Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 29, 1992

Volume 5, Number 8

[ Page 3187 ]

The House met at 10:06 a.m.

Prayers.

Ministerial Statement

NEGOTIATIONS WITH DOCTORS

Hon. E. Cull: Hon. Speaker, I am rising this morning to report on the status of negotiations with the British Columbia Medical Association. After 12 meetings that I've personally been involved in and many more meetings that staff have been engaged in, including 27 hours of work by somewhere between 40 and 60 people over this weekend, I regret to inform the House that we have been unable to reach an agreement with the British Columbia Medical Association.

I wish I could tell you that it was close, and that I could hold out some hope that a few more hours or some time would bring us closer together, but it isn't close. There is a fundamental principle that the Medical Association has yet to understand: the principle that it is this Legislature's responsibility and obligation to set the budget. I can only conclude, as I did last night at the end of two days of intense discussions with the BCMA, that they did not have a mandate to reach an agreement with the government and that they sought only to change the rules.

At the outset of our meetings, we agreed that there were three major issues that still required political-level discussions. Over the weekend we had staff dealing with the technical issues, which we will come to later as we go through the bill. But at the political level, we agreed the issues were: the co-management of the health care system, specifically negotiations for fees and dispute resolution; how to live within the 1992-93 budget that has been established at $1.271 billion; and third was the pension plan.

On the first issue of co-management, the government offered the B.C. Medical Association partnership in co-managing with the government and the public. We offered consultation on the appointment of the chair -- the chair being one of the nine members who would be appointed: three from the public, three from the government and three from the BCMA. We offered separate fee negotiations with the Ministry of Finance or some other body of government; or a separate, arm's-length individual would be appointed by the Medical Services Commission to carry out negotiations. If such negotiations failed to reach a negotiated settlement, we offered conciliation. We offered input into the budget-setting process so that setting future years' budgets would have the involvement of the Medical Services Commission, and thereby the doctors and the public. We offered them a full range of tools to ensure that we live within the budget.

The BCMA's counteroffer included the creation of something that I can only describe as a slush fund. It included tying the hands of cabinet with respect to the approval of special warrants. They requested that we eliminate reference in Bill 71 to the Canada Health Act, which protects British Columbians from having medically necessary services deinsured. They proposed binding arbitration in disguise. They called it non-binding, but any way that we looked at it, it was still binding arbitration. They asked us to guarantee their right to extra-bill patients.

On the second issue, which is living within the '92-93 budget, we offered them a full range of tools that would include public and practitioner education and guidelines to back up doctors who tell us they have difficulty refusing unnecessary medical tests to patients -- because patients will come in and demand them, and if they don't provide them they'll just go down the hall to another doctor. We offered auditing and offered to look at the Medical Services Plan to make sure that there were no unnecessary services covered by the plan. We offered to look at other agencies which should be paying their own way for medical services, including the Insurance Corporation of British Columbia. We went one step further than we had prior to this weekend and agreed that if, after having done all of that, we were still unable to make this year's budget, we would agree to limit the doctors' share through prorationing -- whether it was targeted or general prorationing -- to no more than 2 percent of the budget.

The BCMA responded by asking us to "grow" the budget. On paper they said they accepted the $1.271 billion, but they suggested a number of things be added. While we haven't had many hours to cost it out, somewhere between $50 million and $100 million would have to be added to the budget. They suggested we reduce services to British Columbians. The example they gave us is the one they thought we should start with, which was to delist examinations for eyeglass prescriptions. I think those kinds of suggestions are totally unacceptable to people in this province.

On the third issue of the pension, the government offered to cost-share the RRSP plan that had been developed. We offered to pay $12.5 million per year for five years, at which point we would renegotiate the deal with them. The B.C. Medical Association said yes. They agreed to cost-sharing, but they wanted the government to continue with $25 million a year in perpetuity.

Clearly, we have been unable to reach an agreement. Clearly, the leadership of the BCMA is unwilling to share the economic burden that all British Columbians are having to share this year. I think it is unacceptable to the taxpayers that doctors would essentially ask us to write a blank cheque for them to set their own budgets. It is important now that we proceed with the passage of Bill 71, so we can put in place the mechanisms that are needed to make sure we live within this year's budget.

We have listened to the concerns of the BCMA. I will be bringing forward amendments that reflect some of its concerns, but this government has to be responsible to the taxpayers as a whole. We have to balance the interests of everyone. One of our most important responsibilities is to set a budget for health care that everyone must live within. I regret that the BCMA has been unable to acknowledge this obligation; but setting the budget is a decision we're entrusted to make.

In conclusion, hon. Speaker, I will be continuing to ask the BCMA to join us in kind, to bring forward

[ Page 3188 ]

reforms to health care, to work with us to help us manage the health care system more effectively -- not by just asking us to increase the budget or to provide special warrants. I asked it to acknowledge that it is the responsibility of this chamber to establish budgets, and it is the responsibility of this government to manage effectively within those budgets. Once that acceptance and acknowledgment is made, we can go forward together and guarantee that health care in British Columbia will not be compromised.

[10:15]

L. Reid: In my view, this government is compromising the health care of British Columbians. This Bill 71, which is before us as we speak, is not about the government's ability to manage its budget. In my view, they are unable at this time to manage their budget adequately. We have a situation where we are down to the wire -- midnight tomorrow -- for the budget in this province to be handled appropriately. Bill 71 is not about a meaningful reform of health care. It has been suggested by the minister opposite that somehow the inability of this government to understand conciliation and process and to reach a consensus with the B.C. Medical Association, with the doctors of this province, is the high road.

I have significant difficulties with the inability of this government to present the issues fairly and squarely, in the eyes of the public. Health care in British Columbia is about fairness, and it is about adequate access. If you look at the back of your CareCard, it says: "This card is the property of the province of British Columbia, and it is to be presented when using all provincial health care programs, including Medical Services Plan." This is what taxpayers pay for: an entitlement to their health care system. To whitewash the issue -- which, in my view, is rationing of health care in this province -- by saying that it's somehow appropriate to lay all the problems at the doorstep of physicians is not something that I think we can continue to have purported as being the truth in the public domain.

Doctors in this province have stated publicly that the government has the authority to set the budget. There is no difficulty with that; it has been stated publicly. They have said it, and this government has agreed they have said it. So to suggest that that no longer exists is abundantly unfair to the taxpayers in this province, who, in my view, are not receiving the clearest picture of where this dispute is headed.

If I may, there are two issues before us. This dispute is whether or not this government has any understanding of negotiations, conciliation or process. The lack of notice that I received this morning in order to respond to this ministerial statement speaks strongly to the fact that they have no sense of timing or process. This is about cost overruns in the budget and who is responsible for that. For the last 24 years governments in this province have cost-shared overruns in the budget. That is an issue that we need to deal with. It is simply not appropriate to suggest that that's going to be left at anybody's doorstep.

