Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 22, 1992

Volume 4, No. 23

[ Page 2819 ]

The House met at 10:37 a.m.

Prayers.

Hon. B. Barlee: Somewhere in the precincts is Ken Rekrutiak, the president of Centra Gas B.C. Inc. He presided over a tournament between the media and the House at Cowichan last weekend. Unfortunately, for the fourth year in a row, the media lost.

I have a present to give one of the Liberals who was not there to get his present from Centra Gas. I would be delighted to give it to him afterwards.

D. Streifel: It seems that I can go for months without any visitors, and then they come in droves. Visiting in the precincts today is my former boss, the president and chief executive officer of UFCW Local 1518, Brooke Sundin. I ask the House to make him welcome.

Orders of the Day

Hon. G. Clark: First of all, with the House's indulgence, I'd like to discuss this week, or at least today, as we hopefully move to conclude lots of business. We've looked at sitting today from 10:30 to 1 o'clock, breaking from 1 o'clock to 2 o'clock for lunch and then coming back at 2 o'clock and sitting until 11 o'clock. I think that is not a bad pattern for the week.

If members on the opposite side object to that, I have absolutely no problem going to the normal rules of the House and sitting for a couple weeks in July. I want members to know that we're quite prepared to do that.

Interjections.

The Speaker: Order, please, hon. members.

Hon. G. Clark: I don't want to take the opportunity to debate. I just want to make the point that this is not an attempt at all.... We're trying to be cooperative. The opposition has been very cooperative, and I commend them for that. We don't have any problem at all reverting to that at any time. It's just a matter of trying to expedite it for all members of the House.

With that, hon. Speaker, I call second reading of Bill 71, the Medical and Health Care Services Act.

MEDICAL AND HEALTH CARE
SERVICES ACT

Hon. E. Cull: The Medical and Health Care Services Act provides a new vision for the management of medical services in British Columbia, in keeping with many of the challenges that are facing medicare today. The legislation under which the Medical Services Plan and the Medical Services Commission currently operate dates from 1968. There has clearly been a need to modernize this legislation and improve the management of the plan. Indeed, many of the administrative amendments that are in the act have been under discussion since 1988.

As members know, there are also some more pressing and immediate concerns that require a legislative solution. Specifically, there is the need to ensure that the Legislature can determine the overall budget for medical services. It is our desire to find a way to do that so the rights of doctors are balanced with the needs of the taxpaying public. This bill provides a way to meet both ongoing and future challenges through the development of a new model for the Medical Services Plan, a co-management model -- a partnership of the public, providers and government. This will be the first true co-management model of its kind in Canada, and I hope that it will become a model for provinces right across the country.

The act provides for a new Medical Services Commission to be established, consisting of an equal number of members of the government, the medical profession and the public, those public representatives to be chosen jointly by the government and the medical professions group, the B.C. Medical Association. The commission will provide a fair and balanced approach to the management of medical services in the public interest. Other health care practitioners covered by the Medical Services Plan will also be able to participate in the management of their part of the plan in a similar co-management way through a system of subcommittees that will be formally established by the Lieutenant-Governor-in-Council. The new commission will be charged with a legislated mandate to ensure reasonable access for residents throughout the province to quality medical care, health care and diagnostic facility services.

The act recognizes the Legislature's primary role in establishing the overall funding available in each fiscal year. The commission is required to remain within this funding level, and is given a variety of tools to ensure that they can do that. These include the funding of educational activities and working with the colleges which govern practitioners to develop directives and guidelines for clinical practice, as well as specific financial tools. Subject to the Canada Health Act, the commission may determine what services are paid as benefits. The commission is also given powers to establish categories of practitioners, to establish budgets and payment schedules for these categories and to adjust payments as necessary to meet the funding objectives of the Legislature.

The act clarifies the roles and the responsibilities of beneficiaries who provide professional services, including the services of diagnostic facilities under the Medical Services Plan. As at present, residents of British Columbia are entitled to be enrolled under the Medical Services Plan upon application and the payment of premiums. Practitioners who are in good standing with their licensing body are also enrolled in the plan upon application. Provision is made for the submission and assessment of claims to be paid in accordance with the Medical Services Plan payment schedules in essentially the same manner as is presently the case.

We have taken measures to ensure that beneficiaries are properly informed of situations in which they may 

[ Page 2820 ]

be required to pay a practitioner directly or may not be able to claim payment for the service under the plan -- for example, when they are receiving a service that is not a benefit under the Medical Services Plan. In such cases it will be incumbent on the practitioner to advise the patient in a manner that the person can understand that there will be a payment required; and we recognize that for some people written notice may not satisfactorily meet this requirement.

[10:45]

Further protection is made for beneficiaries under a new section which deals with agreements made by third parties to pay for or remit Medical Services Plan premiums. Misuse of such funds is an offence and the directors or officers of a corporation who concur in such misuse would be personally liable. In addition, a statutory lien is created over such funds which will, we hope, shelter the funds to some extent in case of bankruptcy or other proceedings.

Provision is made to ensure that the payments made under the Medical Services Plan are not misused or abused by beneficiaries or by service providers. The commission is able, for cause defined in the act, to make orders which limit the entitlement of certain beneficiaries, practitioners or diagnostic facilities to have payment made under the plan. Such orders can only be made after formal hearings in which the requirements of natural justice are met. The commission's orders in this regard are also subject to an independent appeal board, which is newly established in this act. Certain serious abuses of the plan, such as fraudulent claims, may also result in charges as offences.

The commission's powers are continued to approve diagnostic facilities for the purposes of providing benefits under the act. Provision has also been made for hearings in respect to cancellation or amendments of approvals. Consistent with the recommendations of the auditor general, the commission's powers of investigation and audit for the purpose of substantiating claims have also been considerably enhanced. The commission can appoint inspectors who may request or inspect records for the purpose of audit of claims made by practitioners or of patterns of practice or billing. As well, inspectors can ensure that approved diagnostic facilities comply with the conditions of their approval.

Government has given very careful consideration, in developing the inspection and audit powers, to protecting the rights of practitioners and beneficiaries. Inspectors do not have a right to view the delivery of services by a practitioner to a patient. Their powers are conferred with respect to the practitioner's records to substantiate a claim for payment. We have clearly stated that medical records must be inspected or requested for inspection only by an inspector who is a medical practitioner. The inspectors appointed by the commission, like all persons acting under the act, are subject to a duty of confidentiality and may be charged with an offence if this is breached.

In providing the ability to have this audit power of medical records, B.C. is following the practice of Manitoba, New Brunswick and Nova Scotia. In addition, Alberta, Ontario, Saskatchewan and Newfoundland have similar powers where, for the purpose of substantiating a claim, they can request medical records. As I have mentioned above, the new appeal board will be established to hear appeals from the commission's decisions in matters which significantly impact the right of beneficiaries and practitioners of diagnostic facilities to participate in and have payment made under the plan. This board will be chaired by a lawyer and will have members appointed after consultation with the licensing bodies of the various medical and health care practitioners. It will be able to substitute its decision for a decision of the commission in these matters.

In developing this legislation, we have consulted with medical and health care practitioners and with consumers. We have endeavoured to incorporate their comments and concerns. However, I must acknowledge that not all of those we have consulted would agree with all provisions of the act. My staff continues to be available to meet with the B.C. Medical Association to see whether we can agree on any further refinements to the legislation.

But time is running out. The budget that was established for physician services in this fiscal year is being spent now as we debate. If we are to ensure that we remain within that budget and that we are not forced to bring in a special warrant at the end of the year for tens of millions of dollars as we did last year, we have to manage the Medical Services Plan better.

I believe this legislation will be innovative and provide a useful framework for taking the Medical Services Plan into the challenges of the next decade and beyond.

L. Reid: Our health care, education and social welfare services are viewed by many as significant achievements of which Canadians should be proud. Hospital insurance is so taken for granted in Canada that little or no notice was taken of its fortieth anniversary in 1987. British Columbians should be particularly interested, because hospital insurance was a field in which this province was a pioneer.

When the B.C. Hospital Insurance Service was established in 1949, it was only the second such scheme in Canada. Health insurance had been on the agenda of the Liberal Party in British Columbia since the 1920s. When Duff Pattullo became Premier in 1933, his Provincial Secretary went to work on its implementation. It was not until 1936 that the Legislature passed a health insurance act, which was never proclaimed. When Byron Johnson became leader of the Liberal Party and Premier late in 1947, he found that the hospitals and municipalities were having severe financial problems due to the inflation of the late 1940s. Johnson and his Minister of Health and Welfare, George Pearson, turned to hospital insurance as a solution to part of this problem. At its spring session in 1948 the Legislature passed an act to provide for the establishment of hospital insurance and financial aid to hospitals, with hospital insurance to begin on January 1, 1949.

These comments are taken from the writings of Douglas Turnbull, who began his term of office as B.C.'s Minister of Health and Welfare in the year 1950 and is today an honoured member of our caucus. In assuming 

[ Page 2821 ]

the appointment of Minister of Health and Welfare, Douglas Turnbull was in charge of three services: a social welfare branch, a public health branch and a hospital insurance branch. Some 42 years later we are still discussing models of health care delivery. We are still trying to seek a balance between prevention and cure.

The role of the Health ministry continues to be to provide services to the people of this province. Canada and many other countries in this world will be grappling with the question of funding for health care well into the next century. To begin this process by excluding any group of caregivers is foolhardy at best. British Columbians are looking for an end to confrontation and adversarial relationships. The 40 percent of British Columbians who voted for this government believed that they were going to see an end to confrontation. They believed their candidates when their candidates promised them conciliation, not confrontation. Consensus-building is an evolutionary process, and it saddens me to realize that British Columbians now have a government that has simply not evolved.

