1984 Legislative Session: 1st Session, 33rd Parliament
Hansard
The following electronic version is for informational purposes only.
The printed version remains the official version.
(Hansard)
FRIDAY, FEBRUARY 3, 1984
Morning Sitting
[ Page 3067 ]
CONTENTS
Routine Proceedings
Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)
On vote 44: minister's office –– 3067
Mrs. Dailly
Mr. Lauk
Mr. Blencoe
Mr. Rose
Mr. Cocke
Mr. Skelly
Appendix –– 3083
FRIDAY, FEBRUARY 3, 1984
The House met at 10:07 a.m.
[Mr. Strachan in the chair.]
Prayers.
HON. A. FRASER: Mr. Speaker, I would like to bring up a point of privilege. Yesterday in question period the member for Atlin (Mr. Passarell), I think it was, asked about opening certain motor vehicle testing stations for buses. I replied that we were not opening stations for testing buses and that we have never tested buses in this particular station — the Victoria station — as I recall it.
I have checked and found that some buses had been checked in this station. I apologize if I misled the House; it was not my intention to do so.
MR. HOWARD: Mr. Speaker, it will also be recalled that the member for Atlin raised this subject matter as a question of privilege late yesterday afternoon before the adjournment and set before the House certain instances. On behalf of the member for Atlin, who regretfully is not able to be with us this morning, we want to express our appreciation to the minister for taking the course that he has taken in expressing his apologies. We commend that course of action to all other hon. members of the cabinet.
DEPUTY SPEAKER: Thank you, hon. members. The Chair will consider the matter settled.
Interjections.
DEPUTY SPEAKER: Order, please. The Chair has been advised that the second member for Victoria wishes to be recognized.
MR. BLENCOE: Mr. Speaker, I rise under standing order 35 to ask leave to move an adjournment of the House to discuss a definite matter of urgent public importance. The matter relates to Conmac Stages Ltd. Recent information from experts implies that a poorly adjusted emergency brake system led to the fatal crash on Monday, January 30, on Mount Washington. Furthermore, on CBC radio this morning a former employee of Conmac stated that buses due for inspection with this particular company were fitted with parts raided from other buses not due for inspection in order to ensure a positive inspection for that bus, and upon completion of inspection the old parts were put back on the inspected bus. That is a serious allegation, Mr. Speaker. Furthermore, due to the fact that there are now allegations that Conmac was granted certain operating licences in 1979 by cabinet order, overruling the Motor Carrier Commission, this issue can only be dealt with properly by full public inquiry and is therefore an urgent public issue and of urgent public importance. If the House so recognizes it, I have a motion to put before the House.
DEPUTY SPEAKER: Thank you, hon. member. The Chair will take the matter under advisement and, without prejudice, return to the member as quickly as possible.
Orders of the Day
The House in Committee of Supply; Mr. Pelton in the chair.
ESTIMATES: MINISTRY OF HEALTH
(continued)
On vote 44: minister's office, $182,438.
MRS. DAILLY: First of all, I want to thank the minister for giving an opening statement to the House yesterday; that was appreciated. In my new role as health critic I have a number of areas I would like to bring to the attention of the minister, but there is one I'm going to start right in on. I realize that estimates are really question period time, so I don't intend to make a lot of speeches to you.
[10:15]
The first area I want to deal with this morning with the Minister of Health is the area of prevention, which to my mind is the core of the whole area of looking at a decrease in health costs. Relevant to the area of prevention, I want to deal with something that is very important to all of us, particularly this morning: that is, the whole area of prevention of accidents in vehicles. That is why I want to ask the minister a question in reference to the very serious and tragic accident which recently took place because of inadequate safety procedures. Traffic vehicle accidents which put people in hospitals have a definite effect on health costs. I have always been an outspoken critic.... I think Mr. Chairman knows of the inadequate moves of the government towards the testing of motor vehicles. Therefore I ask the Minister of Health: as a Minister of the Crown, does he not place priority on ensuring that his government does everything possible to ensure that motor vehicles, including school buses and buses for charter for schoolchildren, are adequately inspected by his government? I wonder if the minister would answer that this morning.
HON. MR. NIELSEN: Obviously the costs associated with the repair of people after they have been involved in an accident are a major concern to the Ministry of Health and to the provincial government.
There are a number of reasons why accidents occur, one of which could be the safety of the vehicle itself. I think it's agreed that the majority of accidents involving motor vehicles occur because of the person in control of the vehicle. But there are inevitably going to be accidents because of faulty equipment or failure of a system on a vehicle, some of which, I presume, could be noted by way of inspection either by the owner, a mechanic or an inspector of some kind. I don't think that you would reach a point where you would still prevent failure. Perhaps if people were more diligent in the safety of their vehicles, there could be some decline in the accidents, I believe the methods used to inspect vehicles, particularly buses, should be adequate to ensure their safety.
The particular accident the member and other members have been referring to is under obvious review at this time — a coroner's inquest and so on. Perhaps some recommendations will be made by that coroner's inquest and there will be a response from the ministries in government who have that responsibility. But I think that is somewhat premature in that we have not had the findings of the coroner's inquest.
[ Page 3068 ]
Yes, of course, accidents of all kinds should be viewed with an eye toward preventing them, whether in vehicles or other locations. A significant number of people in our institutions now are there because of accidents. Accidents will always be with us, unfortunately. But I agree that in principle we should attempt to have methods whereby we can minimize the effects of accidents whether they are motor vehicle accidents or others.
MRS. DAILLY: I thank the minister for answering that for me, Mr. Chairman, and I'm glad to hear he says we must have proper methods. I just want to leave that for the moment by saying I hope the minister will be a strong advocate in his cabinet for the restoration of proper motor vehicle testing once again in this province.
Mr. Chairman, I have another question for the minister. It is, I think, a very simple question. I wonder if he would give me the courtesy of a reply. Would he tell the House if he believes in the basic five principles of medicare.
HON. MR. NIELSEN: The basic five principles of medicare as developed by whom, I would have to ask: whether it is the basic concepts of medicare, Monique Begin version, or some of the other folks. Bill C-3, I believe it is, the federal government's attempt to intervene in the area of provincial jurisdiction, outlines what they refer to as the "criteria" of medicare. I believe in our response to Mme Begin we have told her that we meet the criteria as far as we believe the criteria are expressed; the universality, the accessibility and so on, I think, are already met by us. But I'm not going to adhere to some philosophical statement by an unknown author. I think our program in British Columbia does meet the requirements of the medicare concept in Canada. It is consistent government policy that they are met. Mr. Chairman, the member might wish to specifically identify the five points that she refers to if she wants further discussion on that point.
MRS. DAILLY: The minister pointed out something which concerns me when he made his first statement yesterday to the House. As I said, I was pleased that he did speak, but underlying his opening statement there was a grave omission. He did not give any indication to the people of British Columbia that he has any basic philosophy or principle re his ministry, particularly re medicare. When I asked the minister if he agreed with the principles of medicare, I was somewhat stunned to find that the minister said "whose principles?"
Medicare was first adopted in the province of Saskatchewan. I won't go through the history of that now. I think most of us are aware that it was through Tommy Douglas, former Premier of Saskatchewan, that we had the first hospital insurance and then comprehensive medicare. Not only the CCF at that time but also many leading advocates wanted to bring about a proper comprehensive health system. They accepted the fact that there are five basic principles. Those basic principles are still accepted by the majority of recognized organizations concerned about health today. The Registered Nurses' Association is one of the leading advocates for those basic principles across Canada and in our province.
Here are the basic principles which are accepted by the majority of people who have been concerned about adequate health delivery in Canada and in the province of British Columbia:
HON. MR. NIELSEN: Since we're dealing in principle and since words can be interpreted as to what they may mean, I would say that the medicare plan in British Columbia meets all of those five points. Our medicare system is publicly administered, it is comprehensive, it is universal, it has access and it is portable. The discussions going on in Canada at this time with respect to these five principles, or five words, see different interpretations of what they may mean. I can assure you, Mr. Chairman, that the federal minister responsible for health in Canada has a somewhat different point of view on what accessibility means than do many of the provincial ministers of health. In fact, the definition of those words is singularly lacking in the proposed Canada Health Act, so it is subject to a reasonable amount of interpretation. But yes, I believe the medicare program in British Columbia does meet those five points. In fact, in some instances I believe the medicare system in our province exceeds some of those points. I think the action of the government over the years since medicare was introduced in British Columbia clearly indicates that it is the philosophy of this government that those points be met, notwithstanding that there can be a tremendous amount of dialogue as to what the words themselves may mean — words such as "comprehensiveness, " "universality" and "accessibility." But in principle that's adhered to by our system.
MRS. DAILLY: I am absolutely stunned to think that the minister could actually say he believes that medicare, as it operates under the Social Credit government of British Columbia, meets particularly the criterion of accessibility, when his government has been imposing more and more user fees, higher premiums and hospital user fees on the people of British Columbia. How on earth can you call it universal and accessible to all the people of British Columbia? I don't think the minister and his cabinet realize that when a person who is struggling on a low fixed income, or who has had particularly bad times with employment, has to come up with approximately $200 a year in premiums, as they are now imposed by that government, these people are denied the accessibility that they should have under a full medicare system. How on earth can you say that you have left the doors open?
I know the minister will say: "We never leave anyone outside the hospital. They can always be brought in." Mr. Chairman, I know now that people are arriving at hospital
[ Page 3069 ]
doors and being asked: "Have you got your medicare card?" My God, they suddenly realize, they haven't paid up their premium. They were not informed. Maybe there are letters coming out from some employers in the province, but many people in this province, particularly the young people out of work, aren't even aware that their medicare premium has been cancelled. They may be allowed into that hospital, but from then on they are going to be hounded in one way or the other to get that money paid up, or they are going to be put in a position where they are once more feeling like a charity case. The whole idea of medicare coming into Canada and British Columbia was to remove that old syndrome of it being a charity case.
We all pay our taxes, including that young man or woman who is out of work. Suddenly they find they are second-class citizens because of the high imposition being placed on them by the Social Credit government. I say to that minister: you are eroding medicare in British Columbia, and I ask you again to please explain to me how you can possibly say that you are meeting all those criteria when you are imposing higher and higher fees on the people of British Columbia.
[10:30]
HON. MR. HEWITT: Mr. Chairman, I ask leave to make an introduction.
Leave granted.
HON. MR. HEWITT: Mr. Chairman, I'd like to take this opportunity to introduce my daughter Linda and her friend Andrew McKay, who are visiting the Legislative Assembly for the first time. I'd ask the House to bid them welcome.