The Canada Health Act. Doctors are the ones who have stood behind this act, realizing that it was the only thing that dictated where we were going in this province. Somehow it's convenient to suggest now that we'll just dispense with the Canada Health Act.

We are not comfortable with Meech Lake-style negotiations. What happened this weekend was basically holding a gun to the head of health care and to the heads of taxpayers, because health care will be rationed in this province if Bill 71 goes forward. Bill 71 is not about doctors' salaries. Bill 71 is how we deliver health care in the province. We are looking at a significant reform to the way health care is delivered. To bang it through in ten days or less and to suggest that somehow it's appropriate to introduce the bill on June 16 and complete it in the following two weeks, that somehow it's acceptable to taxpayers in this province, that somehow it's acceptable to where we want to go as reasonable legislators in terms of how we revamp health care is completely unacceptable to me.

The hon. minister stood today and questioned the mandate of the physicians while in negotiations this past weekend. Does this government have a sincere commitment to resolving this dispute? It doesn't seem to be sincere in terms of where they're headed.

We're talking about a $1.27 billion portion of an almost $6 billion budget. We are suggesting somehow that everything that is wrong in the way health care is delivered in British Columbia somehow rests at the doorstep of our physicians. I do not accept that. I do not see why that is a reasonable position to adopt. I think it's convenient. I think it's possible to whitewash the two issues by suggesting there is somebody to blame for where we are headed in health care. But I can tell you that this situation is not unique to British Columbia. This problem of how we fund health care -- the issue of grappling with the funding of health care -- will be before every single province in this country and every country in the world. To suggest somehow that our physicians are responsible for the ills of an entire health care system Canada-wide makes limited sense. For the minister to rise today and suggest that somehow she has gone forward and made a significant, sincere commitment to resolving this dispute does not sit well with me. This issue is about protecting our health care system. This issue is about being responsive to taxpayers in this province.

The other side of the question, which in my view the minister has cloaked, is the rationing of health care. If you allow so many dollars to deliver a service, when those dollars run out you have indeed rationed the service. That is abundantly clear, and that is the message this Liberal opposition will be taking forward. The people who pay for this health care system -- the taxpayers in the province; the citizens of this province -- have every right to know that the services they have enjoyed up to this point will be less and less available to them over time.

C. Serwa: In the absence of our Health critic, I'm just going to say a few words with respect to the negotiations. The negotiations that are taking place between the doctors and the Minister of Health have

[ Page 3189 ]

absolutely nothing to do with health care in British Columbia. It's a matter of choices, and choices for government are often difficult.

Why are the government, when they are concerned about the cost to the taxpayer of our health care system, coming in with a program of rationing health care? Where was their concern when they committed $200 million to a fixed-wage policy? Politically, where was their concern? Where was their concern when they committed $300 million of taxpayers' money for the repeal of Bill 82? There was no concern expressed there. Where was their concern expressed with the commitment of $1 billion for 1,500 additional full-time-equivalent employees in the province? Where was their concern with $300 million committed to welfare rather than workfare in the province?

The government, lamentably, have put themselves in a very rigid position with health care. Their position in health care is not even realistic. The cap that was suggested to be imposed on doctors is approximately half of the population growth that occurred in the province last year. That is not taking into consideration the aging of our population or those who are retiring here from other provinces. The reality is that the health budget can never be fully capped; it depends on demand. The government of the day couldn't say to those with AIDS who came here a number of years ago: "We're going to put it in the budgetary process, and perhaps next year or the following year we will be able to do something about this matter." Hundreds of millions of dollars were spent -- and had to be spent -- immediately on that.

Government has options, and government has to maintain a cash flow and a strong economy so they can continue to fund the health care system. The position the government has taken, while it is rigid, is neither correct nor appropriate, and rationing of health care will be the end result. With approximately $60 million in latitude, you would have an agreement. If the government is afraid of the loss of face and is willing to risk the loss of health care opportunities for British Columbia citizens, so be it; that's a conscious decision. But the decision was not made in order to save the taxpayers of the province any money; the decision was made to save face for the government of the day.

Orders of the Day

Hon. G. Clark: Hon. Speaker, I call second reading of Bill 71.

MEDICAL AND HEALTH CARE
SERVICES ACT

On the amendment (continued).

K. Jones: It's a pleasure to continue debate on the third amendment to Bill 71. It is an historical situation of three amendments to a bill, and I think it's an indication of the seriousness with which we take the bringing of this bill so hurriedly without the opportunity for a full consultation period of six months, which was what we had previously requested and which was defeated by this government. As an indication of this government's so-called consultation process, this is the type of consultation they practise. It's quite different from what they preach.

I'd like to just carry on. I can remember the way the NDP chastised the previous government for not opening legislation to public input. I remember how the current Premier, then Leader of the Opposition, promised that the NDP would open the legislative process to public input. In fact, there have been bills brought before this legislative session that will not pass into law until next year, in order to allow open and public discussion. It is my strongly held view that the Medical and Health Care Services Act is a bill which probably deserves public input more than any other bill. My constituents tell me, and it is my firmly held belief, that medicare is the public's most cherished public service.

If the public wants medicare 2, as the Premier has called it, then so be it, but at least give the public an honest and open opportunity to say so. I do not recall at any time during the election campaign the NDP promising to change medicare the way the Medical and Health Care Services Act does. There was nothing mentioned of this type of control, this type of legislation that obviously is meant as a hammer to negotiate with the doctors, which is why it is being rushed through at this late hour in this spring session. This is no longer a spring session; it is now a summer session as well as a spring session.

Medicare is far too important to modify it in such a cavalier manner. British Columbia deserves much better, hon. Speaker. Is this any way to plan the future of British Columbia? Is this any way to plan the future, by ramming Bill 71 through this House in a little more than a week? British Columbians deserve much better.

We've heard the hon. Minister of Health tell us that the tax meter is running. We heard the hon. member for Burnaby North eloquently wax on about how much it costs the province every day this bill isn't brought into law. What a manipulation of the situation! This distortion has been correctly set straight by the hon. member for Richmond East, who has reminded the government that it already has the power in the existing Medical Service Act, under regulation 3.09, to adjust doctors' fees to whatever it desires, for whatever reason. Why is this government in such a rush? Why is this government trying to ram this bill through the House during these late days of the current session? Why, hon. Speaker? I certainly see no need for rush.

[10:30]

It is my duty as an opposition MLA to ensure that whatever legislation is brought before this House is of the greatest benefit to the majority of British Columbians. I for one wish to be clearly on the record as one who stood in defence of medicare, as one who stood for the democratic wishes of the public. Stuffing something down the throats of our doctors will not engender a system that's in the best interests of British Columbians. Why won't the government stand back from the legislative hammer and sit down and negotiate in good faith with the doctors? We saw an example of the doctors meeting with the government this weekend, yet

[ Page 3190 ]

there was no movement on the part of the government whatsoever.