Physicians in our province have an integral role to play in the restructuring of our health care system. They have long since identified the areas that need immediate attention and would work diligently with the public, their health colleagues and the government to ensure that the health care system continues to meet the needs of the people it was designed to serve: the patients.

As Health critic for the official opposition, I have often had the opportunity to meet with health care consumers. When the topic of health care arises, I am still astonished with the response that health care is somehow free -- i.e., if you do not directly incur costs, no costs exist. I was very interested to learn of the patient education program underway in Wetaskiwin, Alberta. The project sought to enable all hospitals to use the same framework for cost accounting so that costs could be easily compared. Wetaskiwin has gone a step further and is now able to attach costs on a per-patient basis. The program enables the hospital to better predict its needs and determine where there is waste in the system. The desired outcome of such a plan is to make the public more aware of the cost of quality health care.

Physicians in British Columbia have advocated strongly for public education programs such as this one for many years. Instead, we have a system in which the physician is expected to be the gatekeeper at the same time that she is expected to be the patient advocate. Responsible government must do more than commit physicians in this province to a lower income. It must somehow promote reasonable access, which is a much more complex challenge.

I believe health legislation in this province -- Bills 13, 14, 71 -- to be simplistic in the extreme. The goal of this government cannot be improved health care. It makes no sense to tie reimbursement to a restructuring of the system. Each of these items is important, and each deserves attention. The previous government had more sense than to introduce the Year 2000 education document during salary negotiation. Why is this government attempting to restructure an entire health care system when there are players in the field without agreements? Bills 13 and 71 are not about health care. Both these bills will place physicians in the untenable position of rationing health care on the basis of ability to pay.

Over the past six months I have toured hospitals in this province and spoken to doctors, nurses and others involved in the delivery of health care. These people have many positive and constructive ideas for reforming the system they know best. For the minister to simply cap doctors' salaries and present it as a means to ensure "the viability of our health care system," means this government hasn't been listening.

The Speaker: Order, hon. member. I do hesitate to interrupt. We normally allow wide range in debate in second reading, and I appreciate this is a very complex bill. I think the Chair has allowed considerable length of introduction, and I hope the hon. member is very quickly going to be coming to the actual principle of this bill.

L. Reid: I appreciate the comments, hon. Speaker.

I hope this minister will sit down with people who work in all areas of health care. I think she will find other more meaningful solutions. Nobody wins, least of all patients, if we pit one aspect of the health care system against any other. What possible political points can the NDP government hope to realize by sacrificing the health and welfare of the people of British Columbia? We need a government who will work towards a progressive, interactive solution to health care spending.

I believe government has the responsibility to set the overall health care budget. I believe this is done by understanding how utilization works. Some sense of process must exist as we move to a consideration of health care funding. It is not appropriate to somehow suggest that the responsibility for the cost of health care rests with any one group. In Prince Rupert on June 12, at a meeting with eight local physicians, Health Minister Cull admitted that the government's claim that health care costs are spiralling out of control is simply not true, and that the government got off on the wrong foot in dealing with the province's doctors.

This situation must be corrected. We must examine the recent Royal Commission on Health Care and Costs in the context of this Legislature. Surely there still exists a system of constituent representation in this province. I am of the view that the recommendations of the Seaton commission need to come before the all-party Select Standing Committee on Health and Social Services.

We need to be creative in our attempts to facilitate the public's understanding of utilization. The number of people visiting their physicians is what drives the cost of health care. New diseases, motor vehicle accidents and technological advances drive the cost of health care. Population growth and aging drive the cost of health care. We need to make individual patients more aware of the costs of their health care. Every single service has a cost attached to it, and the public must be more aware 

[ Page 2822 ]

of how they impact the system. Increased utilization will result in increased costs. To somehow suggest that doctors are singly responsible for the cost of health care is wrong. In fact, the percentage of billing against the plan has remained constant over the past five years. Doctors' incomes still account for 18 to 20 percent of the provincial health care budget.

Why would this government isolate any one group of health care providers and suggest they are at fault for the number of patients who visit them? Why would this government throw away a 24-year history of negotiation? When is a promise not a promise? Where is the commitment to open government? Under the Canada Health Act, doctors in this province do have the right to negotiate. These rights cannot be legislated away.

[11:00]

This is a parliament. It should bring together the finest minds to seek resolution. It should bring together people who are interested in doing the right thing. Bill 71 is not the right thing. Bill 71 disfranchises people and throws people off a ship at a time when this government should be doing everything possible to keep people on board. This government cannot simply disregard the Canada Health Act. This level of arrogance will not benefit our health care system.

We need a vision for health care in this province. Where do we want to be six months, five years or ten years from now? The public at large doesn't have a picture in mind of what community care will look like. What is the practical application of such a direction? Where is the implementation plan? To my mind, dollars cannot be committed without first knowing how that recommendation will be implemented. Taxpayers in this province deserve to see the plan before the estimates, not after. We're being told that health care, under this bill, will be co-managed: co-managed by orders-in-council, by the Lieutenant-Governor-in-Council, by its committee structure or by the minister. All these possibilities exist.

The chair of the tripartite commission should not be a voting member. For this commission to be legitimate, it should be operated as a properly constituted corporate board. The executive officer should report to the committee.

The committee should not be responsible for negotiating with physicians. The Minister of Health has a responsibility to engage in meaningful negotiations with the province's physicians. Disputes which cannot be resolved must be considered independent of the commission.

Regularly scheduled monthly meetings would encourage the proper monitoring of our health care system. Meeting four times a year to manage an entire health care system is simply not adequate.

We also need to know the length of committee appointments. Who are these people going to be? Can there still be NDPers out there looking for work? We need to know what constitutes a quorum, and we need to know the voting mechanism.

Another section of this bill which causes me great concern, and should concern the public at large, deals with the auditing functions. This section allows inspectors to scrutinize patient files for billing purposes, which is unacceptable. Patient files are written for clinical purposes, not billing purposes, and they contain sensitive information. I could not condone eliminating doctor-patient confidentiality so that an inspector may pass judgment on the billing of a service provided. We are talking about an abuse of the system that amounts to one-third of 1 percent.

A patterns-of-practice committee currently examines billing practices, and I believe this committee is working well. British Columbians do not want medical inspectors prying into their medical records. Why would the NDP favour more intrusive government? British Columbians want balanced government.

Since medicare was introduced, doctors have negotiated with the government on a variety of medical fees and related benefits. These have been tough, honest and open negotiations, and doctors have negotiated in good faith with both the New Democratic and Social Credit governments. Somehow in 1992 it is appropriate to legislate rather than negotiate. Communication is obviously an art form that this government has not mastered. Health Minister Cull's letter dated March 26, 1992 states: "I am committed to exploring longer term solutions through a full, open dialogue with doctors." Certainly Bill 71 is a remarkable introduction to dialogue with physicians. The government could not even wait to hear what meaningful solutions the doctors had to offer. Why did the NDP immediately begin their interactions with physicians by insulting them? Physicians were willing to participate in a long-range planning process.

I appreciate and support the efforts in the area of preventive medicine. However, early intervention is also critical. It is thus essential that we maintain superior clinical resources to treat patients who have already acquired a disease. As a society, we have not had the discussion as to what we want our health care system to look like. Are we in favour of a combined illness-wellness model? Do we wish to move into the wellness sphere almost exclusively or stay with the current illness model? The question we need to ask is: who has the responsibility for the delivery of these services?

I would submit that the illness model should remain the mandate of the Health ministry and that the wellness model should become the mandate of the Education ministry. Maybe the Ministry of Health doesn't need to be all things to all people. Maybe we are unrealistic in our expectations of one ministry, and maybe this issue will never be resolved satisfactorily under one ministry.

I know that it is unacceptable to select one aspect of the health care system -- namely physicians -- and suggest that a group which receives 20 percent of the entire health care budget is somehow responsible for the ills of an entire system. This figure of 20 percent has not changed over the past five years. Such consistency from physicians could not have triggered such an incredible response from this government without a prior mandate. This government came to office to isolate various groups in our society. You only have to look at the long string....

[ Page 2823 ]

The Speaker: Order, please. Hon. Member, I must again remind you to restrict your comments -- however broad this bill is -- to Bill 71.

L. Reid: Thank you, hon. Speaker. You have only to look at the long string of NDP broken promises to know that such a dramatic about-face had to be planned. Promise number 39, which reflects directly on Bill 71: "A New Democratic government will seek the cooperation of and work closely with our health care professionals and workers." When? And why should this lack of cooperation concern all British Columbians?

This government has cancelled contracts with doctors in British Columbia by suggesting that these contracts never existed. If a doctor's contract can be cancelled so easily, then any contract with government is suspect. Will the teachers be next? Will it be the forest companies or the mining companies? Who is next? What is so important about a contract? Contracts are the way civilized people deal with each other. You have a contract with government called medicare. In return for your premiums and your taxes, the government said that they would provide you with the best medical care possible. What they haven't told you yet is that they are not going to do that anymore.

Hospital care in this province has been rationed. Our wait-lists for surgery are very long and growing longer. Hospitals are cutting staff and closing beds. How will that affect you as a patient? The aim of this government is to ration your medical care. The government knows that if they cut back the total number of medicare dollars, doctors will be forced to cut back services. Some doctors will leave for greener pastures, which will leave physicians in short supply. Those remaining will get busier and busier as they try to keep up with the demand. Is this what you want from your medicare system? Is this what your contract with government promised you when you agreed to pay higher premiums and higher taxes?

Bill 71 has removed the historical and legal rights of physicians to bargain with government. These rights are guaranteed in the Canada Health Act and agreed to by government in the master agreement with the Medical Services Commission.

