[ Page 6221 ]

CONTENTS

Oral Questions

Hazardous wastes. Mrs. Wallace –– 6221

Prince Rupert grain terminal. Ms. Sanford –– 6221

Seedlings for Japan. Mr. Howard –– 6221

Manning Park sale. Mr. Mitchell –– 6222

Sales tax on benefit recording. Ms. Sanford –– 6223

Holiday travel planner. Hon. Mr. Richmond replies –– 6223

Presenting Reports –– 6223

Medical Service Amendment Act, 1985 (Bill 41). Second reading

Hon. Mr. Nielsen –– 6224

Mrs. Dailly –– 6226

Mr. Lea –– 6229

Mr. Macdonald –– 6231

Mr. Passarell–– 6232

Hon. Mr. McGeer –– 6234

Mr. Hanson –– 6235

Mr. Reynolds –– 6237

Mrs. Wallace –– 6238

Mr. Mitchell –– 6239

Mr MacWilliam –– 6241

WEDNESDAY, MAY 22, 1985

The House met at 2:05 p.m.

Prayers.

[Mr. Strachan in the chair.]

MR. REYNOLDS: Mr. Speaker, today it was announced in Victoria that the Victoria Open, a golf tournament taking place July 22-28 of this year — a PGA event — will take place and be sponsored by Pay-Less Gas. I would like the House to congratulate Mr. Allen Vandekerkhove for this great move to support Victoria and tourism in this area.

HON. MR. BRUMMET: Mr. Speaker, I had the pleasure today to meet with a visitor from down south, the Hon. Terry Hemmings, Minister of Housing and Construction and Minister of Public Works in the state of South Australia. He's visiting me and the Minister of Municipal Affairs (Hon. Mr. Ritchie) and the B.C. Buildings Corporation staff today. Traveling with Mr. Hemmings are Mrs. Joyce Hemmings, ministerial adviser Mr. John Luckens, and Mr. Paul Edwards, general manager of the South Australia Housing Trust. I would like the House to make them very welcome today.

MR. REID: Mr. Speaker, on behalf of the first member for Surrey (Mrs. Johnston) and myself, I'd like the House to welcome a member of the Surrey School Board who is in the members' gallery today, Mr. Marvin Hunt.

Oral Questions

HAZARDOUS WASTES

MRS. WALLACE: Mr. Speaker, I had intended to ask my question of the Minister of Energy, Mines and Petroleum Resources (Hon. Mr. Rogers). In his absence I think I will ask his parliamentary secretary.

In April 1984 the Minister of Energy was informed that Hydro was being advised to delay their PCB waste disposal because of the cost involved. What action did the minister take at that time?

MRS. JOHNSTON: I will take that question on notice and get an answer back as promptly as I can.

MRS. WALLACE: The present Minister of Environment's predecessor was advised at the same time that Hydro was being advised not to dispose of their PCB waste because of the cost. Is he aware of any action that was taken at that time by the former minister?

HON. MR. PELTON: No, Mr. Speaker.

PRINCE RUPERT GRAIN TERMINAL

MS. SANFORD: A question to the Premier. Officials of Prince Rupert Grain Ltd., including Dr. Hugh Homer, have proposed that the old Prince Rupert grain terminal be saved for specialty grain products and surplus storage. This would preserve the jobs of about 70 people, as I understand it, Mr. Speaker. Will the Premier advise whether he discussed this proposal with the federal government and the other parties involved when he was at Prince Rupert last week? If so, what was the outcome of those discussions?

HON. MR. BENNETT: Mr. Speaker, in response to the member, I was there when the question was asked of the federal minister during a press conference at the exciting opening of those very modern and high-tech grain unloading facilities in Prince Rupert. The impression I got was that the federal government.... The answer he gave was that the federal government, which has been in charge of the old terminal and the port facilities, would look very hard at ways in which the old facilities could be maintained. I accept that he meant what he said.

MS. SANFORD: Mr. Speaker, I am wondering if the Premier is prepared to state what his position and the position of his government is with respect to retention of that facility.

HON. MR. BENNETT: We certainly support any effort the federal government makes in areas of their jurisdiction to maintain and create jobs in the province of British Columbia.

SEEDLINGS FOR JAPAN

MR. HOWARD: Mr. Speaker, I would like to ask the Minister of Forests if he can confirm that the expected number of seedlings available this year for planting in our forests will be short by some eight million seedlings.

HON. MR. WATERLAND: No, Mr. Speaker, I can't confirm that.

MR. HOWARD: I ask the minister if that is a fact. Does he know that they will be eight million seedlings short this year?

HON. MR. WATERLAND: Mr. Speaker, I've answered the member's question. I cannot confirm that fact — if he claims it to be a fact. I will certainly find out if we have had any difficulty in growing the seedlings required for this year's planting, but I have not been so advised.

MR. HOWARD: I take it that the minister doesn't read the newspapers or listen to what officials in his department say, but that's understandable. I wonder, in the light of that, if the minister can explain to the House why he permitted his colleagues — one of them — to extract from his grasp and potential some 500,000 seedlings that would have been available for planting in British Columbia, so that they could be transported to Japan and given to tourists over there.

HON. MR. WATERLAND: Mr. Speaker, the member for Skeena is badly misinformed. No seedlings which would have been available for planting in British Columbia's forests were sent to Japan.

MR. HOWARD: I want to say that the minister is misinformed. He just doesn't know what's going on within the government, that's all. In light of the fact that there could have been some 1,000 person-days of employment to British Columbians available right now, immediately, if those 500,000 seedlings had not been given away to tourists in Japan, can the minister explain why he permitted that to happen?

[ Page 6222 ]

HON. MR. WATERLAND: Mr. Speaker, perhaps I should explain to the member some of the facts of the subject which he's talking about. A request was made by Mr. Henry Wakabayashi, who is consulting for the provincial government in their involvement in the world's fair in Tsukuba, Japan. He requested that we provide them with 500,000 seedlings. We denied that request, saying that any seedling capacity that we have would be used for the production of seedlings for planting in British Columbia. However, we made available to them about 500,000 seeds, which were excess to the requirements of British Columbia and which could not have been used because of the provenance from which the seed would have to be planted, which would not be usable in British Columbia during the usable life of those seeds.

Those seeds were then taken and grown in three private nurseries. These nurseries were: Arbordale Nursery, which grew 100,000 Douglas fir seedlings; World Silviculture Nursery, which grew 275,000 ponderosa pine and spruce seedlings; and Riverside Nursery, which grew 125,000 ponderosa pine seedlings. These private nurseries produced seedlings out of surplus seed that we donated because it was not usable by us; those are the seedlings which were subsequently provided by the private nurseries to be used in Japan,

[2:15]

MR. HOWARD: Isn't it a fact that if the minister would have been a bit more persuasive with his colleagues, the space taken up by the growing of those 500,000 seedlings could have been used to grow seedlings for planting in British Columbia?

HON. MR. WATERLAND: Mr. Speaker, no, that is not the case. The member seems to think that the only thing involved in reforestation is the growing of seedlings. The growing of seedlings is but one step, which has to be done up to three years ahead and in some cases, in terms of a containerized seedling, one year in advance. But growing the seedlings is but one step. The site preparation is another step which has to be taken, and sites were not prepared for the planting of those seedlings, so there was no point in using that nursery capacity for growing those seedlings.

So we have had an expanding plantation of seedlings throughout the period of time that I've been minister, Mr. Speaker, For example, prior to my becoming Minister of Forests there were fewer than 70 million seedlings planted in the forests of British Columbia. Last year — the year just ended — I believe the figure was 120 million seedlings. That rate of growth is now accelerating.

The member for some strange reason has not asked me recently when we're going to get approval for our forestry agreement. He asked me that question quite regularly up until a few days ago. Now he's giving out the....

Interjections.

HON. MR. WATERLAND: Mr. Speaker, that agreement will allow us to within two years be producing and planting 200 million seedlings a year in the forests of British Columbia. That is quite an accomplishment.

MANNING PARK SALE

MR. MITCHELL: Mr. Speaker, my question is to the Minister of Lands, Parks and Housing. I hope I don't take two years to get the action that we've got out of the Minister of Forests. My question to the minister is: according to the rules and practices of this House the minister is required to table a document referred to in question period. In view of the minister's reference to a secret agreement for the sale of property and assets at Manning Park, will the minister now table that document?

DEPUTY SPEAKER: There is a question there.

HON. MR. BRUMMET: I detected a question there. Thank you, Mr. Speaker. I resent the implication of the secret documents and that sort of thing. That document is available to people who want to drop into the ministry. We don't produce them in great numbers on these contracts, and so the answer to the question, basically, is no.

MR. MITCHELL: It's still a secret document to the people of B.C. if we don't have access to it. Why is the minister hiding the truth about the terms and conditions...?

DEPUTY SPEAKER: One moment. That does impute a dishonourable motive to another hon. member, and I'll ask the member to withdraw that phrase.

MR. MITCHELL: Well, I'm not saying he's telling an untruth; I'm saying he's hiding the truth. He has the truth; he has....

DEPUTY SPEAKER: That offends the Chair, hon. member. Will the member simply withdraw that statement?

MR. MITCHELL: I'll withdraw that statement.

DEPUTY SPEAKER: Thank you. Please proceed.

MR. MITCHELL: Maybe I'll reword it. Why is the minister hiding the facts about the terms and conditions?

DEPUTY SPEAKER: Order, please. Simply ask the question. Withdraw the phrase; it is offensive to Parliament. Thank you.

MR. MITCHELL: Hiding the facts?

DEPUTY SPEAKER: Withdraw, please. A simple withdrawal will be sufficient, thank you.

MR. MITCHELL: Okay. Can I rephrase it again? Why is the minister withholding the truth?

SOME HON. MEMBERS: The facts.

MR. MITCHELL: The facts.

DEPUTY SPEAKER: We seem to have a little problem here. No, that phrase will also have to be withdrawn. Will the member please simply withdraw.

[ Page 6223 ]

MR. MITCHELL: I'll withdraw.

DEPUTY SPEAKER: Thank you.

MR. MITCHELL: We'll rephrase it again, Mr. Speaker. I seem to have your attention, but I haven't got the minister's.

Why is the minister refusing to file a copy of the terms and conditions of the agreement, whereby assets costing the taxpayers of this province $20 million in investments were sold to friends of the government for $500,000? If you realize that $500,000 is but one-fortieth of its true value, or that the assets were sold at a fire sale price of approximately.... The people of B.C. received approximately 2.5 percent of the money they invested in that park. Mr. Speaker, I'm asking why the taxpayers cannot get a copy of the agreement that allowed that to take place.

DEPUTY SPEAKER: Before recognizing the minister, I'll point out that our standing orders require that questions and answers shall be brief and precise and stated without argument or opinion.

HON. MR. BRUMMET: Again, it is evident that there's no point in giving facts to that member, because he doesn't listen. I gave him a correction on his figures yesterday, and he is still quoting the misinformation that he's basing his questions on. If the member wants answers, then he should ask the particular questions. I cannot be held responsible for his incompetence in asking questions.

MR. MITCHELL: The minister did not dispute my facts when I said that the assets were sold for 2.5 percent of the invested value of the taxpayers' money. He hasn't disputed that.

HON. MR. BRUMMET: I certainly don't intend to get into calculations of percentages when that member is using the wrong figures.

SALES TAX ON BENEFIT RECORDING

MS. SANFORD: I have a question for the Minister of Finance. I'm wondering if the minister will advise us approximately how much money has been collected for sales tax on the Canadian-Ethiopian relief record entitled "Tears Are Not Enough."

HON. MR. CURTIS: I thank the member for her question. I'm sorry that I don't have that precise figure available in question period. I will attempt to get it as quickly as possible and bring it to the member.

MR. HOWARD: I wonder if I might have leave to make an introduction, Mr. Speaker.

Leave granted.

MR. HOWARD: I'd like the House to join me in expressing a welcome to a long-time friend of mine, Mr. Satwant Singh, who I've just noticed in the gallery today.

HON. MR. RICHMOND: Mr. Speaker, I would ask leave to answer more fully a question that was asked of me yesterday.

DEPUTY SPEAKER: An answer taken in question period?

HON. MR. RICHMOND: Yes.

DEPUTY SPEAKER: Leave is not required.

HOLIDAY TRAVEL PLANNER

HON. MR. RICHMOND: After being asked yesterday by the member for North Okanagan (Mr. MacWilliam) the reason for Needles showing on our Tourism travel planner, and realizing the urgent nature of the question, and not wanting people to think we take these things lightly, I have done some more research into the question of why Needles appears on the travel planner.

I have come to the conclusion, Mr. Speaker, that Needles appears there for the same reason that Swartz Bay and Galena Bay appear on the maps. If you wish to take a trip on a ferry to Tsawwassen, you must leave from somewhere. Hence we show Swartz Bay on the map, even though there is no town of Swartz Bay. When you wish to cross the Arrow Lakes from the west side to get to Fauquier, you have to leave from somewhere to get to Fauquier. Conversely, and just as important to the people of Fauquier, if you want to leave there and go to the other side of the lake, you have to be able to go to somewhere. That somewhere shows on the map as Needles.

Not only that, Mr. Speaker, but if the member has driven to Needles lately, he will know that the Minister of Transportation and Highways (Hon. A. Fraser) has spent millions of dollars upgrading a road to go to a place called Needles, so that his ferry can leave from somewhere.