Doctors I've talked to are quite prepared to reshape medicare to meet the government's budget targets, but the government must accept the fact that it is blatantly unjust and unfair to expect the doctors to bear the financial brunt of the government's lack of commitment to fund medicare adequately and responsibly. The government should be upfront with the public and tell the public that the government is only prepared to pay so much for medicare and will no longer cover low-priority services. That appears to be the direction this government is going -- the government that claimed medicare was supposed to be universal. We in this Liberal Party have always felt that medicare is for the people who really need it -- the people who shouldn't have to go through means tests -- yet this NDP government is starting to set in motion what will lead to means tests and restriction of services and doctors to this province.

When the Minister of Transportation and Highways cuts back his budget, he doesn't ask the highways contractors and workers to keep building highways but at a reduced price -- certainly not. He determines what he can build with the budget he has, then funds the highest-priority projects and leaves the others. What a howl there would be if the contractors and workers had to continue building highways at their own expense and effort once the budget was set.

What does the Minister of Forests do when his budget runs out? Does he let the forest fires continue burning? Does he force the firefighters to keep fighting the fires at reduced wages? Does he make the firefighters pay for the gasoline in their fire trucks once the budget is spent? Does he make the water bomber owners fly their planes at their own expense when the budget is gone? This is how preposterous Bill 71 is. We cannot expect doctors to do more and more work for lower and lower fees. No one else in society would tolerate this. We cannot in all good faith expect doctors to do so. If we do, this Legislature will only be exploiting the ethics of the hard-working doctors who decide to continue working in the province. We should not be surprised at the outrage that doctors across the province are expressing.

Right this morning, in my community and in the adjoining communities of Surrey and White Rock, the doctors are meeting to determine how they will restrict services. This is the beginning, as has been indicated, of many withdrawals of services in Prince George, Quesnel and many other areas in this province. The current situation needs a cooling-off period during which doctors and the hon. Minister of Health can have a satisfactory opportunity to debate the issues involved, to have the input of all of the community and to be able to bring conciliation and peace to what has to be the most critical area in our community -- our health care.

I'd like to read you some of the comments of doctors who have expressed great concern. This one is from a doctor in Mission:

"I am writing to you as a concerned physician in B.C. I have watched the Minister of Health attack the very system she is supposed to represent. I have noted the professional, reasoned approach of the BCMA. I now see an uninformed public about to lose a standard of health care the envy of the world.

"I really do not want to burden you with reiterating the facts you already know, but I am appalled by the process whereby acts are extinguished, doctors are railroaded and the public is duped, all in short order. That is what sticks in my throat and makes me doubt whether we will ever negotiate in good faith with government again.

"I see that physicians are to subsidize the system should money run short through overutilization. I would recommend that the sewer workers take a cut in pay each month if toilets are flushed more than three times a day, that police salaries are cut if they are called out for too many crimes, that politicians accept a clawback if they are lobbied too often.

"Where is the sense in all this? I don't really care if our contracted pension plan is extinguished or if some sort of individual cap is instituted on a reasonable basis, but this government has chosen to poison the relationship this profession has with the public through mistruths and deception.

"I would be happy to put every penny I have on the audit sheet and then invite you to take my job. I have no doubt you would balk at the thought. No physician enters the profession to make a fortune.

"Yes, we need some sort of negotiated agreement about how much this province is prepared to pay for health care, but to exclude doctors from the process is insane. And now Bill 71 includes a section where patterns of practice are audited by government and not the profession.

"I must admit to shame in voting for an NDP government. We all live and learn. All of my patients are being advised as to what I think of them now. If this bill passes, our MLA can count on being on the street in short order.

"I don't know if we can ever repair the damage, but I would ask for your assistance in throttling this malicious piece of legislation before it takes its first breath. For a profession that is always there when you need us most, this action is the most resounding slap in the face. We count on you and your support."

That's from a specialist in internal medicine from Mission. I am sure that the member will know which riding that is from.

[H. Giesbrecht in the chair.]

I'd like to read from another Mission doctor who's also very concerned.

"I am currently a general surgeon with a practice in Mission. This is a rapidly growing community. Due to the rapid growth, the current level of funding for our hospital is somewhat insufficient to take care of the current demand and needs of this community for services in general surgery. As a result, my waiting-list is increasing at an alarming rate. If the tabled legislation, that being Bill 71, is passed, I believe this will further increase the waiting-list to an unacceptable level.

"I think it is unacceptable for a non-medical government-based agency to be auditing medical files, particularly when there is sensitive, confidential information present. It is my understanding that this may occur in the hopes of inspecting certain physicians practising and billing procedures.

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"One wonders if this present government has not had a hidden agenda all along with the readily available Bill 71 in the event of strong protest over Bills 13 and 14.

"I must convey my deepest concern that if this present bill will pass it will erode a health care system which is already in some difficulty in this province. I thank you for your attention and hope that you will convey these concerns and those of my colleagues to the government in this present debate."

I have another from a doctor practising in Mission:

"As a physician and taxpayer of Mission, I am very concerned about Bill 71, which the NDP government is trying to pass in the House. The implications of this bill are far-reaching and will impact on the health care that all citizens of B.C. have come to expect and deserve. This current government has chosen a very confrontational approach to try to legislate the medical profession of B.C., rather than enter into meaningful negotiations. This has inflamed not only the physicians of the province but also the majority of the residents of Mission.

"In Mission we are already experiencing difficulties in attracting specialists to the area and have, in fact, been seeking psychiatric services for almost ten years. Obstetrical services are also in demand, and a recent applicant from Ontario withdrew his application upon learning of the political and economic climate that has been set by the NDP government.

"I would seek your party's support in debating this bill and pointing out to the NDP government the irrational approach that they have taken to legislate rather than negotiate. I hope that this move will bring some sense to Mr. Harcourt and his government so that Bill 71 will not pass, and a new medicare for B.C. can be fairly negotiated."

Further doctors' inputs.... There seems to be a great deal of concern in Mission, because we have a lot of doctors from there who have expressed sincere concern about this bill. Perhaps there needs to be a little bit of homework done in that riding.

"We are writing because of our concern with the NDP's present attempt to pass Bill 71. As dedicated physicians and members of the BCMA we hope that you can help us as a profession to stop the passage of Bill 71 and preserve Canada's health care system.

"It is quite obvious that Bills 13 and 14 were never meant to be. Instead of constructive discussion with the physicians, the Health minister has hastily created a new bill, Bill 71, which essentially encompasses Bills 13 and 14 and more -- much more. Why the attempt to shove it through before the agreed-upon date? Just another broken promise to add to the list.

"My concerns with Bill 71 include:

"1. The hard cap is inadequate. The global budget is grossly underfunded, as it is based on 1991 demand, and we all know demand increases annually. Most physicians already provide a lot of free services. Should physicians be responsible for providing free services, or should we choose not to see those who have no medical coverage?

