that point of order relating to the calling of question period was before Your Honour in the chair, the time cannot be said to have begun to run.

MR. SPEAKER: Is that the member's point of order?

MR. MACDONALD: Yes.

Interjections.

MR. SPEAKER: Order, please. The Chair has reserved decision and will bring a decision to the House.

MINES INSPECTORS

MR. SEGARTY: Mr. Speaker, I have a question for the Minister of Energy, Mines and Petroleum Resources. With the amount of construction of new coal-mines in the Elk Valley in the constituency of Kootenay, there is a need to increase the number of mines inspectors in the municipality of Fernie. The mines inspector at the present time is not able to keep up with the demands on his time. I wonder if the Minister of Energy, Mines and Petroleum Resources would be interested in doing a study on increasing the staff at the Fernie office of the mines inspection branch.

HON. MR. McCLELLAND: Mr. Speaker, we are experiencing this year in the ministry — particularly in the mining sector of the ministry — a tremendous growth, which of course places some severe restrictions on the opportunity for the available staff to do their job. We have recognized that in this year's budget, and there will be some significant improvements in staffing. But as to the exact staffing numbers and where they go, I'll take that part as notice and provide the member with an answer about where that staff will be dispersed during the course of our estimates.

DISMISSAL OF BRUCE DONALD

MR. MACDONALD: I have a question for the Attorney-General, Mr. Speaker. There is a private lawsuit going on, the Deputy Attorney-General against CBC and Bird. The Attorney-General knows the case I'm referring to. Counsel for the deputy is Mr. Peter Butler. Can the Attorney-General assure the House that Mr. Peter Butler is not being paid directly or indirectly by the government for his activities related to that case?

HON. MR. WILLIAMS: Mr. Peter Butler was engaged by the Deputy Attorney-General as his private counsel. He is not being paid by the government.

[ Page 4907 ]

MR. MACDONALD: The Deputy Attorney-General, in that particular case, attended on examinations for discovery on four or five occasions, when the evidence came out relating to Mr. Bruce Donald and the release of certain public information. Did the Deputy Attorney-General come back to the Attorney-General, report what had been said by the witness relating to that matter — namely, Chris Bird — and was that the information on which the Attorney-General acted, leading up to the dismissal of Mr. Donald?

HON. MR. WILLIAMS: Mr. Speaker, as I indicated yesterday — at least I thought I had; if not I'll make it clear today — the information which I received some two weeks ago or so was in the form of a copy of the transcript of the examinations for discovery which was sent to me by Mr. Butler, in which he indicated certain questions and answers which he thought significant.

MR. MACDONALD: Did the Attorney-General question Mr. Bruce Donald on the phone in March 1980 as to whether or not he was the source of this information having come into the public domain? Was that conversation on tape? I understand the Attorney-General asked Mr. Donald five questions at that time, but did not ask him directly whether he was the source of the information.

HON. MR. WILLIAMS: I had a telephone conversation with Mr. Donald on March 8, 1980 — if my recollection is accurate. As to whether there were five questions posed, I would have to check my notes of that discussion. Yes, I asked Mr. Donald directly if he was the source of information.

MR. MACDONALD: Did the Attorney-General see Mr. Donald on Friday last, and did Mr. Donald not say that he had not lied to the Attorney-General? Contrary to what the Attorney-General said yesterday, he defended himself and said: "I did not lie with respect to that matter." Is that not the case?

HON. MR. WILLIAMS: I met with Mr. Donald last Friday afternoon. I never accused him of lying. I simply asked him whether or not the evidence that was given by Mr. Bird in the examination for discovery was accurate. He said that it was substantially so, although he corrected some of what he considered to be errors in the responses of Mr. Bird. I said to him that in March 1980 he had responded to questions that I posed to him and that those responses were not accurate.

As to whether he had given the document to Mr. Bird, he says he did not give it to him. He admitted last Friday that he had engaged with Mr. Bird in the establishment of a scheme whereby the document would be put in a place and Mr. Donald would make Mr. Bird aware of where that place was and the means of access to it. As a result of this, Mr. Bird got the document. Does it have to be a semantic argument?

MR. MACDONALD: I take it that the Attorney-General is not accusing Mr. Donald of lying then, and I'm glad to have that assurance. Nevertheless, right from about March 1980, did the Attorney- General not take legal advice as to whether or not there wasn't some way he could get rid of Mr. Donald, because he was embarrassing his department and was very upset about how the Attorney-General's department had handled two particular prosecutions?

HON. MR. WILLIAMS: The answer to that question is categorically no,

OMBUDSMANS COMPLAINT ON
BEHALF OF RESIDENTS OF DAISY LAKE

MR. BARRETT: I have a question for the premier. I ask the Premier's response to the ombudsman, who has publicly expressed his frustration at the lack of response to his representation on behalf of Garibaldi residents living near Daisy Lake. Has the Premier decided to take any action in response to the ombudsman's complaint'?

HON. MR. BENNETT: We have received a report from the ombudsman, and it will be considered by the government and the minister responsible.

MR. BARRETT: Is the Premier aware that the Minister of Environment (Hon. Mr. Rogers) has already stated that it was none of the ombudsman's business to interfere with high cabinet policy. Can the Premier assure this House that no cabinet minister has the right to instruct the ombudsman as to what issue he may or may not comment about'?

HON. MR. BENNETT: The government will develop policy, but we're always willing to receive advice, which will be considered.

MR. BARRETT: Can the citizens of British Columbia be guaranteed that no cabinet minister will interfere with the decision of the ombudsman as to what issue he wishes to address himself or the cabinet to?

HON. MR. BENNETT: No cabinet minister has interfered with the ombudsman, and I anticipate no cabinet minister will interfere with the ombudsman. The government will develop policy, and we look forward to receiving advice from many people, including the ombudsman, but particularly from the citizens of B.C. directly affected. In the case brought to mind, I myself have been personally involved in interviewing some of the people, who were reassured when I talked to them.

MR. BARRETT: I wish to make this point perfectly clear, and I ask this question of the Premier. Can the Premier assure the people of British Columbia that the ombudsman is perfectly free to bring to the attention of the public or the cabinet any issue he feels that, in the service of his office, it is necessary for him to bring to the public's attention and the government's attention?

HON. MR. BENNETT: Mr. Speaker. I expect the ombudsman will be governed by the act under which he was appointed, and the government will also be governed by the same legislation.

OMBUDSMAN INVESTIGATION INTO
ELECTORAL REDISTRIBUTION INQUIRY

MR. MACDONALD: I have a supplementary question. In addition to the questions that have been asked by the Leader of the Opposition, I ask the Attorney-General if he was approached by the ombudsman for a legal opinion with respect to a particular investigation. If so, when was he so approached and why has that particular inquiry into electoral redistribution and what proceeded from it — namely, the Gracie's Finger matter — not been allowed to proceed?

[ Page 4908 ]

HON. MR. WILLIAMS: I had a discussion with the ombudsman with respect to that matter, but it is not within my area of responsibility or jurisdiction to dictate to the ombudsman whether he should or should not proceed with any investigation. He does so in accordance with the provisions of his statute.

MR. MACDONALD: Did the Attorney-General offer any opinion whatsoever to the ombudsman as to whether he should proceed with that particular investigation?

HON. MR. WILLIAMS: Mr. Speaker, the answer is no.

COLENUTT CASE

MR. MACDONALD: Mr. Speaker, I have a question for the Attorney-General, of which I gave him notice. A Mr. Colenutt of Vancouver was arrested on May 1, 1980, at 5 o'clock in the morning, although he had lived in his house for six years, was working steadily, there was no police record and the police protested at the arrest warrant that was issued. Why has there been no public inquiry? There has been an investigation under the Provincial Court Act. But why has there been no public inquiry into whether or not there was bias on the part of a justice of the peace in effecting that particular arrest and having a psychiatric examination of Mr. Colenutt ordered?

HON. MR. WILLIAMS: Mr. Speaker, the matter to which the member refers falls within the provisions of the Provincial Court Act and the Police Act of British Columbia. A complaint was made by Mr. Colenutt to the police, and that was dealt with in accordance with the Police Act, and it is my understanding that it has not been pursued.

With respect to the investigation undertaken by the provincial court judge, it was drawn to my attention in a letter from Mr. Colenutt on February 15 this year. I responded that he should request the chief judge of the provincial court to examine the matter further. I understand this has been done.

Precisely what the outcome of that has been I cannot advise the member, because the chief judge is out of the province today; he will return this evening. When that occurs I will ascertain from the chief judge the basis upon which he is continuing the inquiry or not, as it is his responsibility under the act to do, and at that time consideration can be given as to whether or not an inquiry should be ordered. The inquiry of which the member speaks is not a public inquiry as provided for under the Provincial Court Act.

MR. MACDONALD: What I suggested wasn't an inquiry at all; it was an investigation under section 15. There's been no public inquiry whatsoever into this.

I ask the Attorney-General if it is normal that a citizen in the circumstances I've described, without any record, who had freely confessed the facts of the incident, who had lived in that same place and worked steadily for years, should be subject to a warrant of arrest. Is that normal procedure, or does it indicate that there was something very seriously wrong?

MR. SPEAKER: Order, please. Is the member seeking a legal opinion?

MR. MACDONALD: No, I'm asking if that is the practice. Or does that indicate there was something seriously wrong where the Attorney-General should have acted?

HON. MR. WILLIAMS: As the member will I know — or he should have known, having been the Attorney-General of this province — I would suspect the nature of the process taken by the police would be dictated by the nature of the offence.

MR. MACDONALD: Is it normal that a citizen in those circumstances should be subjected on his arrest to psychiatric examination when there was nothing to indicate that such was called for? Who ordered it?

HON. MR. WILLIAMS: The member indicates that he is possessed of information of which I am not. The basis upon whether a psychiatric examination takes place will depend upon the conduct of the individual who's arrested.

ABBOTSFORD VETERINARY LABORATORY

MRS. WALLACE: I've a question for the Minister of Agriculture. It has come to my attention that the cattle in Cowichan-Malahat are dying from what veterinarians believe may be a deficiency of selenium in their diet. Attempts to determine what is causing the problem are seriously hampered by the long delay in obtaining test results from the government veterinary lab in Abbotsford because of understaffing and budget cuts. The addition of a temporary assistant as of today will not provide adequate relief. I would like to ask the minister: will he assure the House that he will take immediate steps to provide adequate staffing to eliminate the severe backlog of work in that laboratory?

MR. SPEAKER: The question asks into the future activity of the minister. Does the minister wish to answer?

HON. MR. HEWITT: Mr. Speaker, I'm not aware of any delays taking place, but I'd certainly be pleased to check it out to ensure that we give proper service to the agricultural community.

MR. SPEAKER: Hon. members, there have been questions in the faces of some who asked about the length of question period. Whenever a decision is reserved, it is without prejudice to whatever order is in progress. Since question period was in progress and a decision was reserved, the Chair asked for the time to run the full 15 minutes. I trust that meets with the approval of the House.

MR. LAUK: On a point of order, Mr. Speaker, under the pressure of confusing points of order, when I rose, I rose under standing order 38. I point out to Mr. Speaker standing order 9. Mr. Speaker ignored the point of order that I raised. I point out that under standing order 9 "Mr. Speaker shall preserve order and decorum, and shall decide questions of order...." It's not discretionary whether the Speaker decides whether or not there is a point of order. He must make a ruling whether or not it's properly within the standing orders, number one; and number two, he shall decide the point of order. It's not discretionary and I point that out, with respect, to the Speaker. The only point that I was rising on was to correct any false impression given by the Minister of

[ Page 4909 ]

Energy (Hon. Mr. McClelland) that I was absent from the House or the precincts on the days in question. That is simply not true.

Interjections.

MR. SPEAKER: Order, please. I will address myself to the part of the point of order which was directed to the Chair: that is, whether or not the Chair must determine whether or not a point of order is indeed a point of order. That authority does rest with the Chair, else it would not be decided what is a spurious point of order and what is a fraudulent point of order. Therefore that power does rest and must rest with the Chair.

MR. LAUK: Mr. Speaker, may I have leave to make an introduction that I inadvertently passed over?

Leave granted.

MR. LAUK: Mr. Speaker and hon. members, in the gallery today are chairman Pauline Weinstein and many members of the Vancouver District School Board. On behalf of the members for Vancouver South, Little Mountain, Vancouver East, Vancouver–Point Grey and Vancouver Centre I'd like to introduce Pauline Weinstein and Tom Alsbury and the other trustees — Wes Knapp, Philip Rankin, and staff. I ask the House to give them a warm welcome.

Orders of the Day

The House in Committee of Supply; Mr. Davidson in the chair.

ESTIMATES: MINISTRY OF
MUNICIPAL AFFAIRS

(continued)

On vote 156: minister's office, $186,675.

Hon. Mr. Gardom moved the committee rise, report progress, and ask leave to sit again.

The House resumed; Mr. Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

HON. MR. GARDOM: Second reading of Bill 16, Mr. Speaker.

MEDICAL SERVICE PLAN ACT, 1981

HON. MR. NIELSEN: In speaking to Bill 16, the Medical Services Plan Act, I would like to offer some information to members in the House and to those who may not be as familiar with the circumstances which, in part, have lead to the introduction of this legislation for consideration of the members.