I will leave the member with the immortal words of Yogi Bear: "If you don't know where you're going, you might end up somewhere else."

DEPUTY SPEAKER: That was an answer to a question taken on notice in question period. A reply is not in order.

Presenting Reports

MR. REE: Mr. Speaker, I have the honour to present a report from the Special Committee of Selection. I move that the report be read and received.

Motion approved.

MR. REE: Mr. Speaker, pursuant to an order of the House made on May 16, 1985, your special committee appointed on March 4, 1985 to prepare and report lists of members to compose the select standing committees of the House for the present session begs to report that the following is the list of members to compose the select standing committee to recommend a person to be appointed ombudsman pursuant to section 2(2) of the Ombudsman Act, being chapter 306 of the Revised Statutes of British Columbia, 1979: Messrs. J.M. Parks, convener, R.G. Fraser, J.J. Kempf, C.C. Michael, W.B. Strachan, Hon. J.A. Nielsen, Hon. W.S. Ritchie, Mrs. E.E. Dailly, Messrs. D.G. Cocke, D.F. Lockstead and G.R. Lea.

Mr. Speaker, by leave, I move that the rules be suspended and the report adopted.

Leave granted.

[ Page 6224 ]

MR. MacWILLIAM: On a point of order, the minister was expanding on an answer....

DEPUTY SPEAKER: Just a moment, please. One more procedure apparently has been.... The question on the motion.

Motion approved.

MR. MacWILLIAM: On the point of order, Mr. Speaker, the minister was expanding at some length on an answer given previously in question period yesterday, so I do believe that under the rules of order, that does allow me a reply.

Interjections.

DEPUTY SPEAKER: Hon. members, the minister took a question or part of a question on notice...

SOME HON. MEMBERS: No, no!

DEPUTY SPEAKER: ...and replied today. That was the statement given to the House. It was not a ministerial statement, and therefore a ministerial reply is not allowed.

MR. HOWARD: I think it should be pointed out that the minister yesterday, in answering questions posed by the member for Okanagan North, replied to them fully, did not take any of them on notice. So in fact when he rose today at the conclusion of question period, he was making a ministerial statement, and as such I think the member — for Okanagan North in this instance — should be afforded the opportunity of a reply.

[2:30]

MRS. WALLACE: Further to the point of order, Mr. Speaker, I would like to point out, in line with what my colleague from Skeena has said, that that did in fact occur yesterday. Also occurring yesterday, the Minister of Environment got up and asked leave to answer a question that I had asked, which turned into a ministerial statement, and which you allowed me to respond to without raising a point of order, which I certainly would have done had you not.

HON. MR. NIELSEN: Mr. Speaker, the Minister of Environment yesterday asked leave to answer a question which he did not answer during estimates, rather than in question period. The member for North Okanagan has asked that he be allowed to reply to an expanded answer to a question answered in question period. Those were his words.

Mr. Speaker, the standing orders do not recognize that situation. The member for North Okanagan asked if he could respond to the minister's expanded answer to a question, and the standing orders simply don't recognize that.

MR. LEA: Mr. Speaker, regardless of the decision you make, I hope you realize the gravity and the importance of this whole topic. Do you realize that many of the unemployed out there today are just sitting at the edge of their chairs waiting for this decision, to see whether it's going to be Needles or Fauquier, or whether it leaves from one side.... It's really important.

DEPUTY SPEAKER: Yes, I appreciate the gravity of your statement.

MR. ROSE: I won't extend the satire that has already been accorded you, Mr. Speaker, but I would like to say that yesterday I was very proud of the Chair for recognizing that this was not really a question taken as notice but in fact a ministerial statement. It seems to me today that what we got here, in the guise of an explanation or an expansion, was an opportunity for a minister, who was accorded a question yesterday, to expand and explain and justify his stand, albeit humorously — and it was very enjoyable. I think that's fine, except that when this goes on, when ministers are permitted, without rebuttal, to get up after question period and say, "Well, I didn't mean that yesterday, but I subsequently found out about this.... Doesn't that amount to a statement by ministers, not just an expansion on a question? I think that, under those conditions, if it is not a question taken as notice, then a rebuttal should be allowed by the person who posed the question.

DEPUTY SPEAKER: Hon. members, the records will show that we had an interesting procedure yesterday: a question arising out of a question taken as notice, if you will, in estimates; whereas today we're discussing a question taken as notice in question period.

Interjections.

DEPUTY SPEAKER: Let me finish, please. I will undertake to review the Journals. I will now put the question to the House: shall leave be granted to the member for Okanagan North?

Leave not granted.

Orders of the Day

HON. MR. NIELSEN: Mr. Speaker, second reading of Bill 41.

MEDICAL SERVICE AMENDMENT ACT, 1985

HON. MR. NIELSEN: Mr. Speaker, I move second reading of Bill 41, Medical Service Amendment Act, 1985. Perhaps a few introductory remarks with respect to the purpose of this bill.

As members would know, Bill 41 resulted in part from the withdrawal of the previous Bill 50. The bill now before the House will reinforce one of the most significant social programs in our province, our medicare plan.

Mr. Speaker, universal medicare has been a reality in our province since 1968, and most citizens take it for granted as something they expect to enjoy. During this period of time, as medicare has become an entrenched social program, some significant patterns have emerged in providing universal medical services. In particular, there has been a spectacular growth in costs and, in British Columbia especially, a rapid growth in the number of physicians, coupled with an oversupply of doctors in the lower mainland, in the Victoria area, and in the Okanagan Valley and other areas. While that oversupply exists in the metropolitan areas of the province, there continues to be a shortage of physicians in rural and isolated communities.

[ Page 6225 ]

The bill directly addresses the question of physician supply by explicitly granting the Medical Services Commission the authority to issue or not to issue what are now called practitioner numbers, which entitle physicians and other health professionals to receive payment from the Medical Services Plan for rendering insured services.

As members are likely aware, Mr. Speaker, the Medical Services Commission has been issuing practitioner numbers since September 1983, according to a control process developed in conjunction with the official organizations representing the medical professions. However, about one year ago several of these organizations withdrew from the committee — withdrew their cooperation. I am told they were told by the CMA not to sit on the committee. Last month the process was called into question by the Chief Justice of the Supreme Court, who ruled the commission did not have the statutory authority to control the issuing of billing numbers. In this bill such authority would be made explicit.

Mr. Speaker, the idea that there could be too many doctors may not be readily appreciated by those who are not directly involved with the economics of our health care system. Frequently it is suggested that the more doctors the better our health care — not necessarily the same, Mr. Speaker. Certainly the costs would be almost out of control if there was no control. Surprising as it may be to some, B.C. has more doctors per capita than any other province. We are way above the national average. Greater Victoria and Vancouver particularly are overendowed with specific types of physicians.

It's quite different when society is paying the entire bill. In a free enterprise health system, where doctors were responsible for collecting their own fees and patients were responsible for paying them, it could be argued that there really was little need for controlling the number of practitioners. The marketplace presumably would play a role. Not so with a nationalized medicare system. Each doctor who joins the system adds several hundred thousand dollars a year to the cost of running the system. As an example, Mr. Speaker, each physician receives an average of $144,000 in gross payments from the plan. In addition each physician generates further costs through his or her ordering of lab tests and through admissions of patients to hospitals.

By the most conservative yardstick, our province has at least 300 more physicians than we actually need. The cost with those 300 is about $50 million. We probably now have 400 to 500 more physicians than we require. In fact, even if B. C. had 300 or 400 or 500 fewer doctors, we still would have the most doctors per capita in Canada. The oversupply of physicians in our metropolitan areas is not a figment of imagination. The fact has been acknowledged by various studies — studies in which the B. C. Medical Association and the College of Physicians and Surgeons were full participants along with government. One study was the Black report — 1979 — which recommended restrictions on practitioner numbers. A similar recommendation emerged from the 1982 study by the Joint Committee on Medical Manpower, which had been established as an outcome of fee negotiations between the government and the BCMA.

Just some interesting figures for a moment, Mr. Speaker: the 1982 study showed that the number of B.C. physicians had grown by more than 30 percent from 1975 to 1982, from 4,016 to 5,380. The major source of this increase was the movement of physicians from other parts of Canada, particularly the other western provinces and Ontario. The study also found that in the ten years from '72 to '82 the number of services provided by physicians rose by 88 percent. The population increased by 26 percent. Services grew more than three times as fast as the population. The committee said: "This strongly suggests that other factors — including the number of physicians in the area — apart from population, 'need' for medical services, determine the level of physician services provided."

Mr. Speaker, we in British Columbia have one physician for each 508 people. The national average is one physician for every 604 people. In New Brunswick it is in excess of 900 per physician. I might add that much has been written and said over the past few years to suggest that Canada in total has an oversupply of physicians. So even then the national average itself is not necessarily an ideal level. It is estimated that if we do not control the production of physicians in Canada, by the year 2000 we'll probably have a surplus of 6,000.

Mr. Speaker, the ratio of physicians to population in greater Vancouver is one physician for every 391 people; in greater Victoria one for every 376. There is no mystery as to why physicians find Vancouver and Victoria attractive areas, not only for the natural attractions, but because there they also have the benefits of first-rate medical facility, a medical school and an active health research community. But whatever the reasons, the fact is that greater Vancouver and Victoria and certain other areas of the province have an overabundance of physicians.

A little bit of history, Mr. Speaker, if I may, because we're engaged right now in quite a battle — well, not much of a battle actually, but an argument, I guess — with the BCMA and PARI. PARI, I explain, is the Professional Association of Residents and Interns. For a while someone thought I was speaking about a Dr. Parry, but it's an association. BCMA and PARI.... In fact, I gather that yesterday we were already advised that they're going to take it to court, which is interesting because the bill isn't law yet, but apparently they're going to take it to court anyway.

Mr. Speaker, I introduced a bill in 1983 known as Bill 24. It contained similar legislation to control the issuance of billing numbers. In consultation with the BCMA it was suggested, as has been suggested for the last decade, that there were better ways to control billing numbers and better ways to control physician supply, manpower. After considerable discussion with the BCMA, we allowed Bill 24 to die on the order paper. During our discussions the BCMA asked if they could take part in a committee which would review applications for billing numbers. We agreed. The BCMA, PARI, the College of Physicians and Surgeons, the B.C. Health Association and the University of British Columbia Medical School were all party to the committee.

[2:45]

Very briefly, the process required an applicant for a practitioner number to be licensed by the College of Physicians and Surgeons, to be granted admitting privileges by the local hospital, and to be recommended by a local medical manpower committee. The latter committee's role was to advise on the need for another position or for certain specialties in the local area. All three of the stages involved full participation by members of the medical profession. In addition, the process included a provincial medical manpower committee to review applications on which the Medical Services Commission requested further advice.

It worked quite well — until they got their walking orders and abandoned the committee. In 1984, 258 practitioner numbers were issued. Of those, 128 were permanent and 130

[ Page 6226 ]

were locums. In 1983 we issued 393 numbers. Last year 135 fewer numbers were issued. It was working well without any adverse effects on health services.

There's a lot being said about the right of doctors to practise wherever they choose to practise. Well, a doctor is licensed by the college. We do not license doctors. We become involved when a doctor seeks to receive compensation from the Medical Plan. We believe that as managers of the plan the commission have a responsibility to manage the plan, not simply to rubber-stamp applications.

It's most interesting that doctors take part in local manpower committees at the hospital level. If a doctor is seeking hospital privileges to practise his profession at a hospital, the medical manpower committee reviews the credentials of the doctor. Finding them to be correct, they then review the need for that physician at that hospital. If they find that they do not require that physician's specialty, or if he's a GP and they do not require another GP on staff, they deny privileges in the same way we wish to review the need for that doctor or his specialty in a region of the province. The medical people take part at the hospital level. They refuse, so far, to take part at the provincial level. We believe it is basically the same principle.

An important part of this bill is the establishing of an advisory committee to review this manpower question. I've been advised by spokesmen for the health professionals that there are better ways of controlling manpower. I've been hearing that for five years; the ministry's been hearing that for ten years at least. I asked the BCMA to prepare their alternatives for me in written form. I have not received those as yet. I asked my deputy ministers a week or ten days ago, when they were meeting with BCMA officials, if they would have the BCMA officials put down in writing what their alternatives to manpower control were. They refused to put them in writing. I told my officials to advise them that it is not serving any useful purpose to continue discussion when we don't really know what it is we're considering. We put our proposals in writing, in the form of Bill 50 and now Bill 41. We asked them to do the same, under their letterhead.

So I don't carry the can when another professional organization accuses us of going after them. The advisory committee will provide the opportunity for the BCMA, PARI, the college, BCHA, for university and other people who may be appointed, to work on the alternatives. But until they come up with the alternatives, we will have some control over the number of practitioner numbers issued in the province.

I told the BCMA last Saturday in Whitehorse that we simply could not stand around and spin our wheels, waiting for these alternative proposals to materialize. We've been waiting ten years now, and I hear the same story: there are better ways. But what are the better ways? There were some suggestions made which I made notes of, but still they haven't been written — and I would suggest that they could be challenged in court without terrible difficulty.

I will ask the advisory committee, if it's established and if these people wish to take part, to prepare their alternatives. We will then review the alternatives, we will test the alternatives from a legal point of view, and we will determine if there would be any difficulties in making use of those alternatives as law. But until that time, we will have some control when this act becomes law. If they can develop a better mousetrap, we'll use it. If they can produce, through the advisory committee, better methods of controlling manpower, we can substitute those methods by regulation.