MR. LAUK: Mr. Chairman, I want to discuss the health and safety aspects of the minister's portfolio. This debate has been going on for some time. It's been going on for a year now — the question of what role the Minister of Health should play. The delivery of health care is one thing; health prevention is another. I think the minister interprets health prevention as preventing the people from getting good health. His role has been a passive one. He is a well-intentioned individual but a very weak minister in terms of his responsibilities as the Minister of Health. As a weak minister, he remained silent when this government introduced legislation to do away with motor vehicle safety inspection, when members of this chamber warned the government that it would lead to more accidents, to injury and death and property loss in this province that would cost the Ministry of Health increased amounts of money to deliver hospital and traumatic service and other services of health.
What was his position? I want the minister to stand up in his estimates now and tell me what his position was in cabinet when they eliminated motor vehicle inspection. We have heard this morning that the bus accident up-Island, which caused the death of one person and probably the paralysis and permanent injury of others, may have been partly caused by the deliberate deception of motor vehicle inspectors by the company involved. I'm asking whether the Minister of Health is demanding that a charge of criminal negligence causing death be laid against that company and those employees.
HON. MR. HEWITT: Why don't you wait till the investigation?
MR. LAUK: Await the investigation, my foot! Let me tell you that if it was any other company or individual out there, those charges would be before the Crown prosecutor right now — right now!
AN HON. MEMBER: Due process.
MR. LAUK: Let me tell you, Mr. Chairman, the due process is that the investigation by the RCMP goes before the regional Crown counsel. An inquest is always suspended or delayed when such an investigation is underway. An allegation has been made that there was a deliberate deception of the motor vehicle inspectors — a deliberate deception which has directly caused the death of an individual. That, under the Criminal Code, is criminal negligence causing death, if those allegations of deception are true. I'm asking whether the Minister of Health....
MR. PARKS: Let's wait for the inquest.
MR. LAUK: Let's wait for the inquest! This Clarence Darrow from Coquitlam, Mr. Chairman, does not know that when a criminal charge is being investigated, the inquest is delayed. If you don't know that, I sentence you to one more year of law school.
Where was the Minister of Health last year when this side of the House pleaded for the maintenance of motor vehicle inspections? We predicted precisely what has happened as a result of the tragic accident that has occurred on Vancouver Island. The reason I raise it now, while investigations are still underway.... Can the Minister of Health and his government assure the province of British Columbia that our kids on skiing trips in this province aren't riding in unsafe vehicles? What assurances can the people have today that your kids and my kids aren't travelling on dangerous buses?
Interjection.
MR. LAUK: The hon. member for Maillardville-Coquitlam (Mr. Parks) says: "Daily or hourly testing." That's his idea of a joke. A person who hasn't the sensitivity or judgment to know when to keep his mouth shut thinks it's funny. Daily or hourly testing. We found out today that the bus involved was supposed to have been inspected six months ago. We don't know the details of whether it was inspected or not; we have no idea. The Minister of Highways (Hon. A. Fraser) is standing in his place making assurances that he cannot make as an honourable minister and member. He cannot make them; he doesn't know the details.
MR. PARKS: You're playing on the tragedy.
MR. LAUK: I want to prevent other tragedies. Stop hiding behind that!
Mr. Chairman, the government should, with great deliberation, be coming forward now with public statements of assurances. How do we know whether these vehicles for hire or for public transit are safe? We do not know from the minister's statements nor from the government's general handling of this problem. It's one thing to say an inquest is being held, but this is not an ordinary death. This was caused by.... A grave suspicion of negligence has arisen, and if the allegations in this morning's media about the deliberate
[ Page 3070 ]
deception of cannibalizing one bus to provide parts for another are true, then an investigation by the Attorney-General's department under the Criminal Code section about criminal negligence causing death should be underway today, without hesitation. Where was the Minister of Health when the motor vehicle inspection legislation was eliminated by the government of the day?
HON. MR. NIELSEN: The member's little outburst there.... I wonder if Dick Vogel is having bad vibrations this morning. It seems to me that we went through exactly the same type of allegations and smear when certain media reports appeared about the former Deputy Attorney-General. I'm not sure if that member was one, but certainly members of that side called for all of these immediate actions, including sealing the doors of the office, because of allegations made by the media. Instant execution. Welcome to the Star Chamber. Mr. Member, you can stand up and do your best imitation of a lawyer, and try to politicize the tragic death of a child if you wish — that's your privilege. Are you seriously suggesting that any member of this House doesn't regret the death of a child in a bus accident? Are you seriously suggesting that any member of this House would recommend and permit fraudulent actions with respect to the inspection of vehicles? I can't accept any media report that is purporting to offer evidence that as far as I know has not yet been presented to any responsible body, either the coroner or the RCMP or whoever may be investigating that. I'm not going to respond to some media report of rumours and allegations from a person who is not even identified. We've gone through too many examples of that, and too many people have been smeared with unfounded allegations.
I can certainly assure the member for Vancouver Centre that I share the grief over the accident involving those youngsters, and I can assure you, Mr. Member, that the grief I share is of far more concern than the dollars associated with repairing these children. I believe the minister responsible for transportation will investigate the circumstances of this incident, and I believe responsible action will be taken. I can't tell you what that might be at this time, because I simply do not have the information or the details. I cannot accept the attitude you've offered — and it's a difference of opinion — that closing of inspection stations relates directly to this situation, although I can understand an argument being advanced that there is some type of correlation or relationship. We are advised the bus was inspected. Perhaps that suggests buses should be inspected more often. Perhaps it suggests that investigation should be underway into the cannibalizing of other buses for purposes of inspection. That's to be decided upon the evidence being offered.
But in the area of health we recognize that there are a number of actions which should be taken by governments to try to eliminate as much as possible the incidence of accidents, particularly fatal accidents, be it with respect to motor vehicles, the workplace or otherwise. The recent bus accident has received a tremendous amount of publicity and it is on the minds of most people. We share in the grief associated with that. But I think it's reaching slightly to suggest that the accident can be directly linked to the closing of the testing stations. It can be suggested, I appreciate, but I can't accept that that is therefore evidence. So I'm not going to get into what I consider to be a strictly political argument over the question. When the information is before us, due consideration shall be given to that.
With respect to prevention — members have talked about prevention — I agree that prevention is a very important aspect of our health care system. Theoretically it should be one of the most successful areas of controlling heath care and health costs, because theoretically prevention is within the grasp of each of us. A tremendous amount of health care expenditure and care is the result of personal lifestyle. I don't know what the percentage might be but it's very high — the number of people in our acute care facilities today who are there for reasons of lifestyle. Many of our people who are undergoing various forms of treatment are having that treatment because of their lifestyles, and the results of those lifestyles can be prevented. If we as a society were to be really successful in preventive health care, it would require a massive change of attitude by the individual.
The medical profession and the scientific world have brought to our society major steps in preventive health care. That which we treat today is very different from what was treated a couple of generations back, because of the introduction by science and the medical professions of preventive methods, including some of the obvious: the antibiotics, the ability to control infections, the ability to immunize against communicable diseases. This has caused a major change. So prevention is certainly working in the control of certain diseases which were common not many years back. I can recall as a youngster the yearly toll of polio victims, and we all, I think, remember the great outbreaks of scarlet fever and other diseases which today are virtually unknown. So prevention does work when science and the medical profession can intervene. But the prevention that most people speak of today is something that can be controlled by an individual to a very large degree. Our society has not accepted that responsibility, because I think our society — and I think we all share the responsibility — expects not prevention, but cure; cure for ailments that many of us have because of lifestyle.
Mr. Chairman, the preventive side of our ministry is not as well known as the curative side, because the publicity is not there. Much of the work is pretty routine and quite dull. But the preventive side has always received priority within the ministry, although it may not have the romance or the adventure. They're doing a very good job. I recognize prevention as being very important in health. I just wish all the citizens of our province and our country would accept their individual responsibilities.
[10:45]
MR. LAUK: Mr. Chairman, in the heat of debate it seems clear that the hon. minister and myself perhaps made remarks that were a little sharper than we might have liked. I don't want to reiterate my point and don't wish in any way to have my point set aside because of some kind of feeling which was not intended: that someone was being smeared in this kind of situation. If people are guilty of criminal conduct, then we have a system for the administration of justice that will determine that. But sometimes the vigorous investigation of such conduct is required.
I have two points to make with respect to this minister's estimates and this tragic accident. There's no doubt in my mind that the Minister of Health is gravely concerned and shares, as must all of us as best we can, not being the parents of the child lost, the grief at that loss. That's not the issue. That's taken. We all understand that. What I'm saying is, what is ministerial responsibility? What is the responsibility
[ Page 3071 ]
of the Minister of Health? I draw the direct connection between motor vehicle inspection and that accident. Does he want us to draw that connection in future accidents? I don't want to stand up in this House and draw that connection again, and that is why I raise it now. Can the government assure the people of British Columbia that the private and public buses of this province are safe for our young people to be transported on for such skiing trips? My guess is that most of them are. But we're not here to guess; we're here to be sure. I think it's the responsibility of the Minister of Health to assure the public of British Columbia that the buses our kids are travelling on are safe and also to take a position with the Attorney-General with respect to the vigorous investigation of the conduct relating to the mechanical safety of the vehicle involved in the tragic accident that has given rise to this kind of debate.
MR. BLENCOE: I want to indicate some deep disappointment with the position of the Minister of Health this morning.
The issue which I brought up under standing order 35 is indeed one before the House, but it is also an issue that must be of concern to the Minister of Health. The issue is not one of a court of Star Chamber or of trying to smear anybody. What has transpired in the last 24 hours is that there has been a serious statement made by a former employee of this particular company that indeed there was serious cannibalization to ensure these buses got through.
MR. CHAIRMAN: Hon. member, the Chair has listened very carefully to the discourse that has been going on over the last 20 minutes or so. The matter to which you are now speaking is before the Speaker, who is going to bring down a ruling on the admissibility of the motion you brought forward to the Chair. Certainly the issue being discussed is a very valid — and emotional — one, but I think it has been reasonably well canvassed. May I suggest, hon. member, that this committee would be well served if we could perhaps get to more direct questioning with respect to the administrative functions of the Minister of Health, which, in fact, is the vote we are discussing at this time.