"2. Limitation of services. The economic impact of utilization is just one side of the coin. Whatever happened to the humane side? How would you feel denying a coronary bypass to a patient because he is just not worth it -- the money is better spent somewhere else -- then to watch as he deteriorates and suffers until death?

"Medicine is complex. No two cases are the same. For example, Mrs. A and Mrs. C both have ovarian cancer and are present with abdominal pain. They're the same age and the same socioeconomic status. In the office Mrs. A is found to have a mass in her pelvis by internal examination. Ultrasound verifies this. She has surgery to remove it and chemotherapy treatment. Mrs. C has a normal internal exam and normal ultrasound. Fluid is found in her abdomen. This is drained with a procedure called paracentesis. This costs money. The fluid is sent for analysis. Cancer markers are done, CT scan is done, microscopic cancer cells are found in the fluid. Treatment is then the same...."

[10:45]

Deputy Speaker: Hon. member, your time has expired.

J. Dalton: I rise this morning to address the third amendment to Bill 71. I was not here the other day when this amendment was introduced in the House, so for the first time I have the actual opportunity to hear remarks of other members and also to contribute to this issue myself.

I think everyone in this House -- although as I look across to the government side I'm not addressing many bodies -- will agree that Bill 71 was introduced very late to this session. In fact, it was not much more than a week ago that Bill 71 was introduced in first reading, and now we are here on the significant issues of second reading and the amendments that the opposition has brought in.

This is the third amendment to Bill 71. The first amendment the opposition brought in dealt with submitting this to committee. That was rejected by the government. The second amendment was a hoist of six months, also rejected by the government. Looking ahead, we can anticipate that the government will also reject this third amendment. Later I intend to make some specific comments about the three aspects of the amendment itself.

I have commented that the bill was brought in very late. It is probably the most significant bill of this spring session and the first session of this thirty-fifth parliament. One has to wonder why the government has brought in such a significant piece of legislation so late in the session. The previous speaker spoke about the spring session, which is now into the summer. I suppose we could remark, if you step outside you will see that a true British Columbia summer has arrived. I guess it's appropriate that once school has adjourned for the summer, the weather turns foul. Maybe in a sense we're all happy to be indoors, where at least it's warm and dry, and not outdoors as many people are at this time.

The predecessors to Bill 71 are Bills 13 and 14, which are still on the order paper. I would make one observation about both of those bills. If nothing else, at least we could say that they were brought on the order paper in a timely fashion, even though I would also have to say they are both wrong. But at least we were not being forced into a rushed situation and a very hurried debate on those bills, if they were to be brought forward.

[ Page 3192 ]

Obviously the government had the real sense -- and I don't mean "sense" in that tone of the word -- that Bills 13 and 14 would not be well received by the public or by the people in the health system. Therefore they have diverted those two bills and now at this late time in the session have introduced Bill 71.

Deputy Speaker: Order, please, hon. member. Just to remind you: we're on the amendment. Please proceed.

J. Dalton: Thank you, hon. Speaker, I appreciate that. I was just about to comment that Bill 71 is certainly not timely, unlike the other two predecessors to it, and I would also add that it is certainly wrong. There is no question that there are many aspects of Bill 71 that are lacking in any sense or ability for reconciliation of the issues.

The Minister of Health this morning, when she rose to make her ministerial statement, of course, made reference to the lengthy discussions over the past weekend between the BCMA and the government on the issues of Bill 71. Unfortunately there is no opportunity for compromise. I would not stand here and suggest that it's because the government is so recalcitrant to compromise, but obviously there were opportunities for the government to recognize the very serious issues that the BCMA has been dealing with and that we are dealing with in our debate on second reading. That unfortunately was not so. So here we are on Monday morning back on the issues of Bill 71 and the amendment the opposition has put forward.

One has to ask why the opposition has now got to the situation of introducing a third amendment to Bill 71, which I understand is somewhat precedent-setting. I can tell you, hon. Speaker, that it was certainly not the intention of the official opposition to create parliamentary history here. We are debating very significant and serious issues that come out of Bill 71.

It is not our intention to be obstructionist or, as some people might suggest, to drag things out. Even though I did comment earlier about the unsummerlike weather outside, there are many other things that we in the opposition -- just like those in the government -- would like to be attending to now. We do not wish to be spending all our time in the House debating, even though it's a very significant piece of legislation. However, we are prepared to address the issues, and we will continue to do so.

We have to recognize that we are dealing with the most important of all government services: health delivery. I would suggest to the government opposite that if we were dealing with legislation that was significantly going to revamp the education system or the delivery of social services or even things that are not as important as those, such as transportation and highways, forests or the environment -- I could go on and on -- we would not be in such a rush. We wouldn't be trying to force things through in the manner in which Bill 71 is being attempted to be forced through. Why is that? What has the government done? Has it got its priorities all out of whack, whereby it thinks that the health system and health delivery are not as important as other government services provided or other areas of government? Well, I hope not. I don't think the government has lost its senses completely, although one might have to wonder, with the very significant issues of the day.

We all recognize the discomfort of the doctors. I want to make a very brief comment about the unfortunate position that doctors now find themselves in. They were prepared for meaningful discussion, and they hoped for compromise. That, of course, did not come to be out of last weekend's negotiations between the government and the BCMA. Now what do we read in here? We read of doctors threatening to withhold services, and in some cases they're actually reducing their services. I don't like that prospect at all, and I might make a personal observation as such. I don't think that doctors, in any way, shape or form, wish to be placed in such an unfortunate circumstance where even the contemplation of withdrawing services has to be considered.

As I have stated in second reading and on one of the previous amendments, doctors are truly professionals. I would think that doctors are more caring than people in any other profession. Of course, it's the nature of the business that they're in, but it's also the nature of the people attracted to medicine. Doctors are not the sort to go out and pound the pavement in disgust over unfortunate legislation or circumstances. They're not the sort to get worked up about issues unless the issues personally affect them or unless they are issues which they recognize as having a very significant social consequence. We all know that doctors are prepared to speak up for the environment, and many doctors are involved in the peace movement and in many areas that involve social concerns. But doctors are primarily professional people whose concern is to provide the best health care to their patients.

We all recognize that our health care system is the best in the world -- or at least it certainly used to be recognized as such. If there are any American visitors or people from other parts of the world in the gallery today -- or people watching on television -- they must be wondering what has happened to British Columbia as part of the Canadian health system that things have gotten so twisted out of shape that our health system is now under such significant attack and debate.

It does seem ironic when we hear some of the things that the Americans are contemplating with regard to health delivery. Of course, this is presidential election year in the United States, and it may very well become an important issue in that campaign. As a way of comparison, in a sense, we might say that the United States is at least contemplating a significant step forward in the delivery of health care; with Bill 71, I would suggest that we are taking a significant step back backwards. That is certainly not something that anyone in this province or country would welcome. I hope that the government does not wish to be a party to a very negative implication on the delivery of health care.