MR. ROSE: You're not long for this world; I think you're going to need a doctor.

HON. MR. NIELSEN: A chiropractor can fix it for me.

MRS. WALLACE: Maybe you should stop smoking.

HON. MR. NIELSEN: That's what I need.

Mr. Speaker, we are not in basic disagreement with the professionals. The BCMA admit there are too many doctors in B.C. What they do disagree with is the method of controlling medical manpower. Unfortunately, they have yet to come up with a proposal that I can actually see. I've heard some comments. Others have dropped hints and suggestions. But I need it in writing. I think the committee will probably provide that for us.

I'm going to be asking the BCMA and the others listed in the bill to sit on the committee. Should they not wish to, fine. If they don't want to take part in the resolution of the problem, then they're going to have to accept our resolution of the problem.

Mr. Speaker, I believe Bill 41 is essential to allow the Medical Services Commission to control the number of practitioner numbers which will be issued in our province; to attempt, at least, to eliminate some of the surplus medical manpower in certain areas of the province; to try to keep costs down a little at least; and perhaps to encourage practitioners to practise elsewhere, where they are desperately needed.

I agree that simply controlling the issuance of numbers is not going to solve the manpower problem. Neither, I would suggest, is ten years of wheel-spinning going to solve the manpower problem. In speaking with the Ministers of Health in Winnipeg last week, every one agreed we have a manpower problem. I'll tell you, the Ministers of Health of all provinces, and the federal minister, are consistent if nothing else. At every meeting everyone agrees we have a problem with manpower. But to this point in time, no one seems to have come up with a resolution. A report is expected to be released soon which will offer certain recommendations on a long-term basis, and we'll probably support it. But we have a problem now. We intend to move in this matter this way until such time as a better method is developed — we hope through cooperation with the professional associations. If they choose not to take part, then we'll have to do it alone.

Mr. Speaker, I move second reading.

MRS. DAILLY: The official opposition will not be supporting this legislation. We have the same concerns that the minister has over the matter of manpower and costs. But our party, the NDP, does not believe in trying to solve a problem with the heavy hand of a centralized government. That is the issue: the heavy hand of a statist government. That's what we have.

Mr. Speaker, the NDP believes in negotiation. The minister has said that he has tried to come up with solutions. As far as we're concerned, he has been the minister and the Social Credit have been the government for many years in this province now, and the very fact that after all these years they throw up their hands and say they can't find a solution and bring in something that is absolutely repugnant to most people in British Columbia says something about the inability of that government to govern.

[ Page 6227 ]

The minister is quite aware that this went before the B.C. Supreme Court. Just to remind the minister of what the Chief Justice said about this attempt...

Interjection.

MRS. DAILLY: I'm talking about the past attempt; I will make that clear. The past attempt of the minister to try to regulate the free mobility of physicians in this province has already been tested. Right?

Interjection.

MRS. DAILLY: I will then talk to the minister very specifically about the case of Dr. Mia, who graduated from the University of British Columbia. He knows what I'm referring to. This case went before Chief Justice McEachem. This physician was denied a billing number by the commission. That is exactly what we're discussing in this bill — the unilateral denial of a billing number by the Medical Services Commission. So when the minister shakes his head and says it's nothing to do with the bill, that's nonsense. That is the basic crux of this bill. It's a denial of the right....

Interjection.

MRS. DAILLY: Yes, you've set up a committee, we agree. And the doctors have said they will sit on that committee. But we're still down to the basic issue of government deciding, if they wish, that they can curtail the free movement of someone in this province.

Interjection.

MRS. DAILLY: Well, I would hope that the minister will explain that a lot more clearly to us, because that is not the way the bill reads.

Interjections.

MRS. DAILLY: You still have a right in this bill, as we read it — and as the physicians and interns of this province and other concerned citizens read it — to curtail the issuance of billing numbers on a geographic basis through the Medical Services Commission. Is that correct? Yes. Well, Mr. Speaker, if you can curtail the issuance of billing numbers on a geographic basis, you as government are taking over the right to curtail the mobility of certain doctors in this province.

Any government which attempts to curtail this mobility is infringing on the Charter of Rights. As the chief justice said: "Until now it has never been suggested, in modem times, that options of location within a province could be restricted." He went on: "After all, this is Canada, where freedom of movement for any lawful purpose has always been one of the handmaidens of liberty."

Interjection.

MRS. DAILLY: The minister says: "Nice words." You know, we on this side happen to feel that to uphold civil liberties is more than nice words. It's what we're all about, and as legislators what we should be concerned about.

Interjection.

MRS. DAILLY: Mr. Speaker, I will just continue. I find the comments of the minister across the floor somewhat helpful, but on the other hand, it seems to me that we are still faced here — I want to get back to the bill — with a basic problem of a centralized government that has thrown up its hands. They're incompetent. They've been ruling this province for years, and they still can't find any solution to this problem except to use a heavy hand and restrict mobility of physicians.

[3:00]

On top of that we have the ironic situation of this Minister of Health.... He has thrown up his hands and says: "Well, nobody's come up with any answers and solutions to me, so I'm going to use a heavy hand." But at the same time, one of his own cabinet ministers keeps boasting about the fact that ever since he became minister of post-secondary universities, communications, whatever, he has been able to increase the number of doctors going through the medical school.

I'm for B.C. students having an opportunity to become whatever they wish. Right? The problem is that today you have not shown any concern about the teachers of this province, who can't go into the faculty of education any more with any hope of getting work because of the recession. On the other hand, Mr. Speaker, we have a problem here where the minister throws up his hands and says: "I can't handle this. We've got too many doctors out there. I think there are too many doctors. The doctors think there are too many." Yet his own cabinet colleague says: "Let's keep producing more and more." You can still put a control on the number going in without denying everyone the opportunity to practise eventually. I'm saying that it all has to go together. But you've taken one approach only, and it's a very heavy-handed approach.

The minister is going to get up and say: "The NDP don't want to see the students becoming doctors in British Columbia." Let us get it clear. We're proud of having a medical faculty; the NDP supported it. But you have to be reasonable today. You can't have one minister complaining that there are too many doctors coming out to practise, and the other one insisting that more go into the school. There has to be a meeting of the minds. That does not mean that young people today cannot attend the B.C. medical faculty. Let's just try to have a meeting of minds on this between you and your colleague.

[Mr. Ree in the chair.]

Mr. Speaker, the other areas that this minister keeps talking about.... He keeps saying over and over again: "There are no alternatives, therefore we've taken this move." He himself referred to the number of studies that have taken place. His government has set up quite a number of studies. He mentioned himself, I believe, the one that took place in 1979, was it — the Black one? I believe that there were some recommendations out of the Black report. Were there none there that the minister could have used?

Interjection.

MRS. DAILLY: If he used some of them, why has it not had an effect then? I hope the minister, when he closes

[ Page 6228 ]

debate, will tell us specifically which ones he actually endorsed, and why it had no effect. Perhaps you just picked the ones that.... Mr. Speaker, perhaps he's really not interested in moving on this in a logical, compassionate, humanistic way. Maybe this minister has a feeling that to take a heavy-handed approach will be populist. Maybe out there the public will think: "Isn't he a great, strong minister? He's taking action." You know, out there the public is also concerned about their access to a doctor. They're not happy with this move to infringe on the free movement of their doctors. I don't think that the minister has, in talking to the public, met with too much approval for this either.

I notice that his committee meetings all seem to be just made up of the doctors and the minister. I haven't noticed too many of the consumers — the people who eventually may have to make use of their doctor — involved in any of these discussions with you. I think it might be interesting for the minister to find out their comments.

I think that the minister has had an opportunity. I know in the Black report there were a number of items suggested, and maybe this will refresh the minister's mind. It did actually suggest that UBC not expand its enrolment to any great degree — the minister obviously rejected that — and "that a joint committee determine the number of residency positions for each specialty." Here are ways of going about this. Was anything done about that? It also suggested "that medical training be nationally coordinated."

The minister has been going back and forth across Canada meeting with the other ministers for years now. What's come out of that? He says we all agree we've got a real problem. Okay, all you Ministers of Health have been getting together and meeting. If you all have the same problem, why is it that only B.C. has moved on this draconian — to quote someone else, not me — measure? I would say it is a draconian method that he is using. What I want to know is: why are we the only place in Canada? Why are we the only province in Canada that has felt it necessary to take this heavy-handed status approach? That's what I want to know, Mr. Speaker. We have other provinces in Canada, as he admits, facing the same problem. They haven't moved in this way with this kind of legislation.

They've also suggested in this report, the Black report, "that a comprehensive incentive program, including bursary loans, community grants, housing and educational grants, be instituted to encourage physicians to go to underserviced areas." Let's remember that this minister has also stated that there are too many in the urban areas, and he thinks being able to move them around at his will will solve this problem. I want to ask the minister why he hasn't embarked on some of these policies. I understand the province of Quebec, for example, has embarked on one of these.

So I ask the minister in closing, and, of course, we'll have an opportunity in committee...? What about a comprehensive incentive program, including bursary loans, community grants, housing and educational grants? What about them? Why has this minister or his government not done anything in this area? I don't think a thing has been done. Maybe he can tell us, but obviously they haven't or he wouldn't be faced with the problem he has today.

They also recommended "that training in rural medicine be expanded, including a special program for psychiatry in Prince George." Now that's just one specific thing. I'm not suggesting that would solve the whole problem, by any means. The suggestion "that a national physician data bank be established" — has that been moved on? All right, there are a number of suggestions there for the minister, yet he throws up his hands and says: "Nothing is coming through." Then there was another committee founded. This was another committee set up in 1982, the joint committee on medical manpower, once again made up of the Medical Services Commission and the BCMA, and no one else.

"Its purpose" — and I know the minister, I'm sure, remembers — "was to evaluate existing physician manpower and to recommend ways of improving distribution and controlling the supply of physicians, and report back to the negotiating committees. As a basis for comparison, the committee accepted the doctor-population ratios of the national committee on physician manpower (1975) and modified these ratios.... Essentially, therefore, the doctor-population ratios in this report did reflect the application of unmodified dubious data from the late sixties and early seventies" — which I would consider would be a basic problem.

Now that minister has some very up-to-date computer equipment which we give him full credit for, and I would hope the data that is being used by these committees.... I would hope that access to these committees would be made by some of the minister's technological feats in his ministry so they can be up to date.

"From the data available at the time, the committee agreed that there was a suggested oversupply of general practitioners in the Vancouver and Victoria areas. The committee suggested nine measures to control physician supply." Now in reading these, I'm not going to say that we endorse all of them. I'd just like the minister, however, not to continually throw up his hands and say: "They never tell us anything. They never come up with anything." Here were some of the suggestions out of this committee: "....to rely on market forces, to provide information (the college's placement list), to limit hospital privileges, to reduce immigration, to apply more stringent licence requirements (Alberta and Hawaii models), to link licensure with hospital privileges, to use financial disincentives (Quebec model), to restrict billing numbers and to control medical school enrolment." That committee made up at that time in 1982 did suggest some restriction. I would like to ask the minister, when he closes debate, to tell us on what basis they suggested that. They also suggested that you should look at the Quebec model, and I wonder why the minister has not been interested in looking at that model. It is an incentive model.

I would like to remind the minister again about the other arguments that we on this side of the House basically have against the bill. I started off by stating to him that the denial of basic freedoms — a government should not be able to tell citizens where they can or cannot work — is one of the fundamental reasons for our opposition. The patients are denied a choice. Here again you have a problem once you start doing this. You could say that you are restricting some of the accessibility features which are paramount to the principles of medicare.

The minister always goes "Ha!" whenever we talk about medicare and the principles, because that minister — and I've listened to him; I've heard him growl when I've mentioned medicare in this House — is really not committed to medicare. As a matter of fact, when that minister speaks of medicare in this House — he's glaring at me, but I will not disappear, Mr. Minister — there is a sardonic tone.

[ Page 6229 ]

MR. ROSE: Yes. Draconian, too.

MRS. DAILLY: Yes, and.... Well, sardonic primarily. For example, today when he talked about medicare, do you know what the minister said when he was introducing his bill? I noted this; he said about medicare:"...all the benefits of medicare which the people of B.C. expect to enjoy." He always throws in this "the people expect," as if somehow or other the people of British Columbia don't really have a right to medicare. I don't think that minister believes they have a right. He really does not believe they have a right to medicare. Whenever we talk about medicare, he refers to the Canada Health Act. He wishes it would disappear.

Interjection.

MRS. DAILLY: Well, the Canada Health Act.... He just said that, yes, it would be a good idea if it disappeared. What is the Canada Health Act all about? It's founded on medicare. The whole principle of medicare — universality, accessibility, portability — all those things are ingrained in the Canada Health Act. And that minister keeps telling this House he wishes that Health Act would disappear. Obviously that minister does not believe in medicare.

That's why any minister who is not philosophically committed to medicare would find it quite simple and easy to bring in this kind of a bill, which absolutely goes against some of the basic principles of medicare. And this is why the people of British Columbia are very nervous about the moves made by the Minister of Health when it comes to infringement into their accessibility to their doctors. After all, what's going to come next? If this minister admits he's tired and doesn't have any more ideas.... If this doesn't work, what's going to come next? What will be the next statist move by the Social Credit government?