MR. BLENCOE: Mr. Chairman, your points are indeed well taken. But there is an issue that is fundamental to the Health ministry, and that is one on which there is doubt in terms of the safety and therefore the health of children and others being transported in public vehicles. This has to be a matter of concern to the Health ministry. There is indeed serious doubt about this particular operation and others. Where there is doubt, there is suspicion. It is incumbent upon government to take immediate action to ensure there are full public inquiries into this kind of thing. I would urge the Minister of Health to have serious words with his colleagues, in particular the Minister of Transportation (Hon. A. Fraser), to try to take this issue and this emotion out of this chamber, to have an open inquiry into this particular issue. The Minister of Health does have some responsibility in this area, and he should make his views known to those who can bring some serious consideration to this matter. I think it is a health issue and should be dealt with very quickly, Mr. Chairman.
MRS. DAILLY: I know the minister was going to answer my concern that the increased use of user fees in the province of British Columbia is, in my opinion, doing away with the whole comprehensive accessibility principle of medicare. Before he takes his place, I want to remind the minister that the implementation of increasing costs for individuals to even get into a hospital now is primarily affecting those who can least afford it. That means that the minister and the Social Credit government are abrogating basic principles of medicare, which was supposed to create and should be creating an equal type of access. I ask the minister how on earth that can still be with us if people who can least afford it are having user fees imposed on them at the same rate as you and I pay. Isn't it ridiculous, when you think of it, that some senior citizens, some unemployed and the poor are the ones...? They're paying exactly the same now in hospital premiums and to get into a hospital per day as you and I, who with our incomes as MLAs most certainly could not be considered in the low bracket. I ask the minister: can he please rationalize for me and for many people in British Columbia how this is keeping open accessibility and equality?
HON. MR. NIELSEN: As I mentioned earlier, when you offer five words and recognize them as being principles, because they're words and because language means different things to different people, there's going to be an argument.
Okay, accessibility as one of these principles. We're talking about people who may or may not have some difficulty in receiving medical care because they're broke. The premium program, the per diems and other charges are not intended to deny people access, and they don't deny people access. Tremendous numbers of people that the member has identified as a group are assisted by the government directly. When you look at the premiums, we have a premium assistance program which can subsidize up to 90 percent of the premium. We have a reasonable number of people in the province who are the responsibility of the Ministry of Human Resources and who are assisted for such costs. We have approximately 700,000 people in the province who have extended medical coverage, in which the per diem costs are paid as a benefit. The majority of premiums are paid by the employer, not the payee.
You have a category of people who are not covered by a plan — either they're not working or their collective agreement doesn't have a plan — and are responsible for their individual premiums and for individual payment, should they be unfortunate enough to wind up in a hospital. I don't know what those numbers are precisely, but I do know that we do assist a great number of those people. Please don't give me this "young person comes to a hospital and they said, 'Where is your card?' and he doesn't have a card, and he's being denied access." Sure, it can happen. The same young person could get into his automobile and forget his insurance had expired, too. That can happen.
We offer a program and a plan. We do not baby-sit every individual in the province. There are personal responsibilities associated with our system. But we do not deny care to the people. In many instances people have gone to hospital to find that their coverage had lapsed because they were behind in their premiums. They were invited to make a back payment, and they were reinstated and covered. Who in this chamber believes that we're going to hound a person to death over medical costs? We're asking the people of the province to share in the costs.
I might mention that when it comes to health care and hospital care and user fees on the per diem basis, when
[ Page 3072 ]
hospitalization was introduced in the province, the co-insurance concept had the patients paying approximately 7.5 percent of the cost. Today they pay approximately 2.5 percent. Of course, if a person is destitute, he can't afford 20 cents or $2 or $20, and he's not going to pay it. But a person of reasonable income, I'm sure, is not distressed. When he goes to a hospital for five days and is asked to pay about $42, when the cost of their stay in the hospital is probably about $2,000, he's extraordinarily pleased that the system is in place.
That money coming in through premiums and user fees is used to provide additional health care. In British Columbia we provide far more health care than is required by way of agreement with the federal government under the medicare scheme. I want to keep those additional benefits for the people of the province. I tell you, Madam Member, if we have to tailor our program to assist that individual person who's broke and destitute, we'll do that rather than destroy the entire system, which would deny the people of British Columbia these extra benefits. That's what the feds want us to do. That's fine. We'll argue with them later. We have additional care under our medicare services for chiropractors, podiatrists, naturopaths, physiotherapists and optometrists. We have a long-term care program, all of which is funded by the people of British Columbia, with assistance of about 25 percent from the feds. Every dollar we bring in in revenue, be it premiums or user fees, is used for additional health care benefits, and we want to retain those additional health care benefits. It's a very simple matter, and I wish the people of the country would understand.
There is no reason to believe we in Canada can afford our health care system at all. The federal government is in debt for hundreds of billions of dollars, and they're pretending that we can actually afford it. We can afford it as long as we can borrow the money, yes. That's how they're running the country right now — by borrowing money. The federal minister says, let's borrow more money to pay for a health care system, which she describes as the best in the world, but she says: "Let's change it to get a few votes." The NDP in the House of Commons said: "Us too." You better believe it, boy. You go across this country in the next federal election and you're going to tell the people: "We'll protect your health care. We'll protect you." You're not going to say: "We'll borrow money to do it."
Right now it's costing this province $2 billion a year as our share of the interest on the federal debt. We could almost double our health budget in B.C. with that $2 billion that's being drained because of the socialistic attitudes of Ottawa that you can continue to go into debt, to borrow money to try to buy the voter in the next federal election. Read Bill C-3 and see.
For that member for Burnaby....
Interjections.
[11:00]
MR. CHAIRMAN: Order, please.
HON. MR. NIELSEN: Mr. Chairman, I am sorry I am elaborating so much on this, but there is a myth in this country. I get a little bit tired of listening to nagging members of legislatures and parliaments who are pretending to the people that you can do certain things and afford certain programs simply by adopting the principle, with absolutely no consideration of where the money is going to come from. I get a little tired of talking to federal people who say: "Oh, all you have to do is raise taxes." That's the answer to everything. It's endless.
The provinces have provided exceptional health care in this country. Even the federal minister agrees it's the best in the world. But she says: "It doesn't fit in with our plan." It doesn't fit in with the Ottawa attitude toward health care, which is a provincial responsibility.
MR. MITCHELL: It's not universal.
HON. MR. NIELSEN: Not universal!
There is no one in this province who is denied access to health care because he's destitute or broke. We are, and always have been, prepared to assist individuals who feel they could be denied health care because of their circumstances. We're not going to throw out the baby with the bath water or say, let's get rid of every other benefit in health care in B.C. because we adhere to the socialistic attitude in Ottawa that it's wrong to ask people to contribute, to a small degree, to their own health care.
We're talking large dollars when we discuss the Ministry of Health estimates. We bring in in excess of $300 million a year in premiums. Throw that out? Okay, what do you cancel — the long-term care program?
Interjections.
MR. CHAIRMAN: Order, please, hon. members. The minister has the floor at the moment.
HON. MR. NIELSEN: In user fees, in round figures, we bring in $80 million. The member for Esquimalt–Port Renfrew (Mr. Mitchell) I'm sure would say: "Raise the taxes. Eliminate them." That's about $400 million.
Interjection.
HON. MR. NIELSEN: The leadership aspirant from Alberni says: "What do the other provinces do?" I think it has been recognized in Canada for some time that certain provinces were considered to be "have" or "have not" provinces. One way of tracking that is by the amount of money transferred between the federal and provincial governments on the cost-sharing program in Canada. For many years Ontario, B.C. and Alberta were considered to be "have" provinces. Those three provinces all collect premiums and user fees of different types. The other provinces may not, although they are considering it; some have put in various things. The other provinces realize that they haven't got the money, and Ottawa has told them: "We don't have it either." You will see a province instituting a 12 percent sales tax and other taxes — very high rates of personal income tax. They don't have the money. And Ottawa's saying: "We're not going to allow you to capture any revenue the way you wish to. Do it our way or we'll take it away from you." That, as I said, is going to be the subject of some debate. It's fine for you people to try to sell to people, hoping to get their vote, the idea that everything in life is free, that there is a free lunch. You know, I heard one of your candidates in the last election say: "Medicare is free." It's not free; it's the biggest expenditure in the country.
So we have a difference of opinion; fine. What's wrong with that? By their action, the people of the province have supported premiums and user fees over the years since each
[ Page 3073 ]
plan was introduced because they've always been there, and they have not stood up in revolt.
MRS. DAILLY: They will.
HON. MR. NIELSEN. Oh, they will. In fact, Mr. Chairman, of all the communication we receive in the Ministry of Health, probably the category that receives the least amount is that of premiums or user fees. Of course, we get some correspondence from people who say they disagree. The vast majority support it. We offer a good health service in B.C., a service which goes beyond the agreement with the federal government on medicare, and we're very proud of it. We have the jurisdictional responsibility to provide it.
Interjection.
HON. MR. NIELSEN: Of course it is. It has been for years.
If we disagree, we disagree, but we are not denying access to people. If there are individual situations, they can be remedied very quickly.
MRS. DAILLY: I did expect in reply to my question that we would get some right-wing rhetoric, and we really did get it, full-blown, from the Minister of Health. And he's quite right: we have to disagree on this because it is a matter of a basic difference in philosophy. But I must come back on a few points the minister made. As most right-wing politicians get carried away in their rhetoric with myths and not facts, I think it is my duty to dispel some of his myths.
That minister and the Social Credit government, along with other conservative governments — here and in the United States, of course — are trying to scare the people into acceptance of paying more and more money on an individual basis for medicare. It's a straight scare tactic. The minister throws up his hands and says: "Where's the money going to come from? Tell me that. If we don't have user fees, I can't provide additional health benefits." Yet sitting right beside the Minister of Health at this moment is the minister in charge of urban transit. That minister, when a comment was made to her sometime last year that ALRT, this system that is going to provide benefit for only a certain sector of the lower mainland, was going to cost over the original, what, $400 million...? In fact, it may reach $1 billion. One billion dollars for a system that was rammed down the throats of the people of Vancouver. We knew it was ridiculous and was going to cost too much money, but we're stuck with it now. We accept that. But that minister said to the press, when asked where she was going to get the extra $400 million: "Oh, we'll find it; we'll borrow." And that Minister of Health stands up and says to this House: "You can't borrow your way into prosperity. You have to find money for medicare, so we're going to put the money on the backs of the poor." And the minister beside him blithely says: "We're going to find $400 million for a transit system that is questionable in its costs."
So when that minister tries to scare the people of British Columbia by saying, "We don't have the money, so we're going to put it on your backs individually," that's the difference between the NDP and the Social Credit government. First, we believe you should look into systems before you bring them in and put all that cost on the people of British Columbia. Secondly, we do not believe that people in the low-income brackets should pay the same for their hospital and their premiums as the people in the higher, and that we will never come to agreement on.