I made a few remarks about doctors, but I don't want to overemphasize that. This bill is not just about doctors. Sure, the doctors are in the lead on the controversy. The doctors are the most significant ele-

[ Page 3193 ]

ment of the delivery of health care, but there are many other components in the health care system also affected by Bill 71. We read and we hear, and I get constant calls and letters in my riding, just as every other member does, I'm sure, about the waiting-lists for surgery and other health care provisions. Why are those waiting-lists occurring? Obviously there are implications that come out of the rationing of health care, as this bill is attempting.

There are other problems dealing with Bill 71 and what it's attempting to do. I made comments earlier, and I may come back to those in a moment in a little more detail. There's no question -- and I know it is a fact in my riding with doctors I've spoken with -- that specialists are leaving this province and this country to practise their profession elsewhere. They're not making that choice lightly. I'm sure that the doctors -- and I know some of them personally -- certainly don't want to relocate their families and uproot their professional and personal life on a whim. They are obviously concerned that Bill 71 and all of its implications are going to cause them a great deal of difficulty to properly practise their profession in this province. What is their choice? It's a very unfortunate choice, but they're leaving. That's a point-blank fact. Specialists are leaving this province. In many cases they're not even choosing to go elsewhere in this country, obviously recognizing that the Canadian health service and health delivery is being affected elsewhere as well. They're choosing to go south of the border or into other parts of the world.

Bill 71 is also very disruptive, in general, to the whole question of health delivery. There are many problems built into Bill 71. The co-management provisions haven't necessarily been well thought out and are certainly, I think, going to cause some difficulties if this bill is introduced into law. The capping of doctors' salaries is only a very small part of a much more universal problem. If you cap doctors' salaries, you are obviously quite directly rationing health care. As doctors are pointing out, what happens when the cap is hit? Do they have the opportunity to renegotiate? No, they don't, because the government is not willing to make concessions on that point. The clock is running. If we get into a situation, as Bill 71 is going to introduce, of capping the salaries of doctors and therefore the capping of health delivery in general, then we are going to see situations that are already developing: doctors withdrawing services, doctors saying that they feel very uncomfortable with the implications of Bill 71 and the implications of capping the salaries. It's a most unfortunate circumstance.

[11:00]

I want to make an observation on a comment made by the Minister of Health in her ministerial statement this morning. She made a reference to protecting the taxpayers of this province. Her remarks were, in particular, dealing with the capping of salaries, which is a part, but not the only part, of Bill 71. That is fine. I have no quarrel with the government speaking on behalf of the taxpayer. Like everyone else in this House, I am a taxpayer. Certainly I can well recognize that rational and well-thought-out protection for taxpayers is more than warranted. However, taxpayers are also users of the health system. I would make a comment to the members opposite that if you were to approach taxpayers in this province and ask them what the most significant government service is and the most significant thing that government does for them, I would submit that a significant majority of them -- if not all -- would say that our health system is number one in the ranking of government services. What is the minister telling us? That she's protecting taxpayers? But is she protecting patients, the users of the system? I would suggest not. I think we are now into -- as with many other areas of legislation that has been introduced in this session -- a question of priorities. I would submit that this government has its priorities in Bill 71 twisted, as it has with other bills that have been introduced. Our priorities should be to protect the delivery of health service and protect the system itself. I'm not standing here trying to protect doctors. Doctors are quite capable of protecting themselves. Certainly the doctors are the vanguard of the argument as far as the opposition against Bill 71 goes, but the doctors are not the only component that we have to think of when we make our remarks in opposition to this bill. We have to think of the patients, the users of the system, the ones who are going to be affected by capping, the ones who are going to be affected by the rationing of health care, the ones who are affected by waiting-lists for surgery and other health delivery that is impacted by this legislation.

We have doctors who are extremely upset -- and when I say doctors, I don't just mean a few doctors. Other members have read into the record excerpts from letters received from all over the province. I'm not going to get into that sort of detail; I don't think it is necessary for me to add to the reading of letters. I think it is more important that we recognize that doctors are now collectively worked up to the point where they are prepared to withdraw their services. I'm sure doctors don't do that with any comfort at all. Doctors wish to provide the best health care for their patients. But when they are forced into a circumstance where they feel they have no choice but to consider withdrawing services, then I think we all have to give a very sober second thought to the impact of Bill 71. There are too many dangerous elements in this legislation to allow it to go unchallenged. We certainly intend to raise these challenges where appropriate.

I would like to make a few remarks about the content of the third amendment that the opposition has introduced and that we are now debating. As all members will know, there are three aspects to the amendment. The first aspect concerns the citizen's right to privacy. Part of the bill allows for the opportunity for patients' records to be inspected. Obviously there is a very dangerous element to that, even putting aside some legal implications that that could create. I think back to another piece of legislation that we put through the House not too long ago dealing with private investigators and the opportunity for government to step in and examine files in that area. Now we have something far more important and far more dangerous in its implication whereby patients' records could be examined through part of what Bill 71 is seeking to

[ Page 3194 ]

introduce. Obviously every one of us would feel very uncomfortable and unsettled by the prospect -- whether it actually happens or not -- of an inspector coming into our doctor's office and asking to search our personal records. That's something I don't think anyone in this country would like to live with or even think of the prospect of.

I mentioned earlier that the second part of the amendment deals with driving doctors -- specialists in particular -- from this province and this country. As I say, I've documented that from people in my own riding who are prepared to make that unfortunate decision. That, of course, is going to compromise the entire delivery of health care. Specialists are feeling that they are being forced -- I wouldn't say compelled; it's perhaps not the right word -- to leave this province because of the implications of this bill and what it will do to health service and health care delivery in this province.

The third aspect of the amendment deals, of course, with the capping of fees. The government would love to -- and perhaps some of them will -- stand up and say: "It's only to protect doctors that you people are introducing the amendment. You've all fallen right in line with the BCMA argument." Well, I can assure you, hon. Speaker, that that is not so. The main concern of the capping is not the difficulty that doctors may face -- as I said earlier, doctors are quite capable of taking care of themselves. We have to concern ourselves with the rationing of health care. Without question, capping salaries is going to ration health care. If that's what the government wants, if this government wishes to attack the universal health care system that this country and this province have enjoyed for many, many years, then I would congratulate the government, because that's what it's done with the capping of salaries.

Then there are the spinoff effects of that, such as doctor discontent. Doctor discontent goes right through the system. If your doctor is unhappy, it's going to produce unhappy nurses, unhappy orderlies and unhappy administrators -- everyone will be unhappy. Maybe the only people who.... I can't think of how happy they're going to be, but if this government allows this bill to be passed, are they going to walk out of here with a smile on their faces? What are they going to say to their constituents when they go back home? I hope they are prepared to face the flak that will be created by this bill being passed into law.