Mr. Speaker, the concept of medical insurance, or medicare as we know it in our province today, has a history of a significant number of years. For a large part of that period of time, there have been a series of agreements between the two principal parties involving the medicare program. The principal parties, over the last 20 or 25 years, have gone by various names. We recognize the names of the principal parties today to be the British Columbia Medical Services Commission and the British Columbia Medical Association. In some years other terminology was used.

As early as the mid-1960s, there was a term used in the agreements that referred to additional charges, additional billing or additional moneys. Various phrases were used with respect to any amount of money which a patient may pay to a medical practitioner in excess of that which has been agreed to by the principal parties of the agreement. Later renditions of the agreement elaborated somewhat on this concept.

I believe in January 1971, these words were elaborated upon even further. Terminology was used and described to express what is referred to as "balance billing," "extra billing," "extra charging," "differential billing" and other terms of the agreement. I would suggest that a lay-person reading the language of that agreement would find it very difficult to understand the differences between the various terms, and perhaps even what each term specifically meant; although I know a legally trained mind probably would have very little difficulty appreciating the language.

The updating of that agreement next occurred, I believe, in 1974. The section which deals with this situation whereby extra billing could take place was included, as it had been in 1971. It was continued.

Many citizens in the province today find it somewhat difficult to appreciate and understand what this terminology — "extra billing" or "balance billing" — might mean. There is an additional expression now finding its way into the vocabulary of Canadians, and that is "patient participation." I believe that some ad-man probably came up with that expression, because it sounds as though it's something you probably would enjoy. Basically, "patient participation" means that a patient would have the opportunity of participating directly in the payment for those services he may receive.

The problem before those who are responsible for the delivery of medical health services in the country — those who are responsible with respect to government action.... Right across Canada today, the provinces and the federal government are concerned about what is occurring in the medicare plan. The Federal Minister of Health, Monique Begin, has indicated that she is very concerned that continuing moves toward balance billing, extra billing or whatever terminology may be used. endangers the concept of medicare. The federal minister has indicated that in the future the federal government will probably develop very rigid positions with respect to the participation of any province which may permit balance billing, extra billing or similar programs under their medicare program.

The federal minister has not communicated that information directly. It has reached various provincial governments indirectly through the media. It would appear that the federal minister is perhaps suggesting what we may see at the next round of bargaining, with respect to various cost-sharing arrangements with the federal government.

In British Columbia I have stressed over the past few months that while negotiations were underway between representatives of the Medical Services Commission and representatives of the British Columbia Medical Association — the negotiating teams — the government of British Columbia has a great respect for the medical practitioners. In no way should it be considered that we are fighting the medical practitioners. We were engaged indirectly, by way of our negotiating team, with the negotiating team on behalf of the

[ Page 4910 ]

British Columbia Medical Association in attempting to reach agreement on a new fee schedule. My understanding in the reports to me was that the people who made up those teams were conducting their negotiations in a responsible and professional way. The government, Mr. Speaker, is not directly involved in the negotiations where representatives of the government are actually bargaining. It is the Medical Services Commission who are actually conducting the bargaining; the government, of course, is responsible for the Medical Services Commission and also for the settlement that may be achieved.

During those negotiations which occurred during the fall and winter months of last year a series of meetings had been scheduled. The entire demands of the Medical Association were presented to our negotiating team. They were responded to by the members of our negotiating team and many problems were resolved, many modifications were suggested, and there was a certain amount of give and take, as negotiations demand.

On the question of the fee schedule adjustment, Mr. Speaker, I'm advised by our chief negotiator that that which was sought by the British Columbia Medical Association was calculated to represent a 47.8 percent increase over the printed schedule fee, or the schedule fee of 1980. The representatives of the British Columbia Medical Association interpret their increase demand to represent approximately 41.6 percent. I'm quite prepared to suggest that the answer perhaps lies between the two figures, because of the lack of exact science in calculating costs and because there is no way of determining precisely what medical services will be conducted for one year's period of time, but I think that we can agree that the demands of the British Columbia Medical Association, as put to our negotiating team, represented a global fee increase between 41 percent and 47 percent or fractions thereof.

After all the smoke had settled and negotiations reached a conclusion, our representatives on the negotiating team finally offered a global figure of 15.2 percent. Representatives of the British Columbia Medical Association had agreed and followed through by presenting that figure to their members — to the practising physicians or the medical people. The process took many weeks before a response was known, and we had been advised that it would take a period of time for the 4,000 doctors — or whatever the precise number is — to respond to the referendum. Mr. Speaker, the referendum stated basically: "Are you in favour of the offer — yes or no?" Included in the literature which was distributed to the medical practitioners was a suggestion that they should not vote on the offer until the president or the executive director of the BCMA or their legal representative had the opportunity of speaking with them. Included in the information which was distributed to the medical practitioners was a series of statements, one of which suggested that to reject the offer did not force a medical practitioner to balance bill. Another suggestion was that balance billing would be a way to force the government to come up with more money. It was also suggested that there was more money available. It was emphasized several times that rejecting the offer did not commit any practising physician to balance bill.

Mr. Speaker, I would suggest that in my opinion the information which was sent to doctors offered a good case for not accepting the 15.2 percent, but I think it's very important that the question put to our physicians in British Columbia did not ask them if they were demanding 47.8 percent or 41.6 percent, but rather: "Do you accept 15.2 percent?" They overwhelmingly said no — to the surprise, I'm sure, of no one. In fact, I was advised at approximately 11 p.m. March 30 this year that the doctors in British Columbia who are members of the British Columbia Medical Association voted 93.71 percent against accepting the offer of 15.2 percent; in addition, 86.5 percent of the doctors indicated that they would consider the concept of balance billing at their discretion as of April 1.

Mr. Speaker, it was my belief for a period of time that the provincial government or the Medical Services Commission would be advised of the outcome of the vote by the members of the BCMA at noon, March 27. I had been advised of this by our negotiators, and it was also the belief of the chairman of the Medical Services Commission. I was also told that this has been the tradition, although I didn't have the opportunity of confirming that.

I believe it was on the twenty-seventh, or perhaps the twenty-sixth, when we were advised — at least the information reached me — that the information would not be made available on March 27, but rather the week following. I attempted to see if it would be possible for me to receive the information, as Minister of Health, either on the Friday or perhaps the Saturday, so that I might have the advantage of knowing the results of the vote and could seek opinions from my colleagues as to what alternatives the government might consider. I was unable to obtain that information on the Saturday. I did not have the opportunity — nor did I make the attempt — to receive it on theSun day, but I was advised that the information would come to me by telephone on Monday evening. A suggestion had been made that perhaps it would be better to personally communicate the information, and that occurred, as I mentioned previously, at 11 p.m. last Monday. The representatives of the British Columbia Medical Association met with me and two of my colleagues to present us with the information.

I know that this subject is highly controversial and is receiving a tremendous amount of attention throughout the province and probably across the country, but there are a number of facts of the matter which I think members of the House should be aware of. At the meeting last Monday evening, upon receiving the letter addressed to Dr. David Bolton, who is chairman of the Medical Services Commission, which advised Dr. Bolton of the result of the vote, representatives of the British Columbia Medical Association, two colleagues of mine and I discussed the opportunity of any alternatives to what was apparently being demanded, in part, in the letter. The final paragraph says: "In accordance with clause 5 of our agreement with the commission, our members are now at liberty under the terms of the agreement consented to by government to commence balance billing effective April 1, 1981."

I asked representatives of the BCMA if there were any alternatives they might suggest, other than balance billing, to begin April 1. I was advised by the representatives that the alternative, authorized by way of a motion of the BCMA board that evening, for them to give to government was basically that, unless government or the commission agreed to meet the association's schedule — their fee guide — and unless any future agreement retained the protective clause.... The protective clause they referred to was 3(e) of the agreement which basically says that extra billing shall not occur if the offer of the commission equals 90 percent of the association's demand, or words to that effect. We were

[ Page 4911 ]

advised that this was their minimum position. If the government or the commission were to accept the demands of the association, which we interpreted to be 90 percent of 47.8 percent — which perhaps the association interprets as 90 percent of 41.6 percent — and we guaranteed that this so-called protective clause would be continued in any future agreement, then they would not invoke balance billing on April 1.

I might add that this was for a very good reason. If we agreed to 90 percent of their demands, we would have an agreement. Therefore the balance billing would not come into effect. I asked if there were any other alternatives. I was advised that the board offered them no other mandate than making this demand to prevent balance billing. I asked if there was any room for negotiation or arbitration. I was advised that the only mandate provided to the spokesmen was, as they previously advised, that unless the government or the commission agreed to meet the association's schedule and any future agreement retained the protective clause, then balance billing would occur effective April 1, 1981.

I think it's important for those persons particularly concerned about this situation to know that members of the cabinet who met with the BCMA did not — as I was asked today — threaten the BCMA with legislation, nor did any of the members threaten the BCMA with anything. We were not in a position to make a counteroffer, because we had been advised by the representatives that they were not in a position to negotiate. So no counteroffer was made. I attempted to recite very carefully for my own edification what they were demanding of us.

We were advised that negotiations were acceptable at any time, except the minimum required would be balance billing but they had no mandate to offer more than that at that time. We accepted their information; we accepted the letter. It was decided the next day to respond by this legislation.

The legislation before us basically provides that the terms of the agreement which expired March 31, 1980 be continued for an indefinite period until such time as, by way of negotiation or arbitration, a new agreement is achieved. During that period of time, Mr. Speaker, the legislation prohibits the concept of extra billing, balance billing or extra charging. A physician who is a participant in the plan and who would choose to extra-bill, balance-bill or extra-charge could be removed from the plan by the commission. Any charges to patients by that physician would be available through the Medical Services Commission as a direct payment to the patient, rather than to the medical practitioner.

The present regulations and plan provide the opportunity for a physician to opt out of Medicare. That has been the case for as many years as I understand the plan to have been in effect. There was a remark by a former Health minister in British Columbia, Ralph Loffmark, to the effect that the clause which seems to have caused so much difficulty of late was introduced to allay the fears of doctors that perhaps they may be forced to provide medical services under a medicare plan. I interpret that to mean that there would be an opportunity for doctors to have a choice and to opt out of the plan. That opportunity is before them, and it always has been before them.

The clause referred to, the one which seems to permit balance billing, is a very different clause and a very different philosophy. I think the difficulties of that clause have been recognized by many people now. When it was introduced in its earliest days, perhaps there was the thought that it would never come into play. But the clause is so awkward: it simply permits one of the two participating principals to make such an excessive demand that the other could not respond to that by achieving 90 percent. Therefore. according to the clause, balance billing could then occur. because it is expressly prohibited if 90 percent is achieved. When one side is asking for what amounts to 47.8 percent, I think it could be understood that the Medical Services Commission would have great difficulty in coming up with 90 percent of that. Thus, according to some legal opinion, balance billing may occur.

In the negotiations between the Medical Services Commission and the BCMA, the commission does not attempt to advise doctors as to what the fee should be for specific medical procedures. The Medical Services Commission believes that the BCMA is perhaps in a better position to determine the relative values of certain medical procedures. Basically, the negotiations involve a global increase in the medical services payments which will be made. with the Medical Association able to determine any equalization or equity of payments for various medical procedures. This must be vetted by the B.C. Medical Services Commission, but basically it is the BCMA who are given that opportunity to determine how that global amount of money will be distributed. We believe that's probably the best method.

We do receive complaints from some medical practitioners that perhaps a general practitioner should receive a higher increase than a specialist, or vice versa. In the negotiations this year it was recommended that, indeed, there would be a higher percentage increase for general practitioners than for specialists.

Going back to the bill in some detail, as I mentioned, the legislation provides for an extension of the present agreement and the present rates. at least to this time. It also prohibits the practice of extra billing, balance billing or extra charging, and permits that negotiation could continue. It permits that arbitration could be brought in by order-in-council by order of the cabinet, and permits the cabinet a certain amount of ability to determine the terms of reference in effect of the arbitration board or the arbitrator. An example would be how long it may take to come up with a resolution of the problem of the medical-fee services. It also provides, with the ability of the commission, to have a doctor no longer part of medicare should he choose to violate other sections of the bill. It also provides the opportunity of reinstating a practising physician.

Most importantly. the legislation specifically says that any agreement achieved through negotiation, arbitration or whatever method may be available under the act shall not include the ability of extra billing, balance billing or extra charging. The reason for this is that it was felt by myself and others that the problem is not just one of today but one of future agreements as well. If we were going to move in a legislative manner to prohibit extra billing, balance billing or extra charging this year then it would be foolish not to ensure that the problem will not occur year after year.

I want to indicate in the strongest terms that the government and the Ministry of Health do not consider themselves to be engaged in a fight with doctors. We believe the negotiations which took place during the fall and winter were legitimate negotiations and were conducted in good faith. That we were unable to reach an agreement is not that unusual in any form of labour-management negotiations. We were unable to reach an agreement. The offer was put to the members and it was rejected. Therefore we must look to whatever alterna-

[ Page 4912 ]

tives are available. We were advised by representatives of the British Columbia Medical Association on Monday evening that apparently negotiation was not an alternative nor would arbitration be an alternative. The only alternative is: "Please agree to our demands and guarantee us the right to extra bill in the future should we deem it to be necessary." We chose what we felt was a reasonable alternative for government, and it is before us — Bill 16.