The minister asks where we're going to get the money. I pointed out one area where money is being wasted, but unfortunately that government has set us on that track. He keeps talking about the millions of dollars of debt of the federal government, and yet the Social Credit government of British Columbia always fails to mention the fact that their debt has tripled since they came into office. And what is each person in British Columbia paying for the financial bungling of the Social Credit government? Increased debt loads — and he has the nerve to talk about the federal government and their debt.
To try to bring this to, I hope, a more positive debate, I agree with the minister that we have a responsibility in prevention. He asks where we are going to get the money that those premiums are bringing in if we dispense with them. I pointed out one area: more efficient handling of their present finances. I also want to point out that there are many areas of prevention that I think the minister and I would probably agree on. Lifestyle definitely has a tremendous amount to do with the increased costs of hospitals. But there are a whole list of other areas of preventive medicare and new systems of medicare which I would like to discuss with the minister in more detail. I know that we will have that chance in the next estimates, when they come, because the money we're debating now is already spent. So I'm just threshing around here talking about moneys that have been spent. But that's why I'm using this opportunity to talk about some basic philosophy with that minister. The whole thrust of medicare in this province and in Canada is at stake, because of right-wing rhetoric that is trying to convince the people of Canada that they can't afford their medicare system anymore.
I want to read to the minister a couple of facts. I am not using rhetoric; I'm using facts. Mr. Chairman, I must give the minister great credit; he's a master of right-wing rhetoric. It scares people, because most people in British Columbia are struggling so much today with just trying to get by under the oppressive economic situation that they can't take time to dissect some of that right-wing rhetoric that keeps coming forth from the Social Credit cabinet. My job as a member of the opposition is to try to bring some reason and light to the public of British Columbia and cut through all that myth and rhetoric that pours out of the Social Credit members.
This is for the benefit of the minister. When he meets with his federal counterparts, I hope he will bring this up to them. We hear the complaint that health care costs have become excessive and must be controlled. This is one of the prevailing myths about medicare. The truth is that the cost of Canada's health care system, as a percentage of the GNP, is lower than that of most other industrialized countries. Canada, over the past several years, has spent annually just over 7 percent of its GNP on health care, compared with, on an average, the 8 percent spent in Australia, France and Sweden and the 9 percent spent by West Germany. The United States does not have medicare. I'm sorry to say it, but I really believe some of our Social Credit members would like us to revert to that barbaric system which exists in the United States, where people today still are being stuck with these enormous $100,000 hospital bills. The United States, which is the only major western nation without public health insurance, has spent between 9 and 10 percent of its GNP for a much less fair and accessible system than ours.
[ Page 3074 ]
I leave those facts at the moment with the minister. All I can say to him is: please stop using that right-wing rhetoric to try to scare the people, and give them some facts.
[11:15]
MR. ROSE: I would love to get into this sort of general argument about whether user fees are fair or unfair. I'll resist the main impulse to do that, but I'd like to tell the minister that some people who are very close to my own family who have been out of work have lapsed in their premiums. While they may not write the minister and admit that they can't afford their premiums, they wouldn't look forward to having health care on the basis of charity rather than right. I would also like to remind the minister that it's been our party's, I suppose, pet project for the last 50 years, ever since the Liberals promised it in about 1919. They promised medicare as part of their platform. As a matter of fact, I think it passed this Legislature. That, incidentally, was the same year that they composed "I'm Forever Blowing Bubbles." But that is probably incidental to the argument.
What I'm talking about, Mr. Chairman, and what I'd like to raise with the minister is a local matter. The minister knows what I'm going to talk about already. It has to do with the opening of the Eagle Ridge Hospital in Port Moody to serve that area that I represent, which in the paper recently was called the "ozone capital of the west," having to do with its difficult occlusions in the matter of air purity. One of the reasons for that particular distinction is that it probably is the centre of the most intense traffic pattern anywhere in the lower mainland. Any traffic going up the Fraser Valley on the north side has to go through the Coquitlam-Moody area. I don't think there's another community or small city comparable to Port Moody through which more cars flow every day. In addition to that, Port Moody is a seaport. Port Coquitlam is a railhead. There are thousands of trucks carrying dangerous cargos through there every day. At some time there could be a very tragic accident. We had one near-tragedy recently in Mississauga. I think that if we had an accident in the Port Coquitlam–Port Moody area during rush-hour traffic....
If a dangerous cargo of propane, butane or something like that carried by truck or rail blew up, I think it would make Mississauga look like a Sunday-school picnic. It is a very dangerous and potentially inflammatory area. That is why we need certain facilities that were recognized by the community as long as ten years ago.
When the residents of that area organized to request a hospital.... That goes back at least ten years; as a matter of fact, the person who perhaps would be more in tune with what is happening is my colleague the member for Maillardville-Coquitlam (Mr. Parks), who was the chairman of the foundation to raise money. The point is that this was money raised by the community; this was the demand voiced by the community. Ultimately the Ministry of Health, aided by the efforts of those citizens, built a very fine hospital worth millions of dollars. I don't know precisely what it cost, but it's all finished. It came in something like $100,000 under budget. It's about ready to be staffed. The staffing contracts for the emergency service have been arranged for and let.
I don't know whether to stop while the minister is being briefed.
We are told that we can expect an opening by October 1, which means that until then that building will sit idle. From that point on we're told to expect a phase-in situation while that building is allowed to fill up and while decisions are made regarding what share the Eagle Ridge Hospital in Port Moody — the brand spanking new, fully equipped Eagle Ridge — will have with St. Mary's and the Royal Columbian.
First of all, I would like to ask the reason for this long delay in opening the Eagle Ridge Hospital. Is it a matter of money-saving? Certainly it is not a matter of the facility not being there or being equipped. What is the reason that we have to wait another full year beyond its proposed opening date and its completion date?
HON. MR. NIELSEN: The plans at the moment are to open the hospital in the fall, and I don't think there's a great amount of disagreement with the board about that. They would like to have seen it opened earlier, sure. But it's because of money, yes; we've had to make some adjustments. We've delayed the opening of some facilities and made modifications in others. It is an economic reason — a fiscal reason.
I appreciate the member's comments about potential disasters that could occur in certain areas. Obviously a hospital situated nearby would be of major assistance. However, all hospitals are not going to be able to do all things for all people, as we can appreciate. Citing the example the member used, in a situation such as that you probably would have a great need for intensive care with respect to burns. I would think they would utilize Vancouver General Hospital for that purpose, rather than expect Eagle Ridge to be able to respond in that precise expertise that is available at the burns unit at Vancouver General. We expect Eagle Ridge to be a fine hospital for the community. We don't suggest they're going to be able to do all for all. Yes, they will be working closely with Royal Columbian and St. Mary's; all three hospitals will be working very closely.
Eagle Ridge hospital was originally planned some years back. When it opens in the fall it will be quite different from the original ideas and concepts. There have been changes. But still it will be a fine hospital, and I believe it will meet the requirements of the community.
At the moment, Mr. Member, the only area of argument — and argument really is too strong a term; the only area of disagreement or discussion — is the role of the emergency room. They refer to it as an ambulatory care unit. We're into discussions now: what should the role be, or should Royal Columbian accept a greater role in emergency and Eagle Ridge accept a greater role in community hospital needs? That's where the discussion is right now.
It will be a fine hospital, and I think we can accommodate most of the desires of the board. I hope we can. Hopefully it will open up this fall, and it will be a fine facility, The reason it was delayed rather than opening in the spring was the consideration of our budgets and the fiscal problems we've had. So I can assure the member that the situation is in reasonable shape. We've had many discussions with the board, and they are continuing; I think one is scheduled a week or so from now. We'll try to provide that community with a very fine facility. We hope we are in a position where if we can identify them now, perhaps we can avoid situations that would have to be remedied later. We'd rather not put something into that hospital that later should be removed. That's what we're trying to work out with the board, the Royal Columbian and St. Mary's.
MR. ROSE: I thank the minister for his response, and I'd like to comment on two or three things.
[ Page 3075 ]
I suppose the first thing is the last thing he mentioned: that he wouldn't want to put something in the hospital that later would need to be removed. I take it that this would be outfitting or equipment of various kinds. My information is that the emergency unit as planned is all complete. The question is whether we're going to be able to use that emergency equipment. I quote from the letter of the chairman of the board, who is certainly, so far as I know, not a supporter of my party: "Emergency service staffing at Eagle Ridge is fundamental to the community program role for which Eagle Ridge was designed and built." If it is fundamental, that means that there should be no question as to whether or not we should have it. Earlier in his letter he wants to reassure the friends of Eagle Ridge Hospital: "I would like to assure all of you that the situation at Eagle Ridge Hospital is basically unchanged from our approved planned general hospital role."
I think the minister can appreciate that there is some distinction — if not major, at least slight — between what he has told us and what the chairman of the board has told us. I've received what I suppose you would call expressions of concern through various avenues, but emanating from the local police in Port Moody, who are extremely worried because of the traffic volume in that area and the fact that the place is a bottleneck; that if you don't have the emergency role, they would probably never get to the burn unit — if it happened to be that kind of accident — at the Vancouver General Hospital. Furthermore, if you go along at any time from seven o'clock until nine in the morning, or during the rush hours in the afternoon, it's virtually impossible for anybody to get along the Lougheed to Riverview. So there's an ever-increasing population of families building up that slope right above there. We've got a highly industrialized Port Moody — the Ipsco plant, the Neptune Bulk Terminals, the Esso refinery, B.C. Hydro. There's an application being considered for B.C. Hydro to burn natural gas to boost power volumes during peak periods. I would say the place is a tinderbox.
[Mr. Strachan in the chair.]
So you've got all this trucking with dangerous cargo. I'm urging the minister.... I'm making as strong a representation as I can to have him and his officials alter their view about the emergency unit. Certainly it may not be as good as the emergency unit in Bellevue in New York. We know that. But just because it doesn't have everything, including the ribbons and all the other stuff that is extremely sophisticated, is no reason it can't do part of the job. It'll need to do part of the job if there is ever an accident there, and I think we'll have to anticipate one. That's why we have emergency procedures under the fire chiefs in those areas. That's why the police are concerned; that's why the industrialists are concerned for their people in those areas. Six hundred people went through Eagle Ridge last Sunday. The community is vitally interested. The traffic is not going to get less, because the ALRT is not going to Port Moody. I urge the minister and his officials not to turn a blind eye to those people. Let them phase it in. They can operate for eight hours a day starting October 1 and going to 12 and later 16. Certainly everyone agrees it can't do everything — but they'll be able to do something, and a hell of lot more than they're able to do right now if that thing doesn't open.