I mentioned earlier that this denial or handing out of billing numbers on a geographical basis can discriminate against young graduates. I don't think there's any question about that. I'd like the minister to let us know how he feels about more and more young people being encouraged to go into our medical faculty, when at the other end he's brought in a bill which is going to deny them access to practice. What kind of sense is there in that? The young graduates are being encouraged by that minister, obviously, and his colleague, the Minister of Universities (Hon. Mr. McGeer), to keep going into medical school, and yet he brings into the House today a bill which will deny them access to practice.

[3:15]

Also what about women? Fortunately there are more and more women going into medical school. We know that in the last few years there's been a dramatic increase in the number of women entering medical school. Now they'll be denied practice, even though there is becoming a greater demand in the public for women physicians. All these young people who are coming out now — how are they going to get a job?

Interjection.

MRS. DAILLY: We don't believe in any discrimination. I would go to a male or female doctor. I imagine you would, too.

Interjection.

MRS. DAILLY: Neither of us would.

But, Mr. Speaker, I think the problem we have here is that it's the young people who are coming out who are going to primarily be discriminated against. I think that's most unfair. How is the minister going to handle that situation? Is the minister perhaps not...? Should he not be devoting some attention maybe to some kind of incentives at the other end, so that some of the doctors at the other end of the scale might consider — those who are tired now and perhaps would like to get out of practice...? Perhaps there should be some consideration given at the other end of the scale, not just to the heavy-handed measures on the young ones who are coming in.

So, Mr. Speaker, we have a number of concerns, primarily from the point of view of this heavy-handed statism approach, this move to limit the civil liberties of one sector of our society, the physicians of this province. It's a fact that if this bill goes through, those basic things are going to take place in the province of British Columbia. That is why, Mr. Speaker, I have started off this debate today with some of those basic concerns. A number of others on the floor in the official opposition who also have concerns dealing with these aspects and with others want to follow me. So I would hope that the minister will pay due attention to our concerns and realize that here is a bill which is not really going to solve his basic problem. That is the issue. We ask him to withdraw that bill and maybe set up a committee involving even.... He may make a face at this: why not involve some of the MLAs?

MR. MACDONALD: Even the public.

MRS. DAILLY: Even the public might be interested, and the MLAs who are supposed to represent the public. Why have you never invited us to assist in this? If you're not getting any help otherwise, we're here. We would much prefer to be sitting down working positively on this with you, Mr. Minister, than having to stand up here and have thrown at us a bill which to our minds is a simplistic, heavy-handed approach that will not work.

MR. LEA: Like the official opposition, I will not be voting for this bill, but possibly not for the same reasons. I don't believe that the minister is trying to destroy medicare. I don't think that's his intention at all. I don't think he is the harbinger of the forces of fascist evil, trying to make the doctors run on time. I'm not going to vote for the bill because I don't think it'll work. I think probably the minister has some doubts in that direction.

The official opposition pointed out that the government has been in power for a lot of years and they don't seem to have an answer to this problem. I found it amusing in a way that the official opposition has been in opposition longer than the government's been in power and they don't seem to have a position either, except to read out some possible positions written by someone else. But let's not commit ourselves to a position on this issue, because it may not turn out to be where all the votes are.

Mr. Speaker, I don't know whether we have a problem of too many doctors, but I agree that we have a problem in where doctors live and practise in the province — obviously in the urban areas, the more desirable areas to live, in some people's minds; not in all, but in some. They'd like to live in Victoria. The minister read out some statistics in terms of doctor-population ratio that make you wonder who's going to

[ Page 6230 ]

the doctor and how often if a doctor can make the kind of money they seem to make out of 300 patients each — or even less if it's per patient to doctor to population.

Probably one of the problems we have is that we don't have a ministry of health in this province, or in any other. We have ministries of sickness as opposed to ministries of health. We don't pay nearly enough attention to preventive health care. We don't pay nearly enough attention to those areas where we could reduce the need for the kind of medical services that we supply now. But the incentive system is one that I think could possibly work.

Why is it not possible to negotiate remote and urban areas of the province with the doctors, and to pay the doctors a higher fee for service in the remote areas? Would we not be getting the same desired effect? Wouldn't we then be using an incentive system to have doctors move out of the urban area into the rural area, the incentive being that they can make more money if they go to the rural area? That seems to be an incentive that works for the rest of us. Why isn't it good enough for the doctors? I suspect that it is. I suspect that if you sat down with the medical profession and negotiated that kind of package, it would be possible to have fruitful negotiations and reach a conclusion that would leave everybody maybe not completely happy, but a consensus that could be worked into the future.

Another area where we could consider an incentive program is the student going to medical school. If a student wanted, sign a contract that after completion of studies and internship they would serve a certain period of time in a remote area of the province, the trade-off being that the government or the people of the province would help that student in terms of money getting the medical degree; but for that help they would owe the people of the province a certain term of years in a remote area. I suspect that many of them, after they had practised there for a while, wouldn't even want to come back to the urban area. It would be a system of getting them out there to see what they think of more rural living.

So there are two incentive programs, Mr. Speaker. One is the incentive program in the training itself: that there would be more help from the taxpayer for those medical students who would sign a contract to spend a certain amount of years in the rural or remote areas of the province. A double-fee system; possibly even a triple-fee system. You could have remote, rural and urban fee systems. But it would be an incentive system.

A number of times the minister used the words "manpower control, " and I think that's the problem. We're trying to control the dispersement of the manpower instead of using an incentive system and allowing doctors to practise where they want. I thought the minister used a very bad example to make his point, and I think he'd probably agree with me.

If you're a doctor in the system now and you move, say, to a place like Terrace, what if you're fully licensed and you have a medical number, but you can't get hospital privileges? When you start looking behind the scenes at why some of those doctors don't get hospital privileges, it's not based so much on manpower as who has the heavy investment in what medical clinic in town. It's sort of like the island mentality. You live on the island and the population is always one short until you arrive, then it's just right and you don't want any more.

That happens in a number of small communities. A few doctors have operated in the community for some time. They feel that the ratio is just right and they want to keep it that way. Instead of examining whether someone should have hospital privileges just based on their qualifications, they base it oftentimes on their own economic problems they may have. They want to keep their income up to pay off debts. That's happened, and I know of that.

What will work? Can you, in a centralized way, pass a piece of legislation that does not meet the general will of the people that are going to be governed by that legislation? Can you have a cooperative, harmonious society if you do it that way? I don't feel qualified to speak on the legal niceties of whether it meets the terms of the Charter. But I do know that the only way things will work is if there is a negotiated consensus around which people can work. You can't lay a heavy on them and expect people to work productively and happily and harmoniously in society. It doesn't work that way.

The incentive system is the only system that we can use. We don't apply this same standard to lawyers. We don't apply this same standard to any other profession that I know of, but we're singling out the doctors. Admittedly, it's a problem. The question that we're debating in the Legislature today is how to resolve the problem. Do we do it by a centralized government saying: "You are going to get a billing number, and you aren't because of where you live"?

The minister's absolutely right in terms of mobility. The doctor can live anywhere he wants. The problem is, can the doctor make a living, or does he have an opportunity to compete to make a living? That's what this act will remove — the opportunity for a fully qualified doctor, a resident of B.C., possibly born and educated in B.C., who will not be able to get a billing number to practise medicine. In that way, you do take away choice from patients, from citizens, because you may want to go to a doctor who doesn't have a billing number but is practising, and you can't afford to pay the fee if he doesn't have a billing number. So freedom of mobility may not be the question. The freedom to make a living and the freedom of choice of patients is affected, though.

I have a feeling that if you went to the incentive method, both in the training field and the requirement that you owe the people of British Columbia a certain amount of time in a rural or remote area.... The incentive program of a double- or triple-fee system for doctors could mean that urban doctors may get less than they get now because you don't want to raise the aggregate in terms of the medical system. That may be a fact. It might mean urban doctors would get less and rural doctors would get more.

But at least it would be a consensus; at least it would be workable; at least it's something that could meet the general will; at least it would fit into the democratic model. It would not leave a society behind it strewn with hard feelings and a lack of proper attitude. It would leave a happy society. I think we could go that way, and when the minister closes I'd like to ask him to express his opinion. He's probably been working with this more closely than the rest of us.

Have these kinds of approaches been taken with the British Columbia Medical Association — the incentive system both at the school level or university level and the number of fee systems between rural, remote and urban? Has that been a discussion between government and the medical profession? Have they turned it down? Have they said they won't discuss it? It seems that all of those avenues should be taken before we come in with a bill that's going to take away the

[ Page 6231 ]

opportunity for some people to practise medicine in this province.

I think that the marketplace would sort it out. It wouldn't be very long before there would be people saying: "Well, I'm not going to medical school, because you can't make a living at it." It would sort itself out. People aren't going to continue to go to medical school when they know that there's a glut on the market and they can't make a living. The marketplace would sort it out. The patient preference would sort it out, as opposed to government sorting it out for the citizens and for the medical profession.

So I'll be voting against the bill. I'd actually like to see the minister withdraw the bill, go back to the bargaining table and sort it out that way. In the end it's the only way that it's going to work for the doctors and for the patients and for all of the citizens of this province. You cannot legislate this; it has to be negotiated.

[3:30]

MR. MACDONALD: Mr. Speaker, I support what the member for Burnaby North (Mrs. Dailly) has said: that it is very unjust that young people should go through medical school for five years and then have the province of British Columbia tell them that, even though they're qualified, they may not practise their trade — and do that by legislation. The minister says: "Well, it won't work out that way." But I think that everyone who qualifies has a right to practise their trade. It's a denial of civil liberties.

HON. MR. NIELSEN: They can all practise in Vancouver?

MR. MACDONALD: No, no.

What the minister is doing in this bill is presenting a smokescreen, under the pretence that he is controlling manpower, when the real problem is that the costs of the Medical Plan have spiralled out of control under his administration in the last seven years. The answer that he comes up with in this legislation is not going to solve the basic problem, which is medical costs. We should ask the real Jim Nielsen to please stand up. He comes on before the people of British Columbia as a stem fighter for restraint against the demands of the medical profession for more money. In fact, Mr. Speaker, that minister has been shovelling money in the hundreds of millions out of the back of the truck to doctors.His real face is Mr. Giveaway; his make-believe face is Mr. Restraint. You might wonder why anyone with two faces would use the one we're looking at.

MR. WILLIAMS: Unkind!

MR. MACDONALD: I want to give the figures. The figures don't lie. The legislation is not addressing this problem, and it should be. Fee-for-service payments to the roughly — and I'll come back to the exact figures....The Medical Plan are very cooperative in this respect, as they should be. I commend their work and their dedication — all of them. Fee-for-service payments to the roughly 5,000 doctors in British Columbia have risen exponentially every year in the last seven, and they are still rising. In 1978-79, from tax and premium dollars of the people of British Columbia, the Medical Plan paid $321,524,000 in fees for service. By 1984-85 — the figures have just come in — these fee-for-service payments had risen to $752,463,000, which is considerably more than double. In one recession year, when speeches were ringing in this Legislature about how teachers, wage-earners and all the other people in the province of British Columbia should be pulling in their belts, Medical Plan pay-outs to our doctors increased by $142 million, which on average per doctor in gross sums was $28,000 for each of them in that one year. So it's very obvious, Mr. Speaker, that some have been under more restraint than others.

"Well," you say, looking at those figures, "does it matter, when there has been no increase whatsoever in social assistance rates and people are suffering in terms of basic things like good food?" It does matter. The same dollar can't go everywhere. Does it matter, when in the case of transit, as my colleague from Vancouver East (Mr. Williams) pointed out, the transit subsidy has been reduced since 1982-83 from $91 million to $72 million, a reduction affecting thousands of people — poor people to be sure? I don't blame the doctors for asking for more, like Oliver Twist. I don't know any group in the province of British Columbia that doesn't ask for more. I blame the minister for fiscal mismanagement. However, some groups are more influential than others. I guess the old working-class tune from Great Britain is unfortunately still true today: "It's the rich what gets the gravy, it's the poor what gets the blame."

Many doctors, including my own, work very hard and well for a very reasonable income. Yet there are far too many who are making $200,000, $300,000, $400,000 and $500,000 in gross payments — and I'll come to the matter of overheads in a moment — and that's far too much public money that has flown out under this particular minister. Can you imagine a doctor who is worth four times as much as the Premier of British Columbia?

AN HON. MEMBER: Yes.

MR. MACDONALD: Oh, you can? I guess several people can.

The number of doctors could perhaps be given a little more exactly with the figures I've got. The last precise count was 2,335 general practitioners and 1,661 specialists. Then there are part-time doctors, who are classified as those who work part-time and gross less than $30,000 a year, bringing the present total of doctors up to 5,351.

The minister is quite right in saying that there are more qualified doctors who want to be able to work in medicine in British Columbia and build a plan. And why not? Under that minister the schedule of medical fees is 32 percent above the Canadian average. The doctors I have mentioned, who are perfectly good citizens of the province of British Columbia — and hard-working and capable — have nevertheless received an average extra payment from the Medical Plan of $86,000 a year in the last seven years. So of course you're going to have a surplus of medical manpower. But, Mr. Speaker, the problem is costs, and the government is not addressing that.

The member for Burnaby North is quite right: you can't let young people go through school, with areas of the province desperately needing doctors and not getting proper medical service, and then deny them the right to practise their profession.

Interjection.