I believe we can achieve an equitable settlement with the British Columbia Medical Association and the doctors they represent. I don't believe it's necessary for spokesmen for government, the Ministry of Health, BCMA or others to indicate that medicare may be at the point of destruction. I think we're into a situation whereby we must achieve a settlement through some method which is available to us. I'm not quite sure what that method may be other than the method which is provided for in the legislation.

I might report to the House that I have had no communication from the BCMA since our meeting Monday night. My understanding was that the Monday night meeting indicated the only mandate they had to offer was that we accept their demands and guarantee that balance billing could occur in the future. We responded by introducing Bill 16.

I trust that I've had the opportunity of providing some basic information and limited history as to what has occurred this year.

I have one final point. In speaking with the negotiating team over the last number of months I was advised that for much of the time in negotiations it appeared that a settlement was possible and that a percentage of increase in the fee schedule could be agreed to. In this type of negotiation, of course, the numbers are never constant. There's give, there's take, there are modifications throughout. I was told by our negotiators that it appeared a settlement was within reach at one time, and then suddenly they detected what appeared to be a change in attitude. My negotiators advised me that they felt at that time it was clear an agreement could not be reached based on a percentage increase. For the first time it became evident to them, in their opinion, that the purpose of this year's negotiations was to see that balance billing began, and the negotiations ended.

MR. COCKE: Mr. Speaker, it's a sad day that we have to arrive at a conclusion of negotiations in such a manner as we are doing now. I think probably the unfortunate part of the scenario is that all we hear is one side of the negotiation process. The minister didn't sit in on those negotiations, of course; he was informed. I think what we are looking at today really is almost like the result of what happens when an irresistible force meets an immovable object. Put yourself on either side of that equation, on either side of that table, and hence we are here.

Mr. Speaker, I certainly agree that in a province where we are now paying 35 percent of the entire cost of the medicare system, courtesy of the government of the day, to expect the patient to pay at the other end of the line would be expecting far too much. As far as I am concerned, extra billing, balance billing, double billing or any other kind of billing is totally unacceptable to this party, and that's our policy.

I would like to underline that statement by reading to you a portion of an order-in-council passed on June 6, 1974. Section 3(3) of that order-in-council said as follows: "Subject to subsection (2), where a practitioner renders an insured service to an insured person he shall not be entitled to receive in respect of that service a fee in excess of the prescribed cost under the schedule of costs in relationship to that service." That very definitely put our position on the line.

I have been upset over the last while upon listening to the radio and reading the papers from time to time, and have noted that I have been charged as the one who introduced this question into the agreement. Now, of course, the Premier has told us — and, as a matter of fact, I have the 1971 agreement — that it was introduced by Ralph Loffmark, or the commission that he was responsible for. Poor Ralph — it wasn't him at all, it was Wesley Black, because in those days the Provincial Secretary was the minister responsible. That changed, as we all know, when we reorganized the whole medical service of the province — in Victoria, in any event — and moved medicare to where it rightfully belongs in the Ministry of Health. Anyway, Mr. Speaker, I'm certainly not going to dwell on that.

I agree that this kind of provision means that one can make an inordinate demand. If the government, commission or whoever is responsible cannot meet that demand within 90 percent, then we go to extra billing or balance billing. Certainly we support the situation. We also support the situation where a doctor in free enterprise B.C. who wishes to opt out may do so. In la belle province, the province of Quebec, if a doctor opts out the medicare commission doesn't pay a dime. So really we are being more than fair here with a patient. However, a doctor is not likely to do as well, in my view, if he or she opts out.

Mr. Speaker, as I stand here now, having listened to Dr. Mandeville for the last number of days say on every level of media, "I have been double-crossed," I am wondering just precisely what Dr. Mandeville means by "I" or "we" have been double-crossed.

Does it mean, Mr. Speaker, that he was under the impression that the doctors would be allowed to extra-bill, and that there has been some kind of a change of heart, strategy or what have you, of this government that would bring him to a point in time and a place where he would say: "I have been double-crossed" or "we have been double-crossed"? Was he ever given an undertaking or was he ever given the impression that they would be allowed to extra-bill? It is very strange that we are at a point in time when we have seen a change of ministers at the crucial point. So I wonder, could that have contributed to the resignation of the former minister? I just wonder because I keep hearing it, including this morning on that great public network, the CBC, which is not even remotely related to General Motors, Mr. Member for Dewdney (Mr. Mussallem). I would just like to know why he keeps saying it.

Why do we oppose extra billing? Let me put it very clearly: we didn't have access in 1974 when we made the decision about what has been referred to as Canada's national-provincial health program for the '80s, and this is dubbed the Hall commission report. The Hall commission report, in part, states a number of reasons one would be opposed to extra billing. To modify any position that he might take prior to stating why his opposition to extra billing, Justice Hall says: "The state has not the right to conscript the services of physicians. The efforts to harmonize those conflicting concepts have been unsuccessful in every province." He goes on to talk about his solution, and in talking about his solution he quotes the Stoddard-Woodward study. What did that study say? That study said: "The effect of extra billing on patients' access to care and attitudes toward the Ontario

[ Page 4913 ]

health system...." He went right through it, and this is what happened in their study of the Ontario health system.

"In areas of Ontario where there is a relatively high general practitioner opting out and medium- to high-specialist opting out, approximately one-third of the households have experienced extra billing by physicians. A comparison of income of households which have and have not experienced extra billing supports the suggestion that physicians with relatively high income patient populations are more likely to opt out and extra-bill their patients. Some households respond to extra billing by using multiple physicians. They may go to another general practitioner who has not opted out."

But in any event, what they did find here was that the low-income people, the elderly, the people with fixed incomes — most often in need of the services of physicians — were the ones most affected.

Now they did a survey:

"Most respondents report they did not attempt to discuss their bill with their physicians in his office.

"Sixty percent of those extra-billed indicated that they would be embarrassed to ask a doctor to reduce his fees. There was no difference between the poor and the non-poor in that particular question. There was no difference between the poor and the non-poor in terms of attitude.

"The poor who are extra-billed are significantly more likely to report that they have reduced utilization or delayed in seeking medical care because of the cost.

"In the absence of extra billing no difference was seen in the proportion of poor and non-poor delaying or failing to see a doctor because of the costs. Nearly twice as many poor as non-poor report the cost of doctor services creates a financial problem for them."

On and on it goes. It goes to a point where Mr. Justice Hall says: "I totally reject the idea that physicians must accept what any given province must decide unilaterally to pay." Having gone all through his opposition to extra billing, he says that he rejects the fact that there should be compulsion.

We're in the same position. We reject it. We also listen to what's going on in the province. We've heard from 70,000 members of the federated council of senior citizens whose representative body voted against extra billing. We've heard from the 100,000-member Royal Canadian Legion (Pacific Command) and their representative body voted against extra billing. We've heard from such allied professionals as the RNABC — the Registered Nurses Association of British Columbia — who opposing extra billing. We're offended by the thoughts of doctors' offices being equipped with Master Charge and Chargex. We are totally in opposition to this form of billing.

We see before us a situation that is most unfortunate. I go back to June of last year, and I noticed the headlines "Doctors Unveil Drive for More Money," and "Patients Will Pay if Victoria Balks." That's one of the first headlines, and that was a number of months before negotiations. I thought the strategy then was not all that great. I thought the doctors, who were enunciating the policy of the association — that is leading their strategy — got off on the wrong foot. I don't think that was a great way to start off, saying that if we don't get our way, we're going to extra-bill. That is unfortunately how it happened. That was the foot we were off on long before the association did any real negotiating.

Mr. Speaker, am I to believe that Dr. Bud Lott and his group presented to the representatives of the medical commission such a hard-line position that there was no possibility of negotiations? It's almost unbelievable. I believe that the vast majority of physicians in this province wanted a negotiated settlement. I believe it was achievable, and I'm very sorry that their ends were not met by what occurred subsequently. Of course I've heard from the minister, but also from those very close to the negotiations, that the government was guiding their negotiators — that is the negotiators of the commission — in a very tight way. In other words, I believe there was a great deal of resistance of both sides to make any kind of deal. I've also heard the rumour that they were close at one point. That rumour also includes the fact that there was more on the table for a moment. Obviously something happened, and it didn't occur.

I have gone through editorials and news stories from all over this province, and read letter after letter, and people have been advising for a long time that we were in trouble in this respect. At all costs we must conserve medicare — this most productive form of payment and receiving services from physicians. We thought the fight was over in 1964 when Tommy Douglas fought it out in Saskatchewan. Now we're back to fighting again. On that first part I will suggest that we would be most opposed to extra billing.

I want to ask some questions about this legislation. I believe, in the first place, that this legislation could have included — or could have been used as and might yet be used as — a means to get negotiations going again, rather than resorting to any of the aspects of this, other than the aspect of getting rid of extra billing as a threat. I believe that the doctors should have been offered some form of arbitration before this whole piece of legislation was brought in. The Hall commission suggests arbitration, but it doesn't suggest the clause that's in this bill. Section 6 of this bill isn't arbitration at all.

Interjection.

MR. COCKE: We certainly will vote against this section.

MR. LEGGATT: My way or no way.

MR. COCKE: My way or no way — totalitarian to the end.

They even have the nerve to dub it the "arbitration" section. It's not arbitration., The cabinet appoints an arbitrator or an arbitration board, dictates the terms, provides the turf, and then they wonder why the doctors arc a little bit peeved. How would you feel if you had had your legs cut off at either the ankles or the knees — at some joint, I'll tell you.

[Mr. Davidson in the chair.]

I took time out today — we've only had one day to really study this — and I talked to a number of people who have done a number of arbitrations over the years, some of the most outstanding mediators and arbitrators in the province. When I read the section to them they say: "My, that certainly is a one-sided sort of affair, There is no room in this, unless the government gets up today and says there is some way that they're going to give a commitment that the arbitrator or arbitration board be negotiated."

I rather agree. I would like the government to stand up today and say: "We've made a mistake. We're going to put

[ Page 4914 ]

forward an amendment in committee and amend this section." In amending that section, then they've got to go to the last section of this bill; that is more tyranny. This is the trouble the opposition has with this government. They bring in a basically good principle: that is, the principle of protecting the people from extra billing. But then they make such a tyrannical implementation that it's very hard to justify and very difficult for us to live with. It's a government of extremes.

MR. LEGGATT: Judge, jury, prosecutor — everything.

MR. COCKE: "Judge, jury, prosecutor," my colleague quite rightly says.

As far as I'm concerned, if they bring in a proper arbitration system.... I've got something here to help the Attorney-General (Hon. Mr. Williams) or the House Leader (Hon. Mr. Gardom), if they would like to have a look at it. I'd recommend the education system of arbitration where each side has a chance to pick a person and those two have to agree on the chairperson. What's wrong with that? What's wrong with a little democracy? It's good enough for the education system, but it's not good enough for this government. I wonder what would have happened in the education system if this power-hungry group had a chance to redo what was done years ago in arbitration for the school teachers. Heaven help them!

Mr. Speaker, I have the greatest respect for the medical community of this province, and I don't see why the medical community of this province should be treated as shabbily as they're being treated in these two sections of this bill. That regulation section of this bill could very easily be amended. All you'd have to do is delete (a), (b) and (d). That makes it reasonable. The Lieutenant-Governor can regulate the rest of it. But just to give you an idea, suspending or varying provisions of an agreement in the process....

What is an agreement, when a cabinet by order-in-council can suspend or vary the provisions of that agreement unilaterally? Mr. Speaker, we have had experience with what this government does with that kind of tyrannical power. Will we vote against this section? We sure will, unless the government will use their noggins now and give us an undertaking that they're going to amend. We can provide the wording, because the wording is in many old acts.

Mr. Speaker, this is a very serious situation, an extremely serious situation, a situation that can develop into the kind of confrontation and antagonism that we see today. I can show the ministers, who are responsible for legislative drafting, a number of acts; but I just take them to the education act — that one would do. As far as section 8 is concerned, all you have to do is a little deleting, and that deleting will do just fine, thank you.

Mr. Speaker, there is one other way, but I think it's a little too — as some of my colleagues might say — loose, and that is where the parties agree to accept an arbitrator, and failing an agreement among the parties they go to the chief justice. In a way, that's the Hall commission, except that he starts with the chief justice. But in any event, if the government could give us some sort of an undertaking that they're going to amend, this House can be very happy that we'll proceed with the legislation, the government can get on with other business and the doctors and the Medical Commission can hammer things out.

Now, Mr. Speaker, let me suggest some aspects of what I see. I have been careful not to suggest that the doctors were asking too much up until today or that the government was offering too little, because negotiations were in process. I suggest that if you go across this province, you will find that the doctors have been seen to be getting too little in the offer of the government; they have an extremely good case for getting more.

MR. BRUMMET: How much would you give them?