MR. COCKE: I realize that much of the in-depth estimate procedure will be happening again not too long from now, and I noted there was a bit of a philosophical thing going on. Not one to evade that sort of situation, I thought I would say a word or two along that line and also make some suggestions for the future, and maybe ask a couple of questions.
The minister talked about prevention and said that side receives priority. I'm not sure it receives the priority it deserves. I recognize that public health and the people involved in public health are most important. I also recognize that they can't do an awful lot about lifestyles, but they can try. A lot of the people I consider to be in the preventive area have suffered some of the worst cuts.
[11:30]
There's another aspect to prevention. That's the whole question of early treatment of an incident — whether it be an accident or a cardiovascular incident or a cerebral incident. One of the ways that we dealt with that in this province....
Of course, I go back a little way. I can remember that when we first were government we found a province that didn't even legislate the standard of equipment, nor did it legislate the standard of training for any person in the emergency system — and that's mainly ambulance. There were many ambulances running out of mortuaries. After all, the businesses sort of coincided — under those circumstances they certainly did. I suggest to you that when the legislation was brought in determining standards of procedure, standards of training and standards of equipment, we had a new outlook altogether. We also found that we had a province where most areas could not meet those standards. Therefore a provincewide ambulance system was put in place, a system which is relatively inexpensive. I understand it's going to be cut again, and Lord only knows, it's near the bone now.
As a matter of fact, in many areas such as Surrey, where you haven't yet got — in that vast area of Surrey, with a relatively heavy concentration of people — a paramedic service.... That's absolutely shameful. There is no paramedic service in Surrey. The EMA3s are not out there. They stop at the Fraser River. They don't get into the areas around the Fraser Valley — on either side — in any number at all. They are even scarce in Vancouver — scarce enough now, Mr. Chairman, that if the accident that happened to a former minister of the Crown happened again, I would wonder whether or not that three or four minutes of potential survival would have been met. I have heard far too many reports saying that the service is becoming less and less available in terms of that necessary time. I think the system is part of prevention from this standpoint: the earlier the intervention, the more likelihood of not only survival but also reduced morbidity and a less lengthy hospital stay. I think that the emergency service, rather than being cut, should be beefed up.
Way, way back when the cuts began to fall, we talked about the idiocy of cutting back on home care. The minister, of course, told us that there was some fat in the system. But the fat in the system didn't justify the generalized cuts. If you want to keep people out of hospital and you want to keep them at home, give them the support system that they require. My office, like the minister's office and every other MLA's office that's listening, gets calls with respect to cuts and calls which tell us that the cuts have generated another user for a bed in an acute-care hospital. It is a crazy way to act. Our whole system should be aimed at keeping people in the least alienating of climates. When they built the new children's hospital, did
[ Page 3076 ]
they think then, with all their planning, of the need for what the minister sort of talks about as being preventive? I think part of being preventive is keeping people at home wherever possible.
In that relatively new facility we have a huge radiology department that is certainly not full. I'll guarantee that the radiologists will fill it as fast as they can. However, we have the out-patient department that's so small that it's unbelievable in this day and age when hospital care is extremely costly. What we should be doing at every opportunity is keeping them out. Yet by virtue of the way we're doing it, without planning and without thought, that's what's happening. Enough of that for the moment.
I would like to refer to some of the things that I heard the minister roaring about. He was talking about the socialistic attitude of Ottawa. Ottawa is a strange place with the Liberals there — the chameleons of the country. That's one of the reasons their survival is so great. In a way that used to be the Socred situation: they could respond to people's needs or attitudes. I gather they did a job of polling. One minute they're right-wing, one minute they're left-wing and one minute they're on the fence, but that's neither here nor there.
I don't think it's a matter of questioning the attitudes of Ottawa. It was the Social Credit government that went down to Ottawa after we lost as government. They continued the negotiations with Ottawa, caved in and went the route of Ontario and Alberta, which had high tax bases at that time, with no thought at all for the areas in this country that were then have-not. We had a good high tax base. The grant and the percentage tax points would be beneficial to us. We could see that. Selfishly we went down there and negotiated and took the Ontario and Alberta line, and that's the way it has gone. Now they squawk about the federal contribution. If you had fought as hard as we said you should fight to maintain the 50-50 operation, then maybe there could have been a federal-provincial partnership that would have recognized that we're all in this bag together. You could have done something about it.
From the standpoint of these three provinces that have user fees and medicare premiums, the minister says that he prefers this to taxation. What an irresponsible remark to make. Taxation, if fairly applied in raising those same funds, do not unfairly subjugate some of those people. Let's talk about user fees for a second. The person most likely to be least able to afford the user fees is the person who is going to be attacked by those user fees. If somebody could show me where user fees were actually a deterrent, then I think we could have a little argument around that. But the deterrent in our system is purely the deterrent that is mounted in the doctor's office. I've never seen a hospital yet that admits a patient upon request. A patient does not walk into a hospital and be admitted, except in emergency, but they're still not admitted to the hospital unless the doctor makes a request for that bed. Unfortunately, they're not having a lot of success in some instances, but that's neither here nor there. Other provinces have said: "Let's take this whole question and make it fair across the board. Let those who are well share." That's the whole idea of insurance: sharing the risk. When you have the authority to say that everyone share who can share, then, for heaven's sake, isn't it a far better world? As far as I'm concerned, with medicare premiums you're going to have to raise the $300-and-some-odd million someplace. We're doing it right now. We're disadvantaging a lot of people. The percentage of unemployed young people under 25 out there without medical coverage is astronomical. Many of those people will eventually be one heck of a charge on the health system, because they will neglect care that they feel they cannot afford because of the fact that they haven't got coverage. It's pure and simple. Even the advocate of the great gem of the Social Credit government, the university Health Sciences Centre Hospital, would agree with that.
The fair way is to go the route of the distribution of the obligation to the widest number of people, and particularly to those who can afford it. Somebody from over there said that everything is free; nobody suggests that. I'm prepared to pay more in order that somebody else down the line who isn't as well-fixed can be covered. We have to do that anyway in the long run. The only problem is that we take it over to Human Resources, with all the indignities that that brings into the situation.
I think the arguments for increased user fees and increased medicare premiums are not solid enough to really sell. The larger the proportion of individuals who are ill or paying their own shot becomes, the least effective the whole medicare system is. Certainly it cannot be universal.
Tommy Douglas, a name that would be well-loved on that side of the House, said not long ago: "Unless those of us who believe in medicare raise our voices in no uncertain terms and unless we arouse our neighbours and our friends and our communities, we are sounding the death knell of medicare in this country." Tommy Douglas started the fight. Let's not kid ourselves. We all know about the legislation and the motions that were in the House of Commons and also in British Columbia. I think the first motion calling for a medical system was somewhere around 1929. The real fight to get this recognized was with Tommy Douglas and, of course, his successor the then Premier Lloyd. They had a fight. They didn't have quite such a fight in terms of the hospital insurance issue, which came before, because of the fact that most of them were community owned or operated in any event. They would have that same fight in the United States, however, because of the number of private hospitals there.
[11:45]
In any event, I agree with those who say that nothing in life is free. It's how you distribute the obligations. I think that we're crazy unless we really study that carefully, and I think we're on the wrong course here. The minister told the world during the campaign that I was a prevaricator for having said that there would be increases, but they happened immediately after the government was re-elected. They'll go on happening, and the larger the percentage of the total they become and the less involved government becomes, the less access people have who need it most will have.
The member for Burnaby-North (Mrs. Dailly) was talking about the percentages of GNP. Those percentages read out were 1979 percentages, as I recall. I've talked to a couple of economists who have said that even our percentage has increased, probably by one percentile. But the United States has also increased to somewhere close to 11 percent of their gross national product. So we may be somewhere up in the staggering 8.5 percent, but they are still significantly higher than we are. I make the charge that their system is not nearly as efficient as ours, yet our system is being taken in that direction every day by these conservative-minded people who think that privatization, free enterprise and all those other pretty words are the way to go to deliver health care.
It's not something that should be left to chance. It's not something that should be regarded as anything short of a
[ Page 3077 ]
human right, which is exactly what I feel health care delivery is. The access to that health care delivery system should be universal.
With a little nerve we would do a little more experimentation; we would do a little bit more work in terms of alternatives. I know, when you're up against that medical profession.... They are a tough bunch; they're the only game in town, so to speak, and so on and so forth. When you mention community health centres or health maintenance organizations, they shudder. We made a very small start on that.
Interjection.
MR. COCKE: The Foulkes report is only buried because we have a conservative, stupid Social Credit government. I'll tell you who they're burying right now, Pat, before you leave here. I was going to mention this anyway, someday. They're burying your UBC Health Sciences Centre Hospital. They hit them badly to begin with. As I recall, there's at least 97 percent occupancy right now with three or four wards closed — I've got it somewhere. But they're hitting them again, because the pink slips are flying over there like confetti. It's a shame. It really is.
HON. MR. McGEER: It is a shame.
MR. COCKE: No, it really is. Not that I have ever agreed with the placing of that hospital; I think it's the dumbest place that you could have ever selected. If you've got a health corridor like we have in Vancouver — you know, that Fairview corridor stretching all the way across False Creek to St. Paul's.... You had the marvellous opportunity of bringing gown to town. Instead of that, you took town to gown. That's imbecilic. They've tried it elsewhere and it didn't work. But now you've got it, you're stuck with it. So being stuck with it, for crying out loud, don't make it into a community hospital for Point Grey. At least make it into a tertiary hospital that can do some good. Too bad you couldn't move it lock, stock and barrel to where it belongs. But you can't. You're going to have trouble with that forever and three weeks. Anyway, that's your problem. I didn't make that decision. I resisted it for three years and four months, and I was glad I resisted it. I resisted it on some of the best advice in this country, and then immediately that promise was made when the new government was elected. So there you are. But I'll tell you, the demoralized state of affairs out there is really something. It's all over. Helmcken Road was another mistake, in my opinion. The doctors around this town are having an awful time. They're saying: "Well, gee whiz, maybe someday there'll be a need for a hospital out there, but why wasn't it down on the original spot that was suggested?" It's a bit remote. But it's not near as bad as that university situation.