D. Jarvis: One of the many flaks that they'll have to live with.

J. Dalton: Well, that's true, but then perhaps the government has no intention of going home. Maybe they're all going to scatter into the woods after this session. We in opposition know that we can go home quite proudly and face our constituents, because we've been speaking on behalf of their concerns -- the concerns of all of them, not just of the taxpayers, as the minister was commenting on this morning, but more importantly of the users of the system, everyone who's affected by Bill 71.

Hon. Speaker, in closing I again have to restate my personal -- and, of course, the official opposition's -- concerns with Bill 71. There are many, many things that this bill creates in the way of problems. We all have to very seriously give true consideration to what the impact of Bill 71 will be, not just on the providers of health care -- doctors, nurses and others -- but most importantly, on the people that at least we in the opposition are prepared to speak for: the users of the system, the patients. All of us are potentially patients. I haven't been to my doctor for quite a long time, but that doesn't mean I may not have to go and visit him tomorrow. I may, heaven forbid, need emergency attention. Perhaps some people opposite would suggest -- and I'll beat them to the punch -- that I may need that now. But the fact is that we all have to feel comfortable that we have immediate and current access to the system. This bill is going to deny all of us, potentially, such access.

Hon. L. Boone: I rise against the amendment proposed by the opposition. Although this is not a bill that any one of us would like to see being brought in, I think it is one that has shown itself to be necessary through the events of the past few weeks.

Anybody who pretends that this is anything other than a money issue is living in a dreamland. Look at the headlines: "Doctors Say Government Must Boost Budget," "Money Remains Major Hurdle for Doctors." It has nothing to do with the level of health care; it has nothing to do with the health care that the doctors are concerned about. It has to do with cash, and it has to do with doctors wanting more money than the public can afford to give them at this time. The negotiations over the weekend with the Minister of Health have shown that the BCMA leadership -- and I'm sure it's not all BCMA members -- are unwilling to negotiate in good faith and really unwilling to come to an agreement that the province can live with.

There is already a 4.7 percent increase in MSP premiums for physicians. That is where physicians get their dollars from. I think many people out there, in this economic climate, would be more than happy to have a 4.7 percent increase and would thank their lucky stars, in fact, that they had any income at all. I often wonder what province or what country or what planet some of these people are living in, when they can complain about a cap that gives them earnings far in excess of what the average person has.

This is not a situation that the average person is really comfortable dealing with. For the physicians in this province to pretend that health care is going to decrease, that it's going to be rationed, that people are not going to be given the proper type of care, is very serious indeed. I'm very concerned that there are physicians out there making these statements and in fact denying some of their patients services. I don't think all of them are doing that, and I don't think the more responsible ones are, but I'm very concerned that there are some out there who are doing that.

Bill 71 is a responsible bill. It provides, for the first time ever, some input into how MSP premiums are paid, how they are spent, by the physicians and by the

[ Page 3195 ]

public, not just the government. For years the MSP budget has been held accountable only by the government. The government has been the only one to say what's paid through MSP, how much is paid, and all those sorts of things. For the first time ever, the physicians and the public are given a say. This opposition wants to deny this. They want to deny the right of the public to have a say as to what goes on in their health care system. Shame on you! Shame on you for not taking up this cause that for the first time ever, people have a responsibility and they are going to have a say.

[11:15]

And then to put out the fear, as you have, that people are going to have their records seized by the government -- totally wrong. Shame again! Records will not be seized by a government. This means that records can be reviewed by a qualified physician that the government appoints, only for those who look like they may be abusing the system. I don't think anybody who is in a responsible frame of mind would say that the government doesn't have a responsibility to review the records of those that they think are abusing the system or not billing correctly. Surely that's a responsible way to handle things. But then again, this is a responsible government, and you can't expect responsible actions from those opposite.

I'm really getting very concerned as well when you hear people talking about capping salaries. If doctors had salaries per se, we wouldn't be in this situation. Doctors do not have salaries. They have a fee for service that is unlimited; it is only limited by the amount of money they can draw from the public purse according to the number of times they bill. As long as they have that bottomless pit, that open wallet, they can bill as much as they want and the public has to pay it. You and I, the average taxpayer, have to pay that.

If one really wanted to be responsible, one would put doctors on salaries, but that is not what this government has chosen to do. This government has chosen to try to give the doctors an opportunity to negotiate, to sit down and determine what would take place within the cap that's there. But for some reason or other they have chosen to take this up and have decided to oppose this in every way, shape or form.

What the physicians have proposed is that this new act should not even have a reference to the Canada Health Act. That would enable them to introduce user fees. Once again, is this a caring thought from a group of people who want to introduce user fees? They're not concerned about whether a service is available, only about how much more they can be paid for it. Government after government has been opposed to user fees. The Canada Health Act has prevented governments, such as the previous Social Credit government, from introducing user fees on hospital care, which would produce a two-tiered system where those who can afford it can get better care. That's the type of system that the physicians would like to see -- I won't say physicians, but the BCMA -- put in place so that their fees can be increased, and the average person will have limited access to the health care system.

They also want to see the budget increased by $60 million at a time when revenues in this province are going down, when the pulp industry is suffering tremendously, when we've got taxes from the southern half of this continent -- the U.S.A. -- on our softwood lumber, when people are out on the streets, when there's unemployment. The BCMA wants $60 million put back into the hospital budget on top of a 4 percent increase.

I think it's time for the people of British Columbia to understand that there are limited funds; that this government has set its priorities. Health care is a priority for us. We have increased the funding for that. We have increased the funding for education. We have increased the funding for social services. We have met our priorities, but we have not taxed the taxpayer to the hilt. I think that if you talk to the average taxpayer today, they will tell you that they can't afford much more. They really can't afford to have any more taxes put on them. They don't want to see their services cut any more, either. They don't want to see their roads unrepaired; they don't want to see their schools in portables; they don't want to see those things taking place. In order to meet those priorities, this government has to be responsible. This government has to say: "This is what the taxpayers can afford, and this is what we can afford in this province." We have said that; the taxpayers have said that. They told us when we were elected that they wanted us to set our priorities. They told us they wanted us to get our economic house in order. We've done that.

I think it's time the doctors became a part of the solution. They can and should become a part of the solution, help us and the people get this province back on the road to recovery and not hinder us at every point along the way. As I said, this is a bill that is unfortunate, but it's necessary. We need this, or, quite frankly, the taxpayers will not be able to afford health care whatsoever in the future.

D. Symons: I, too, must rise and speak in favour of this amendment. We have tried, as has been pointed out by the government, to slow the bill down. There is no doubt of that. We have to admit that we're doing this and be proud of it, because this bill is flawed. It's unfortunate that what we have before us in Bill 71 is simply a rewrite of Bill 13. The government acknowledged that Bill 13 was flawed in the sense that it did not bring it forward. The government let it die on the order paper. It is simply bringing it before us again. It is going ahead with Bill 71 as a replacement bill. The fact that it did that with Bill 13 points out the real problem before us today. The problem is that this legislation has been put forward very hastily and ill-advisedly. It hasn't been properly discussed over a period of time with the stakeholders who are affected by it.