MR. COCKE: Mr. Speaker, the member for North Peace River with short tenure — he's a one-timer all the way — asks the question: what would I give them? Of course, one can't answer that, even with a great deal more knowledge of the situation than I have. It's something that should be determined at the bargaining table — and it can be determined at the bargaining table if given a chance. He wouldn't understand that; he supports this kind of totalitarian situation.

There is a tremendous amount of support for the doctors, and if we could see to it that half-decent negotiations go on, we would all be much more satisfied in this province. Wouldn't it be lovely if we could go away from here today and say: "No arbitration; get back to the bargaining table; get it done; get back to work, everybody, and let's get this thing over with." That would be what I'd like to see.

The minister said that the doctors demanded 47 percent, or they interpreted their own demand as 41 percent. He said they were hard-line on that. If that's the case, then that's the first time the doctors have ever come to the bargaining table not prepared to negotiate. On the other hand, we hear that the government was equally hard-line. I saw no offer during the time I read the press other than 15.2 percent. Did anybody see it go from 7 to 10 to 12 to 14 to 15 percent? No, one offer, take it or leave it. That's negotiations.

I'm not being an apologist for the doctors. I think they made some mistakes. But I'll tell you right now that the average doctor across this province wants to get this resolved, and you're not going to get it resolved if we leave a tremendous amount of residual anger.

I'd like the minister to table the letter that he mentioned. I think I can demand that he table the letter, by virtue of the fact that he used it as part of his opening remarks. On a point of order, I would ask that that letter now be tabled.

DEPUTY SPEAKER: The member raises a point of order while he is speaking, or is he simply asking at this time...?

MR. COCKE: Point of order while I'm speaking.

DEPUTY SPEAKER: As I understand it, you're asking for tabling of the document referred to.

Hon. members, if the member who was just speaking has concluded his speech, I would have to suggest that if the member takes the point of order at this particular time he would lose his place in debate. I would suggest that he could raise that particular point at the conclusion of his speech.

MR. LAUK: On a point of order, Mr. Speaker, during the course of the remarks of the Minister of Health he referred substantially to a letter and read from it extensively. I would ask that under the rules of the House the minister now table that letter before completion of debate on this bill.

[ Page 4915 ]

DEPUTY SPEAKER: Hon. member, I have just indicated that that request may be made at the conclusion of the speech of the member who is now speaking. The actual time for making such a request is either at the conclusion of the minister's address or at the conclusion of the member's address. I would respectfully suggest the motion would be in order at the conclusion of the address by the member for New Westminster.

MR. LAUK: A point of order.

DEPUTY SPEAKER: Hon. members, just prior to entertaining a further motion from the first member, I will cite page 460 of May:

"Another rule or principle of debate may be here added. A minister of the Crown is not at liberty to read or quote from a despatch or other state paper not before the House, unless he be prepared to lay it upon the table.... This principle is so reasonable that it has not been contested; and when the objection has been made in time, it has been generally acquiesced in."

MR. LAUK: With respect, a point of order is in order at any time during the proceedings...

DEPUTY SPEAKER: That's true, hon. member.

MR. LAUK: ...and a point of order can be raised by any member, even to the point of interrupting his speech. I do so under that standing order and especially to point out to Mr. Speaker that under the rules you’ve just mentioned, the minister has not seen fit to table such a letter. We've been waiting patiently for him to do so, which is the usual course, and he has not done so. I ask, Mr. Speaker, that the minister table that letter immediately; and I respectively submit that it should not, need not, nor can it wait to the end of any other member's speech. It has to do with the minister's speech.

DEPUTY SPEAKER: Thank you for the point of order, hon. member. I have indicated that in that case I would have no alternative but to indicate that the member for New Westminster would then lose his place in debate.

MR. LAUK: If he raised the point of order....

DEPUTY SPEAKER: Order, please. I recognize the member for New Westminster who is seeking the floor on a point of order.

MR. COCKE: No, Mr. Speaker. I would like to resume my remarks, and I'll ask for the document at the end of the remarks. I would hope the document doesn't dissolve, disappear or go up in flames during the period that I....

Mr. Speaker, we were treated to a rather fascinating scenario by the minister. He said — and I have great difficulty with the statement that he made — that three members, or a number of members, from the medical profession came in the dark of night recently and met with three cabinet ministers: himself and two others. He asked at that time whether the medical profession were in a position to make a counter-offer. Under those circumstances, how could that be possible? There were three members of the cabinet asking for a counter-offer when the medical profession was supposed to be negotiating with the Medical Services Commission — three cabinet ministers at midnight or something — and they started discussing whether or not there could be any kind of negotiating. You can't negotiate with three cabinet ministers. They don't have the right to negotiate, in any event. We know they call the shots.

I just find I'm apprehensive about the whole situation. I don't like the way it's gone. I'm also worried about.... For instance, we're talking about an agreement, and I wrote down carefully what the minister said. He said: "We're talking about an agreement that was terminating on March 31, 1980." That's a year ago. I thought the contract probably ended on March 31.1981, but maybe we're not looking at the same contract. I'm quoting him. and I would suspect that there's going to be an answer that maybe he's even talking about a different contract.

He was talking about the whole question of opting out, and I didn't have any access to any quotes of what Ralph Loffmark had to say about that. Ralph didn't do very much with respect to medicare because it wasn't his responsibility. I recognize he was on Treasury Board at that time and so may have made some remarks about opting out and a number of other things, but he certainly didn't do it as the minister responsible. The minister responsible was the Hon. Wesley Black at the time, who, incidentally. has done a report on the distribution of doctors and so on and so forth, and I haven't seen very much implementation of that report.

I believe that the government is in a position now where it can give us some assurance. It can give us some assurance that it will clean up this mess that this bill creates with respect to those two clauses that I'm dealing with. Those are section 6 and section 8, which I contend are a real problem. Just to review our position with respect to the whole question of extra billing, I'd like to quote a paper that is edited by Dr. J. O'Brien-Bell called the Western Medical News. It is probably not one of the most left-wing papers that's ever been put on the face of this globe. However, it's quoting my discussion when Hon. Rafe Mair asked that he be excused from speaking to the Medical Association, and they decided to ask me in his place. I'm quoted here as saying: "I should also remind you that during my ministry the BMA was recognized as representing the medical profession at the negotiating table." Then he goes on to quote me again: "We are not in favour of extra billing, extra charging or balance billing." That was in the paper in July 1980. I think it was in June last year that I said it.

I said then: "However, I am willing to consider a real safety valve" — incidentally, this is before the Hall commission — "with real meaning that will impose discipline on both government and profession in terms of pay. I am willing to consider arbitration or some other method that will satisfy both parties."

Unfortunately. Mr. Speaker, what we see before us today is not something that satisfies both parties. It gives the government the gun. It's bad enough for any government, but this government particularly should not be allowed to have this. If they have any common sense and any sensibility about what they're doing, they will today amend this bill to give a little bit of balance in section 6 and section 7. Let's hear from them very soon. Will the minister — and the Attorney-General (Hon. Mr. Williams) — nod if they feel that we're making a point with respect to this whole question of sections 6 and 8?

[ Page 4916 ]

DEPUTY SPEAKER: Is the member the designated speaker?

MR. COCKE: The member is about to finalize his remarks, Mr. Speaker. We might need one later on. I ask that in the next few minutes the government sincerely rethink what they've done. They've done one good thing: they've outlawed extra billing. The bad thing is section 6 and section 8.

Mr. Speaker, on a point of order, I ask that the letter that the minister read from during his debate be tabled at this time.

DEPUTY SPEAKER: Is there any comment from the minister?

HON. MR. NIELSEN: Mr. Speaker, I believe you re indicating some action on my part. Are you requesting that I table the letter?

DEPUTY SPEAKER: Hon. members, for your benefit I will read once again from May, page 460, chapter 14; Maintenance of Order During Debate, entitled "Citing documents not before the House:" "A minister of the Crown is not at liberty to read or quote from a dispatch or other state paper not before the House unless he is prepared to lay it upon the table. It has also been admitted that a document which has been cited ought to be laid upon the table of the House." I can do no more than cite the information for the member.

HON. MR. NIELSEN: Mr. Speaker, I have no hesitation upon following that directive. I wonder, perhaps, if Mr. Speaker could see that I have the opportunity of obtaining a copy of the letter for use in concluding my remarks this afternoon. I have no objection to tabling the letter, either at this time or following conclusion of my remarks later this afternoon, but I would like to make use of the document in my subsequent remarks.

DEPUTY SPEAKER: If the minister would be good enough to forward the copy to the table, a photocopy will be made and the original returned to the minister.

HON. MR. BENNETT: Mr. Speaker, speaking briefly in support of the bill, I think all of us are concerned about the climate in which the bill is introduced today. Hopefully, in all negotiations — whether in the private sector, between labour and management, in the public sector or in this area of doctors with the medicare system — it is always the first preference that a successful conclusion come from the bargaining system. As we have often seen in the past in other areas, this is not always the case. This time we have the further complicating factor that within the contract — and I agree, it has been in since 1971, reinforced in 1974 — there was a clause that allowed for balance billing to be undertaken, should the rate schedule not be 90 percent of the fee schedule set by the doctors. There was nothing in there to preclude the doctors' fee schedule being arbitrarily increased by 50 or 100 percent, thus making it impossible for the 90 percent to follow. That is the difficulty that we were faced with.

This government very clearly has as its policy that we are not in favour of balance billing, although I understand balance billing does take place in a number of provinces. I don't know whether the province of Saskatchewan is one of those provinces.

HON. MR. McCLELLAND: It is.

HON. MR. BENNETT: The Minister of Energy says: "Yes, it is." British Columbia has never had balance billing. We're one of the fortunate provinces that, to my knowledge, does not at this time have any doctors who have opted out of the medicare system. The doctors in the medical profession in this province deserve a lot of credit.

I remember — and the member for New Westminster (Mr. Cocke) took a lot of pride in it — the major fight over medicare in Saskatchewan under Tommy Douglas. There were hostilities. A lot of things were said and acts undertaken that I wouldn't brag about, but would regret. I look back on the way medicare was brought in in this province — the second province to bring in medicare — and it was with great cooperation from the doctors. Because of them, it came in peacefully. I can remember the high opinion the late Premier W.A.C. Bennett had of Dr. McCoy and others for the way in which they assisted in developing the medicare system in British Columbia. They're to be given credit that over the years they have been in large measure responsible for our having an outstanding health service within this province.

It is not with any great glee that we're here today passing a bill that apparently has us in conflict with one of the important ingredients in the delivery of health care in this province. Nor is it a time when partisan politics can be usefully employed in debate to assist the situation. Of course, negotiations do not take place through the newspapers. Responsible negotiations by professionals within the system — whether they're employed by the government or the medical profession — take place at the bargaining table. The publicity game is for those who would play politics with bargaining. We've seen that in other areas in this province; but we certainly don't want to see it played here, nor do I believe it has been played. There is a case to be made, because public funds are being employed, that the public should be informed on how much the medical plan will cost through taxation. It's their plan; it's being assisted by public funds.

Some mention was made by the member for New Westminster that the people of the province pay 35 percent of the insurance program through premiums. I was not sure whether he was suggesting — because his other remarks were dealing with those on low or no income being unduly burdened in this way.... I want to say that in this province there is assistance for....

MR. COCKE: Read your budget.

HON. MR. BENNETT: Certainly it's 35 percent for those who can afford it, but the member well knows that for those who have low income, part of the premium, or in some cases all of the premium, is paid for them in this province. I wouldn't want the implication to be left that the unfortunate in this province are penalized with an unaffordable premium, because that too would defeat the principle of medicare. While there are premiums that do relate to the cost of medicare, the poor and unfortunate in this province are assisted by government, and in many cases totally assisted so that there is no cost to them at all.

MR. COCKE: And the rest are paying 33 percent.

HON. MR. BENNETT: Yes, under insurance there is a premium for those who have the ability to pay. I wouldn't

[ Page 4917 ]

want the implication left that somehow the poor were being hard done by in this province, because our system has assisted them at no cost for many years. I only want to clear that up in case a misconception may have been spread, and to assure them that this will continue.

Now what do we want to achieve? Obviously, the best thing to be achieved would be to have an agreeable conclusion without hostility. I fear from the tenor of the argument taking place — not in this House but outside, as I had the opportunity to hear some portions of radio shows — that people have missed the point. I don't think we should encourage some of the discussion in which people are either attacking doctors or saying that they're getting poor service, because I believe that by and large in this province they get the best service in this country. I would hate to see the argument extend beyond how we're going to finance medicare in the future and how we will deal at this time with the policy of no balance billing.

Hopefully, because there are a number of options contained within this bill, we'll get a conclusion — whatever option is chosen — and the manner in which it's carried out will give satisfaction to both the public at large, who pay for the scheme through taxes and fees, and the medical profession, and the working relationship we've had for these many years since the inception of medicare will continue.