Getting back to these community health centres — I was only trying to get in a word before our eminent authority on brain research left — I believe that we should look seriously at all the reports, particularly reports of HMOs that are close to us. For years one of the success stories has been the Puget Sound — the health maintenance organization that centres in Seattle and is around that county. One of the good things I think they did, at the suggestion of the then governor of the day, was include a number of quite poor and poverty-stricken people as a percentage of the HMO there, which would reflect the total state in terms of comparison, and of course they got the state's help from that standpoint. It gives them a good cross-section in terms of age, it gives them a good cross-section in terms of economic status, and so on. They are doing such a lot better job than the state at large, or anywhere else, virtually, that I know of. One of the major benefits, of course, is the reduced amount of surgery, the reduced amount of hospitalization required, because they're Johnny on the spot.
One of the things that's counterproductive — and eventually we're going to have to come to this conclusion....
It's not going to happen for a generation, it's not going to be easy, but sooner or later we're going to have to come to the conclusion that the least cost-beneficial way to do business is on a fee-for-service basis. Having said that, I don't suggest that we make public servants out of doctors, because that would be even worse. But I think that we should have that community opportunity to get involved, and slowly make the transition to alternative delivery systems.
I think I've said this before in this House, but I'll bet you that in the United States they're going to be going to that system before we are, in a different way. You know who's going to make that thing stick? The insurance companies. They're even more powerful than the American Medical Association.
Interjections.
MR. COCKE: No, they will just set up their group practices. It won't be on that.... There's Omineca hopping around. You know what I'm talking about, too. Too bad we talked about it in the detail that you don't understand.
Mr. Chairman, in any event, notwithstanding the member for Omineca (Mr. Kempf), this is an area that should be studied and should be talked about in some great detail with the profession. Younger people coming into the profession surely will have a more progressive attitude toward where they are going in this respect. I think, for an example, alternative areas of health care should be available for those who are prepared to pay at the present time. For instance, we set up the pain clinics in acupuncture for one reason and one reason only, and that was to study it. They haven't progressed one inch. They are still pain clinics. There have been no standards set. Doctors are now learning how to do acupuncture and denying access to that procedure to any eastern. I was in China. I have taken acupuncture, and I'm dead sold on it. The one thing that was able to bring my blood pressure to normal was acupuncture, for crying out loud. Yet the only way you can get that procedure is counter to the law of the land — not our law but the law that we've given the physicians to go out harassing these people. I believe that they should be brought in under umbrella legislation — I notice this is happening in Alberta now — along with others who have something to offer the health system.
A lot of things have to be looked at if we really want to provide the alternatives and bring down the costs, and we just must. I agree with the minister: you just can't go on living with the way things are going in health care. But I say there are alternatives, and we'd better get on the course as quickly as we can in order to save what we have, which is, as he says, one of the best in the world. But it's going to become less and less one of the best unless we give it a lot more deep thought and research and dust off the Foulkes report just for fun.
The member for Vancouver–Point Grey jumps out of here and talks about the Foulkes report. That was one of the best reports that's been made in Canada. It's comparable to the
[ Page 3078 ]
Castonguay report. It is far superior to the Hastings report, not in any way deprecating the Hastings report, which was narrow in its outlook and needed to be so. The Foulkes report has something to offer.
Anyway, Mr. Chairman, I see that the red light is on. I could get an intervening speaker, but I'm sure that my colleague would like to carry on with her estimates.
MRS. DAILLY: Mr. Chairman, I'm sure that the minister may want to comment sometime this morning on some of the good points made by the previous speaker.
I would like to ask the minister some questions on the financing of hospitals.
I'm sure that there must be great confusion out there in the public's mind when they know that for a number of years now they have been subjected to some serious cutbacks in hospital services in our hospitals in varying degrees. We have to pay tribute, of course, to the staff of these hospitals — physicians and nurses, etc. — who have done their best to cope with what we consider a fairly stringent lack of financing. I think that most of the hospitals are now operating down to the bone. This is what we understand. But the confusion comes in the taxpayers' minds when they know that many of their relatives have been put in corridors in hospitals and suffered some of the embarrassment of having to lie there in a hospital corridor instead of having a room, because of bed shortages. I don't think there is any MLA in this Legislature who hasn't had a great number of letters detailing these problems.
[12:00]
But my question to the minister, to start off the debate on the matter of hospital financing, is simply this. How can you explain how some hospitals apparently are racking up surpluses at the same time as we have these complaints — and many have been validated — on extremely unfair conditions to patients and staff because of cutbacks? I'm not zeroing in on any hospital. I know that that minister has his list and I have mine of the present situation of deficits, surpluses and those who say they are just holding at breaking even. I'm sure the minister will be getting letters on this, too, and I would like to know how you can explain this in the area of overall planning, without singling out any hospital: that some can have surpluses, some deficits, and so on. I would like to hear the minister give an explanation for this, please.
HON. MR. NIELSEN: As the member would know, the forecasting of hospital expenditures is not a precise science and is subject to some variation when the actual amount is totalled at the end of the fiscal year. At the end of March 1983 the financial statements that were gathered, modified and reviewed, and which reflected the accruals for labour settlements known to date, and so on, gave us a figure of approximately $50 million in surplus throughout the system. Why that would occur is a very good question, and I think there is an answer to it. The hospitals were advised that they could retain any surplus for purposes of expenditure in the next year, and I think some of the hospitals felt: "Well, if we can retain that surplus and offset next year's expenditures with a portion of it, then perhaps there may be less need to dispose of the budget this year for fear of seeing a cut next year if we didn't spend all our money." That's human nature, I suppose.
A very important factor, however, has been the tremendous cooperation by the hospitals in the province, recognizing very serious times, from a fiscal point of view. A tremendous amount of work has been done by the hospitals. I think all members in the House should know that many administrators, members of boards and staff have said they really didn't appreciate how serious the situation was and they are surprised they were able to develop innovative programs in their hospitals which resulted in the saving of money. Many of them, speaking to me, said: "We've really never had to give that area consideration before." So they've done a pretty fair job, as they should.
Some hospitals have seen surpluses and others deficits, and the others fall slightly in between. I think where the public can become confused is when a hospital is making some noise, particularly at election time, while sitting on a $2.5 million surplus, and screaming about not having enough money to open a couple of beds or a ward or whatever it may be. I certainly do not condemn a hospital if they have achieved a surplus at the end of the year, provided that surplus is not excessive to the point that we would have to examine the people in our ministry's capability of forecasting budgets. Similarly, if they suffer a deficit far in excess of what we might have anticipated, we would have to look at their own in-house management.
We have developed some slight changes in funding of hospitals over the past few years which I think have resulted in far better and more efficient management of the funds and the hospitals themselves. We offered them what we refer to as a global budget rather than a line budget, and we have made some modifications. We also review their budgets on a quarterly basis, which allows them to respond to the unknown factor much more realistically. I think that basically the hospitals have done a pretty good job over the last couple of years; this reflects in their situation.
One of the great problems is hospital facilities which are functioning throughout the province and serving a need, but in some instances serving a need which was there at one time but today may not be; yet the facility is still there, designed for that purpose. Perhaps an example of that would be, as the member from Moody (Mr. Rose) mentioned earlier, the changes that can take place in a hospital from planning to actual opening. At Eagle Ridge Hospital, originally the plans would have included a pediatric ward and a maternity ward, but they're not going to be there, because there has been a change in attitudes.
The Vancouver General Hospital, with the opening of the other facilities, eliminated certain wards. But we were still in a position in the province, as late as December 7 — that's the last date I have before me — of having 1,344 acute-care beds open but not occupied. This would suggest that in many communities, because facilities have been there and were opened in time when the need may have been somewhat different, we have a surplus of space in some areas while in others we seem to have a lack of beds. I think that all in all in the balance we're doing pretty well with respect to that.
We still must seriously address the number of acute-care beds which are open and available but are not being occupied, because the cost is still there for the hospital: December 7, 1,344 such beds; December 1, 1,380; October 25, 1,509; August 11, 1,597. We're not condemning the hospitals for that; we're simply reflecting on the situation. We have to balance it off; we have to realize where the priorities are. Where a hospital has surplus space, we either convert it to another use which is needed, close a ward, or see that the funds go to a hospital that requires it to pick up in a deficit position of space. But on balance, Mr. Chairman, I think they've done a first-class job.
[ Page 3079 ]
MRS. DAILLY: I appreciate the detailed answer the minister has given, but I do want to make this point to the minister and see if he agrees with me. We realize that hospitals vary in the way they operate, just as schools and districts do — as you know, Mr. Chairman — in their management policies and how they handle the money given to them by the taxpayers of British Columbia.
The minister pointed out one case of one hospital that has questionable management. I'm glad he didn't bring it up, because I think it is unfair to bring up the name of the hospital here. I think we have to be very careful — and this is the thing I want to discuss with the minister — in raising that, that there is a spectre in the public's mind: "My God, maybe this is all over the province." This minister did back up his remarks by saying, and I was pleased, that by and large most hospitals are operating well. But my question is: considering that the hospitals receive their money from the provincial government, and I know they vary in authority and control from school districts — with which I am more familiar — I am aware of the fact, nevertheless, that the internal policies of a hospital are by and large governed by the policies of the provincial government and particularly by their financing policies. Therefore I say to the minister: when you mention the fact that there are some acute-care beds not being used, it does raise, to my mind, a question about the overall planning within the ministry. If I recall, Mr. Chairman, the minister suggested that some hospital boards bring out the worst cases during an election. There was an implication by the minister that they were using their problems through a political mechanism. I ask the minister: because officials simply respond to what is being asked by politicians, is it not true that the cabinet is responsible for building hospitals on a political basis or making promises about them where they were not really needed? I think we had better face the reality that the majority of problems faced in hospitals today primarily emanate from the policies of the present government. What kind of planning facilities do you have in the ministry at this time that work with hospitals to avoid misplacement of beds in certain areas and capital construction at a time when we have other areas of hospitals that desperately need more attention? Yet we find you are embarking upon or approving new capital construction. What do you base all this on?
HON. MR. NIELSEN: There's a very general statement in B.C. and in our society that if politics stayed out of health care we would be able to make advances much more rapidly. Unfortunately that's asking a little too much. But if politics really stayed out of health care, we would be able to advance much more rapidly than is possible.
The member would be familiar with a very serious problem in health care with respect to hospitals. Hospitals are built to last forever, and when they get old, we can't properly utilize them. One of the really serious problems is what to do with some of the older buildings which cannot even be renovated. They have to be knocked down rather than renovated. But some of the facilities in the hospital itself have become badly outdated simply because of advances in technology.