Medicine is an honourable profession in British Columbia. The medical profession wants to play a part in the inevitable changes which will take place in the delivery of health care. We will see regional planning come to health care. We will see decisions that originate in the community. We wish to see these programs administered in an equitable fashion. We need integrated health services. We need better coordination among the key players. For that to happen, we need time. We need time for this bill to be considered by the public at large.

This issue is bigger than doctors' incomes, hon. Speaker. This is about restructuring an entire health care system for all British Columbians. Bill 71 brings many items to the table, many of which require significant community involvement. This government has a responsibility to its electorate to ensure that this is the best legislation possible, and that our health care system will somehow be improved as a result of its adoption. This cannot be done in isolation.

The Liberal opposition believes the NDP has an obligation to consult. British Columbians believe it too. We do not favour this bill going to committee at the conclusion of second reading debate. Should it survive reasonable scrutiny by the public over the next two to three months, it could be considered again at a fall sitting of this Legislature.

Balanced governments do not proceed with such haste. To move this legislation through third reading in less than ten days smacks of incredible arrogance. Health care reforms require enormous political courage and preparation. British Columbians need their government to consult, to prepare and to refine a direction for health care with them, not for them. That was the promise. We await the outcome.

B. Jones: I appreciate the remarks of the Liberal critic for health care. If anybody wanted to exploit a very difficult situation in this province for narrow partisan purposes, I think the member opposite has done an excellent job of that. Unfortunately, most of what she had to say is completely backwards. This government and this bill is not, as described, an anti-doctor, anti-physician bill. That's certainly not the government's view, and it's certainly not my view.

My father-in-law was a physician for 40 years. He was a medical officer in the war, and I know from firsthand experience the kind of sacrifice that physicians and their families make to provide the kind of quality health care that we have in this province. I know the years of training that go into the preparation to become a physician. I know the skill and the abilities that physicians bring to their work in this province, and I know the very difficult decisions that those physicians make, often life and death decisions. We make decisions as politicians, but I think those kinds of personal decisions where you see the families impacted deserve a great deal of credit. This government and this legislation is not anti-doctor legislation.

It's my view too, and I think the government's view, that doctors are not overpaid. This is not just a bill about reducing physicians' salaries. Physicians by and large, I think, are compensated very fairly for the valuable service they bring to British Columbia. I respect the very negative feelings that doctors have at this time. I think we've all received many letters expressing those views strongly, and those views in the medical community are widely held at this time. They certainly found Bills 13 and 14 offensive. They felt singled out. They felt picked on. They felt betrayed by this government. They did feel singled out. But I think groups are feeling singled out as a result of the difficult budget circumstances that this province faced. I think members opposite by now understand the potential of a $3 billion deficit for one year and what that means to each family and each individual in this province. But not everybody can be singled out. Teachers feel singled out, lawyers feel singled out, hospitals feel singled out, the HEU feels singled out, Sport B.C. feels singled out, highway contractors feel singled out, and on and on and on. We were in a very difficult circumstance with 

[ Page 2824 ]

respect to this budget because of the disaster left by members opposite when they were swept out of office on October 17, 1991.

The Premier has agreed, with respect to this legislation and with respect to the budget in particular, that there should have been more consultation, and that didn't happen. We'll talk about consultation in a minute, but as far as consultation around the budget, ideally there should have been more consultation. We put together a budget following the election in probably the shortest time that had ever happened in British Columbia's history, and not all elements of those budgets were discussed by all those stakeholders that ideally should have been discussed.

This bill in its initial form has been discussed with the BCMA since 1988, so we're talking four years of discussions. You haven't been at the table. You haven't been a party to the political process in this province. You don't know that this bill has been discussed with the BCMA since 1988.

There are elements, however, that are quite new that came about as a result of the negotiation process that has taken place in the last couple of months in this province. They are the creative, imaginative, forward-thinking parts that the BCMA and the government agree is the direction that this province should go. Those are the major elements of this bill that are going to ensure the kind of consultation and cooperation that members opposite seem concerned about.

[11:15]

This model of co-management guarantees consultation, guarantees cooperation and guarantees that all the parties -- the public, the government and the physicians -- have a say in how that part of the budget is managed. Prior to the budget announcement, I admit that there had not been as much consultation as there should have been. Since that time their have been tremendous efforts -- I think what you could even describe as heroic efforts -- on the part of the minister to spend every possible opportunity in meeting with the BCMA, late at night and on weekends. The member opposite shakes her head. She wasn't at the table; I was. I know the kind of productive discussions and meetings of the minds between physicians -- as represented by the BCMA -- and the government that happened at these meetings. I know the kind of cooperation.

Let me read a couple of excerpts of correspondences between the BCMA and the government. I apologize for these glasses; they're the only ones that I could find. From May 21, to the hon. minister....

L. Fox: Are you trying to hide?

B. Jones: I explained that I lost my other glasses. I'll take these off after I read these quotes. From May 21, 1992, to the hon. minister:

"The level of involvement you have personally taken in the dispute is welcomed, and, like you, I believe that a lasting solution is not only necessary, but attainable. I am delighted you have embraced our suggestion that a joint management committee.... I acknowledge that we have reached understandings on many of the elements that need to be part of a complete resolution, and look forward to further constructive meetings between us."

On June 2 the same writer, who is the president of the BCMA, wrote to the same minister:

"Following our discussion of Sunday, May 31, 1992, it is obvious that your Wednesday meeting with cabinet and our Wednesday and Thursday meeting with BCMA board of directors are key events along the critical path to resolving our dispute. Although it has been slow and difficult going we are, I believe making progress toward resolution."

Also from the BCMA: "The innovative approach of expanding the Medical Services Commission into an equally represented tripartite board -- government, public and medical profession -- with appropriate authority certainly represents a concept that can be built upon." So there was tremendous cooperation and understanding at the table. I think that situation exists now, unless it's exacerbated by the kind of inflammatory rhetoric that we hear from members opposite, and is very close to resolution. I think that's in the interests of the public; it's in the interests of the government; it's in the interest of health care in this province that that dispute be resolved.

The member opposite talked about the auditing function. We have a system where we spend billions of dollars in billings. I don't think the public wants an honour system. I think the public wants a sensitive mechanism that provides a check and balance to that system. I think that's what's being proposed in Bill 71. I think we don't want auditors; we want physicians, who understand billing and good medical practice, to be able to audit a few doctors and their billings. That's all that's going to be accomplished by this bill, but I think it provides a level of accountability for physician services in this province that the public wants, demands and deserves.

I was most appreciative of the comment by the Liberal critic for health care when she said she appreciated the right of the government to establish the Medical Services Plan budget, because that's what this bill is all about. This bill is all about establishing what I think everybody in this province thought in the past was a right. It wasn't. Every year members opposite and members on this side sat down, debated the estimates of the Health ministry and set a budget. Guess what happened to that budget every year? There was a $50 million overrun. Every year the legislators who thought they were voting on a particular item in the budget.... I think it was an affront. It should be an affront to members opposite to not have a mechanism which allows you to vote on a budget that is going to be maintained, not on a budget that you know is automatically going to be exceeded as soon as you vote on it. I think that was an affront to the Legislature, and I think it would be an affront to members opposite if we weren't bringing in a budget that we were going to try as hard as possible to adhere to.

This government, unlike the previous administration, isn't going to do it that way and pass special warrants willy-nilly. This government is going to be fiscally responsible. This government is going to manage the hard-earned dollars that taxpayers contribute to this province. This government is going to get a handle on those things that need some exercise of control.

[ Page 2825 ]

The member opposite mentioned the Seaton commission report. The Seaton commission report understands that one-third of every dollar passed in this chamber goes to health care. It understands that we're talking about $2,000 for every man, woman and child in this province annually. It understands that that's enough, that the levels of funding we have for health care in this province are adequate. We don't need to spend more. The Seaton commission tells us that we need to spend more wisely. That's what Bill 71 is all about. Unless we do, I think we take the great risk in this province and in this country of losing our medicare system. It's one of the things that I am so proud of as a Canadian, and I virtually cross my heart every time I go to another country and come back without having to use another country's medical services. One of the things that we are so proud of as Canadians is our universally accessible, publicly administered health care system. I think we know the deficits that governments across this country are facing.

The member opposite is right. The costs of health care have not skyrocketed. Across this country 15 years ago we spent 25 cents of every dollar on health care, and 6 cents of every dollar on debt servicing. In this year we spend a little bit more on health care -- 27 cents -- but we spend twice as much -- 12 cents -- on debt servicing. We have to get the books of this country and this province under control, and that's what Bill 71 helps us achieve.

We are proud of our system. We do want to preserve it. We want a system where it doesn't matter whether you're the richest citizen in British Columbia or the poorest citizen, you can still go to the very best physician in this province and in this country. We need this bill to co-manage. I'm sure members opposite aren't saying that physicians should not have a say in how these dollars are spent. Members opposite are not saying the public should not have a say in how these dollars are spent. That's what this bill says: those three parties -- the government, the public and the physicians -- are going to manage, and are going to have the tools in this bill to manage properly, the tools that will make sure that medical services are provided that are necessary and are going to help the health care of our citizens.

This is an innovative and imaginative piece of legislation, the crux of which -- the expanded Medical Services Commission -- came out of negotiations in the last month with the physicians. They support that concept of co-management. We have to ensure that we can provide the best medical care in this province in the spirit that has been existing in this province for many years. The public needs this bill. Health care in this province needs this bill, and in fact, medicare in Canada needs this bill.

F. Randall: I ask leave for an introduction, hon. Speaker.

Leave granted.