I think this is not a time to inflame the situation. I hope that from today, with the passage of this bill in this House — and I'm hopeful it will be unanimous and go on record as opposing balance billing — the contract settlement can be achieved on those other matters that are contained in the negotiation without that being a complicating factor. I take it from what I've heard from the other side of the House that their position today is that they are not in favour of balance billing, although that is not the position of all the New Democratic Parties in this country. So, Mr. Speaker, in that vein I would hope that the debate will not be confrontational or picky, but that it will, in fact, try to help us create a climate in which a very positive conclusion can be achieved.

My only comment to the people of the province whom we represent — and amongst them the doctors of this province, whom we also represent — is that we recognize that this Legislature and the government have a public trust: on one side to ensure the provision of health care, on the other side the responsible management of that health-care program by the moneys sent by the taxpayers of this province to government. The government does not intend to be cheap; in fact, the government intends to be able to provide the best healthcare system with fair compensation to the medical profession in this province. Sometimes, to achieve that in dealing with a dispute between different parties requires the wisdom of Solomon, and in any dispute not all parties are happy. When the agreement is concluded, I'm hopeful in this area that most of the people in the province will be happy — happy, at least, that we have ensured the medicare system and enshrined the principle that balance billing will not be a part of it.

Mr. Speaker, I don't quarrel with sections of this bill, because there are a number of options open for a successful conclusion. I support the bill wholeheartedly, and I would hope that during the rest of the debate we perhaps could focus on what we're trying to achieve — and that is a successful conclusion to a very difficult problem that is brought in in a difficult climate. I would hope that no member of this Legislature will take the opportunity to try and make that situation worse.

MR. HALL: Mr. Speaker, the Premier never fails to amaze me. He'll catch it on the squawk box, I'm sure — one of his many executives assistants will tell him what I've said. But he said he didn't want politics injected into the argument, and then tries to slide them in himself, when he said that he didn't know whether our opposition today was the same as other New Democratic Parties across the country. Our opposition to this bill is what we will say it is today, Mr. Speaker. Within the confines of the debate on this bill, I don't give a damn what other New Democratic Parties across this country have said. This is the position we have, Mr. Speaker,

If I wanted to, I'd go and try and find out what the position of the other Social Credit Parties — if there are any — in other provinces is. Perhaps I could go to the library and find out what the policy of the Edmund Burke Society is in Ontario — it provides most of the Ontario Social Credit candidates, who by most normal human standards would be banned from seeking public office. And he says don't introduce politics into the debate!

He couldn't even understand the reference to what has already been provided to pay for medicare in this province. The Premier of our province, architect of the budget, I presume, couldn't even understand that 35 percent of the cost of medicare is provided by direct premiums already and his own Minister of Finance (Hon. Mr. Curtis) will tell us that. What the member for New Westminster (Mr. Cocke) was saying is: "Enough is enough — no more dollars from ordinary people's pockets to pay for the cost of medicare."

What the member for Langley (Hon. Mr. McClelland) is trying to say when he says that the provinces may or may not do something is all very well and good, but other provinces don't have premiums for medicare. May I also say that it wasn't this side of the House that tried to inject politics on the "Webster" show on Monday morning about where the balance billing came from. It was the member for Okanagan South (Hon. Mr. Bennett) who introduced politics...

MR. BARBER: And he got it wrong.

MR. HALL: ...and got it wrong.

The history of this particular subject, medicare....

Interjection.

MR. HALL: We're just straightening out the record because you don't do much reading. You haven't been here that long, so you will learn something,

When W.A.C. Bennett introduced medicare in this province, to his credit, without very much trouble whatsoever he put it under the charge of a minister whose administrative capabilities he was sure of — he put it no higher than that — Mr. Black. It remained in those capable hands of the Provincial Secretary of this province from the day of its inception until I, as the Provincial Secretary in 1972, instituted an order-in-council transferring it to the Ministry of Health. For the Premier to suggest that somebody might interject politics into this debate seems, as I say, a little strange — coming from somebody who has himself on three separate occasions tried to interject politics into this debate...

MR. BARBER: And made two separate mistakes.

MR. HALL: ...and made mistakes on the way along.

[ Page 4918 ]

I remember attending meetings of the Medical Services Commission in the winter of 1972 before I handed it over to the Minister of Health, and saw the members of the Medical Services Commission who were responsible for the clauses that the present Minister of Health has read to us today. Who were those members? There was Mr. Jeffrey Stewart, a longtime senior public servant in the 1960s into the 1970s. Another member of the Medical Services Commission at that time who saw the incorporation of that kind of thing was Mr. Jerry Bryson, Deputy Minister of Finance. The lawyer who dealt with the negotiations of the Medical Services Commission at that time was Mr. Jerry Cross — a long-time public servant in this Legislature at that table, and latterly Deputy Provincial Secretary in your administration. So for the Premier to try to suggest those kinds of things is really not very good.

The negotiations that have gone on, if one can so describe them, between the doctors and the government, through the agencies that they both use have obviously been long, difficult and — perhaps more to the point — unsuccessful. I thought we would have been treated today — and I think the House should have been treated today — to a chapter and verse account by the Minister of Health, new though he is in the portfolio, of what has happened. We didn't get that. We got one passing reference to the fact that somewhere along the line some accommodation was made; there were some things settled. There is nothing at all in the way of a report, as we face the Draconian measure. There is nothing in the way of a report at all about what has happened in those bargaining sessions.

The agreement that we've talked about already goes back some 15 years. We saw the first mention of what we're trying to outlaw today in January 1971. Both sides of this House already through the Minister of Health, the Premier and the critic on our side have indicated to you, Mr. Speaker, that they are against the concept of extra billing — the federal government too. We are, however, in favour of better negotiations. It is obvious from the figures the Minister of Health has quoted that there has been no movement on either side. If there had been some movement, I think we would have heard about it. If there has been movement there is still time for us to hear about it when he sums up second reading in this debate.

[Mr. Strachan in the chair.]

I was phoned by a couple of doctors today, one of whom has already been mentioned today, Dr. O'Brien-Bell. He happens to be a constituent of mine, has run for political office, has been an alderman in Surrey and, I think, ran provincially in one election — although I think it was in the Delta riding he ran provincially. He rang up to discuss this bill with me. One of his calls was for fairness, and I think that's the call that should go out today — for fairness. I think what the public expects to be produced today is fairness.

I have little in common with Dr. O'Brien-Bell politically. I remember his District 6 newsletters and many conversations I've had with him. But he too was disappointed by the arrival of this bill yesterday; he too has characterized it in strong language. The other doctors have characterized it in the language used by my colleague, and I think we're entitled to ask again why the word "double-cross" was used. Why was such a strong, harsh word used when this bill was introduced? What was the understanding of the doctors that they would seek to use a word as strong and with such implication as the word "double-cross"? Those are the questions we'd like the Minister of Health to answer when he sums up on second reading.

A 93 percent rejection vote is one thing, although I've been around labour negotiations, acceptance votes and decisions to take certain courses of action for long enough to know that oftentimes one should get a strong vote in order to strengthen the hands of one's negotiators. It seems to me that something must have been in the doctors' minds when we got such an outrageous statement, considering most of these kinds of meetings are at such a high level. On the other hand, when we examine the history of the relationships that have been taking place between this government and the doctors over the last six months, perhaps it's no surprise.

I don't know what the previous Minister of Health led the doctors to believe; he's gone. I don't know what promises he made or whether the ministers on the other side know what promises he made. I do know that he wouldn't see them, and that's hardly the start of good negotiation. That hardly sets the stall to allow your people to do a good job for you if you at least don't give them a good launching-pad — if you don't do the normal, human, courteous thing. I read in theVancouver Province on March 9 that Dr. Alex Mandeville says he has only met our current Minister of Health once, when he spent 12 minutes with him and had the opportunity to speak to him for about 15 seconds. Far be it from me to tell the Minister of Health how to conduct his portfolio, but that seems to me to be an awfully short period of time to exchange a few pleasantries with the leader of the doctors of this province. If Dr. Mandeville's wrong.... If that's the best our new Minister of Health and Dr. Alex Mandeville could do in terms of meeting each other, then I don't think we're being particularly well served. That's what I'm saying: that the public — doctors and patients alike — should expect from this bill and this Legislature fairness and better negotiation, and it's got to start somewhere.

We've all had enough material from the BCMA to read into the record all sorts of things. I saw the minister hold his copy up, and I suppose if we took a federal government proposal seriously we could now file this with the Clerk and have them all printed, if I understand what's happening in Ottawa to be correct. Nevertheless it was a good package of material that was sent to us and reminded me of some of the wars of the clippings that used to take place in this House before we had a Hansard.

May I now turn to the bill and the offensive sections that my colleague for New Westminster has talked about. They are contained in sections 6 and 8.

If the negotiations have failed as miserably as they obviously have failed, then either somebody is going get stiffed on this or somebody isn't going to get stiffed. It seems to me that one of the ways to avoid that is not to follow the course of action as laid down in Bill 16. The only way in which we're going to get fairness, the only way in which we're going to be observed to be fair and the only way in which the public, the taxpayers, the doctors — the participants in all of this — are going to really feel as though they've had a last gasp chance of coming out with a meaningful package, is to alter section 6. I heartily echo the words used by the member for New Westminster that this is really kangaroo court, Star Chamber stuff. These are tyrannical, sweeping powers. It's all of those things that I remember hearing so often between 1972 and 1975.

[ Page 4919 ]

I'm going to tell the member from Vernon (Hon. Mrs. Jordan), for instance, that if this had appeared in a piece of New Democratic Party legislation, we wouldn't have heard the end of it for days and days. I want to go to Vernon, Mr. Caucus Chairman, and walk around with section 6 and tell the good people of Vernon what has happened and what kind of deal is going on in terms of the new Social Credit administration. If ever I saw the kind of awesome power — jackboot legislation — that they used to fondly and shrilly cry about, it's contained in section 6. I do hope that the Attorney-General and the House Leader will take whatever last looks they can at this legislation. Frankly, it's not necessarily doomed to failure, because they've got the numbers over there — they've got this huge majority that they can sweep all this through whenever they want — but it will last and taste in the mouths and the minds and hearts of people in British Columbia when they see a Star Chamber arrangement like that.

HON. MR. GARDOM: Mr. Speaker, I support the legislation, but I want to say that it is saddening because I regret, as certainly does my colleague, the Minister of Health, that the impasse is occasioned and that the impasses had to result in Bill 16 being in front of this Legislative Assembly this afternoon. I do concur with the sentiments of my colleague, and we in government do have the duty — and indeed the responsibility — for all of the people and taxpayers to represent the public interest. As such, we are trustees for the taxpayers in our province and for their tax-paid clear dollars.

I also sense some very understandable frustration in the minds of certain of the medical profession that their historic income leadership has been affected over the past years, and indeed I think it is a fact that some doctors today, by virtue of overhead increases that are beyond their control, are perhaps incurring a loss of personal return for that which they earned and enjoyed some few years before. They express concern about this.

What they're facing is what I would call the "income compression syndrome." I've heard said to me — and I hope this is correct — that the house calls of a plumber, or a veterinarian or whatever are in excess of that allowed for a general practitioner. Everyone in society would raise some questions about that. Should a baseball player make a million dollars a year? Personally, I don't think so. I think that this is perhaps a sign of a society fast becoming decadent, and particularly when those kinds of returns are never really related to essential activities, but perhaps most of all to hedonistic activities. Are there going to be cures for that type of thing? I don't know, but I do know that the pediatrician of this world, the general practitioner, the heart surgeon, the minister and the priest are worth a dickens of a lot more to this society than these people who are receiving these outlandish returns at the present time.

I have to pose a few questions to which I don't know the answers at all. I doubt very much whether anyone in here has the answers to them, and I don't know if the medical profession has the answers to them either, but they're matters which the profession will find itself debating — and correctly so — over the years to come. They will deserve debate and will indeed deserve consideration, because we are living in our country under the most highly commendable philosophical and sociological direction of making medical aid, treatment and care affordable and available for all of our citizens. I think that's a commendable route for a country to take, and I don't think we should move back from that one iota. We are also aware of the fact that that kind of care, treatment and aid imposes a huge impost upon the taxpayer and upon the public purse. It cannot be open-ended. It has to be shepherded, and that's the responsibility of the trustees for the taxpayer. That's what the government is. What the market can afford only refers, in this instance, to the one market — the Canadian taxpayer. Hence we're facing these inevitable tugs and pulls. We're going to be facing those, not just today, not just in this debate in this Legislature in 1981, but insofar as medical care is concerned we're going to be facing these tugs and pulls right across the country over the years to come, unless — God forbid — we ever decided as a country or as a province that we would not have the taxpayer receiving the kind of medical treatment that he's receiving today with payment from the source being taken care of.

I pose this question to the medical profession. I'm not advocating it, but it's a question that in my view they should be debating. Maybe the fee-for-service system is anarchistic. Maybe the payment for skills should not relate to specific parts of the human body or for special services to specific areas of the human frame. Maybe there should be hourly rates with pay for certain specific skills. I don't know. Maybe it should be taken into consideration where those skills are performed — in a facility that is totally publicly supported and paid for or in one that is privately supported and paid for by the doctor himself.

MR. SKELLY: Lawyers too?

HON. MR. GARDOM: I'm going to speak about lawyers in a moment, my friend.