If this had been done properly in a timely fashion, we would not be having the discussions that have been going on in this House over the past few days. This is the unfortunate situation which I find myself in today, where I have to get up and speak against the bill the government is bringing forward and look for a delay in the process of putting this bill through the House, so

[ Page 3196 ]

that we can properly address the concerns of the doctors, patients and citizens of this province. It's for that reason that I feel I have to get up today and speak against the quick passage of Bill 71. That is the problem here: it's the speed with which the government is bringing this bill forward.

We find the government talks a great deal in this bill about co-management: the working together and the consultation process that's going to go on, and the committee that's going to be formed in order that the doctors and the government can work together in a co-management program. It sounds very nice in words and looks not too bad in print until you look at it carefully. Even though it's called co-management, we find out that what has really happened is that the power is still in the hands of the minister and the bureaucrats. It's just a public relations effort when the government refers to this word "co-management."

[The Speaker in the chair.]

Interjection.

D. Symons: The members says: "Shame!" That's exactly what this is. It's a shame that we're spending this energy by bringing forth a PR relationship of co-management. It's certainly not that when you look at it carefully. We have a commission with no voting mechanism set up in the bill on how it is to work. We find also that most of the powers are going to be given to people who are appointed. Indeed, the real sharing of power does not manage to sneak into the system. We have a system that's going to build subcommittees. These subcommittees are not appointed by the committee, which has a balance in it; rather, it allows a subcommittee to be appointed by the minister.

J. Beattie: What are the subcommittees for?

D. Symons: They can be for anything that the minister decides. Read the bill, and you will find out.

J. Beattie: You are so far off....

D. Symons: Then I think the wording of the bill is inadequate, if that's the case. The case here is exactly that the bill is not clear enough. It certainly is not clear enough to the doctors. If the members opposite are suggesting that it's perfectly clear and that the doctors are misreading it, then obviously the bill needs to be rewritten and put into plain language so everybody can understand precisely what is on the table. The problem between the government and the doctors seems to be exactly what is occurring in the House: there seems to be a different interpretation of what the bill is saying. If that's the case, then the bill is flawed, because it is not clear. And if it is clear, then both sides will know precisely where they stand. That does not seem to be the matter.... And the problem of what is happening in the press.... We should not have medicine by the press; we should have medicine delivered by the government in a timely and efficient manner to the people of this province. What is being given to us today is mismanagement of our health care budget, mismanagement of the health care system that is going to be delivered to the people of this province.

I started off by saying there are some faults in the bill, and one of them is certainly that this is a rewrite of a bill the government has acknowledged is faulty. There is also the problem of confidentiality of patients' records, which has been brought up a couple of times before. It's a problem that needs to be addressed. Also, I might add that during the ministerial statement earlier this morning the minister mentioned that they'll be bringing in some amendments that reflect some of the concerns expressed by the BCMA; the government is admitting that there are difficulties or flaws within this bill. They've admitted it twice: in the House today and by not bringing forth Bill 13, which is basically what Bill 71 is a rewrite of. We have this problem that the government is admitting: they've a bill that's flawed, that needs changes, but they still persist in rushing it through.

We tried to offer the government an alternative -- to bring it to a legislative committee. When I first became a member of this Legislature, I thought that that was what committees were for. In my naivety I believed that committees were going to have things referred to them so they could be discussed, and that the best bill could be brought before the House after it had gone through a timely process of discussion in an all-party committee. It seems that these committees are not to be used for that purpose. The committees are to be used for setting up a committee meeting near the beginning of the legislative session, and that's where it stands. We never refer anything to them. We had a chance in this House to refer something meaningful to a committee. The committee could have done something meaningful and brought it before the House, so that we would not have ended up spending time over the last few days arguing whether this bill should or should not go forward. The government stymied that move.

We then asked that the bill be delayed for six months so that there would be more opportunity for consultation before the bill is actually passed into law and the government realized they'd made mistakes and would have to bring in more amendments or bills to amend the bill that they're now amending. This is not the timely way to go.

The only other alternative we have left to us is our third amendment, which is basically saying that we don't want the bill to go forward, because there are some flaws in it.

Interjection.

D. Symons: The hon. member says they blew it. I guess that's the best description of what this bill is.

I'm afraid that the bill can also place restrictions on patient tests that the doctor can order. It doesn't say it there, but you read between the lines and the implication is there that this will be the case; that the doctors are basically going to be put into a position of a conflict of interest. The doctor is going to have the patient in front of them expressing his or her needs and concerns, and the doctor is going to have to balance that against

[ Page 3197 ]

the fact that the government is putting him in a position of having to safeguard budgetary procedures for the Ministry of Health. "I have to balance my services I'm giving to this patient along with the government telling me that I have to balance the budget for the province in medical services. Between those two, what do I give the patient? What does the government expect me to do financially?" That can be a real dilemma for a doctor to be put in that position.

This really represents another instance by this NDP government of non-delivered promises. During their election campaign, in promise 39 -- which has been quoted before -- they said: "A New Democrat government will seek the cooperation and work closely with our health professionals and workers in making the health care system work more effectively." This cooperation and working more closely is not taking place. It's another broken promise, a non-delivered promised -- another NDP.

I think what we have to watch in all of this is the fact that this bill is a significant rewrite of the entire Medical Service Act. It is not just simply a slight change. It is rewrite of that whole act. As such, it really deserves more time.

[11:30]

Why the rush? Why must this bill go through in a matter of a couple of weeks, from the time it was first introduced in this House to the time they want it passed? If they really wanted to do it in a timely fashion, they could have introduced it in the first week of the Legislature, not the closing days. There are discussions going on regarding changes to the Legal Profession Act in British Columbia. These discussions have been going on for more than a year. There seems to be no rush there. They're discussing what the changes should be with the legal profession, and they're negotiating back and forth to make the appropriate changes. Not so with the medical profession. What they have is Bills 13 and 14 put before them, and then the rewrite of Bill 71 in very short order, from the time the Legislature had the Speech from the Throne indicating there was something coming down the tube to last week when this bill was brought in for second reading. It seems that there is a terrific rush. Basically, I cannot understand it. The government tells us that the reason for the rush is they're going to save $50 million if they rush this through now, because that is what the doctors will be getting extra out of the system if they don't put it through now. I understand that the doctors have offered to sign an agreement to satisfy the budgetary problems for this year. They will make sure that it will not go beyond what is budgeted for this year, but the government seems to be insisting on bringing it in this year. The doctors prefer to wait and have it properly negotiated, and then the government will have to concern themselves with next year, but not this year. So why the rush? I still cannot understand it. If the doctors are willing to make concession, why the rush?