F. Randall: We have a group in the gallery from the John Knox elementary school in Burnaby-Edmonds. They're accompanied by Mr. Peter Valkenier and a number of parents. At noon today they're off on a five-day sailing trip from the harbour here. I wish I was going on that five-day trip, too. Would the House please make them welcome.

G. Wilson: In rising today to speak against this bill, I do so because we on this side of the House in the Liberal opposition believe the principles outlined in this bill will not work toward the development of a health care system that will be affordable in British Columbia, that will allow for the access to the needed medical services that will be required by the people of British Columbia. It essentially allows for the introduction of a system of financing that will put much, if not all, of the control in the hands of government, without any recognition of the rising demand and control for services that will be required.

Clearly, if one looks at the factors involved in this bill that we take some exception to.... I'd like to confine my comments to three particular areas: the introduction of the powers of audit and inspection; this concept of co-management, which has been loudly lauded by members opposite; and the provision of the powers of the committee that will be established. And I'd like to talk somewhat in respect to the principle that drives this kind of direction towards the financing of this health care bill.

I was pleased that the member for Burnaby North finally admitted that there was lack of consultation. It is quite clear that there has been lack of consultation. In his remarks he admitted that the Premier had said there should be more consultation. Had there been more consultation, there would have been a more serious analysis of the impact of this bill, and we might have taken a different direction.

The member opposite suggests that it is important for government to set the budget, and that is so. All of us would agree that if the taxpayers will ultimately have to find the dollars for the provision of health care services, it is important for government to have a handle on what those tax dollars would be. But it is also important to recognize that if you put a fixed or capped allowance and if you essentially establish a budget that you're going to hold and engrave in stone, you have to recognize that the demand on the service is likely to push the demand beyond the levels that are budgeted. The question that is not considered in this bill and is not dealt with -- I have yet to hear a member opposite in this government address it -- is: what happens in the health care system when we reach the limit? What happens when the next person comes in to have a practising physician provide service and the limit is there? It is structured, and we've said that now we're going to put that limit in stone.

Co-management is something that all of us would like to see put in place on a model that will be realistic in its approach, that will be consultative prior to implementation and that will allow for a certain amount of flexibility, which that is desirable in a system, recognizing the changing user demand on the health care system. I don't believe that this bill can be done without a proper, more thorough and more 

[ Page 2826 ]

adequate examination of the provision of health care services. Matters need to be addressed with respect to preventive care which, I understand, are in the initial stages of being addressed with respect to the development of community-based systems in community health care. Matters need to be addressed with respect to the practising physicians who are outside the urban areas of this province, where there is a rising demand for services not currently provided and not currently affordable within the structure of budgeting that we see in the health care system today.

Sadly, it seems that this bill has come in with a single motivating factor. I understand that the phrase being used -- certainly by the Finance minister -- is this idea of a claw-back or a need to recover or recoup within the budgetary structure of this question. It is a need to claw back this dollar in order for the government to be able to realize its financial and fiscal obligations within this framework.

[11:30]

Understanding what the government has done with its budget and understanding the government's need to restrict revenue expenditure -- we're all sympathetic to the fact that we have a very difficult financial situation in the province -- we would expect that this government would want to be absolutely prudent in the way it commits its dollar and in the way it finances it. To be prudent in the way we commit our money is something that all of us want. But to be prudent at the expense of a health care system prior to having in place a proposition that is going to allow for that health care system to be adequately and properly financed with a long-range and long-term goal toward the kind of health care system that all of us want in this province, we believe is foolhardy. We've seen that this government has not undertaken in the first months of its mandate to do the analysis, negotiation and work with physicians so that the implementation of this new system is going to be both realizable and financially affordable by the people of British Columbia, without putting a significant burden on those who require the health care system.

The member opposite talks about the Seaton report. Many of us on this side of the House made submissions to and were actively involved with the Seaton commission. Unlike some members opposite, the Liberals in this province have been working hard for a long time trying to bring about a new and different system with respect to health care. It's important that those members opposite who now find themselves newly elected in this rookie government don't judge us by themselves, when they suggest that we only started to think about issues when we became elected. Unlike members opposite, those of us in the Liberal opposition have been giving great thought to these issues for many years. That clearly can be seen if one looks back at the kinds of submissions that have been made by members of the Liberal opposition over the past years.

Hon. Speaker, with respect to the one provision on co-management, we have to recognize that while I think all of us would agree that a co-management system is desirable, a co-management system must not be left to the power in the hands of bureaucrats and of cabinet. There has to be a mechanism whereby those people who are involved in the delivery of health care have a proposition for providing the best advice with respect to long-range financial planning in the health care system. When we get into a position of understanding what kind of health care system we see as desirable for this province in the long term, then with a much more consultative and evaluative process, we will be able to put in place the kind of financing that will be necessary if we're going to maintain the B.C. health care system at the level that all of us would want not only for this generation but for future generations.

Hon. Speaker, we also see within this bill the question of the powers of audit and inspection. There is no member in the Liberal opposition who would argue, if somebody is abusing the system or is involved in illegal activity, that those individuals should not be immediately identified and dealt with. We recognize, however, that there seems to be a proposition here that the system that has worked for many years in the province is somehow flawed, and that there's something wrong with the system where you have a regulatory authority that can analyze and examine the medical profession to make sure that doctors are in place, are doing the work they are charged to do and are billing fairly, adequately, properly and legally, and that the government should have this battery of inspectors who would have the power of audit and inspection allowed by this bill to move into a doctor's office and to make copies of medical records. They would be able to use those medical records with a proposition to not just go after the doctor, but essentially to build a case of records against practitioners in the province of British Columbia.

Hon. Speaker, we find this offensive, because we recognize and believe that there has to be the utmost sensitivity toward a patient and doctor relationship that provides for the protection of medical records, so that medical records will not fall into the hands of these inspectors. We recognize that, if there are going to be the powers of audit and inspection, quite clearly the powers of audit and inspection should be left in the hands of the medical practitioners who can and will do an adequate and proper job of policing their own.

Hon. Speaker, I find it absolutely ironic that, within the proposition and in listening to the members opposite who are laughing, the trade unions in this province have for many years correctly believed that they are the best and most appropriate policing agency to ensure that their members have the right and the responsibility to ensure that their honesty and integrity is respected. In the teaching profession we have heard this for many years. It has been accepted. It's a practice that I believe has been preached by the NDP when they are out there talking to the public. But when it comes to doctors, then that principle goes out the window. In the same manner, doctors should not be accorded the right to collectively bargain for their rights and salaries. This bill says that there are two sets of rights: there are rights for those people who are involved in the collective bargaining process through a registered trade union movement, and then there are rights for those people who are members of a professional association.

[ Page 2827 ]

We say that there is an inconsistency in what is being provided with respect to the powers of audit and inspection. We believe it to be an offensive direction that suggests that the honesty and integrity of practising physicians in this province is suspect, and therefore there has to be this group of inspectors in the hands of and in the power of cabinet. They should be able to go in and seize medical records in order to try and identify those people who are abusing or offending.

In this round of negotiation and with Bill 71 as it has been brought here, we have witnessed the politicization of the health care system in this province beyond anybody's expectation. Nobody, least of all the doctors, believed that with this NDP government, who for so many years spoke out in favour of depoliticizing health care, education and other professional services, they would see a betrayal of that commitment to the extent and level that we have seen since this government came to power. It is an absolute betrayal of the trust that was provided to this government not only by practising physicians but by practising members of every other professional association. What we wanted, and what I believe the people thought they were voting for in the last election, was an end to that kind of confrontation and politicization of our health care system. Sadly, we see that there has been a major assault against the doctors.

Lastly, let me comment on the question of the powers of this committee. The government is going to reintroduce the elements of Bill 13, almost in its entirety. We are essentially assuming that the embarrassment that this minister suffered through the lack of consultation -- it was eloquently admitted to by the member for Burnaby North, despite the protestations of this minister that there had been full and adequate consultation -- wasn't enough. We are now moving forward to see Bill 71 introduced, the proposition that will reintroduce most, if not all, of the elements of Bill 13.

We need legislation that will provide a funding mechanism for health care that will encourage the very best doctors to stay, to work, to live in British Columbia and to provide services for the people of British Columbia. We need to put legislation in place that will attract those from outside our province to come to British Columbia and set up practice so that our doctors and hospitals will be the envy of hospitals all over North America, and not just Canada.

This bill will drive doctors out of the province. Doctors simply will not wish to come to a province in which there are endless waiting-lists, in which we find the politicization of the health care system and in which we are now going to have a group of inspectors who will be allowed to go in and seize medical records and inspect doctors when there is some belief of an offence against established billing practices.

We suggest that the proration and capping of fees allowed in the bill amounts to a rationing of what will be provided in health care. While it is important for us to have a handle on the question of health care provision, if you do put in that kind of inflexibility, at some point doctors themselves are simply going to find that their ability to freely practise will be inhibited. Therefore the ability of British Columbians to have open access to a health care system that is affordable and will provide those kinds of services will also be removed.

We're suggesting that this bill is flawed. It is wrong in its approach and philosophy. It does not do what is so desperately needed in this province: create a mechanism whereby there can be a dispassionate ongoing discussion of how health care systems should be reviewed, changed and amended to provide an affordable system of health care that will work for all British Columbians.

It is also important to note that this bill does nothing at all to try to resolve the inequities we see in the province with respect to the geographic distribution of doctors, despite the fact that members opposite would protest loudly that this is precisely the intent of this bill. The members opposite suggest that somehow the regional budgeting system provided for in this bill is going to work for the people in Prince Rupert, where we've seen this minister go to oversee the closure of beds. Or in Prince George, where we have seen the doctors frustrated because they are unable to deal with or provide for the rising demand. Or in Kamloops, which was the venue for a promised cancer clinic which never materialized from this government. Or in Kelowna, where we see that because of the increased number of senior citizens the rising demand is going to go much further than what was originally anticipated.