Maybe the process of taxation or the review of accounts should be more carefully looked at than is done in the medical profession at the present time. My friend across the floor refers to lawyers. We do know that there is a process of taxing bills of lawyers. Lawyers are doing work on the basis of hourly rates and on the basis of documentation. I think the legal profession has a similar responsibility to check into that to see whether or not their processes are anachronistic.

I think these are the problems that the profession across the country is going to have to pay more care to. I think they themselves often question whether a gall bladder should have a greater degree of return than a tonsillectomy or whatever. These are problems in which we in government and the citizens of our country are going to have to receive some guidance from the profession.

Mr. Speaker, I've said at the outset that I'm supporting the measure. I'm looking forward to the closing remarks of my colleague. I would close by repeating that it is regrettable that this type of legislation is before the House, but unfortunately it is necessary.

MR. NICOLSON: We heard some very stimulating thoughts from the previous speaker: however, he didn't really address this bill. This bill with its section 6 and section 8, while it seeks in principle to redress an emergent problem that we're faced with, certainly has two aspects that are very clumsy and very unfair. In fact, to give credit to my colleague the second member for Victoria (Mr. Hanson), this is an unbalanced bill. We have heard leaders of the medical profession say that they were double-crossed.

One looks at the strange circumstances of the departure of the former Minister of Health, Rafe Mair, in a most unex-

[ Page 4920 ]

pected way. I can't think of a member I ever saw come into this House who was more suited in terms of actually enjoying this House; a person who fit in, not in terms of my agreeing with his political philosophy, but who was at ease in this House and almost seemed to be moulded to sit in here and present the conservative point of view in the Legislature. Why would a person such as this, who obviously enjoyed his political role, depart in such an unexpected manner? We have the people in the medical profession, and I think that like my colleagues who would seek to lead the teaching profession, in dealing with this government they have been a rather naive group. When they say that they've been double-crossed, I believe them. I think I know why they've been double-crossed. I think I know why Rafe Mair left under such unusual circumstances.

During the budget debate I referred to some of the questions that were enclosed in a Martin Goldfarb public opinion sampling, taken late in December and, I think, submitted to the government in early January. One of the questions in it was: "Do you think any of these groups are carrying more than their fair share of the tax burden?" Does, does not. One of the groups identified was professional people — that is, engineers, doctors, lawyers.

More specifically, there were questions such as:

"Under our current medicare system people are not charged when they go to see their doctors or for the medical services they receive. Some people have suggested that this has led to rapidly rising medicare costs, because people abuse the system or are encouraged to seek medical attention more often than they need to, because it is free. How much of any abuse of the medicare system do you think there is — a lot, some, only a little, none?"

A little more specifically, question 4 (c) asked:

"Would you like to see the government impose a nominal fee on each patient each time he or she visits his or her doctor, in order to discourage abuse of the medicare system — yes, no, no opinion?"

[Mr. Speaker in the chair.]

Most important and, I think, most alarming is:

"In most provinces doctors fees or rates are set by the province in conjunction with the provincial medical association representing the doctors. In some provinces some doctors have decided to opt out of the medicare plan in order to increase their fees. Instead of being paid directly out of the province's medicare plan, these doctors ask the patient himself to collect from the plan and then pay the rest of the higher fee on his own. In this way, opted-out doctors can charge fees higher than those set by the province's medicare fee schedule. Do you think the provincial government should permit or prohibit this practice?"

Permit, prohibit — those were the two choices.

It's strange that the results of this questionnaire — which I believe was in the government's hands probably just shortly before the resignation of Rafe Mair — should come in. It's strange that the profession should say that they've been double-crossed. Yet it does make some sense. There is a little bit of an explanation here, when we see that the government right at that time was sampling public opinion. It probably got a very resounding "prohibit," when up until the time that this questionnaire came into their hands they had probably agreed to allow some kind of balance billing.

As one who has seen this operate in the United States — I am fairly well versed on how it works down there — it's something I certainly don't want to see here. I think that is why the government is in trouble. When you do not bargain in good faith, when you move the goal post — as we have heard said was done; I believe that that is what was done.... That is why, I think, that type of collective bargaining process — such as it was; it's not complete collective bargaining — failed.

I am in favour of the aspects of this bill which will prohibit extra billing. Sections 6 and 8, particularly section 8(d), in which the Lieutenant-Governor, if they impose and pick an arbitrator, and then have their arbitrator impose an arbitration.... If the government doesn't like the arbitration under section 8(d), they will then be able to change the agreement as they like. In other words, there is no agreement. The Lieutenant-Governor-in-Council will be able to change it any which way he pleases. I don't think that is the way to prohibit balance billing in this province. I think it can be done in a much better way. The sooner we get back to fair treatment and trust on both sides, the better it will be for all people in this province.

MR. SPEAKER: The Minister of Tourism.

HON. MRS. JORDAN: Thank you, Mr. Speaker.

MR. COCKE: How did your husband vote, Pat?

HON. MRS. JORDAN: Well, of course, that's the sort of infantile, ill-thought-out remark we've come to expect from the opposition.

MR. SPEAKER: Order, please. I would encourage the hon. minister not to be so easily deterred from her....

HON. MRS. JORDAN: Well, Mr. Speaker, as a delicate flower from the countryside of this province I have to maintain my sensitivity in order to serve well those people who send me here.

It was interesting to hear the comments of the opposition, and to see their opposition to section 6 of this act, which only serves to reinforce the fact that it's very evident that they're not listening or thinking or doing their homework. It has been said by the minister in this House that as late as last Monday at 11 p.m.... After many hours of negotiations and many overtures by the government negotiating team and the minister to ask the physicians' negotiating team if they would come back to the table if there was an avenue through which this could be resolved, and being told no, the government is forced to take the position it is taking today.

It is hard to rationalize the position of the opposition when one thinks that their own members stood up in this House when they were government.... The then Minister of Transportation said in the ferry settlement: "What could I do? They had a gun to my head." Today we hear those members saying: "Don't be too firm; don't be too tough; tippy-toe on forever." This government will not let anyone put a gun to its head, because it represents the interest of the people and we have a responsibility to take a position. Secondly, every effort has been made to meet a reasonable settlement with the physicians. They themselves have endeavoured to cut off and have cut off negotiations. Therefore, if we're going to deal with this bill and we do not believe we

[ Page 4921 ]

can accept balance billing, we have to do it openly and aboveboard. That's exactly what this bill does.

I am breaking a silence that I've kept in this House for 14 years. I have never spoken in relation to physicians, or any areas that would affect my family in that sense, probably unlike many other professionally associated people in this House. I rise today to address this debate with considerable concern and great regret, because in this province we have and enjoy the highest standard of medical care for the most number of people anywhere in the world. In this province we have the greatest opportunity for the trained and scientific mind and artistic abilities of the physician to live one of the highest standards of living in the world, to practise in the greatest area of freedom in the world, and to have an assurance that his returns will be guaranteed if not the greatest in the world.

That came about not because of the type of frivolous debate we've heard in this House or some of the statements that have been made outside of this House, but because of a genuine desire of a government of the day and a profession of the day to meet their obligations to the citizens, and because of a genuine time-honoured till the end of the earth — that no family should be wiped out financially by the devastations of illness. We'll never cure all illness, but at least we can go to great lengths to try to cure the financial complications that exist in many areas of the world today, including our good neighbours in the United States, and which existed in this province until the time of W.A.C. Bennett, the Social credit government and the practising physicians of the day. Mr. Speaker, that is intolerable. The devastation of illness in its narrowest and broadest implications — as you yourself know, sir — is most difficult to bear. It's because of this that I stand,

I must first address myself, as probably no one else in this House can, to the leadership of the British Columbia Medical Society and team. I was appalled when I turned on the radio at 6 o'clock today to hear a representative of one of history's most respected professions use such words as "double-cross" and liken the situation of the practising physician in British Columbia today to that of the workers in Poland. To be most charitable, I could suggest that those statements and many others, which I don't intend to quote, were intemperate. In making those statements, I suggest a gentleman of a profession of great honour, representing hundreds of people in this province in terms of their dedication and their families' dedication, not only removed himself from the realm of a responsible, knowledgeable leader and negotiator, but he took with him those families and those professionals who were relying upon him to represent them.

Mr. Speaker, the position of the physicians in their negotiations at this time has not only been greatly weakened by ill-advised negotiating teams, but has been almost devastated by the statements of its leader. Part of the art of medicine and part of the ability of the physician to cure today, even in this highly sophisticated time of medical practice, depends upon the confidence the patient has, not only in the profession but in his or her own physician. I suggest to you that today's display has weakened that confidence and that many a citizen will say: "Good heavens, if a responsible doctor — not only a scientific and artful physician but a leader of the physicians — behaves in that manner and reacts in that sense under duress, is that a characteristic of the profession and is that a characteristic of my physician?"

Mr. Speaker, this is purely a personal statement, but I must tell you that I, as a member of a family whose money is going to support that leader and that negotiating committee in the best interests of health care the patients and the physicians of this province, am ashamed and embarrassed, and I can only hope that the public will understand.

I'd like to make it very clear, in supporting the position of our government and being part of the decision-making process, that I firmly believe that 90 percent of the physicians in this province — be they researchers, family practitioners, public health physicians or specialists — are very hard working and dedicated gentlemen who have spent years of their lives in a highly intensive program which has precluded them from other enjoyable activities and other economic benefits that are open to other processions and trades.

MS. SANFORD: No women, eh?

MS. BROWN: Are you not prepared to recognize their existence? Disgraceful!

HON. MRS. JORDAN: Mr. Speaker, there are women in the profession.

MS. BROWN: It's about time you found that out.

HON. MRS. JORDAN: If the opposition wishes to single out women.... I happen to think of the profession in total — I'm sorry.

MS. BROWN: They are all men, eh?

HON. MRS. JORDAN: Mr. Speaker, behind and beside those people are families, wives, husbands and children who by and large have themselves contributed greatly to the professional development of those individuals, who themselves have known simple interruptions that few other families know, such as looking forward for months to a picnic and, once again, finding it interrupted just as the family is ready to leave. The average physician in this province is not concerned with the dollar; they're not businessmen and they're not investors. They seek no more than to practise good health care in a healthy climate, have enough money that they can enjoy some of the nice things in life, as others do, and take a holiday once in a while if they can get off, and not have to be worrying at the age of 55 or 60 or 65, when their best years are gone — and their best years are least long of almost any profession — how they are going to live and support their families.

I suggest that average physicians in British Columbia today are deeply distressed by what is happening. They are finding themselves way over their heads in understanding this. I can't forget, nor can we not mention at this time, that too often the physicians in society have been everyone's favourite indoor sport. It's been very fashionable — whether you're Reader's Digest, members of the opposition or perhaps even from time to time members of my own party — to make sweeping statements about physicians and their incomes, their dedication or lack of dedication. But I put to you that there are certainly those in the profession that cause embarrassment, but no more and perhaps much less when one looks at the stresses of the profession than anywhere else. I put to you that this has been very offensive to many physicians and their families. It's been very difficult for their

[ Page 4922 ]

families, because of the sacrifice they have to make in being part of the team that attains the goal of good health care.

The blue book — and I mention it because I don't overlook it — has been, and is, a constant embarrassment to the physicians, not because they resent having their returns from the Medical Plan published, but because of the manipulation that goes on with those figures and the misinterpretation that is left there. Those are gross figures. Most physicians hire registered nurses, cleaners and any number of people in their offices, to help provide a plant at their own cost that contains the best possible climate for the practice of medicine.

MR. NICOLSON: Who published it in the newspapers?

MR. BARBER: It was W.A.C. who did that.

HON. MRS. JORDAN: We're again hearing foolish comments from the opposition, who, as is their custom, have not yet in this debate been able to be open and frank.

The member for New Westminster (Mr. Cocke) might well own up, during the debate in this House, to the fact that he was the man who, when he went before the medical society and promised the moon, caused some of the confusion the average doctor is experiencing today. He promised pension plans, dental care plans, increases in wages and freedom of movement between patient and physician. He promised everything, but he didn't tell them he didn't believe in balance billing. So perhaps the physicians would be wise to look at those promises made by the opposition, who are constantly moving back and forth in this debate.

I don't think that in this debate we can overlook the fact that there are many inequities that exist within the payment system as designed by the physicians themselves, and that this matter should be addressed within the profession. But it should not part of the thinking at this time.

I believe there is ample room in this province for the patterns-of-practice committee of the physicians to have more opportunity to take action where abuses and inequities exist. But that should not be part of the discussion at this time.

When we address ourselves to the bill before the House today and the current situation we experience in British Columbia, I think that, on the average physician's mind at first blush is the thought that balance billing is an answer. I believe many of them out there sincerely thought that this could have appeal, that it could provide less burden on the taxpayer, that it could lead to control of abuse, that balance billing in itself would be controllable in its escalation and that doctors would make more money or be able to receive a fair return for their efforts. But I would suggest this is not so, because many of the costs built into medical care today go much further than the doctors' daily billing practices. Part of it goes back to the training, and this is something we as a society must address if we're not to develop a system which we can't afford to use because of its cost. The training in medicine today leans very heavily on expensive practices and technical diagnostic aids rather than artistic diagnostic aids. This is something we must think about when we talk about the cost of medicine.