I guess over the past few years one of the more common areas of discussion and argument with the hospitals has to do with CAT scanners and other forms of scanners. There are situations in which you may have a well-stocked radiology department in a hospital, but the pressure is for other than that type of equipment. You wind up with situations in which a hospital is built for a community need and therefore included all of the standard wards, and then another facility is perhaps built in the proximity. The specific need in that one hospital becomes redundant. They may or may not be able to convert it to another use. The numbers I referred to — and I did receive a later one on January 26 and the number was 1097.... In many instances some of these beds are maternity or pediatric and the need simply is no longer as it was when the hospital was designed for that purpose. The ministry planning division works very closely with hospitals and with long-range planning of the regional hospital districts to try to determine what will be required at a certain point in time and to try to work toward it. But I would suggest that it is quite an inexact science. We can only anticipate what will be available at some time in the future. I think the record would suggest that a reasonably good job has been done.
[12:15]
But like everything else involved in provinces and countries, there are decisions made by government, whichever government it may be, which may not be the absolute result of the technicians within the ministry. Sometimes that's good; sometimes it's not good. That's our system. But the planning is, I think, adequate. I think it's regrettable, and I suppose people get a little distressed when they see a brand-new facility open and the first thing that seems to happen is some redesign. I don't know what the reasons would be. It could be the specifications received in the construction or planning were inconsistent with the actual size of the equipment. That can occur. I think we could relate it to the idea of building our own home, and the day we moved in we realized that we didn't build enough closet space. That can occur. But one of the problems is that some of these hospitals age very fast — an example is St. Paul's Hospital in Vancouver. A very large portion of that hospital is going to be demolished and replaced by a new facility because it was built at a time when it would appear they had never heard of running water or a reasonable electrical system. Air-conditioning was yet to be discovered. It simply cannot provide the level of service that people in our province expect. So there is always going to be a situation in the health care field with respect to facilities where you're going to be utilizing the decisions of the past, and if we're going to keep building hospitals to last forever, we're going to have to use them for that period of time.
I think Helmcken hospital is an example of new ideas in hospital construction. According to the people who advise me, the new Helmcken hospital could actually be completely gutted and redesigned in whatever configuration you might need in the future without modifying the structure of the building itself, rather than, as in the past, built for one specific use, and that's basically it. But they have improved, thankfully.
MR. SKELLY: I'm sometimes surprised at the minister's statements. When he says that politics should be kept out of health care, I remember what one of my teachers told me when I was going to school. He was trying to teach me something about ancient history. He said there are two different words in Greek. One is "politics," which relates to the polis, the life of the city, to involvement in public life. In Greek terms involvement in public life was one of the highest of ideals. He told us what the word meant that was the opposite of polis, or involvement in public life. The definition is one person to himself. Id iota. In modern terms it translates to "idiot." So the opposite to involvement in public
[ Page 3080 ]
life, in the polis or politics, is idiocy. I think that applies to health as well, because health concerns all of us. It concerns our constituents. It concerns us as representatives of our constituents. If it doesn't concern politics, then nothing should.
HON. MR. NIELSEN: It doesn't have to be partisan politics.
MR. SKELLY: I'm going to try to be as non-partisan as possible, but I think once you get involved in politics, then you get involved in some partisanship; it's hard to avoid; it's not necessarily a negative thing unless positions get so hardened on both sides that nothing gets done and nobody is listened to or heard.
One thing that has concerned me about the debate so far today is the emphasis on the treatment side of health rather than on prevention or the maintenance of a positive approach to health. Going back to the throne speech, which is, I guess, why we came to this session on June 23, 1983, on page 7 of the first Hansard of this session it says:
My government will introduce a new fitness program this year that will encourage British Columbians to partake of regular physical activity to maintain good health and well-being. The program will have an indirect beneficial impact on productivity across all sectors of society.
Yes, it does have an impact on productivity: healthy people are productive people. Also, healthy people make fewer demands on the provincial economy — on the budgets for medicare and on the hospital budgets. I just wonder what happened to that promise made in the throne speech for a new fitness program to encourage British Columbians to take part in a program of regular physical activity. I haven't seen it materialize anywhere in the province. I wonder if the minister could explain to me what happened to that promise.
Reading through last year's annual report of the Central Vancouver Island Health Unit, under the topic of prevention it says: "The Only Way to Go. With ever-rising health care costs, the only method to arrest these costs is to expand preventive programs. The public have to be educated in the principles of preventing disease. As the majority of Canadians are now non-smokers..." It goes on to discuss non-smoking.
Health education is a slow but very productive field. We need to expand it dramatically to improve everyone's health and to reduce the ever-escalating cost of health care. It seems to me that the preventive aspect of health care is one of those areas that politicians don't want to get into because you can't build big edifices or take credit for things done on a very low-key, face-to-face individual basis. If they can't build monuments, politicians don't seem to be much interested in the preventive aspect of health care.
Our Central Vancouver Island Health Unit is now complaining that they're very short-staffed. In fact, they were grateful for the recession because it cut back on the number of new buildings and new restaurants being opened, so they didn't have to do as many inspections. It also cut back on the number of subdivisions in the central Vancouver Island area, and they could catch up on the backlog of sewerage and septic tank inspections that they were required to do. So the recession was a good thing for preventive health, because it virtually ground the economy to a halt. But if a recovery takes place in the coming year, then even more pressure is going to be on the preventive health system than during the last little while. Yet we're running short-staffed in many areas. There is a freeze on the hiring of nurses. We're short of audiologists and speech specialists in the Central Vancouver Island Health Unit: all those positions that can help us to identify health problems before they become serious; all those positions that help us to educate the general public on how they can avoid becoming a charge on the health care system by improving their lifestyles and changing their health habits.
Those things appear to be cut back or to have less priority — not with the minister, I would say, but with the people who establish the budgets in the province. The minister did write a letter to the Central Vancouver Island Health Unit during 1982 in which.... "We are pleased by the minister’s written and verbal commitment to make public health the first priority of his ministry. We look forward in 1983 to the money and staff to match this commitment." Unfortunately, the money and the staff didn't materialize within the Central Vancouver Island Health Unit to match that stated commitment. I wonder what the minister is planning to do in order to demonstrate his commitment in financial terms and in terms of staff. For example, we're short of psychiatric social workers on the west coast of Vancouver Island. We had a position open because of a number of juvenile suicides in that area. There are serious problems in public health that we need to get on top of and to prevent. Although the minister states the priority, it doesn't seem to be there in terms of placing the money where the priority is said to be.
There's an article in a public opinion magazine I was reading a short time ago which says that we even have to go beyond the relatively negative goal of prevention of sickness. "There are two positive goals: the maintenance of positive health and the pursuit and promotion of physical, mental and social fitness. This will require another new breed of health specialist, experts in education and especially in advertising, marketing and propaganda for health." This is a new thing that's happening in the health field: people are actually going out, promoting it and marketing it, and delivering the message to people around the province and the country that health is actually a good thing. I think the ministry is missing the boat a little bit if we're not putting much more emphasis on the promotional and preventive side of health care. I don't see the ministry in the province of B.C. doing that. We got the promise in the throne speech; we have the minister's verbal commitment to the Central Vancouver Island Health Unit; we have people all over the world and in the professions talking about this new, active marketing approach to public health; we have changes in lifestyle, and yet this ministry seems to have fallen behind quite a bit in that approach.
I'm also concerned about the minister's comments on medicare and the premium-based medicare we have in British Columbia, on how we're going to pay the costs, and on comparing the costs of our system with the income tax-based system — and I know exactly what he was talking about when he was talking about the have and the have-not provinces. I'm wondering if any studies have been done within his ministry to show what the options are. What would it cost the people of British Columbia, individual taxpayers, if the system were based on income tax? On the other hand, now we have temporary premium assistance and premium subsidies and a number of administrative measures to make sure that the poor, if they humbly approach the ministry and show that they don't have the money, will have their premiums paid. What is
[ Page 3081 ]
the administrative cost of doing that? There are staff involved, forms to be filled out, processing, and you have to do that processing every year. So there is a cost to that.
Also, on the issue of user fees, whenever a person approaches a hospital, they have to fill out the necessary forms and pay the necessary few bucks a day for hospital care. If they don't pay, then they have to be billed, and there are staff and forms required to do that, postage that must be paid and collection agencies that must pursue the people who don't pay. So there is a cost attached to the premium system, just collecting the premiums and making decisions between those able to pay and those not.
Has the minister done a study of the whole system and a comparison with the income tax-based system, which doesn't require a separate collection organization? Clearly, if you're watching the debate in the federal House of Commons, they do have a collection system there no matter what your opinions are on how it works. Has the minister done that kind of study, and is that study available to the public? Will the minister table it in the House? It's hard to debate a tax-based system as opposed to the premium-based system if we don't have the facts upon which to base that debate and if the ministry hasn't done the necessary studies and made them available to the public. So that's a question I'd like to ask the minister.
[12:30]
Also, on the issue of user charges, it seems to me that this province spends a tremendous amount of money building hospitals and providing those hospitals to the public, and when we think of the public we always think of the patients. Yet the people who send patients to hospitals are doctors. It's difficult for a patient to send himself to a hospital. So it appears to me that it's really the doctors who use the hospitals as places where they can practise. I'm told that often doctors will send a patient to the hospital when it's not really necessary. In order to get the patient out of the doctor's office, he'll have him committed to a hospital. Is there any user charge on the doctors for practising in a facility that was established and paid for by the public? Have user charges on physicians been considered? Those physicians use material that's purchased by the hospital for patient care and treatment, and it seems to me that possibly the patients aren't abusing the hospital but in some cases the doctors are abusing the hospital or the health care system by sending the patients there.
I'm wondering if that aspect of medical care has been examined by the minister, and if there has been any consideration given, if we're to agree to the principle of user fees at all, to those user fees being assessed against the doctors. Now I know that what's going to happen is that those fees will then be transferred back onto the public through the medicare system, and we'll end up paying for it ourselves one way or the other. But it seems that part of the abuse of the hospital system can't be blamed on the patients but can be blamed on doctors who are very busy and use the hospital system as a way of diverting patients until they have time to go back and see them.
[Mr. Pelton in the chair.]
This minister has been a Minister of Environment as well as Health minister. A number of concerns are being expressed nowadays about environmental health. When we were talking earlier today about the tragic accident up on Mount Washington with a bus, these are really health issues because they relate to public facilities which if they're abused or improperly used will result in people becoming a charge on the health care system. But the same applies to a number of other things: the introduction of hazardous chemicals into the workplace, the use of pesticides and the distribution of those chemicals into our environment, the way people work and the equipment that they work with. So there are a number of things involved here. I guess that relates back to the positive health care system.
They say that much of the disease that's present in society today is environmentally caused. It's caused by things that we insert into the environment that can ultimately lead to some pretty serious diseases. Yet it seems to me that in no aspect of the province's jurisdiction, and very little in federal jurisdiction, do we really go after these environmental causes.