This bill does nothing to recognize the proposition that British Columbia urgently needs reform in our health care system that is logical and consultative, and has as its primary goal a re-evaluation of the concept of health care delivery in B.C. to make it more accessible, affordable and far more dynamic in its approach toward meeting the rising demands of British Columbians. It is unfortunate that this government drafted a bill in what has become the late hours of a spring sitting of the Legislature. It is unfortunate that this bill was not drafted during the period this government sat in opposition, when they could have been working, consulting and making sure that consultation with the practitioners in this province brought about a proper and well-thought-through bill.

What we're seeing now is a knee-jerk reaction to the fiscal problems this government claims to have inherited from the previous government. We don't wish to go back through that full debate on the budget, but what we can tell you is this: the members of the Liberal opposition suggest that there is a better way to provide health care funding, to put in place co-management and to institutionalize the proposition of a co-management system that would enfranchise, not disfranchise health care givers; that would enfranchise, not disfranchise members of communities looking toward community-based health care systems; that would, most of all, provide the knowledge for all British Columbians that we have a health care system which would be affordable not just through the 1992 budget year, but on an ongoing basis over the next decade and in decades to come.

[11:45]

[ Page 2828 ]

We would have built up a trust -- it's a word that the vocabulary of the members opposite seems to be devoid of in its entirety -- not only with the doctors but with all health care providers in British Columbia, that this government would not single out any one sector or provide for a proposition which would simply send a signal that there is no trust between doctors and government. Therefore we need to have this group of inspectors to go forward and take care of looking after the interests of the government with respect to trying to claw back -- which are the words used -- dollars into a treasury that are so desperately needed.

When you look at the number of patronage appointments that have been made, if you put a price tag on those questions, if you look at the number of people who have been brought onto commissions, if you look at the amount of money that this government has spent hiring their own, it becomes particularly offensive when you start to see what is proposed in Bill 71, and I urge all members of this House to vote it down.

D. Schreck: It's with great pleasure that I rise to support Bill 71. I will divide my comments into five sections. I'm going to speak briefly about the history of how we got to where we are, and how it is that Bill 71 is the logical step to be introduced now. Why there is an urgency is my second point: why we must proceed with Bill 71 now. Third is a little analysis of the alternative that seems to be implied in opposition criticism; fourth, particular attention to the distortions on the audit provisions in Bill 71; and finally, to return to what this should really be all about, and that is how we promote wellness rather than illness -- the wellness model.

Returning then, hon. Speaker, to the first point: how we got to where we are. Bill 71 is the logical next step, the logical evolution in 25 years of public medical insurance in this province. The opposition has shown that they fundamentally fail to understand the history of medicare in this province. In 1986, negotiations between the B.C. Medical Association and the Medical Services Commission led to voluntary agreement on the imposition of a cap on payments. Similar caps were negotiated between medical associations and provincial medical insurance carriers, the equivalent of British Columbia's Medical Services Commission, across the nation. As each agreement has subsequently come up in British Columbia in the last six years, there's been some debate over the nature of that cap, whether it should be a rigid cap or a flexible cap and precisely what the pay-back scheme should be. But there has always been agreement, for the last six years, that there should be a cap.

That was a movement from the initial days of medicare in the late sixties, when we went from private health insurance for doctors to public health insurance for doctors, where there was a straight insurance model. All that was done was that public health insurance replaced private health insurance. By the mid-'eighties we had negotiations going on between the British Columbia Medical Association and the provincial Medical Services Commission to cap payments to doctors and move towards a managed system.

Bill 71 completes the discussions that have been going on between the profession and government for 25 years, and takes the next logical step in going from a model of health insurance that existed 25 years ago to a model of managing payments to physicians and managing the health care system that we have today. Bill 71 takes that next increment -- not a radical change, hon. Speaker -- to make into law co-managing the system that has been freely negotiated for the last six years, recognizing what those opposition critics have said: that it is really this Legislature that should have the power to set the budget. This Legislature should determine the budget, not some arbitrary third power; not uncontrolled billings, but this Legislature. Now how do we do that, hon. Speaker?

G. Wilson: Let's do that with the BCGEU.

D. Schreck: My friend the Leader of the Opposition called: "Should we do that with the BCGEU?" And I've heard them call: "Should we do that in education?" I say to that Leader of the Opposition, that's precisely what this Legislature does. A budget is set, and the parties then manage within the budget. That's what we're talking about doing.

I've gotten letters from many physicians -- none from my constituents, but many from physicians. It's important we understand that physicians are not speaking with a unified voice on this matter. I find that the letters group into three categories. Some physicians, as I shall point out later, seem to be in agreement with the official opposition by calling for the introduction of user fees -- patient participation or greater patient awareness of individual costs, or whatever euphemism you want to put around it -- and they essentially want to roll the clock back 25 years. I have a fundamental, philosophical disagreement with those physicians. My government is not going in that direction.

We have physicians who want a blank cheque and who say that the Legislature shouldn't have the power to control how much is spent on medical services. We must disagree with those practitioners.

The majority of practitioners I've spoken to, including those who have sat in my own living room discussing these matters within the last few weeks, have said that they see an approach whereby we can work together and co-manage the system and whereby the Legislature can set a budget, and then the respective parties representing the government, the profession and some neutral third parties agreed to by the two -- exactly the same as an arbitration panel -- can carry out the will of the Legislature and manage the Medical Services Commission. That is what Bill 71 does. It implements the will that has not only been expressed over the 25 years of the evolution of the history of medical insurance in this province but has been expressed by the majority of doctors when they have told us what they want. To those who want to go beyond that and introduce user fees or ask for a blank cheque, I have to say sorry, that is unreasonable. We will not go in that direction. We are fighting for the preservation of medicare, not the destruction of it.

[ Page 2829 ]

I said my second point would be: why the urgency? Why is it that we need Bill 71 -- or without Bill 71, Bill 13 -- now? That point was made perfectly clear by the misunderstanding of the leader of the official opposition when he said: "What happens when we run out of money?" Well, that's the point. The way a cap on the system has worked, and will continue to work, is that each payment period, payments are adjusted so that we never run out of money. We don't spend, spend, spend and in the last month say that the money is gone; there's no more left.

[D. Streifel in the chair.]

What has been taking place in this province, and in every other province in the country that has caps on their system, is that monthly adjustments have been made, so payments may be reduced this month by 1, 5 or 10 percent, or whatever is necessary to prorate them and over the course of the year gradually bring the payments precisely within budget. What would happen if we didn't have Bill 13 or Bill 71? We would run out of money -- precisely what the Leader of the Opposition has said he fears. We need Bill 13, Bill 71 or a contractual agreement with the profession immediately if we are going to manage the system.

What's the alternative? We've had no alternative advocated by the opposition party. We have an element of the British Columbia Medical Association saying that what's wrong with the approach is that the Legislature is fixing the budget too tightly. They say -- much the same as the words of the leader of the official opposition -- that utilization drives the system and that we must roll over and put forth whatever money it takes to pay for that utilization. I urge all members who haven't read the Seaton report of the Royal Commission on Health Care and Costs to do so. The Seaton report, after spending $6 million touring the province and listening to submissions throughout the province, came to the conclusion that health care is adequately financed; it doesn't require more money; the funds need redistributing within health care; and there should be a fixed cap on doctors' billings.

Bill 71 essentially implements the most important provisions of the royal commission report on controlling costs for the doctors' side of billings. It's ironic that when it was originally released, the leaders of all key stakeholders in this province, including the B.C. Medical Association, stood up and publicly went on the record saying that they basically agreed with the fundamental thrust of the royal commission report. I didn't hear them say: "I agree with the thrust of the report except where it gores my ox." No, I heard them say: "We agree with the thrust of the report." And of course, they should agree with the thrust of the report, because it's a logical evolution of 25 years of history of public medical insurance.

The only way we could create any breathing room at all without Bill 71 or Bill 13 would be to reach a voluntary contract that accomplishes essentially the same thing. The Leader of the Opposition obviously did not listen to my colleague the Parliamentary Secretary to the Minister of Health when he stated that he personally sat in on the consultations to attempt to reach such an agreement, which the president of the B.C. Medical Association referred to in correspondence with the minister as "negotiations." They came very close. But we don't have forever. At stake in this budget year alone is between $50 million and $100 million. The opposition may say that we can throw $50 million to $100 million more into payments to physicians. The Royal Commission on Health Care did not recommend that. They supported that this government do what we have done: to take that money and put it into mental health; to put it into long-term care; to put it into community resources. That is the re-allocation, the decision that my government has made and a decision that I support.

They say that we should keep this blank-cheque, open-ended-insurance-system approach to medicare rather than the managed approach that Bill 71 introduces. What are the logical consequences of that? They are the same as the logical consequences of not controlling the public deficit and the debt burden; the logical consequences are those of uncontrolled, exponential, compound growth. You can take any element of government spending, and if it grows more rapidly than population growth plus inflation, it inevitably consumes everything we've got: our entire productive capacity. Health care in this nation used to consume about 5 percent of gross national product. With the introduction of public health insurance, it grew from 5 percent of gross national product in the mid-1950s to around 7 percent of gross national product in 1971 when medicare was complete across the nation.

That was a 50 percent increase in spending, not in absolute terms but as a share of the pie. Panic racked the nation. Health ministers across the nation in the early seventies said that something had to be done to bring this system under control. We benefited from both reasonable negotiations with practitioners and exceptional economic growth, leading to health care remaining at 7 percent of gross national product -- within one-tenth of 1 percent or so -- throughout all of the 1970s.