[ Page 6232 ]

MR. MACDONALD: Well, yes. But under this bill, Mr. Minister, if the problem is manpower and not costs — which it isn't, and the minister should know that — you and your appointees will have the power to grant or withhold billing numbers. You shouldn't have that. You shouldn't be able to deny the carpenter the use of his last; the state shouldn't be here to deny anybody the right to practise a profession such as medicine — or law — when they're qualified and have spent money going through medical school. As the member for Burnaby North says, it's a denial of a basic civil right, and the wrong solution to the problem that I have enunciated. In this respect, Chief Justice McEachern was quite right: under the Charter of Rights you can't deny a qualified person the right to move or practise his or her profession.

There is a crying need in many parts of the province for medical assistance, for medical doctors who have....

Interjection.

MR. MACDONALD: Yes, let the member for Atlin (Mr. Passarell) get to his feet and tell us about areas where those doctors are needed.

Interjection.

MR. MACDONALD: Under your control. You say that, eh? Legislation gives you the power to cut it off.

The real cost drain remains, notwithstanding this panacea that has been offered by the minister. Cutting back on the number of new doctors won't solve it. There are better, more cost-effective ways to deliver medical care, and the minister hasn't taken them seriously at all. There should be, beginning in areas which have that need for medical care which is not being met, community clinics with salaried doctors and paramedical help under the Medical Plan. The fee for service must begin to give way to a fair annual payment to doctors for the care of a patient.

AN HON. MEMBER: A salary.

MR. MACDONALD: I'm not talking about a salary there, Mr. Minister. You misunderstand me. My own good doctor, for looking after me, would receive so much a year. And if he kept me healthy and on my feet, he would make as much or more money, and he would have more time to spend with his family. Because today my doctor — who is Dr. Henry Chong, and is a very good doctor — works very hard, and his family life is almost nonexistent, with a holiday of ten days. That's not right; even from the standpoint of the people working in the profession it's not right.

Mr. Speaker, there are better ways in which we can service those areas that need medical care. In the estimates the minister and I talked about a Dr. M. Fisher, who's on Main Street. He made, gross.... You know, the overhead costs are carefully hidden. We don't see them. The doctors talk about a Price, Waterhouse report, but they won't show it to the public. They say it's 40 percent — that overhead is 40 percent of what they take in. Well, I think there could be some offices where it is 40 percent, but in most cases it must be much less, particularly as you go.... Well, take a surgeon who's making $300,000 from the plan, and he has a reception office and works out of the hospital. Is his overhead 40 percent? Of course it's nothing like it.

So take our friend Dr. Fisher, who received from the plan, with a very small office, $496,000 last year for dispensing mostly Valium. My friend from Prince Rupert says: give him an incentive plan, and he'll go north and dispense Valium to the people in the northern areas of the province of British Columbia. So what would we do — instead of $496,000, we double that, in his case, to try and persuade him to leave? I doubt if he would.

That's not the way to go. You've got to provide the alternative ways, along with the fee-for-service for the time being at least, of delivering effective medical care — the best available — at a proper cost to the public, and stop this spiralling out of control of medical costs. If you did adopt an alternative such as I've been suggesting, there would be an incentive to keep people well and a disincentive to treatment.

MR. PASSARELL: Mr. Speaker, I'd like to discuss my own constituency a little, and why I will be supporting this bill today. In the community of Atlin we have no doctor. There are 350 people there in the winter, maybe a little less. In the summer it can get up to 600. We have a doctor who comes down from Whitehorse in the Yukon Territory. He has recreational property in Atlin. That's one of the reasons why he comes down. But when he comes down he puts a flag up — runs up a blue flag — that there is a doctor in town. This doctor, who has come to his recreational property in Atlin, informs the community that there is a doctor in the vicinity. He could be out on the lake fishing ten miles from Atlin. He could be hiking in the mountains 40 miles from Atlin. He puts a flag up.

I wonder how many people in this Legislature would want their constituents — and I talk about the mainland MLAs — to have health care provided in their communities by putting a flag up to inform people that there is a doctor in the vicinity. That's a shame, Mr. Speaker, because we're talking about 1985; we're not talking about Canada in the 1700s.

[3:45]

Hundreds of years ago the Hudson's Bay Company used to raise a flag. They raised a flag when there was rum, when the rum shipment came into town, In Atlin we have a flag raised when there's a doctor in town. Parents, when their children are hurt, or a grandfather or someone in their immediate family.... When they're hurt and they have to go see a doctor, sometimes they have to drive hundreds of miles — sometimes even outside the province — to see a doctor. Cassiar, which is the biggest community in the constituency of Atlin, has a doctor there. He is supported by the company of Cassiar Brinco, which encourages having a doctor in the facility. At one time, not too long ago, it used to be called a private hospital.

But I have 12 communities out of the 17 communities that I represent — 25 percent of this province — that do not have doctors: Atlin, Lower Post, Good Hope Lake, Telegraph Creek, Iskut, Eddontenajon, Bob Quinn Lake, Meziadin, Nass Camp, Greenville, Canyon City and Kincolith. The people have to rely on RNs, nurses, who provide excellent service to those residents in the far north. I'll never fault an RN for the services that they've performed in lieu of a doctor in the far north.

AN HON. MEMBER: Do they deliver babies?

MR. PASSARELL: Nurses are the major health care functionary in the far north. They provide more service than

[ Page 6233 ]

doctors ever will in the far north. I've received numerous letters from constituents, people that I know personally, about complaints regarding the lack of GPs in the far north. The responsibility falls upon the RNs, or LPNs in some cases. Mr. Speaker, it's not the same to have to go to a RN if your son or daughter is in a life-or-death struggle. I'm not faulting the RNs, as I said previously. When you're talking about a member of your own family in a life-or-death struggle, it's just not the same not to be able to see a doctor.

I get a kick out of these doctors. They're the highest-paid employees in the country, with salaries coming close to $100,000, and the taxpayers of British Columbia and Canada pay for these salaries.

I graduated as a teacher. Let's say that when I got my degree, I got a billing number. It was called a certificate at the time, and it was signed by the Hon. Eileen Dailly. I'm very proud of that. She was the Minister of Education. But let's say I received a number. I cannot go to a school board in Vancouver or Victoria and say: "Hey, I got my certificate. Give me a job." It's not the same. There are other professions similar to that. Why should doctors have the exclusive privilege, once they have their number, of saying they can practise in Vancouver? It's like a God-given right to them.

I also get upset with doctors who believe that they are a privileged class. I know that we would never bring politics onto the floor of this Legislature and talk about class distinctions, but the doctors look upon themselves as a certain class in society, dictating to the rest of us how much they should make, where they should practise and how long they should work. I'm tired of that. My taxes pay for these people. Those 12 communities that I represent have the right to see a doctor once in a while. They should not have to wait until a flag is raised in the community of Atlin to be able to see a doctor, who is coming down from Whitehorse to his recreational property.

The B.C. Medical Association opposes Bill 41 because of the Charter of Rights. If there had been a Charter of Rights in the 1940s, when the first CCF government brought in socialized medicine in the province of Saskatchewan — and the CCF stood their ground on this — we probably never would have had socialized medicine in this country. We would have a situation similar to that in the United States, where the rich can afford medical assistance and the poor become second-class citizens and have to go to special hospitals. Of course the CCF government at that time faced hostilities from doctors. There were statements made then that were very similar to those made by Dr. Karr in this morning's paper. It's been a principle of the NDP to stand for the basic rights of human beings to have health care in this country.

As I mentioned, Dr. Karr is president of the doctors. He stated that they acknowledge that B.C. has more doctors than any other province. That's fine. I think many speakers today have mentioned that. But where are they? They stay in Vancouver, Victoria and the lower mainland. Dr. Karr said that doctors would avoid practising in remote areas of British Columbia for fear of being locked in. Locked in? When I was a teacher, did I feel that I was being locked in because I went up to Good Hope Lake to provide education to children? What are these doctors talking about?

Isn't it their job to provide health care to any individual in this province regardless of what their colour is, what their race is or where they live? How can they say they're going to be locked in? That's bunk. I think any doctor who would make a statement like that should scrutinize his thoughts again. Locked in. They might have to go up and work three months or six months in the north, where residents have not been able to see a doctor.

He goes on further, and this is the point that really gets my goat. He threatens northerners when he says that they will fight what they see as being a direct threat to the health of the people in British Columbia. It is a threat, saying that he's going to oppose this bill because it's a threat to the health of the people of B.C.

These words were used before in different situations, in different historical contexts. They used it against the CCF — the NDP — in Saskatchewan. They've used it at times when other provinces started to bring in socialized medicine.

We in the north aren't expecting anything special. We're not expecting the government to come out and say: "We're going to bring all these new doctors up into the Atlin constituency." We just want the health care that people on the mainland take for granted. We pay the same medical fees and the same taxes. Why can't we have the same services? We're not asking for a big hospital to be built in these 12 communities that I mentioned, but why not allow some doctors to come up there? If they don't like it, they're not going to be locked in. A teacher is not locked in because he comes up north to teach for a few years. They might gain some experience that they'd never gain by sitting in a city. They might enjoy some lifestyle that northerners have, that we take by choice and not because we live in the cozy confines of Vancouver.

I don't think, Mr. Speaker, that anybody's naive enough to think that this bill is automatically going to make a change overnight, and that once the government and the opposition vote on this, doctors are going to rush up north; but it's a start, I believe. I'm talking not because of party policies or because I'm an NDPer, but because I believe, in my conscience, that I have to support this bill. I'm not selling out my party principles, and I'm not selling out philosophical beliefs that I have grown up with and that my parents have taught me. I seriously believe that we have to start stepping on these doctors when they start taking the north for granted and making statements in the paper threatening people by saying: "If you pass this bill, we won't go up north; it'll force us to stay in the cities."

I propose a number of resolutions or issues that doctors should be addressing. The first one: these employees of the government... They receive their salaries because of our taxes, so more or less they are employees of the government. They're the highest paid employees of the government service across Canada. I propose that 3 percent of their gross salaries a year go to help finance a flying doctor service that's similar to the one in Australia. If you're making $100,000 a year when there are more and more people standing in food banks, I think you can donate 3 percent of your salary out of $100,000 to go up north and provide some medical assistance. They might learn something, because they're going to see people who really appreciate their services.

Secondly, I'd like to see — to go along with number one that doctors donate five days a year for service in the north to provide medical assistance. Five days a year; they can take it on a holiday, and write it off on income tax if they want to. Most of them are private corporations anyway; they probably can find out some way to write it off. Lawyers provide services in legal aid aspects; why can't doctors get out of the mainland, and come up and provide some kind of health care?

[ Page 6234 ]

When I was talking about the wealth from the taxpayers — how they gain their large increases in salaries — let's talk about Dr. Jory. He used to be president of the B.C. Medical Association. He got his hands and wrists slapped a few years ago. He lives, Mr. Speaker, half the year in England, in a castle or in some....

HON. MEMBER: Magic pumpkin.

MR. PASSARELL: Yes. His children go to a private school in England. But where does he make his money — by working six months in the province of British Columbia. The way I look at it, Mr. Speaker, if our money is good enough to pay his salary, our province is good enough for him to live in, too.

I'd also like to see doctors hold province-wide hearings — and not by just going up to Prince George and then getting on the first available commercial aircraft and flying back to Vancouver the next morning. They should come up in the fall and winter of this year and drive around in a vehicle. I know they won't be able to use my motorcycle, but I think we could find them some accommodation to get around in the far north, hold some kind of province-wide hearings there and listen to the concerns that rural residents have and the problems that they have faced year after year by not having doctors in the far north. They would see exactly what the people feel about the profession of the doctors, because, in essence, we all pay their salaries. They have to come and talk to us and find out exactly what our concerns are.

Another idea that I'd like to see is that the pay difference that B.C. taxpayers pay to doctors — between a specialist and a GP — be restricted. There is a big gap between what GPs get and what specialists get, and I would like to see that restricted.

Mr. Speaker, I'm proud to belong to a political party that allows me to stand on the floor of the Legislature and say what I believe in, and not to be held back because of a doctrine, as I've seen in the six years that I've been an MLA. The doctrine of some political parties will not allow an individual to stand and say what they feel they should be saying. I'm proud that the New Democratic Party and my caucus members have allowed me the opportunity to stand and do this. I don't follow the beat of the same drum of a lot of individuals. People can label me as they wish, but I have the concerns, I think........ I'm not anything special. I'm just a person who has been elected, and I try to listen to what other people tell me. I listen to the voices and the concerns and the wishes and the dreams and the aspirations of people up north, who desire to be treated equally, not specially — not a special class, not a special privilege, as the doctors look upon themselves, but to be treated equally. I think any of us who live in the far north want to be treated equally. We want medical assistance by doctors. Let them come up north. If this bill doesn't work, I'm going to be the first one up on this floor attacking the hon. minister. But I will be putting my name behind the government today, or tomorrow, supporting this bill, because my conscience cannot allow me to support what doctors have done to make us second-class citizens in the far north.

[4:00]

HON. MR. McGEER: Mr. Speaker, I rise to support the bill, but particularly the remarks made by the member for Atlin (Mr. Passarell). He makes clear, of course, that he is not supported by the New Democratic Party in that respect. We have a rather different philosophy from the party's, which I conclude would become their policy were they to become government.

[Mr. Strachan in the chair.]