Billing procedures and faulty payments in themselves will be very cumbersome and costly to the average physician. On the whole they are not business people, and I believe many of them appreciate this and are very concerned about it. Will it keep the cost of medical care down? Mr. Speaker, the cost of operating a balance-billing service is such that it will build in its own increases regardless of whether the physician has a desire to keep it down. A deterrent to those who would abuse the system? I suggest not. Those who are not able to pay would still receive the service. Those who would abuse will continue to abuse, because the abuser generally tends to be a person who doesn't have a conscience in terms of his responsibilities, and those would fall into the area of uncollectable debts. Therefore, ever more a burden would fall upon the taxpayer. Abuses on both sides should be curtailed, but not through these negotiations.

In my mind there's no question that balance billing would see the introduction of a two-tier medical care system in British Columbia. This would eventually lead to one system for the rich and those with influence, and another for those who are not necessarily poor, but with no influence. We learned, after experience rather than before, through reason and research, that a balance-billing system can lead to the destruction of a medicare system.

Mr. Speaker, as I mentioned before, I've broken a 14-year silence. I would reaffirm my belief that the government, through our minister and the negotiating committee, has acted in good faith. The minister had said publicly that he would not negotiate through the media, and he hasn't. I don't believe there was any doubt in anyone's mind in British Columbia who has followed the medical-care system in this province through the years that the government simply could not permit balance billing. I suggest that for the head of the negotiating committee to say that Mme Bégin really doesn't mean anything when she says that she's concerned only exemplifies the naivete of that individual. It's my personal conviction that the federal government would be concerned.

Today the doctor and physician in training do not experience the poverty days of the past. They receive a reasonable stipend for their training period, and therefore they can enter into their income-earning days in a better financial position than they could previously. There is the opportunity for a physician to treat a patient and to be sure that he has an income. I believe that the patients want to see their physicians fairly paid in British Columbia, but I must reaffirm that I believe that no family or patient should be wiped out by the cost of medical care. The responsibility for this government at this time is to guard the future of medical care in British Columbia, to protect the taxpayer and, as much as possible, to see that the medical-practice climate in this province is as free and as healthy as possible and that the physician does receive a fair return. Earlier in my presentation I rejected comments made by the leadership of the medical negotiating team. I would call upon him, as one of the families involved as well as a member of this House, to please come back to the bargaining table. If there was a mistake in negotiating themselves into a corner, then that can be rectified. It would take no more, I'm sure, than a phone call, and this bill that we all regret bringing in would never have to be applied.

MR. LEVI: The previous speaker said that she was breaking a silence of some 14 years. I regret very much that she didn't continue that silence for another 14 years, because her remarks have added nothing. She referred to some of the behaviour of the leadership of the doctors as offensive. Frankly I found her remarks very offensive, in view of the situation that we are in. This is really very much a historical moment, because we have had to legislate with respect to double billing. The whole safety of the medicare system is at stake, and that decision has been made. What I wonder about is that because the bill passes.... There are certainly at

[ Page 4923 ]

least two sections in there that are as offensive to us as I think they must be to the physicians — particularly the arbitration one. I begin to wonder what is going to happen tomorrow, and how people are going to be able to come back to the bargaining table when they're looking at an arbitration system which is somewhat offensive. That creates great difficulty, and then we have a member of the cabinet get up and add to this kind of offensiveness, particularly by the remarks she made about my colleague from New Westminster (Mr. Cocke). She comes in; she's ill-informed; she makes bombastic statements and then goes on to break her silence.

Last year in the Medical Journal for May 1980, in its page on the Ministry of Health, the profession said:

"In B.C. the four basic principles of medicare — portability, universality, comprehensiveness and public administration — are being upheld. The Ministry of Health remains committed to them.... The issue of reasonable compensation for service providers is a great concern. Regardless of the current situation in British Columbia, the activities of national associations are sure to bring the remuneration of health professionals to the forefront...."

This was written almost a year ago.

"The issue of physician remuneration is difficult to rationalize within any social system. Some groups believe that there is nothing wrong with the system that cannot be cured with money; that physicians will not opt out and bill patients more, if they get more through the Medical Services Plan, "

Mr. Speaker, in May of last year the position was that it was reasonable. That was a reasonable position to take — particularly their remark about the rationalizing the issue of physician remuneration within a social system. It is difficult. We heard this afternoon the Minister of Intergovernmental Relations (Hon. Mr. Gardom) take a stab at it, and his comparisons were inappropriate and really unfounded.

But, Mr. Speaker, what concerns me most is: what is going to happen tomorrow and the day after? With the bill we have preserved the medicare system. Certainly if section 6 remains in the bill, then I would suggest that the confrontation is going to continue. I would ask the members of the government to look very seriously at this, because that's a very serious roadblock. We have time-honoured methods that we can use; in terms of arbitration in this province we don't need a newfangled, offensive one. We don't need that at all, because tomorrow, after we're finished here in terms of this legislation, sooner or later the government and the doctors have got to come together, and we don't want any roadblocks that would prohibit that from happening.

[Mr. Davidson in the chair.]

I regret that when the minister introduced the bill he didn't take the time to really talk about the moment of history in terms of the medical system. What he really did was to give us a rundown of what was taking place behind the scenes, most of which we apparently knew anyway, because people were certainly on the doctors' side, dealing through the press. I was not convinced that the minister saw the urgency in the historical perspective of what we're trying to save here today.

The Premier's remarks added nothing other than his usual uninformed political input. I'm surprised that across the way not one backbencher has got up to say anything at all about this issue, and they're receiving the same kind of letters that every MLA in this House is receiving from people who are very worried about the possibility that there will be deterrent fees in terms of the medical program. All right, I hope we're going to stop that now, but I certainly would urge the government, Mr. Speaker, to take a second look certainly at section 6, because it can place a roadblock in the negotiations that have got to take place some time after today and make it more difficult, with its intent to inflame the situation, which certainly we don't want.

That's what the government has to look at now. There is no disagreement on that side or this side about double billing, and there never has been, but the question is: don't put roadblocks in the way of future negotiations which have to take place tomorrow. That's the important part now in terms of how this legislation is going to be passed. If they go ahead with this terrible roadblock, then we're going to have great difficulty eventually in resolving this problem in terms of the future of the medicare plan,

HON. MR. VANDER ZALM: Mr. Speaker, it gives me pleasure to speak in support of the bill. However, of course, I'm sure that we all have some reservations about certain aspects of these particular proceedings, and I am similarly concerned. I'm just a little confused by the remarks made by the member for Maillardville-Coquitlam (Mr. Levi) when he continually talks about "double billing." I'm not sure that we're really dealing here with a matter of double billing. Anyone looking at Hansard in the future might really take it from the remarks made by the member that in fact there was some proposal to double-bill, and that's certainly not my understanding of it. But I can appreciate there could be some confusion on the other side — and possibly there is confusion everywhere, I'll admit to that.

I listened earlier to the health critic from the opposition, and I was hoping that perhaps he could provide some enlightenment and possibly some suggestions as to how he would have approached the problem, but I didn't really hear anything. So then I referred back to a newspaper article that I saw very recently, which made reference to the controversial clause in the earlier agreement. I'll mention the remarks therein now, so that possibly one of the opposition members may give some explanation of that as well. It says:

"Cocke said that clause" — that clause being the clause with respect to extra billing — "which is now meaningless because the contract has expired, was instituted at the doctors' request during the bargaining process. He said the doctors were angry because cabinet had passed an order-in-council that any doctor who extra-billed would be opted out of the plan. Therefore they wanted something in the contract relating to balance billing, if a negotiated settlement could not be reached."

Then comes the most confusing part of all:

" 'It doesn't change my position.' said Cocke. 'I'm dead opposed to balance billing, and the point is, even if I ever did support it — which I didn't — I don't support it now.' "

The doctors in British Columbia are very busy people. They work long hours; they must be available all days. They're very dedicated and very busy. As a matter of fact, probably many are often too busy — they complain about that — and possibly because of this, they don't have the opportunity to provide the time that they would like to see made available for their patients. I agree that at times there is the

[ Page 4924 ]

danger of pill-pushing, where you give the patient a prescription and you get on with the next because the line keeps getting longer. That's not good. Certainly that's a matter of concern.

I don't have an explanation as to why this is in total, because on a per capita basis, we're told we have more doctors here than they have in most, if not all, other parts of North America. Again, I can't verify that exactly, but it's often said. I do know that we have a lot of doctors. Still, they are very busy people. Therefore, the argument that is often made that there should be some charge to people — a deterrent fee; it's been called other names — to discourage them from simply coming for a sore finger, a minor cut, a bruise or whatever, has some validity. In part, there might be an argument made, and I've often heard it made, in support of this approach.

We're not talking about that now. Whether that's a part of the solution now or ever, I'm not certain. Hopefully, we can hear from the professionals and receive some further advice on that. Negotiations with the profession probably ought to be ongoing all of the time. It's unfortunate that we should be legislating a resolution to an impasse after many months of trying to negotiate. I'm sure the doctors might well ask: "Why us? Why not others?" There is a difference between doctors and most other groups: they naturally provide a very essential service; they must be available in time of need for whomever. As all are aware, we, the taxpayers, pay a large part of what I'm told is nearly a quarter of a million dollars to train a doctor. A good part of it is picked up by the taxpayers. I'm sure no one minds that. We're hoping that more people, particularly in British Columbia, will seek this as their profession. But it is a consideration.

It must be said that doctors do not have the large capital investment that others do, because once more the taxpayers provide not only hospitals and clinics, but the tremendously expensive equipment as well — the tools that the doctor uses. We also pay for the tremendous cost of nursing care, which again is an assist to the whole of the profession. We pay for the therapists, consultants and counsellors — all essential parts of the fabric which makes up the doctor's practice. I think it has to be recognized — it's not in defence of legislation, but it's a matter that is worthy of discussion — that doctors do have a relatively small investment, and the taxpayers pay for a large portion of total health costs.

In my opinion, as elected representatives we have a responsibility to see how these costs might be distributed. I think it's a little presumptuous to believe that doctors should be making those decisions. The decision some years ago — at the initiative of the doctors in part — was medicare, and medicare paid by the government. Some would argue that if some doctors want to leave the program and cultivate a practice among the rich people, then maybe they should do so with their own tools and provide their own privately funded hospitals. That argument would certainly come to the fore if we saw a massive exodus of doctors from the program. Hopefully, we won't be faced with that. I don't believe we will. If there were another solution.... Possibly there is opportunity for bargaining and there may be a resolution before it comes to the day when the final step must be taken. If that's possible, I'm sure that everyone on both sides of the House would hope that this happens.

We don't want extra billing, because that would fall most heavily on the poor and the sick. It is often said that those people might be exempted; but often it is not only the paying, it is the fear of possibly being faced with having to pay. Not all of the poor people in British Columbia want some form of welfare in whatever way. They would much prefer to be like everyone else, without having some label attached to them. We don't have a perfect system. Not one of us here, nor the doctors out there, are completely right. There is validity in each of the arguments. Hopefully, some day soon we can all agree on a better approach. But to come in with a request which would force that which is objectionable and which really doesn't treat all people equitably is something that we cannot accept. I am certainly one of those who is somewhat saddened that we cannot arrive at a mutually agreeable solution. I hold the profession — my doctor and every doctor — in very high regard, as I'm sure all of us do. I respect the difficulties they face — as do all people, more and more, in an ever-changing society and with all of the pressures of inflation. But I certainly hope and trust that the doctors and the profession will respect our dilemma as well.

MR. KING: Mr. Speaker, I'm going to be fairly brief. I just want to make a couple of observations about certain comments which various members on the government side have made before I address myself to the particular aspects of the bill which we in the opposition find objectionable. I think I heard the last speaker correctly in indicating, for the first time in the House, that he would be receptive to the establishment of a deterrent fee by doctors. That would be something he would look at, he indicated. I find that very interesting. That's the first indication that I have ever heard from any member on either side of this House that they would look to the erosion in any way of the medicare system in the province of British Columbia. I'm rather shocked at that statement by the Minister of Municipal Affairs.

In any event, for public edification it would seem that all members of the House, regardless of party, are dedicated to preventing extra billing, balance billing, double billing or whatever euphemism you wish to attach to it. All members of the Legislature, I think it's safe to say, are opposed to that kind of development occurring. We certainly support the preservation of medicare. The doctors have known that. Contrary to the statements by the Minister of Tourism (Hon. Mrs. Jordan), my colleague, the former Minister of Health, the member for New Westminster (Mr. Cocke), stated in his speech to the BCMA that he was indeed opposed to extra billing of any kind. That's a matter of record, so I don't know why the minister continues to make statements which are not borne out by the facts in any way. That's unfortunate, but we're becoming used to it, I guess.