But then the honeymoon came to an end. What happened is that health care in Canada has grown from 7 percent of the gross national product at the end of the 1970s to almost 9 percent of the gross national product today. It is one-third of government spending. It must be controlled. We have a system that keeps people from becoming bankrupt when they become ill, but that still produces people who die seven years earlier if they are poor and people who have a higher incidence of tuberculosis, high blood pressure and every disabling condition you can think of, notwithstanding our medicare system. It is time to shift from this illness-oriented approach to a wellness-oriented approach; from an approach which has been exceptionally successful in keeping people from becoming bankrupt if they become ill, but which has moved very negligibly on the other side of the equation -- that of seeing that health outcomes are reasonably the same, irrespective of one's socioeconomic position.

[12:00]

[ Page 2830 ]

We see that no real alternative is being proposed by the opposition. Or do we? My third point is: what exactly has the opposition said we should do? I'm very appreciative of Hansard, because people can go back and pick out some consistent themes from that diatribe we have heard. What have those themes been? The opposition Health critic said that she was astonished to hear from some constituents that patients just don't know what health care really costs, that they think it's free. That theme was repeated, with vague references to the need for user fees. The opposition critic said that we need to make patients aware of how much the system actually costs.

What I hear in the opposition criticism is the echo of that minority of physicians who write to me to say that what we really need is a blank-cheque system, with user fees to control it. That will not save medicare; that will be the death of medicare. That is what Bill 71 is here to prevent. Bill 71 is here so that we can manage the system without doing it on the backs of the poor through user fees, and so that we can do so with the cooperation of the physicians.

Interjection.

D. Schreck: I hear the opposition House Leader calling out: "How's that going to happen? Who's going to do it?" Well, there are a couple of answers to that. One of them has to do with the audit provisions of Bill 71. I'll touch briefly on that and then go into the co-management features.

D. Mitchell: Hon. Speaker, if I could just raise a point of order, the member for North Vancouver-Lonsdale has possibly misunderstood me. He claims to be responding to a comment that I made, asking some questions. The questions I asked him were: how is he going to vote on this bill? Does he support it? He misinterpreted that, so I'd like to put that on the record.

Deputy Speaker: The Chair has a difficult time in determining which standing order is being violated, hon. member.

B. Jones: Hon. Speaker, on the same point of order, I think it's an abuse of this place when a member disagrees with something that a member who has the floor is saying, rises on a point of order and interrupts his speech. I think it's totally inappropriate. The opposition House Leader knows that it's inappropriate. It's an abuse of the rules, and I don't think it should be allowed.

Deputy Speaker: Thank you, hon. member. Your words are well taken.

D. Schreck: I actually thank my colleagues for this brief pause. I would simply say to the opposition House Leader that if he's going to heckle, he should do so clearly and loudly, so that we can all enjoy the thrust of the debate.

On the matter of the audit provisions, it is nothing but an act of I hope unintentional terrorism -- or maybe a misunderstanding of the bill, to be more generous about it -- to shout, as some extra-parliamentary critics have, and as I now hear echoed from the opposition benches, the gross distortion of the audit provisions in Bill 71. The opposition benches refer to the audit provisions in Bill 71 as inspectors coming in to look at confidential medical records.

It's interesting -- and it again shows the complete lack of historical knowledge of the medical services system from the opposition benches -- to compare some of the problems that died on the order paper introduced in the restraint period of 1983 with the audit provisions in Bill 71. The provision that died on the order paper, introduced in 1983, called for accounting types to go in and audit medical records. I was one of the loudest critics in the community saying that was an incorrect and wrong approach.

[The Speaker in the chair.]

Bill 71 provides that only medical practitioners -- only doctors -- can look at another doctor's records. That is an inherent safeguard, for that audit provision is not only backed up by the privacy provisions within Bill 71 -- some of the strictest privacy provisions in government, stricter even, some say, than those in Bill 50 -- it is also backed up by the code of ethics of the College of Physicians and Surgeons. If a physician acting on behalf of the Medical Services Commission -- not the government -- were to breach confidentiality, that physician would not only be in breach of the privacy provisions of Bill 71, that physician would also be in breach of his or her own code of ethics with the College of Physicians and Surgeons. He or she would stand disciplinary hearings by that self-governing profession. So I say that the opposition hasn't read the bill.

The opposition says: "Well, shouldn't the profession be totally self-regulating?" Here we have the opposition not understanding the difference between a billing system and professional standards. If, in the course of a physician doing an audit for the Medical Services Commission, irregularities were picked up with respect to medical practice -- professional standards -- it wouldn't be the Medical Services Commission that would deal with that matter. Bound by the code of ethics, as that medical doctor who is looking at the records is, that medical doctor would refer the matter to the College of Physicians and Surgeons, so that profession could self-regulate. No one is saying that the profession should not only regulate professional standards, but should also regulate in an uncontrolled manner its billings to the public purse. All this act does is move in a consistent manner with other jurisdictions that have implemented audit standards for professional practices.

Anyone who is a lawyer understands that barristers have the right to inspect legal records, which can be of an equal sensitivity in terms of their confidentiality. Anyone who has reviewed other jurisdictions in health services has understood that they are far ahead of us in terms of audit standards of inspecting the so-called honour system. No one is talking about violating confidentiality. We have strict provisions, we have a 

[ Page 2831 ]

self-regulating profession and we are assisting that self-regulating profession by balancing billing controls with professional standards and doing so only by inspectors who are bound by the code of ethics of that self-regulating profession.

The opposition is engaging in needless scaremongering. They have shown a lack of historical understanding and have done a disservice to the people of British Columbia in opposing these provisions within Bill 71. I talked about how Bill 71 is the logical conclusion of 25 years of public health insurance. It is urgent and needed now. Every attempt to reach an alternative has been unsuccessful; hence it is the productive and logical step to take. I've shown how the opposition has actually advocated user fees and echoed a rather shallow approach. We've talked about how the opposition misunderstood the audit provisions.

Finally, the opposition said: "Maybe an illness-oriented system is really what we still need. Maybe it's too early to go to a wellness model." That flies in the face of over 20 years of talking about the need. In fact, it was a federal Liberal, Marc Lalonde, who was most noted for advocating the shift to the wellness-oriented approach. Notwithstanding that, they say: "Maybe it's too early. Maybe education can take care of that approach." Every ministry of government must be involved in promoting wellness. My colleague the Minister of Transportation and Highways is involved in promoting wellness when new highways are built to higher standards. My colleague the Attorney General is involved in a wellness approach when seatbelt provisions and drinking-driving regulations are enforced. My colleague the Minister of Municipal Affairs is involved in a wellness approach when new sewage and water lines go in and when public housing is promoted. Every aspect of government involves a shift to a wellness-oriented approach.

Wellness also has a proper basis in the Ministry of Health. For too long in this province mental health has been neglected, community health has been neglected, long-term care has been neglected....

G. Wilson: Point of order. Bill 71 talks about a fairly specific set of requirements for the provision of financing of health care; it doesn't talk about universal health care and its benefits. I wonder, hon. Speaker, if you could instruct the member to keep his comments specifically to Bill 71.

The Speaker: Actually, the Chair has reminded other hon. members that while we usually allow wide-ranging debate -- and the bill is, of course, wide-ranging -- hon. members should try to restrict their debate to the principles of Bill 71.

D. Schreck: Thank you, hon. Speaker. Under the old maxim that they don't shoot at dead ducks, I take the repeated interruptions by the official opposition on points of order as the highest form of flattery. I hope it encourages the official opposition to get together a coherent, logical and understandable critique and alternative to Bill 71, for what we've heard so far is anything but.

We see that Bill 71 is urgently needed in order bring about cost control, as recommended by the royal commission report. If we don't go ahead with Bill 71, it will have a financial impact of between $50 million and $100 million. It is that $50 million to $100 million that my colleague the Minister of Health has reallocated to wellness. I am extremely proud of that.

We have heard many misrepresentations of Bill 71. It is essential that the community understand the commitment of my government to medicare and health care. That is a longtime and historical commitment, a commitment that is sustained and furthered with the advancement of Bill 71.

L. Fox: I rise to speak against Bill 71. If I might be permitted to make a very brief observation prior to beginning my speech, I now know why that last member didn't make it into the cabinet.

Much has been said by backbenchers of this government about the fact that they've had this horrendous financial disaster that they had to do something about, but not one word was said by either of those members about their spending $1 billion hiring 1,500 new employees at the expense of closing beds in hospitals and laying off nurses. Neither is one word said about the impacts of the fair wage policy and those costs. There are many other instances throughout the whole budget that you could refer back to this particular bill and the lack of need for it.

One of the large concerns I have about this bill.... There may be some very good items within this bill, hon. Speaker, but if that were the case, why would we have this minister pushing this thing forward so fast without a lot of time for dialogue? There has certainly not been a lot of dialogue with the doctors, and certainly none at all with the Professional Association of Residents and Interns. Why are we pushing this forward? It can't be because of budget constraints, because I have a quote right here from a letter -- as a matter of fact, a news release -- sent by the B.C. Medical Association, which suggested that they were prepared to sign an agreement with the minister, in order to satisfy her budget problems for this year and to allow a longer time for discussion on some of the impacts of this bill.

[12:15]

Other speakers on the backbencher side of the government have spoken up and suggested that the doctors were in favour of this. I hear heckling down the way here all the time from the fellow from Cariboo North, who says: "Ask the doctors." The member for Burnaby North quoted the doctors' letter. I've got several of them, and man alive, there are quotes here which not only bring up a lot of concern in my mind about the credibility of this minister with that profession but also the credibility of the government with that profession.