The point which the member for Atlin makes, and the one which he himself has demonstrated by example, is individual rights — i.e. patients' rights — over professional rights. When we support programs like medicare, we support those for the benefit of the patient, not for the benefit of the doctor. When human rights have to be considered, the human rights of the patient must be those that come first. But in the official position of the New Democratic Party that principle has not emerged. That, I take it, is the dilemma of a party which claims to represent the common man, but repeatedly in this House turns up defending the vested interest.

The first member for Vancouver East (Mr. Macdonald), who just left this chamber, drew attention to the Charter of Rights, but he also drew attention to the cost of medicare, pointing out that this has to be an issue involving every citizen of British Columbia; they pay the taxes. Do they get value for the taxes that they pay in Atlin, where there are no doctors? What use is an insurance scheme, supported by taxes, to the people of Atlin? "Well, " says the member for Burnaby North (Mrs. Dailly), "you offer an incentive." But, Mr. Speaker, that is precisely what was done in British Columbia, by giving an average fee for service — demanded by the doctors and defended by the NDP — of 32 percent above the national average. That incentive worked: the doctors did come to British Columbia.

I'll tell you where a large group came from: they came from the United Kingdom, in some years 100 physicians a year, a number of physicians that we have yet to graduate from our medical school in British Columbia. Why? Because in Great Britain they had the very per-capita system that the first member for Vancouver East advocates that we introduce into British Columbia. I suppose that were the NDP in power and to bring what I take it is the official position of the NDP and therefore the policy of the programs they would introduce, that would solve the physician supply. A per-capita program here, even if it could be introduced with federal legislation, would soon cause the physicians to leave, perhaps many of them to go back to Great Britain. But that system has not only worked out poorly for the physicians so that they want to emigrate and naturally come to the place that offers the highest fees schedule; it's not worked out terribly well for the patient either.

I'll tell you what a lot of the physicians do in the United Kingdom. I've talked to them after they've come to British Columbia, and what they do is this. They're paid so much per capita to keep you well. It might be the Minister of Health. He's got a problem with his back now, so you scratch him off your list. You just go through the list every six months, and anybody who's sick a lot gets scratched off the list, and then there is lots of time to play golf. But that's the system proven to work in this fashion; that's the system the New Democratic Party wants to introduce into British Columbia. That's how they intend to get medical services to the ill in this province. That's not going to solve the problem of the member for Atlin.

The member for Burnaby North, who led off criticizing the government in this debate and for this bill and decried the

[ Page 6235 ]

fact that British Columbia graduates were not receiving billing numbers from the Medical Services Commission, neglected to tell the chamber one thing: every single person who applied was offered a billing number if only they would go to the areas that needed physicians. But they didn't go to Atlin; they didn't go to Smithers; they didn't go to Stewart. They went to court. They went to court for their right to 32 percent higher average fees than anywhere else in Canada and the amenities of urban living. You're defending that when you vote against the bill, and you're saying you approve of that. You want the physicians to go to court instead of going to Atlin. Only one of your members will stand up and say: "People should go to Atlin and not go to court."

MR. VEITCH: He's a good member.

HON. MR. McGEER: He's a good member, because he's been where there are no physicians. He pays his taxes. He belongs to the insurance scheme, as do the constituents up there who support your party. Have you got a policy that will bring them medical services? No, sir, you haven't. All you have a policy of doing is attacking the government and supporting the vested interests. You say it's the human right of the doctor to go to court and demand the right to be the one more physician in the city of Victoria; if anybody comes up with a policy that will send that physician or encourage him to go to Atlin, that has to be attacked as unfair. That's what your members have said — all of you. Read what you said in Hansard and then you'll know that the New Democratic Party is bankrupt of policy, even when you have a member who describes to you the problem and says: "Solve it in my area." Not one of you can do that. You should be ashamed of yourselves. You've only got one person in your caucus who speaks for the average citizen, and he has to come almost and apologize to you in this House for letting him speak out on behalf of citizens in Atlin. What kind of a party is that? What kind of a party is it, Mr. Speaker, that would harbour this sort of thing?

While we're on the subject of human rights, which you've been championing over there, I want to say that the physician who isn't obligated to serve an underserviced area, who wants to bring health services to the most overdoctored area in Canada at premium cost to the taxpayers of this province.... We've got another problem with human rights if that's going to be the cornerstone. Why should that extra physician, if he's entitled to a billing number, not be entitled to go onto the medical staff of the hospital of his choice? Why shouldn't he be a member of the medical staff at the Royal Jubilee Hospital or the Vancouver General Hospital if he wants and he has patients who need medical service? That extra billing number might get the Minister of Health with his bad back, and the physician might say: "You need an operation." Can he get a hospital bed, which is supported by the taxpayers — same medicare system that you people here are saying entitles that physician to the number? It doesn't entitle him to a hospital bed, and if you're his patient it doesn't entitle you to get that tax-supported hospital bed. No, sir. That goes to the physician who wants to protect the system of unrestricted billing numbers and also wants to protect the system of privileges in individual hospitals.

I want to tell you that what the minister is doing, Mr. Speaker, is bringing patient rights to British Columbia, and you people over there in the official opposition — the member for Burnaby North and the first member for Vancouver East — and, I'm sorry to say, the member for Prince Rupert are not supporting patient rights. You're supporting vested interests, as you always do in that party. I don't care whether it's the labour unions or the doctors' unions or the teachers' union. Yes, sir, if it's a union and a special interest you can count on the NDP support. They're always for special privileges for some. They're never, despite all the verbiage in this House, for equal rights for all.

No, the New Democratic Party shouldn't be listening to the bill or to the minister or to me. The New Democratic Party should be listening to their conscience, represented by the member for Atlin. We're going to vote on this bill, and I think this will be a day of infamy for the New Democratic Party.

MR. HANSON: Mr. Speaker, I happen to think that it's ironic that that Universities minister would take his place in this debate on this bill when British Columbia is at the absolute bottom in all of Canada in terms of training university people. We happen to rank tenth in the production of university graduates in all of Canada.

DEPUTY SPEAKER: Hon. member....

MR. HANSON: Mr. Speaker, I'm getting to my point. The point is that that minister took his place and made a spurious speech when the Black report of 1979 suggested that the remedy to this pressing problem — and there's no doubt on this side of the House that it is a problem — was that a comprehensive incentive program, including bursary loans, community grants, housing and educational grants, be instituted to encourage physicians to underserviced areas. Yet that minister in charge of bursaries and loans has stripped British Columbia to the lowest level in all of Canada for university training. For him to stand up in this House and take the spurious line we just heard is an absolute disgrace. Mr. Speaker, please dismiss his speech entirely.

It is not the first time that this government has addressed a health or social problem by stripping away liberties. That course of action has been taken on a number of occasions. It has always failed; it has always been costly; and it has always been pointed out by this side of the House that it was a foolish course.

Mr. Speaker, do you recall the heroin treatment program championed by the member for Langley (Hon. Mr. McClelland)? It cost the taxpayers of this province millions of dollars: millions of dollars of lost money on a program that stripped away liberties, was struck down by the courts and cost the taxpayers a fortune. It didn't work, and we pointed it out at the beginning. This is the same thing.

The chief justice of the supreme court said a number of things in his judgment on the Bill 50 question, and I believe that those remarks should be outlined again.

[4:15]

Interjection.

MR. HANSON: It was on the practitioners' case; thank you.

I think it's important that all members of the House know the major points that he stressed in his conclusions. He said:

"It is inconceivable that the Charter of Rights and Freedoms could assure the right to pursue the lawful gaining of a livelihood in any province, only to have

[ Page 6236 ]

that right limited within a province. I have considered, but rejected, the suggestion that the Charter only guarantees mobility between provinces but does not guarantee free movement within a province."

What we have before us is a make-work project for lawyers. It's a political bill; it has nothing to do with addressing the so-called — in their terms — manpower question. We don't dispute the fact that there's a maldistribution of physicians in the province, and that there's a serious problem pointed out by the member for Atlin (Mr. Passarell) and other members in this House from outside of metropolitan Vancouver and greater Victoria. There is no question that there's a maldistribution in the quality of health care delivery in British Columbia. We don't dispute that fact.

But this is the wrong way to deal with it. It's the wrong way to deal with it because it will not work; it cuts away at fundamental liberties which will be struck down in the courts, which will cost a fortune in tax dollars, rather than address the fundamental questions that could be addressed as follows.

Mr. Speaker, I have heard Dr. David Suzuki on a number of occasions, and he is very concerned about this question of the mutual responsibilities in taxpayers or citizens of a province financing the education of needed professionals, and having those professionals perhaps leave the country or not provide services that should be required. His argument is this. For every physician trained in a medical school there are five equally qualified citizens that for one reason or another are not admitted or cannot afford, or whatever, to go to medical school. There should be a program whereby students that have the ability, that have the qualifications to undertake medical training, should get full support from the province.

In exchange — I'm talking about students that would participate in the following program for financial reasons, where they are not able to pursue a medical education — they would undertake in a contractual way with the province to guarantee service for a certain time period, for a term certain, in an underserviced area of the province in exchange for full funding, full bursaries, etc. In other words, the educational payments in tuition and books would be provided in exchange for an undertaking of service after graduation, after becoming fully qualified. That would be one prong. Secondly, there should be a full incentive program as pointed out by Mr. Black in 1979 — the comprehensive incentive program including bursary loans, community grants, housing, educational grants and so on — to meet the kinds of legitimate concerns and needs that do exist.

But what we have is a government that is willing to strip away fundamental liberties to try and address a social or administrative problem. It does not work. It is going to cost us more money in the long run. There is no doubt about that. Just as the heroin treatment program was a failure, this bill and its contents will also be a failure. It will be a make-work project for lawyers and will cost the taxpayers of this province an incredible amount of money.

Let's just look, for example, at the tradition where the young, talented, innovative doctors who are just graduating now from the universities.... They are being told that their liberties are gone, and they will not be entitled to billing numbers. Rather than taking a positive approach whereby the ministry could sit down with the medical schools, with the different agencies involved, and work out an incentive program that would mobilize doctors and talents into the regions as required, we get the traditional Socred punitive response, which is doomed to failure.

So who will suffer? We maintain, Mr. Speaker, that many of the young and talented physicians that are presently graduating and coming up for application of billing numbers will leave the province, after the people of this province have financed their education, because the government is not willing to pursue a positive, negotiated settlement to a serious social and health administration problem. This is just coercion and a punitive approach that doesn't work. They constantly have to prove that they are the toughest — not that they are the most skilled negotiators, not that they are willing to sit down and meet individuals and respect their fundamental liberties and come to a negotiated settlement on any matter. No, it's a matter of they know best, and they'll do it by legislation.

The people of the north and the people in remote areas are going to suffer, because this will not encourage doctors into those areas. We're going to be facing legal fights and so on. Let me read a little bit more from Mr. McEachern's conclusions in his Supreme Court decision. He said:

"Our history shows that restrictions on movement for purposes of employment were, short of imprisonment, the most severe deprivation of freedom and liberty. This is demonstrated by a brief glance at history."

He goes through the development of law in this area:

"I have no doubt that freedom of movement within the province for the purpose of lawful employment or enterprise or for the practice of a profession, trade or calling by qualified persons in any community is indeed a right, properly embraced within the rubric of liberty."

He's saying that in our tradition over the hundreds of years of common law, that the right to practise one's employment and freedom of movement is a fundamental tenet of the rubric of liberty. So we know that this bill is going to be struck down by the courts, because restricting movement within a province is no different than restricting movement within the country, and that is contrary to the Charter of Rights and Freedoms. So why are we going through this exercise? We're going through this exercise because Social Credit is now in a pre-election mode and this is a political bill to tackle the doctors. They're taking on the college instructors, the university instructors and the teachers; the public sector workers have had their day in the barrel; and now it's the doctors' turn, for political purposes.

Interjection.

MR. HANSON: Construction workers have had their turn. I'm sorry if I've left........ The list is so extensive that I couldn't possibly list them all.

Mr. McEachern goes on:

"A limitation on the free right to practise a profession and a further limitation on the right of mobility within a province are vastly more serious than other suspensions...that take place under other legislation and have been struck down, such as temporary suspension of a driver's licence.... Then unquestionably the right of a member of the College of Physicians to practise medicine and to move throughout the realm for that purpose must also be a liberty."

[ Page 6237 ]

There are more ways to deal with the problem. Mr. Speaker, it's a sorry day when the only solution to problems in the province is the restriction of liberties. We see it all the time: the firing of duly elected school boards, constantly appointing your own trustees. That's a practice that you've developed over some period of time. A hospital board has different points of view — wipe them out and put in a trustee; take it over.

On this side of the House we happen to think the Charter of Rights and Freedoms is a valuable and important codifying of our rights and freedoms, and it's very important that we be vigilant in protecting them.

Mr. Speaker, Justice McEachern says:

"We cannot abrogate fundamental liberties that I am considering in this case. This practice, particularly the geographical restriction on where physicians may practise, cannot withstand any careful analysis. It offends too seriously against fundamental rights in a free country."

So if we have this as the backdrop and the overall context of the problem, that the courts will uphold the rights of individuals, professionals or other occupations to move freely intraprovincially as well as interprovincially, then we have a serious problem, because we're going to be just spending money on court cases. The A-G's ministry is going to be up to their eyeballs in researching and spending the taxpayers' money on fighting on behalf of the province on a bill that is basically wrong and a bill that basically will not work and is ineffective.