I was a bit concerned by the Tourism minister's categorization of the leadership of the BCMA — that their conduct was embarrassing, inflammatory and intemperate. People do things in the heat of bargaining — any kind of bargaining — that perhaps they would rethink at another time when they were not in the heat of debate and negotiation. I don't think it serves the interest of health care in the province very well to have particularly a minister of the Crown get into this slanging match that appears to have developed in some way. I don't think that serves the interests of the Minister of Health, who is responsible for trying to bring some order out of a very serious conflict which has developed. I was disappointed that the Minister of Tourism got involved in that kind of thing.

The minister also said that the government was not prepared to let anyone hold a gun to their head, and that the doctors lived in the greatest area of freedom in the world right

[ Page 4925 ]

here in British Columbia. Well, the opposition's main thrust with respect to the legislation before us is: yes, we support the objective of preventing balance billing, but we object most strenuously to the provisions of section 6 and section 8.

I don't seek to be overly critical of the government in my remarks this afternoon. Rather, I want to make a very strong appeal to the government to listen to the arguments we make, weigh them carefully and consider an amendment in this matter. Quite frankly, I think the debate on this aspect — which is not a partisan debate — is about some logic, and it's a debate about a fair mechanism for resolving disputes when the parties are unable to negotiate a mutually acceptable agreement.

There's a concept known as natural justice. I submit that natural justice is not being served when one of the protagonists in a dispute is authorized, as provided under sections 6 and 8, to set up the criteria for an arbitration, appoint the arbitrator and then give that arbitrator the power not only to impose a settlement but, indeed, the power to vary and change an existing contract provision. That goes beyond the pale of reasonableness. That goes beyond the need of the authority required to bring about an arbitrated settlement of a dispute in this case.

I think the Attorney-General (Hon. Mr. Williams), the former Minister of Labour in this province, and, I would think, the existing Minister of Labour (Hon. Mr. Heinrich) would really have some serious reservations about this kind of provision. Certainly it's preferable if both parties can agree, and have the right at least to try to agree, on a nominee, mutually acceptable to both parties, from whose decisions might flow a degree of confidence and acceptance that would never occur once the government has arbitrarily appointed a referee — whether a single arbitrator or a three-person board — without any consultation from the other party to the dispute, namely the B.C. Medical Association.

It doesn't really take a great degree of perspicacity to understand that this is a well-established concept. First of all, it provides the parties with an opportunity to try and agree not only on the arbitrator but also on the ground rules that will be used by that arbitrator. There are all kinds of serious implications that flow from the arbitrary mechanism the minister has chosen thus far. What matters will be arbitrable? Under this provision the cabinet, the Lieutenant-Governor-in-Council has the authority to designate what matters are arbitrable. That offends every concept of industrial relations law in the province that applies to the trade union sector. So why should we not expect the doctors to at least receive equity and evenhanded treatment within the concept of the bargaining structure? I see absolutely no reason to foul up this legislation, which I think could receive the unanimous approval of the House if it carried a fair and even-handed mechanism for final resolution of a dispute.

The other think I want to say in this respect is that it's very difficult under these circumstances for the doctors to — as some of our members have called for — come back to the bargaining table and attempt to bargain in good faith when they see this kind of draconia measure hanging over their heads. They say: "Look, how can we negotiate when the cabinet has the absolute power to impose a very restrictive mechanism for solving this dispute, for naming the judge and the prosecutor, and in effect guaranteeing what the sentence and decision is going to be?" I appeal to the Minister of Health (Hon. Mr. Neilsen) very sincerely and very seriously, as, I might add, someone who has had a good deal of experience in the area of arbitration, to look very seriously and very hard at this particular provision and see whether or not he could agree to amendments that would set up a fair and consistent mechanism of arbitration, one for which other models are available in the province. My colleague for New Westminster (Mr. Cocke) talked about the system under the School Act, and I think that's a fair one. I think it would be preferable, if in the final analysis agreement could not be achieved between the parties on the selection of an arbitrator, that the Minister of Labour rather than the Minister of Health, who is directly involved, make the appointment. That is the provision under the School Act, and I commend it to the minister in this case.

We certainly don't want to inflame what is a very regrettable situation in this Legislature and what is a rather tense situation in the province in many people's minds. But what we are recommending here, we feel, would serve to calm some troubled waters in having to go this route and making it as palatable as possible under very difficult circumstances. I commend it to the minister.

[Mr. Speaker in the chair.]

HON. MR. NIELSEN: I have a few points in response to some of the comments that have been offered today.

Several members from the opposite side of the House made reference to statements attributed to Dr. Mandeville and reported in various newspapers, including the Times-Colonist of Tuesday, March 31, where Dr. Mandeville is quoted as saying: "It's a double-cross. They've double-crossed the doctors of B.C." At least three members on the opposition side wondered what that reference could possibly be. I guess they'd have to ask Dr. Mandeville. I'm led to believe that the reference to a double-cross is with respect to the agreement signed in 1974. which under section 3(e) permits balance billing. I've been told by people associated with the medical profession that this is the double-cross in the eyes of some of the medical people; that they had an agreement that said there shall be no balance billing while the schedule of costs prescribed by the commission is a minimum of 90 percent of the association's then current schedule as it may be revised, and so on. The legislation before us today does not permit balance billing, and I believe that is what they were referring to as a double-cross. It may not be the answer provided to members by some of the doctors. but that's my understanding of that reference,

It’s interesting to note as well that there is certainly a lack of understanding generally about the terms of those agreements, programs, concepts and style of negotiation associated with this yearly exercise. The member for New Westminster was exercised somewhat about references that this 1974 agreement was the first one which introduced that concept of balance billing. I think it has been widely circulated that indeed it was well before that. It was interesting to look at a letter to the editor by Dr. Mandeville in the Vancouver Sun the other day, where he said it was introduced in 1974. So it seems to be a widespread misconception. In fact, one of the esteemed members of our press gallery phoned the BCMA and asked them when it started, and they were told 1974.

Reference was made to the availability to speak with such people as Dr. Mandeville, and to my memory. I believe I had six opportunities to speak with Dr. Mandeville in March. I think that's pretty good availability, and I'm always available if requested, of course.

[ Page 4926 ]

A lot of people have asked why a bill was introduced at the eleventh hour. I believe they deserve some explanation, as best we have. It's been mentioned publicly. The negotiations this year ended February 27, which was the last time our negotiating teams met. We were advised of the results of the vote on March 30. We had one day between the expiry of the agreement and the day balance billing was to begin. I want to make this very clear once again, because some members appear to be somewhat confused as to what the circumstances may have been. The representatives of the BCMA indicated most firmly at 11 p.m. last Monday that they had no capacity or mandate to negotiate. Negotiations had ended on February 27, and balance billing would occur unless we capitulated to their entire package — to their demands. There was no room for negotiation. We were advised most explicitly that the BCMA board had not provided a mandate for them to consider negotiation or arbitration. So there was no manoeuvrability at all, and that was very clearly stated to those of us who were present.

I believe the matter has been canvassed by members in the House. I have one comment in response to a statement by a member on the other side about arbitration. I am advised by our negotiators that arbitration was indeed suggested, or at least referred to by our negotiating team during the negotiations over the months. I was advised by a representative of the BCMA negotiating team that they did not have the mandate to seek arbitration.

I have one final comment. The team negotiating on behalf of the Medical Services Commission did modify its offer during that period of time. I am advised that the BCMA position relative to fee-schedule modification remained static. It was not modified at all.

I move second reading.

Motion approved unanimously on a division.

HON. MR. NIELSEN: With leave, I move that Bill 16 be referred to a Committee of the Whole House to be considered forthwith.

Leave granted.

Bill 16, Medical Service Plan Act, 1981, read a second time and referred to a Committee of the Whole House for consideration forthwith.

MEDICAL SERVICE PLAN ACT, 1981

The House in committee on Bill 16; Mr. Davidson in the chair.

Sections 1 to 5 inclusive approved.

On section 6.

MR. COCKE: Mr. Chairman, I realize that you were not in the House because you're the Chairman of the committee, and therefore you'd be unaware of the fact that the minister did not answer one single solitary question with respect to this section. I don't blame him — he's ashamed of it.

This is one of the two objectionable sections in this act. Mr. Chairman, not one of the people speaking for the government can give us any reason why there is a section here that gives the government these unilateral, wide-sweeping powers to deal with a profession as noble as the medical profession. I just don't understand it. You don't have this kind of thing in the Arbitration Act, the School Act or the Essential Service Disputes Act — you don't have this kind of thing in legislation.

Mr. Chairman, there seems to be a new morality — or an immorality or an amorality — developing. Therefore I will give the government one more chance. I propose the following amendment to section 6: that subsection (1) be deleted and the following be substituted:

"6 (l) That the Lieutenant-Governor-in-Council may by order direct that any dispute between the association and the commission respecting renewal, amendment or replacement of the agreement be resolved by arbitration, provided

"(a) an arbitration board shall consist of one member representing the association, one member representing the commission and a chairman mutually agreed upon by the members nominated by the association and commission;

"(b) in the event of failure of either party to appoint a representative or the two representatives to agree upon a chairperson, the minister shall make such appointments as are required to constitute the arbitration board."

I so move, Mr. Chairman.

MR. CHAIRMAN: The amendment appears to be substantially in order.

On the amendment.

MR. KING: I want to support the amendment and second my colleague's proposal for a change to this particular section. I find it exceedingly difficult to believe that all the government members would support the kind of arbitration mechanism now contained in the bill. The amendment simply brings the mechanism for arbitration up to a reasonable par with precedent already developed in this province. That precedent relates directly to the School Act, providing a fair mechanism that both parties can embrace and respect when they are unable to negotiate an agreement, and they have to turn to arbitration as a method of final resolution to a dispute. What we have here is a totally one-sided mechanism where cabinet, which has a direct and vested interest in the dispute, appoints a judge in the matter and sets up the ground rules under which that judge will function, identifies the issue to be arbitrated, then gives the arbitrator the authority to determine not only a question in negotiation but, in fact, a mandate to alter the contract already in existence.

Under the Labour Code of the province of British Columbia, where the majority of arbitration work takes place in the industrial relations sphere, any arbitrator who attempts to impinge in any way upon a contract or to alter a contract provision would be struck down by the courts as being beyond his jurisdiction. Why does the government feel impelled to give these absolutely unusual, unprecedented powers to an arbitrator, in respect to his relationship with doctors? It's not even-handed. It's totally unjustified. I defy any member on the government benches to get up and give any intelligent dissertation as to why these kinds of provisions in the act are necessary.

I want to tell you, Mr. Chairman, that the Minister of Labour (Hon. Mr. Heinrich) certainly knows it's absolutely

[ Page 4927 ]

wrong. I don't know how, in good conscience, he could vote for the provision, or fail to support the amendment, when the amendment simply brings equity and a common standard of even-handedness between this particular provision and the very act that he presides over as Minister of Labour. How can he vote against a system that he is responsible for administering and preserving in his own domain?

In all sincerity, I appeal to the Minister of Health, who failed to respond in any way to the opposition's request, to think on this matter and to accept the amendments, which in no way weaken the government's position but do provide some fair treatment for the parties to a dispute. I urge him to to take a very serious look at it.

MR. GABELMANN: Mr. Chairman, I will cede my place if the minister is prepared to accept the amendment.

Section 6, as printed, is not in fact an arbitration section at all. It is misnamed. Any member of this Legislature who has read section 6 will know that. I note in the last ten minutes or so a number of members of cabinet have apparently been reading this section for the first time. I don't think that when cabinet considered the bill — if they did — they understood what they had passed in that cabinet session. Arbitration is when the two parties agree to choose by some mechanism some third party to come in with a settlement — a final solution, so to speak. What this bill does is to allow the Minister of Health to appoint his deputy, Bernie Smith, or anyone else he likes to write the terms of the contract for the doctors. That's not arbitration. What we are trying to deal with is to, in fact, by this amendment bring an arbitration process into this particular situation. What the bill says — and any member of this House who takes two minutes to read the first part of section 6 will understand very quickly — is that the bill allows the government to pick one person, anybody they like, with no reference whatsoever to the BCMA, to bring in a settlement, and if that hand-picked person brings in a settlement that isn't quite proper, the cabinet can then change it again. What kind of an arbitration process is that? That's not arbitration.

We have in this province some groups of workers or employees who have chosen arbitration as a solution. Teachers are the group that come to mind most readily. We have in the statutes of this province legislation spelling out how the arbitration works in those cases. Our amendment actually takes the words from that particular act and puts it into this medical act. What that process does is to allow both parties to choose one person each and those two people will pick a third person, and there are mechanisms if that fails. Whatever one thinks about arbitration as a solution in wage and salary negotiations — and I have some very real reservations — it, nevertheless, has worked within the teaching profession. Why not use the same principle here as there?

It would be very easy for the government to accept our amendment at this point. It’s not crazy words we've dreamed up; it's words taken out of another statute that the government and we have supported. Accept the amendment.

The House resumed; Mr. Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Division in committee ordered to be recorded in the Journals of the House.

Hon. Mr. Phillips tabled the 1980 annual report of the British Columbia Railway.

Hon. Mr. Hyndman tabled the annual report of the Ministry of Consumer and Corporate Affairs for the year ending March 31, 1980.

Hon. Mr. Gardom moved adjournment of the House.

Motion approved,

The House adjourned at 5:55 p.m.