I am extremely concerned that we are losing an opportunity to deal with these rising health care costs by using a confrontational approach that will gain no one anything -- absolutely nothing. All we will do is end up fighting one another and not dealing with the real problem, and that is a concern.

[ Page 2832 ]

I would suggest that there are many areas within this bill that deserve a lot of dialogue, not just with the medical profession but with the public at large. They have a vested interest in what happens with respect to Bill 71, and they're not given the opportunity to give their input because of the speed of this bill. That concerns me.

We had backbenchers talk about wellness. The only real incident that I've seen to do with wellness was the cutting of the sports budget by this government, which was a program that indeed promoted wellness. What did we do with that as a government? We cut it by $2 million, which will certainly impact the people of my area who participate in that program of wellness.

There are many areas within this bill that deserve a lot of consideration, and I appreciate and understand the need to deal with the rising health care costs. I think every member in this Legislature understands that they have to be addressed. Certainly members of the public understand that they have to be addressed, and I haven't heard one medical practitioner tell me anything other than that. Everybody understands that we have problems in health care and that we want to see them addressed. But they want to see them addressed in a very understanding, long, deliberate process that involves everyone, so that we're not in here throwing stones at one another.

Interjection.

L. Fox: The Seaton report made all kinds of observations and recommendations; one of the recommendations it did not make is in this commission. While this commission that has been appointed has all kinds of opportunities, it also has some limitations. In my view, it is fairly easily manipulated through orders-in-council, which could strike subcommittees to deal with issues, take those issues out of the commission and deal with them specifically. One other issue that concerns me a lot is that the chair could have the authority of the commission. That has to be a concern. I want to tell you, hon. Speaker, that I quickly looked down the list of failed NDP candidates to try to figure out who that chair might be. Obviously the Chair will be one of this government's failed candidates, or perhaps a retired one that didn't quite make his pension.

I'm extremely concerned that this bill is going to promote two-tiered medical care. I understand the regional concept in it, but I know the difficulty of achieving specialized care in the northern and rural parts of the province. I already see where two neurosurgeons are leaving North Vancouver. They have already applied for, and have, jobs in the U.S. That leaves an opportunity for a neurosurgeon. For instance, we have one in Prince George. He now has an opportunity to expand by coming to North Vancouver. Obviously he has a lot more technology available to him there; a lot more learning can be done at that centre. So we could lose our neurosurgeon because of the conflict that has been created by Bills 13, 14 and now 71. In Canada last year eight out of nine grads in neurosurgery went to the U.S. That has to be a concern. We've got to understand that conflict will not encourage them.

I'm extremely concerned as well that there is no clause in this bill that allows for any form of dispute resolution -- none whatsoever. It comes right back to the hammer of the minister and the Lieutenant-Governor. I'm concerned that that is either an oversight, because of the speed at which this bill has come forward, or a lack of concern on behalf of the minister about that kind of process.

We want to talk about change in the health care system. I've heard statements being thrown across the floor about user fees and all the rest of it. Playing those kinds of games is indeed fear-mongering. The member for North Vancouver-Lonsdale threw that out as a scare tactic. I think it's really unfortunate. Health care is something that each one of us has to have. The great opportunities that we presently enjoy to in fact achieve an appropriate level of care.... We have to understand that the number of senior citizens will increase dramatically over the next several years. It's going to put a horrendous burden on our health care system. How are we addressing that? The capping recognizes a growth factor within British Columbia, but it doesn't recognize the aging problem. It doesn't recognize the fact that there are going to be larger demands by our seniors for health care. It doesn't recognize the technological advances.

We talk about the capping, and we have to ask: "Who's not going to receive treatment?" I heard two backbenchers suggest that we're going to fix a budget and we're going to live within that budget. I have to ask: given the fact that there is an emergent situation, if in fact there are new technologies which allow for new surgeries, which allow for new opportunities for those who have been putting up with severe illnesses or perhaps disabilities for years.... Because of the lack of dollars, because we've achieved our capping, are we going to quit those procedures? Who's not going to have access to it? At what point does the doctor say: "Gee, I really can't prescribe this x-ray because I'm running out of my money. So I'm going to gamble. I'm going to make the conscious decision to gamble that there is nothing wrong with this patient, because I'm close to where I have to be in terms of my capping"

We have to have some understanding of those kinds of concerns and issues. We have to have some process. We can't just reach into the pockets of one particular segment that delivers health care. We can't just say: "Doctors, you're making too much money. We're going to take some of it back." We have to look at this constructively. We have to look at how best we can improve the service with the limited amount we have to spend.

B. Jones: The bill does it.

L. Fox: The bill does not do that. The bill takes a very sharp direction and reaches into the pockets of doctors -- and doctors alone. In fact, it even provides the opportunity for less pay for less experienced doctors. It can categorize them to the point where they would be discriminated against. That is clearly identi-

[ Page 2833 ]

fied to me.... I invite all members to contact the Professional Association of Residents and Interns, and they will give you those kinds of concerns. This is a group of young medical people that we're hoping to encourage to go to all parts of this province, not just to the lower mainland.

If it was not for the positive climate in this province in the last ten years for delivery of health care services....

Interjections.

L. Fox: That's right. Look back at it. We would not have had the opportunity to attract top-quality, foreign-trained doctors to the north. If it weren't for those people, we would be lacking a lot of qualified professional health care. This bill is going to deter them from entering here. This is no longer going to be the land of opportunity, where you are rewarded for many hours of hard work, upgrading your skills and all those other things. We are now just going to say: "Mr. Doctor, you're only going to earn X number of dollars. We don't care how hard you work; we don't care how big your workload is. This is all you're going to earn."

I have a concern for my area. We're going to lose foreign-trained doctors, and we're going to lose the opportunity for individuals to receive good health care in the rural and northern parts of this province. As I said at the outset, I'm sure that given enough time and dialogue through the right process, we could have worked out some of our differences and concerns. I may even be wrong on some of those concerns.

Because of the lack of time and opportunity to do an in-depth analysis and to talk to many of the individuals who will be affected by this bill, the government is ramming it through. I really do not understand for what reason. It certainly isn't budget reasons, because the doctors themselves have told the minister that they would be prepared to deal with this on a one-year term. They would be prepared to address the budgetary considerations for 1991-92 and work on what the approach should be. I'm really appalled that this minister and this government did not utilize that spirit of cooperation, so that the citizens of British Columbia could have achieved a step forward in health care instead of a step backward.

I will be voting against this bill, but I do look forward to the committee stage, where we can explore it in some depth.

A. Cowie: I rise to speak against this bill. I wish to speak primarily about three aspects: capping and fees, co-management and auditing. I'll speak about the intent of the bill in those three aspects, not the detail.

Essentially, restructuring is necessary. The doctors I've talked to in my riding of Vancouver-Quilchena are most upset. They're upset mostly because of the lack of consultation, at least as they understand it. They have not been consulted to the extent that they want. They also feel that we have to look at what medical provisions we are going to have in this province. I always like to put it in terms of "form follows function." Let's see what the function is. We all know that in Oregon they've gone through a two-year process to find out what their medical service is about. That is a good process. It was a full, consultative process, and then they got into the form. I've been told that doctors approve of that review. We cannot supply full services on absolutely everything. There are a number of aesthetic and low-priority provisions, and we simply have to find other ways of doing those.

[12:30]

I lived for a short while in Britain, where, as you know, they have a medical health system provided by the government. When my wife had her first baby, it was absolutely necessary for us to have a private doctor in addition to a government doctor. She still had the government doctor and went to a government hospital, but it was a relief to at least have a private opinion. That was the compromise that she and I arrived at. I think it's necessary to have some backup system if you want it. That's an individual's privilege.

Capping. I come from a medical family: my great-grandfather, my grandfather and my father were all doctors. I didn't follow that profession, mainly because I'm not into it quite so much after all that. My mother was also a specialist in the medical profession. I can assure you that we were not a wealthy family just because they were doctors. I can assure you that if my father was alive today, he would be very upset by this bill and by the fact that doctors don't have control over their own profession. This is taking more and more control away from them. A lot of doctors feel a great deal of pride in their profession -- in fact, all doctors do. They want at least to have control of the billing. They do not mind an audit purely on a billing basis, and that goes on right now. According to the doctors in my riding, if any doctor is getting out of line, the government already knows it just by looking at the billing. If other doctors see that a doctor is taking advantage of the situation, they can meet and deal with that themselves.

I think what we need more and more in this country is professional organizations looking after their own professions, rather than government overlooking their professions. You wouldn't have a structural engineer from the provincial government overviewing the structural engineering association, surely, just as you would try in this instance to have the doctors as much as possible regulating their own profession. It's less costly and far better from a professional-pride point of view.

As to the fees, I think we've talked about that before. I won't go over it, as it's really a matter of negotiation. Every profession wants to be able to negotiate its fees wherever possible. They know that they have to work within a total system, and if there's not enough money, they have to make sure that their fees are within reason.

As far as co-management goes, I personally think that's actually a good idea. I don't think every profession rejects the public and the government being involved. I think, though, that it needs more time to work its way out, so that everybody can work with it properly.

Regarding the audit, it's the main thing that I think my father would have been very upset with. Maybe I misunderstand it -- that's a possibility -- but if a gov-

[ Page 2834 ]

ernment official could come and look at the records of a private patient, he'd be very upset. Only in a case where there's criminal activity or that sort of thing should this be possible. Under a normal billing process, that's absolutely not necessary.

I will be voting against this bill. It needs more time and more consultation, and I think that the minister should look at the Oregon model as a possibility in this province.