In the meantime, what are we saying to the international medical community? We're not saying, come and provide the best quality of service, bring your skills and so on. We're not saying to our new young talented doctors, come and let us sit down and discuss various possibilities where you could provide service and the province would deal fairly with you. We have the situation where the province and the taxpayers have paid for their medical training and now they're going to be attracted to other jurisdictions, go abroad or to the States or to other parts of Canada where the freedoms are upheld, until this is settled.

It's a denial of basic freedoms. I've made those points, Mr. Speaker. Also, as our lead-off speaker, the member for Burnaby North (Mrs. Dailly), indicated, it's only in the last few years where women have entered into the medical profession in significant numbers. That particular increase in the number of graduates just started a few years ago, and a larger percentage of women practitioners are now coming onto the scene. This particular group within our society is going to be unjustly discriminated against, in addition to the restriction of their mobility within the province, because just when they had an opportunity to begin to practise and consider the kinds of discussions and negotiations which could take place, their career path will be truncated and they will start looking at other areas as well.

Mr. Speaker, it's a very sorry day when the only response of the government to social problems, to health problems and to administration problems is to undermine fundamental rights and liberties. Surely that's not the way to do business. It's going to fail. It's going to lose.

[4:30]

The Minister of Universities (Hon. Mr. McGeer) falsely accused this side of the House of not having a program. We certainly do have a program. We would encourage, in a positive way, through the incentive programs of Mr. Black, a settlement in the underserviced areas of the province. We would sit down in a consultative way, not constantly combative and looking to pick fights that only end up with a lot of cost.

One final comment, Mr. Speaker. In Mr. McEachern's judgment he said that categories of ins and outs — in other words, those professionals that can be in and those that are out — are created within the commission and the college.

"The practice works against youth and talent by lifting the drawbridge to protect established members already within the plan against competition, and it purports to give the commission power to dictate where within a free country and a free province physicians may practise and therefore where they will live. In many of its aspects this practice is the antithesis of fundamental justice."

MR. REYNOLDS: I won't be very long, but I have to make some comments on Bill 41, after listening in my office to the member for Atlin (Mr. Passarell), who is going to vote for this bill. I'm amazed that members of his own party, after listening to his explanation as to why he would be voting for the bill, can get up and make speeches like the one we just heard from the first member for Victoria. He talks about how doctors are going to go to other provinces where freedoms are upheld. He also talked in other areas of "liberty."

[Mr. Ree in the chair.]

I wonder if the first member for Victoria and other members of the NDP caucus listen to what's happening in their party in other provinces in Canada. I was reading a Winnipeg Free Press article where Mr. Desjardins, who is the Minister of Health in that province, as an NDP member, was quoted as saying: "Manitoba should have some way of regulating where physicians practise, to ensure everyone has access to medical care." Mr. Speaker, that's what Bill 41 is all about. The Health minister in Manitoba agrees with Bill 41; yet we've got NDP members in this House who are saying that it's not a good bill.

Let me give you some further quotes. The Minister of Health in Manitoba says:

"'I find it difficult that governments can't come up with something, ' he said, adding some form of regulation must be adopted. During debate on his department's estimates in the Legislature, Desjardins said he was disappointed the courts ruled unconstitutional British Columbia's policy of regulating where doctors practise by controlling their billing numbers. He said he agreed with the policy...."

There's the Minister of Health in Manitoba, an NDP province, who agrees with the NDP member for Atlin that Bill 41 is a good bill for Canada, and he agrees with our Minister of Health; yet we've got NDP members in this House getting up and giving all the reasons why they support the doctors. It's very easy to sit there and agree with everything and knock the government. But certainly in this bill the NDP members should at least have some solutions to the problem, not just knock the bill. One of their own party members, a Minister of Health in this country, agrees with the Social Credit government in British Columbia that Bill 41 is not only a good thing for British Columbia but would be good for the province of Manitoba and good for all of Canada.

[ Page 6238 ]

Interjection.

MR. REYNOLDS: The Minister of Health says, "Watch and weep." I'll bet he is weeping, because he would like to bring in the same legislation in his province.

Another quote; I think it was the first member for Vancouver East (Mr. Macdonald), and I'll get to some of his comments in a minute. He talked about freedom. The Health minister in Manitoba says: "It's okay to talk about freedom of the individual...but what about the population in general?" Mr. Speaker, I think that's something these NDP members here should take a look at when they're talking about Bill 41. They should all go home tonight and read the speech from the member for Atlin. It made a lot of sense. He talked about being a teacher. He can't just walk in from Atlin to the city of Vancouver, and walk into the school board. He's got a certificate, just like a doctor has his degree. Can he walk into the school board in Vancouver and say, "Here's my certificate; give me a job"?

There are rules and regulations. There are responsibilities that go with certificates and with degrees. That's what this bill is all about. The doctors have not lived up to that responsibility. It's not an easy decision. Nobody likes to put controls on people, but in certain segments of society, and within our society, there must be controls. In a lot of cases we agree upon those controls. But where there can be no agreement, you then require legislation.

I mentioned the member, with his certificate. I'm sure, because he's got that feeling.... He's got the feeling of his constituents in the north, who are saying to him: "How could you vote against this bill? You know that this bill is going to help us get some medical service up in this northern area" — as it will help get medical service in many, many other areas.

The first member for Vancouver East talked about the freedom to practise their profession. He related lawyers to doctors. There's a great difference there. Certainly the lawyers have a degree, I guess, equivalent to that of a doctor to practise their profession, and we don't tell them where to go, but, Mr. Speaker, there's a big difference there. The lawyers get fees for services paid for by the general public as they need them. The taxpayer pays the doctors. There's a great difference there. When your fees are paid by the taxpayer, the taxpayer has to have some input as to how those fees are paid. It gets right down....

I haven't heard any of the members of the NDP getting up complaining about the fact that to just drive a taxicab, whether it's in the city of Victoria or the city of Vancouver, you must have a licence and you must have a licence to drive in a certain area. You can't just go and buy or rent a car and decide that you're going to be a taxi. We have regulations that say where you can and cannot drive a taxicab. I haven't heard the NDP getting up and saying we should abolish that law in the province of British Columbia so that a lot of people can get jobs driving cabs. Heaven knows, with the messy, dirty cabs we've got in the city of Vancouver, I'd love to see that law abolished so we could get some people driving clean taxicabs there. But, Mr. Speaker, this party of the people isn't talking about those taxi drivers, and there are regulations there. You can't go out and buy an airplane and start flying an airplane; the government has regulations there, and those regulations, in most cases, are agreed upon through negotiation.

I would finish up just by saying that the College of Physicians and Surgeons has to come to grips with this problem. This bill is going to solve it for them, but why haven't they come to the government and said: "We know we've got a problem in Atlin; we know we've got a problem in rural areas; we know you only have so many dollars to spend on health care. All of those doctors who are practising in Victoria and Vancouver and the urban areas will take a 10 percent cut in their fees so we can put a 10 percent increase on the fees of those doctors in the rural areas." Why hasn't the college come with a commonsense plan like that? They haven't done that because, I think, the college is no different. And when you speak of the college, you're not speaking of all the doctors, because not all the doctors necessarily agree with that political group called the College of Physicians and Surgeons. Why hasn't that college come? They sit with the minister. They negotiate. They talk, but they won't put anything in writing. The simplest of things: negotiate a different fee schedule. But, Mr. Speaker, they won't sign up for that because it affects the pocketbooks of all of them.

I would suggest, as I did earlier, that the members of the NDP would do well to support this legislation. It's fair legislation. When negotiations break down.... The member for Atlin has made it very, very plain, and I know, and his colleagues must know, that it's never easy to vote against your party in any parliament. It's a gut-wrenching thing to do, but he has obviously studied the issue. He comes from an area where he knows there's a problem and he knows this is the solution to his problem. I would suggest, Mr. Speaker, that his colleagues should read his speech very well and not only applaud what he's doing, but join him when we vote on this bill and vote with the government.

MRS. WALLACE: Mr. Speaker, if I shared my colleague from Atlin's belief that this bill would in fact bring doctors to Atlin, I might be persuaded to support it, but I can't see that happening. What this bill is doing is saying to new entrants into the medical profession: "We're going to give you a life sentence. You will get a billing number to practise in a certain place. It's only good for that. It's not exchangeable. You can't do anything about it except stay and practise in that place for as long as you practise medicine." That's why it isn't working, Mr. Speaker. That's one of the main reasons why it isn't working. And it won't work. That's what's so bad about it. We're creating a situation here that is protecting those people who have billing numbers, regardless of age or ability or capability, and to all the new people we're saying: "No — unless you accept a life sentence to go to Atlin." You may have never been in the north. You may have no understanding of the people there.

My colleague from Victoria talked about the idea of some bursaries — some training facilities — and that's something that's been talked about for a long time: the need to take people from these outlying areas, people who understand the situation and who know the people, and give them the opportunity to become professionals in the field of medicine so they can go back and work with the people they know and provide the kind of service that those people have every right to expect. It won't happen through simply setting and limiting billing numbers.

I'm particularly concerned about the women who have been studying medicine. In 1982 only 15 percent of the practising physicians in Canada were women, and there was a real move to try to improve that. It was projected that it would increase within 30 years to 40 percent as opposed to 15

[ Page 6239 ]

percent. In fact 50 percent of medical students are now women.

Women are the historic care-givers: the midwives, the wise women of ancient times. They have lost their role in medicine. Now they are trying to regain it, and what's going to happen? They're not going to get the opportunity to practise here in British Columbia, in spite of the fact that 50 percent of those new students are now women. We're not going to change that imbalance one little bit, because if I were a young woman graduating in medicine I would not be prepared to accept a life sentence to some outlying area.

What we should be doing is the bursary system, with a guarantee that people from those areas are prepared to go back for a period of however many years to practise medicine in that area. That's the long-term solution. The short-term solution is community clinics. We started that to a degree when we were in government, and it worked very well. If this government had brought in that sort of an arrangement for the outlying areas of the province like Atlin, and had put in community clinics where young doctors could go for a year or two and provide the kind of medical service that is needed, with a support staff around them, with a clinical setup to facilitate their practices, we would have proper medical care in those outlying areas. But without that kind of an approach it's not happening.

[4:45]

I submit that the government is simply evading its responsibility by bringing in this simplistic and autocratic solution to a problem that is solvable through reason and negotiation. It's been mentioned that they've talked about negotiating on the fee schedule, and they couldn't get anything in writing from the doctors. That suggests to me, Mr. Speaker, that the minister has not been negotiating in good faith with those people.

HON. MR. NIELSEN: You're confused as usual — very confused.

MRS. WALLACE: Mr. Speaker, if I'm confused, I think the minister is more confused if he thinks that this kind of autocratic legislation will bring about a remedy to the situation he has outlined, which we all agree with. We know there is an overpopulation of doctors in the lower mainland, and perhaps on Vancouver Island, and a shortage of doctors in those outlying areas. But he has the wrong solution. This isn't going to work. It's going to create nothing but problems and isn't going to solve the problem that so badly needs solving, which could be solved by community clinics; which could be solved by bringing in people from those outlying areas and giving them the proper training, with an understanding that they would go back for a few years; which could be solved by talking to the impending doctors, the 100 or so who are graduating from UBC this year, on the basis of short-term assignments and some sort of incentives, not necessarily personal, to go into those areas.

But where do they practise? What sort of facility do they have? I heard my colleague from Atlin talk about operating on a kitchen table. That's like something out of the early 1900s on the prairies where I was raised. It's not good enough for British Columbia in 1985. Those kinds of facilities could be provided by the minister, and through negotiation I'm sure he could find doctors who would go into those areas for a period of time. But they're not going to be prepared to sign their life away forever, which is really what they're doing if they accept this minister's ultimatum in this act. It's the wrong way to go.

There's a major question there, a very serious problem, one that — as I've said — particularly affects women, who are going to be barred from practice. We are not going to be able to bring up that percentage of women involved in acting as doctors because of this legislation, and that's contrary to every aspect of society today, where women are beginning to take their rightful place. This is a deterrent to that. A deterrent? It's an impossible hurdle.

I know there's no point in urging the minister to reconsider. His mind is made up and he's a very determined gentleman. But it's wrong; it's the wrong way to go. It's not going to bring the answer that we all want. It's not going to provide medical service in those outlying areas, and for that reason I'm opposed to it. It's not going to give women access to the medical profession to bring that percentage up from 15 percent to the 40 percent that is aimed at in 30 years. It's going to leave us sitting at 15 percent, and that's wrong too. That's wrong too, because there is a real demand, particularly among women, to have women doctors.

Interjection.

MRS. WALLACE: It's wrong, Mr. Speaker, it's just wrong, and that's why I'm opposed to it. It has nothing to do with being negative, because I believe there are other solutions. That minister has failed to recognize the possibility of community clinics in those areas, and in the long haul his costs would be far less if he were to do that. He would then have the kind of service that would be available to those residents of those sparsely populated areas, and we would have equality not only for doctors but for the people of British Columbia.

MR. MITCHELL: When I listened to the minister at the beginning of this debate on this bill, I agreed with everything he said. The problems that face the people of British Columbia because of the concentration of the experienced doctors in the banana belt of British Columbia, Vancouver or Victoria, and the problems it causes to the citizens of British Columbia.... I listened to him, and I agreed a hundred percent with what he was saying. But as many of my colleagues have said, the method that he goes about it in this bill.... And this is the only thing we're debating: this bill, the contents of this bill and what this bill will accomplish. It is not — and this is our problem with this bill — going to bring medical service to the outlying areas of British Columbia.