Port Alberni, just in the last year, has been advised by the Ministry of Environment that MacMillan Bloedel's emissions permits from their mills in Port Alberni are going to be revised. The company apparently does not have the funds to bring its pollution control equipment up to the required standards in their pollution control permit; therefore they'd like a revision to reduce their requirements under the pollution control permits. The people of the city of Port Alberni, in exchange, are asking for a study of the health impacts of those emissions on them. A study was done in the mid-1960s by a former Deputy Minister of Health for the province, and by a doctor who's now a Baptist minister in Burnaby. They found that there were indications of health problems that resulted from the air emission system in Port Alberni. They didn't go into very much detail. But the people of Port Alberni are making what I consider to be a legitimate request for a health study to be done prior to any revisions in the pollution control permits which may result in an increased incidence of health problems in Port Alberni.
Has the minister been approached by the Ministry of Environment? Is the minister willing to fund the health study in Port Alberni? I understand that on February 29, the Central Vancouver Island Health Unit is holding a meeting in Port Alberni to discuss the health study. There seems to be strong support for it. Is the minister willing to finance this study so that the people of Port Alberni will have adequate information upon which to judge whether or not the company, MacMillan Bloedel Ltd., should be entitled to reduce its permitted requirements under their pollution control permit? I would urge the ministry to finance that study. It seems to me that that's dollars well spent.
Could the minister address some of those questions for me?
HON. MR. NIELSEN: Mr. Chairman, I think if we are going to have a health study to find out whether MacMillan Bloedel should modify their emissions, they should pay for it. It's an interesting idea — not novel, but interesting — to charge doctors for using hospital space. Think of all the money we would capture from that. Then we could charge teachers for using classrooms, professors for lecture halls and policemen for their vehicles. The idea has been suggested previously. The doctors are not overly enthusiastic about the idea.
We could even charge our members here for using the Legislature. If an audit were done on the advantage to the citizens, the fee might be very high.
On your physical fitness question: within our health promotion in the ministry we have programs established.
[ Page 3082 ]
They are certainly not in a final position, because it is quite experimental. We have demonstration projects in the workplace with respect to low-back injuries and casual absenteeism. We have demonstration projects in the community with respect to health care utilization by seniors; projects in the school system; obesity; cardio-vascular health; fitness components for the ministry manuals and publications; perinatal guide for health professionals; leadership training sessions; pre-retirement seminars; lifestyle workshops; educational materials, audio-visual and so on; development of fitness standards; screening procedures for high-risk employees, health care workers, dietary workers, deputy sheriffs; consultation referral services to companies and corporations regarding development of workplace fitness programs; social marketing studies; understanding attitudes and influence on behaviour of at-risk population; identifying strategies for encouraging and supporting change; consultation to public health nurses, nutritionists and allied health professionals regarding fitness issues. So a fair amount is being done and being organized.
As a very quick comment, in speaking with the people responsible for assisting people in high-stress areas of work, apparently it has had a significant successful appearance. In being able to speak with people who are in high-stress positions, not only the individual working there but also members of the family, it has been apparent that it has resulted in a respectable amount of breakdown prevention, particularly — if there is such a thing — of minor mental problems.
Mr. Member, when you first introduced the subject of physical fitness, I was thinking of the orthopedic surgeon who has advised me of the incredible increase in cases that he has seen since jogging has become as fashionable as it is, particularly in the knees. He has some very strong attitudes toward that, which I won't repeat, because it's his own idea.
The collection of fees, whether by way of an income tax system, by premiums or otherwise. I think the opinion I have, which I expressed earlier, is that using income tax itself — just increasing income tax — to cover the premiums and the hospital user fees, rather than collecting them from a different source, if you like.... The technical aspect of using an income tax filing system for their collection, rather than the submission of premiums through payroll deduction and other methods of collecting fees, has been considered and examined by the ministry from a technical, administrative point of view. Mr. Member, as an example, let us say we were to attach a tax or a fee as part of the income tax form and collect it at that point, rather than by way of submission of premiums. There could be some savings in administration. There are some serious problems in attempting to do that, but there could be savings. That's a technical aspect. I believe Quebec has been doing that. There could be considerable savings in administrative costs for our Medical Services Plan. That's if we could keep up with the technology available today as well, because there's no question that there are improved systems.
We've been speaking with the providers of health care, as I think they prefer to call themselves, as to how we can modify the system. In many areas our system is in need of major renovation from a technical point of view — communications and so on. We still rely very much on the telephone to doctors' offices and others to get some very basic information, which could be readily available through a very inexpensive computer system, if terminals were properly located in doctors' offices, hospitals, and so on. That's coming. It's just a matter of time and finding the dollars.
Public and preventive health. We recognize the need for public health, and we recognize the various difficulties health units have in maintaining their staffing. Primarily there are two reasons for that: one is a matter of having the necessary funds; the second is the recruitment of suitable people. In many areas of the province those two aspects can be almost equal as to why we have some difficulty. Specialists in public health are sometimes quite difficult to locate and then maintain in their position. We do have a large number of people who pull out of an area after a period of time, and sometimes it is very, very difficult to find another person for that position. As well, we must took at the dollars, and one of the frustrations, I suppose, is that we recognize that the health care system probably is adequately funded. One of the great frustrations is that we see it going out at this one end, which means we may not be able to provide what we would like to provide at the other. It's a situation that can't be immediately corrected. We recognize that if we can provide more preventive health care and public health, we might be able to cut down the costs of the acute care level and so on. That's what is consuming all the money at this time, however, and we must cut down that tremendous cost of the hospitals' medical services if we're going to have those funds available to provide some of these others.
It's an unfortunate reflection, Mr. Member, on our society — and I'm not criticizing our society, because we're all part of it — that we do expect our health care system to cure our problem rather than to join with the system in trying to prevent the problem from ever occurring. Unfortunately that is the way people are.
I hope our ministry will have an opportunity to provide some specific information with respect to prevention and what prevention has actually meant to our health care system over the years. Perhaps a lot of people are simply unaware of how health can be affected by preventive health care, so I think we'll have a slight project with respect to that — at very low cost, I might add. I think that covers most of the areas you spoke of.
Environment and health. Of course we've recognized the interrelationship. Possibly the best example in our province would be the availability of our water supply and the relative security of our water supplies. As the member knows, from an environment and health point of view I suppose there are far more illnesses and diseases caused by the lack of purity of water than almost any other environmental aspect. Of course, the purity of the air is equally important and can contribute to many problems, particularly respiratory problems.
Because it's approaching adjournment time and because it's a Friday afternoon, I would move that the committee rise, report progress and ask leave to sit again.
Motion approved.
The House resumed; Mr. Speaker in the chair.
The committee, having reported progress, was granted leave to sit again.
MR. SPEAKER: Hon. members, earlier today the second member for Victoria (Mr. Blencoe) rose under the provisions of standing order 35, sought adjournment of the House
[ Page 3083 ]
for the purpose of discussing a matter of urgent public importance and handed a written statement of the matter to the Chair together with the appropriate motion that he intended to move should a prima facie case be established. The statement handed to the Speaker referred to recent information, statements on CBC radio and certain other "allegations." The matter raised fails to qualify under the provisions of standing order 35 in that it would appear to rely heavily on media reports and accordingly is offered from facts that are in dispute or before they are available. See May, sixteenth edition, page 370. The motion would also fail in that an ordinary parliamentary opportunity will occur shortly to discuss the subject matter of the hon. member's motion. For the stated reasons, the Chair is unable to find the member's application in order.
Hon. A. Fraser tabled answers to questions standing in his name on the order paper.
Hon. Mr. Schroeder moved adjournment of the House.
Motion approved.
The House adjourned at 12:46 p.m.
Appendix
WRITTEN ANSWERS TO QUESTIONS
5 Mr. Stupich asked the Hon. the Minister of Transportation and Highways the following questions:
With respect to the Gabriola Island Ferry—
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
40 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following questions:
1. Is there a cost overrun on the Greenville Bridge construction? If the answer is yes, what is the cost of the overrun?
2. What was the cause of the collapse of the new bridge which was under construction on Highway 37 between Meziadin and Bob Quinn?
3. Does the Minister have plans for highway construction during 1983/84 between Cassiar and Highway 37 junction? If the answer is yes, what are the plans?
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
49 Mr. Blencoe asked the Hon. the Minister of Transportation and Highways the following questions:
With respect to the B.C. Steamship Company, operators of the Princess Marguerite—
1. What are the names and head office addresses of all companies, Canadian and foreign, which supply the services and commodities to the Princess Marguerite for the fiscal year 1982/83 and 1983/84 (to date)?
2. What is the detailed dollar value to each company, Canadian and foreign, which supplies the services and commodities to the Princess Marguerite for the fiscal year 1982/83 and 1983/84 (to date)?
3. What is the purchasing policy currently in use by the B.C. Steamship Company?
[ Page 3084 ]
4. What is the complete listing of quotations received for all services and commodities from companies, Canadian and foreign, supplying the Princess Marguerite for the fiscal year 1982/83 and 1983/84 (to date)?
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
67 Mr. Reynolds asked the Hon. the Minister of Transportation and Highways the following questions:
1. On July 27, did any members of the Public Service in the Ministry of Transportation and Highways leave their positions to attend a rally at the Parliament Buildings, and if so, how many?
2. In reference to No. 1, how many of these public servants will be paid for: (a) the whole day and (b) for part of the day?
3. Will any money be saved by Government as a result of No. 2, and if so, how much?
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
85 Mr. Reynolds asked the Hon. the Minister of Transportation and Highways the following questions:
1. On August 10, did any members of the Public Service in the Ministry of Transportation and Highways leave their positions to attend a rally at Empire Stadium, and if so, how many?
2. In reference to No. 1, how many of these public servants will be paid for: (a) the whole day and (b) for part of the day?
3. Will any money be saved by Government as a result of No. 2, and if so, how much?
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
88 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following question:
On recent highway construction on Highway 37, was the construction equipment used from Fort St. John? If so, and if similar equipment was available at Centreville and registered with the Dease Lake highway office, why was not local equipment hired instead of highway equipment from 400 miles east?
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.
89 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following questions:
With respect to the Atlin Airport—
1. What is the cost to date of the construction?
2. What contractors have been retained for construction of the project?
3. What amounts have been paid to date to the contractors on this project?
[ Page 3085 ]
The Hon. the Minister of Transportation and Highways stated that, in his opinion, the reply should be in the form of a Return and that he had no objection to laying such Return upon the table of the House, and thereupon presented such Return.