V. Anderson: This is a bill which probably affects more people in this province than any other bill we will consider during this session. Regardless of their age or circumstances, everyone has need, at one time or another, of medical treatment. I'm thinking not only of medical treatment that is given by a physician but also of medical treatment in schools, such as preschool immunization programs and a whole host of programs that affect persons from the very moment they are born -- or, indeed, before they are born -- to the very moment when they pass on from this life. This is a bill that affects everyone. Therefore it is one that needs the most careful consideration from every angle and from every perspective.

We have been fortunate in Canada, because a lot of people over the years have worked hard to help to build a good, viable medical system. It was first tested in the small towns of Saskatchewan in the early days, and then it was brought from small-town hospitals -- and programing that was developed there -- until we had the first medicare program in Saskatchewan. I had the experience -- and I call it an experience -- of living through the trials and tribulations of that particular program as it came into being. I know the hurt and division that it caused. I know that many families were divided. Families moved apart during the consideration and implementation of that act. Tensions were so great, even with spouses and children, that people could not continue to live in the same household.

When you have experienced that kind of division over the development of our health care system, then you understand not only the technical feelings but also the emotional feelings on this issue. To them it is not just a matter of dollars and cents. It's a matter of well-being. It's a matter of future opportunities. It's a matter of not having some unfortunate disability that they will have to live with for the rest of their lives because the care was not available to them. It's a matter, as I experienced when studying in the United States, of not having the funds to pay for medical care because there is not the coverage that we're used to or that we expect. I'm also very aware that even with the medical care we do have, there are many thousands of people who need extended benefits and who do not have those opportunities.

Many of these facets are not covered in this bill. We talk about community-based medicare programs, preventive programs -- and well we should. This is the direction that we all must try to develop. This bill hints on this but gives us no understanding of what those community-based programs might be, how they might be organized, who they will be run by, whom they will be responsible to and what the program of the involvement of the community people themselves will be. I talk to the people in the constituency -- the seniors, the unemployed, the family people, the new immigrants who have come into our country and who are trying to discover and understand our system -- and they say that when they hear our discussions and our arguments they fail to see a means by which they can be involved, a means by which they can be part of the implementation of this system.

As I listen to the concerns of the backbenchers on the government side, I appreciate that they wish to get ahead and to undertake these programs as quickly as possible. I hear them saying that some of the proposals in this bill -- not all of them -- within the last month have been developed by discussion between them and the B.C. Medical Association. Even if that agreement was there, and even if we acknowledge that they might have come to some agreement within the last month, that in itself, since it is only a few weeks old, would be a reason to consider this in second reading. Then we could put it out to be studied and examined and more detail presented to the community over the summer, rather than trying to rush it through committee stage and finalize it in this sitting.

When members from the opposite side quote from letters which they say prove the validity of what they are putting forward, I must respond and say what I hear from Steven Hardwicke, the current president of the British Columbia Medical Association. I think we need to hear this in order to put our discussions in context. On June 15, after the government and the doctors had met, he wrote thus to Premier Harcourt:

"I write to request your immediate personal intervention in a dispute which seriously threatens the provision of medical services in the province. I regret I must inform you that the discussions the BCMA officers had with the Hon. Elizabeth Cull, Minister of Health, on Friday and Sunday, June 12 and June 14, 1992, were clearly a sham."

He goes on to acknowledge that the bill will be brought forward. He says it is over 40 pages in length and would constitute a complete rewriting of the medical constitution of the province, which is exactly what the minister has been saying: this bill is a complete rewriting of the medical constitution of the province. It is not, like so many other bills, amendments to bills that are already in place. It's a scrapping of what we have and starting over again. It's that very scrapping of what we have and starting anew, without taking the bill back to the community and letting them see -- not what happened in discussion that brought the bill into being, but what happened about discussions that have to deal with the bill once they have seen its terms of reference, exact wording and implications for them in their own undertakings.

I'm concerned about the response from the nurses and from health workers. I'm concerned about the response from municipal councils, because we have new community processes going into place. But how are they going to affect the municipal councils and village boards of government where these clinics are going in? There's a whole new process of government involvement in communities being suggested here, without the communities involved having the opportu-

[ Page 2835 ]

nity to deal with that and to say: "Yes, this is a good idea, but this is not. With a slight change we could live with it; in fact, we could endorse it."

I'm afraid that the government, in rushing as they have so often, not to put an idea or a proposal out -- because we would affirm the validity of putting an idea and a proposal forth -- but to take that idea and that proposal and say that this is the finished product.... No longer do we need to consult about it or hear from people. No longer do we need to hear from the clients and the seniors.

The amendment should come from the people in the community....

Interjection.

V. Anderson: I hear members on the government side -- the backbenchers -- saying: "Make amendments." But we haven't found that they're willing to hear or accept many amendments. They have done some; we will give them credit for that. But on the whole, they are concerned that their idea go forward, and they believe that they have already heard everything that needs to be heard, so it is difficult.

Hon. Speaker, I am concerned about all of those who work in the health care field, not primarily the doctors. They're probably better able as individuals to take care of themselves than many others in the health care field. But what happens to the disruption that takes place in the health care field? It endangers the well-being, the health, the jobs and the security of all the people who work in the health care field: those who work in the offices, those who clean the offices and the pharmacists in the communities where they live.

I've had the experience of pharmacists having to go out of business, particularly in small communities, because as doctors turn over, they tend to use different prescriptions. So they have a large stock of prescriptions which are no longer usable, and they can't afford to replace them.

[12:45]

There's a whole host of community implications that affect everyone in the health care field, and there's no indication in this bill that all of these various areas will be heard or considered before the bill is passed in final form.

I would urge the government to take Steven Hardwicke, the president of the Medical Association, seriously. He wrote in that same letter to the Premier:

"In our view, the resulting conflict would be contrary to the interest of not only the government and the doctors but also the citizens of the province. We hope to avoid such a state of affairs and therefore ask for the opportunity to meet personally with you and the Minister of Health.... We regret the necessity of asking for your involvement, but at this late stage it seems the only way of avoiding a disastrous outcome for all concerned."

At this point, we must be concerned as we look at this bill, not primarily for the government or the doctors, but for the citizens of the province so that they feel they have involvement in what's taking place. Involvement means not only putting your initial ideas in and having them heard hopefully, honestly and truthfully; involvement means that after you have been heard and your views have been formulated into some kind of proposal or draft bill -- and I say draft bill -- then the bill goes back to the community, to the people so that they may speak and respond to it, so they may be a part of it. It's this process, once again, that this government has failed to understand: that consultation is not a one-time thing; nor is consultation only with a few people, such as health care professionals. It's also with the people who are affected by the work of the health care professionals: the citizens of the province.

It's interesting that we have set up round tables about the environment and other areas of concern. If we're so interested in those areas, how come we do not establish this very important commission with our health care so that the people of the community can hear again, and be heard from, and be part of the planning? I'm sure that if this government forces this through, it will regret it, and our health care system will not be as good, as complete and as full as it should be.

When they talk about setting up committees and commissions, you soon discover when you read through the bill that they're setting up the commission to have three groups of people represented: the government, the physicians and the community. But there are three people from the community on the commission, and how they are going to represent all of the citizens of the province is a very interesting concern. They haven't said how that will come about, except that it will be by agreement between the doctors and the government. What about others being involved in that agreement process as well?

Also, the hon. minister, in presenting her introduction to the bill, said that not only would there be this commission but there would also be other committees established by the Lieutenant-Governor-in-Council which would run parallel to and, I might suggest, often in conflict with this commission, because they will be representative of other groups of people and other interests in the system. There is no suggestion in this bill of how the other committees that are established independent of the commission and that also have the power of the commission are going to relate to each other. Although the hon. minister has put forth this process as one that is fair because it's representative, the bill also puts forth automatically a system whereby a variety of independent commissions are operating. They all have similar powers, and in the final analysis the adjudication between these commissions and committees will be in the hands of the minister.

If you read the bill carefully, what you discover is that the minister is totally in charge of the whole process, because she has kept herself in the adjudication process for all of the committees and commissions. The authority is there. Whenever the minister is concerned about an issue that is not going right, according to the feeling of the government, the minister is in a position to say that she'll appoint another committee and that the committee can go ahead and do the program in the way she would like to see it done.

I am gravely concerned that when we look at the bill and argue about it from the point of view of doctors and the government, we are missing the whole point. We need to be looking at this bill from the point of view of the community and the citizens in the community. We 

[ Page 2836 ]

need to be looking at this bill from the point of view of all of those who work in the total health care system, of which doctors are a minority number. They are not the majority of people who deliver health care in this province, by any way or means. The majority of the people who work in health care are the ones who should work on the negotiation and finalization of the bill. The majority of those who are part of the health care system and who depend on the system for their own livelihood are not being referred to. For the government to sit down with only the doctors to develop a system is to deny the involvement of the majority of the people who work in the health care system and provide health care.

There is no representation here from all of the people who care for senior citizens in our senior citizens' care homes -- an increasing number of our population. If anything needs to be done to upgrade and uplift the medical care in this province, it needs to be for the senior citizens who are in care homes. Those people are not represented or reflected in this bill.

As long as it's only a two-way discussion, may I suggest that if the minister is really concerned with community consultation after the commission is set up, she should sit down now and have a three-way discussion about the proposed bill with doctors, other health care workers, community citizens and, one group that she could draw from very effectively, the two active and vital senior citizens' associations of this province. They would love to sit down and discuss this bill and its proposals, because they're the ones who built what we now have. They're the ones who will be paying a great deal of the taxes, and they're the ones who are going to be greatly impacted by this bill.

V. Anderson moved adjournment of the debate.

Motion approved.

Hon. G. Clark moved adjournment of the House.

Motion approved.

The House adjourned at 12:55 p.m.

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