I know that in my own riding I have one area, like the majority of us who represent rural areas.... I have the area of Port Renfrew. I tell you, it doesn't matter how you restrict the billing numbers to places like Victoria or Vancouver, a doctor is not going to set up a practice in an area like Port Renfrew, where you have, because of the other mismanagement policies of this government, that community dying because of the overharvesting of the timber in that area and the mismanagement of the whole forest industry.

What we have to do is face the reality that in British Columbia there are communities like Port Renfrew, there are communities like Atlin, there are communities scattered through every one of the rural ridings which are not large enough to support a full-time doctor or a competent doctor. Instead of having this particular bill, if we had a bill that was going to provide services in these areas.... Something I

[ Page 6240 ]

had written down earlier was that we have to look at the community clinics, we have to look at the air doctors, we have to look at providing the services the taxpayers are paying for.

Bringing in restrictive legislation that is a smokescreen.... And that's all it is: it's a political smokescreen to make out that the Social Credit government is facing the real problems.... They are not facing the problems; they are not even prepared to give the services equally throughout the province. It's easy to say: "Oh, are you suggesting that we bring all the patients in to Vancouver?" No, we're not, and we never have. Over the years that the NDP has been talking in the health estimates and on political programs, it has been asking to bring in services throughout the province.

When the NDP were in, as my colleague said earlier, we were setting up the idea of clinics. One of the things that this bill will do is to cause the growth of medical clinics in this province, but they will be controlled by a smaller and smaller group of doctors who will have the billing numbers, who will then hire, one way or another, the young, newly trained doctors. You know, I read this bill and I can't help but think that if the Minister of Health had a talk to his colleague the member for North Vancouver–Seymour (Mr. Davis).... When they tried to solve the problems of the large number of fishboats in the industry, they restricted the A licences for salmon fishing, and that was going to solve the overfishing of the industry in the sixties. The only thing that happened was that all of these A licences became a commodity that was sold, and they were bought up. Instead of having four or five single boats that caught X tons of fish, they were then concentrated into one boat with the new technology and the new equipment. Where four or five A licences went into one purse-seiner, the concentration of power caught more fish and was worth more money. This is what's going to happen: the billing numbers of the doctors' profession are going to be worth more money as we go down the line. They can say, "Yes, the commission will restrict the sale of billing numbers," but if this particular philosophy carries on, the facts of economic life — and the medical profession is no different than anything else — are that that billing number, the licence to practise, will have a value that will not increase the services to those who need them.

What the minister said about the bill made a lot of sense, except that the bill does not ensure in any way that if you restrict billing numbers.... We've restricted billing numbers since 1983 and there hasn't been a great run of doctors out into the rural areas. The member for Adin hasn't had a lot of doctors come up into that area. I haven't seen any doctors settle in Port Renfrew. Each of us who has a rural area has not seen an abundance of doctors moving out. The concentration is in the areas that a lot of us like to live in.

We, as legislators, must address this particular issue. We must be prepared to work with the medical community, with the rural communities, to provide that service. Something I've said in every session since I've been here is that we must start using the legislative committees of this House. We must take some of the bills and some of the problems that come before us and go out into the rural communities. We must listen to the experts from the medical profession; we must sit down and work in cooperation. Each of the 57 members is on some of these committees that every year we are appointed to: a committee that never sits, that never faces the problems of British Columbia. It's a committee on paper, and it does not face or recognize or work towards solving some of the problems that this Bill 41 attempts to solve.

The attitude of the government is that they can centralize everything in Victoria and restrict anyone's rights, doctors or anyone else, and that's going to solve the problem. It is not going to solve the problem. I think we do have a problem with the medical profession. We do have a problem in many parts of British Columbia, because the so-called free enterprise in health has not given proper service out in the communities. There is an answer. I don't have a simple answer that I can write down, but members from this side of the House have mentioned some proposals — that the medical profession should be consulted, the communities should be consulted.

[Mr. Witch in the chair.]

As the first member for Victoria (Mr. Hanson) said, for every person who enters the medical universities, there are four or five who are equally as qualified and who want to go in and practise. In the rural areas there are people who are academically qualified and have the desire, who have their roots in the rural communities, but somehow — as we all seem to believe — if you don't have a father or an uncle who is a doctor, your chances of getting into the medical schools are restricted. I've talked to a number of students who have all the academic qualifications, but to get into UBC medical school? Somehow they are shunted out.

[5:00]

We do have a problem in British Columbia, and we have an opportunity to work through the government, through our legislative committees, to take a piece of legislation, to take some of the problems that have been identified by hundreds of communities: the lack of medical services in the rural and northern communities. We should accept that challenge as a committee to go out and talk to the experts, to talk to the patients and to the victims who are paying taxes and not getting that service. I think that is a better way of cooperation. It's a better way of working together, instead of what this government seems to want, which is confrontation. It doesn't really matter if they're having confrontations with the single mothers on welfare or the pulp workers or the construction workers or the civil servants or the police or the school teachers. It's always zeroing in on a confrontation, and that is not going to solve our problem. It's not going to create one new doctor in a rural area. We're going to have to work together.

As I say, I agreed with what the minister said about the problem we have, but I sincerely and honestly do not feel that this bill will cause a great rush of doctors into Atlin or into Port Renfrew or into Bella Bella — all the areas that need doctors. The only way we're going to provide that medical service is to look at it through community clinics or air doctors, as has been pointed out, who work very effectively in many parts of the world. I guess it got the most attention in Australia, but it has worked in areas where doctors will not rush out to set up an office so they can get a billing number to bill Victoria. It's not going to happen.

If we are going to accept our responsibilities, we must take a new approach. We can't afford the pleasures of the continuing confrontation, and this bill lacks the answers that are needed. I know that at times that minister can be very gruff and hard-nosed, but he can be innovative. He can be, mark my words. If he would take that bill and refer it to a legislative committee and give them the responsibility of

[ Page 6241 ]

travelling throughout this province to consult with the communities and the doctors, when that committee was finished and had brought in their report, he could rewrite that bill. He could rewrite that bill like he rewrote Bill 50. He could withdraw it and he would bring in something that would be constructive.

HON. MR. CHABOT: Tour the province? Absolutely disgraceful!

MR. MITCHELL: I'm not on that committee, Mr. Provincial Secretary. I'm not on the committee that would tour.

Interjections.

DEPUTY SPEAKER: Order, please. Please address the Chair. The member for Esquimalt–Port Renfrew has the floor.

MR. MITCHELL: Thank you, Mr. Speaker.

We have a problem and I know that we could have a proper diagnosing of that problem. We could consult with the specialists and the patients — don't just talk to one group, but talk to them all. The committee could be from both sides of the House. I know, Mr. Speaker, that that group, whoever they are — you can draw them by lot or you can have them appointed — would recommend to the minister that he withdraw this bill. They would write him one that would be positive, one that would be constructive and one that would address and maybe solve the problems of shortage of medical services in the rural areas.

MR. MacWILLIAM: There has been a lot of discussion in terms of the intent of this piece of legislation. Certainly my colleague from Atlin has viewed it in a different manner than the rest of the caucus. I don't think that's any reflection whatsoever in terms of where we stand on the issue.... Certainly it's a concern for him, coming from that northern riding which experiences some very considerable problems in terms of adequate medical services. But in terms of the legislation itself, Bill 41 is seeking to address the regional disparity of the level of medical care throughout the province. It's seeking to address the fact that we have too many physicians in one area and not enough in the other. That's the problem, a simple fact. When you look at how the legislation addresses that problem, we can see that that is where the agreement ends. The primary purpose of Bill 41, as it was the primary purpose of Bill 50, which has been withdrawn by the minister, is to give the Medical Service Commission the authority to grant or to withhold a billing number for a physician to practise in the province. It allows the commission to set criteria for the issuing of these numbers that will basically restrict where a physician can practise in this province.

I don't believe that Bill 41 addresses the problem adequately. I don't believe it addresses the problem from the right direction. As is usual, this government has brought in the sledgehammer to drive home the thumb tack, as we've seen time and time before. The minister got so much flak as a result of the original Bill 50 that he, in his wisdom, has withdrawn that piece of legislation and amended it somewhat with Bill 41. However, even though it is softened somewhat, Bill 41 is still following the same intentions that Bill 50 followed. I don't believe it is going to solve the problem at hand. The problem is: how do we get physicians up into areas such as Atlin and the northern communities and the rural communities throughout British Columbia? How do we give a higher level of medical care to those communities? How do we address the problem of too many physicians in some of the more popular urban areas? That's the problem. We don't disagree with the problem. Both sides of the House recognize the problem. The question is: how do we solve it? It's my feeling and that of my colleagues that this legislation will not solve the problem.

I'd like to read you a letter. I received a number of letters from the physicians in my community, but I'll just read a particular sequence from a letter from a Dr. Larrie Mandreck, who writes:

"Such an attempt by Mr. Nielsen to push through such legislation reveals his insensitivity and disregard for the judicial system. Such legislation, coming on the heels of Chief Justice Allan McEachern's decision that the government's policy of restricting doctors' access to medical care billing numbers was 'patently unfair and unjust, ' serves to underscore my impression that the minister believes himself to be above the courts and the constitution upon which the laws of this country have been made."

That is pretty strong stuff. I know that the physicians in the communities of the North Okanagan would not make such comments lightly. They are extremely concerned with the legislation at hand.

You know, when we look at Bill 41, and how the government is going about solving the problem of redistributing physicians throughout the province, it becomes clear that, number one, nobody seems to have been consulted in the process — the government is once again creating legislation in the smoky back rooms of the capital, hasn't consulted the physicians and is ramming through another confrontational piece of legislation — but, more importantly, this government, which honours the concept of unfettered free enterprise, is once again sticking out its long arm and centralizing yet another process in the community. It's done it time and time and time again, with its attack on the public service sector, with its attack on the teachers, with its attack now on the school boards. We have another example of the centralization of authority and the centralization of powers in this capital. You are denying any input from the physicians of this province in attempting to come to a reasoned and consultative solution to the problem at hand. You simply reach out and grasp more control.

It's confrontation. There's been no consultation. It's unfair. It's unworkable, but more to the point, it doesn't even really address the problem. As I mentioned earlier, the minister does have the habit of bringing in the club and then pulling back a bit, so that when he smacks the second time, it doesn't quite feel so bad; it doesn't hurt quite as much as the last time. You know, it's kind of like the analogy of when you have two rocks in your shoe, and it really hurts, and you take one of those stones out. It doesn't hurt so much, and you feel a lot better, but you've still got that single stone in your shoe.

MR. ROSE: It's the same thing as hitting yourself on the head.

MR. MacWILLIAM: Or when somebody has been stepping on your toe, after they get off, it feels so much better, even though your toe is still swollen.

[ Page 6242 ]

Bill 41 will create two classes of physicians in this province: those that have full rights — those that received their billing number before the legislation was passed — and those that don't have full rights, that only really have partial rights. Their billing rights will tie them to a particular geographic area. It's been seen already that since the restriction of billing numbers there have been fewer physicians going up to those remote areas, because they're concerned that they're going to be locked into those areas. Certainly it is a disincentive, not an incentive.

The legislation attempts to solve the problem through compulsion, rather than through negotiation, and it's time that this government learned that in drafting legislation it has to reach out, consult and cooperate with the people that it's bashing on the head right now. There are other ways to skin the cat. You're not going about the process in the right manner. The physicians are now the target; it's more confrontation demonstrated by this government. It just doesn't seem to learn the lesson.

[5:15]

Let's look at some logical arguments against Bill 41. As the physicians have argued — and I would agree — Bill 41 is a denial of basic freedoms and rights. I think that they may have a very good case when it comes to the courts. Secondly, if Bill 41 passes, patients will be denied a choice. They'll be restricted to the old-boy network of the older, established physicians, and the new physicians coming in will be very much limited in where they can practise. A limited pool of older physicians....

Bill 41 discriminates against the young graduates coming into practice. As a matter of fact, if Bill 41 comes into enactment, the young physicians graduating from our one medical school in British Columbia may very well say: "Goodbye, British Columbia. Thank you very much. I'll practise elsewhere." That is not going to solve our problem whatsoever.

Rationing billing numbers, I believe, inflates the price that doctors are getting. Here's some interesting convoluted logic. It assumes that the more physicians that you have in an area, up goes the cost. Now that may be right to a point but, for example, if you don't have any physicians in the area, there will be no costs, because there's simply no treatment. More physicians in the area eventually meets the demand. But if the demand has been met, does placing another physician in there mean that more people are going to get sick more often because that's where the demand is? Does it mean more people will get sick more often, or is it just that each physician will have a slightly lighter workload? What is the cause and effect relationship here? Certainly the costs of medical services are related to the number of times that people get sick, not to the number of physicians. The logic is not there.

I think I've outlined a number of my concerns in terms of Bill 41. I want to re-emphasize once again that we don't disagree in this House. I don't think anyone in this House disagrees with the fact that we do have regional disparities in our level of medical care. The city of Vernon has lots of physicians because it is a nice place to live; I'll admit that. Up in the northern areas, very few. There are regional disparities. We do not discount that fact.

How do we go about solving the problem? I and my colleagues feel Bill 41 is not going about it in the right direction. What are the alternatives? Perhaps we should look at instituting an underserviced area program.....

[Interruption. ]

The House adjourned at 5:30 p.m.