The other part -- and I've mentioned this earlier -- is the negotiations. I'm concerned about the manner in which the negotiations have gone on. The basic club that the government has held over their heads.... They've got negotiations while they've got a bill before the House, and they're simply saying: "Accept what we're offering you. If you don't, we'll club you over the head with the bill." That's not the proper way to negotiate. I'm just wondering where the B.C. Federation of Labour would stand on a set of negotiations like this. If this system was foisted on a union like the IWA, if this method of negotiations was going to go on in that way, I wonder where the B.C. Federation of Labour would stand on this. I'm beginning to wonder.

Interjection.

D. Symons: Not so. If you tell a logger that after he logs so many trees he's not getting paid any more money for it -- even though I hear that the minister had earlier made some comment about a cap on it....

Interjection.

D. Symons: Well, that's your concern. My concern here is that if we take a look at applying this same philosophy to, let's say, ICBC, or another Crown corporation.... Suppose you tell the repair shop people that you're going to place a cap on the total claims for the province and that there's going to be a $300,000 maximum that the repair shop can claim for that year. When this rather large shop reaches that maximum, what do you think will happen when they put in that claim to ICBC? I rather think the shop is going to take an extended holiday. I can't say that I would blame the doctors of this province for doing the same thing when they reach the cap that this government is going to arbitrarily put on.

The previous speaker from Prince George-Mount Robson talked about a fee for services, and indeed that is what we pay the doctors: if they perform the services they receive their fee. But you're saying, by the argument given by that member, that if we reach that arbitrary figure you're putting on here, if the doctor has been giving those services, somehow from that point on the doctor does not receive a fee for services. To me that seems blatantly unfair.

I'm not suggesting, as the member beside me said earlier, that the doctors don't need anybody to stand up and speak for them, but we're speaking for the people of this province not for the doctors of this province, in spite of what the opposite members might be saying. I know that I am not a physician, and I have not spent the time that a doctor has in going through university...

Interjection.

D. Symons: Not quite. ...but I do have a few friends in the medical profession. I went through university with a good friend who is now dean of medicine at the University of British Columbia, and I do know the rigorous sorts of courses they have to take and how difficult it is to become a doctor. When they spend nine years of their lives attaining that, I do expect they are going to be paid something a little more than other people who have not given that much of themselves to get the degree that they have. There are a few members in this House that

[ Page 3198 ]

have gone through that procedure, and I suspect they do know the amount of training and energy that's put into that and the amount of difficulty in getting a degree. It's not open to everybody to be able to become a doctor in this province or in any province -- or to become a doctor, period. In that way I cannot see that we're treating the doctors fairly, in the sense that we have a fee for services, as the hon. member opposite said, but when you reach a certain amount of that we stop giving you a fee for services. It seems blatantly unfair to me. I am concerned that this is not the way we should be negotiating with the doctors. This is not something that should be rushed through at the speed which we seem to be going with this particular bill.

I'd like to close with comments from a doctor who has been sending literature to you and to me. The one that I would like to read I think pretty well sums up how the doctors feel about it, and I rather suspect it sums up fairly well how I feel about this thing going along. In it he says:

"In proposing this legislation you have left no room for discussion, consultation or negotiation. This is unacceptable in any democratic society and ensures confrontation."

We've certainly seen that part of this come true.

"There may be no winner in the confrontation, but there arel certain to be losers in the long run; namely, those who are not only the patients at risk but also the taxpayers and electors of this province. They will not readily forgive a government which, in an act of political tyranny, seriously damages a great institution such as medicare."

With that quote I will say that I'm speaking for the amendment.

A. Warnke: I rise to support this amendment. To be quite honest with you, hon. Speaker, I'm quite surprised in many ways that I have to get up and speak to yet another amendment, because prior to this we had put forward two amendments. I really thought that both amendments were quite adequate. Indeed, as we all recall, I had mentioned in reference to the second amendment that this was the last and only option available for the opposition in order to save this particular bill, if we were to save it. I would have thought that was a reasonable option for the government to respond to.

What is even more interesting is that the Minister of Health comes forth in this House to make a statement, and guess what the statement contains? The statement contains that the government will consider putting forward amendments to this particular bill. If the government is now willing to add extra amendments to this particular bill, then what was so wrong with the first and second amendments that were put forward by this opposition?

It is just amazing that, after the second amendment we put forward, we would delay the implementation of this bill to provide the government with the opportunity to put forward amendments, and that we would discuss amendments. We firmly believe that there were certain fundamental problems with this particular bill, and the minister this morning conceded that this bill had problems with it and needs amendments.

Interjection.

A. Warnke: That's a concession, and we are talking about the third amendment, hon. Speaker. I do not understand what the member is getting all excited about. The fact is....

Hon. L. Boone: You're getting all excited.

A. Warnke: Oh, now we have the hon. member for Prince George-Mount Robson popping up, and some of the comments that she makes are very interesting. That hon. member started her comments this morning by saying that no one wants to see this bill. That's interesting, because the Minister of Health, on a previous occasion on this particular bill, said that no one wants to see this bill introduced.

Goodness, hon. Speaker, I wish this government would make up its mind. Does it want this bill or not? No one wants to see this bill. This government keeps saying they don't want to see this bill. The member for Prince George-Mount Robson says we do not want to see this bill. Well then, take it right out of there. This government can't make up its mind; it cannot construct a bill. This is the reason I'm so surprised that I have to get up here and oppose it. Now I've been forced to oppose this particular bill and favour this third amendment.

I thought the first amendment we put forward was a very reasonable amendment, and I put forward arguments in favour of that amendment. I thought it was a very reasonable amendment which the government members could easily respond to and say: "Yes, this is very reasonable. We'll take it to a committee; we will have a look at it and see where the bill needs improvement." Indeed, the Minister of Health even made concessions at the outset that this bill needs improvement -- like the member for Prince George-Mount Robson, who conceded a few moments ago in exactly the same words: "No one wants to see this bill." If no one wants to see this bill and no one wants to make the hard decisions, and all the rest of it, then let us sit down and take a look at this bill and see how it can be improved.

The second time I got up, in favour of the second amendment, I really thought that would be the last time I would talk on this particular subject -- except for at committee stage, if it were to get that far. That was a reasonable amendment to simply delay the implementation of this bill by six months. Surely we are still going to be in session, one way or another, and therefore it was not a way of killing the bill. To suggest otherwise is to cast aspersions on this opposition.

This government wouldn't listen to that. It is still insistent on passing this bill in toto in the way it's being presented, yet at the same time conceding that there may be problems with it, because it will require some amendments. This government simply has trouble making up its mind whether they like the bill or not.

Interjections.

[ Page 3199 ]

A. Warnke: Well, I'm not so sure. A couple of a members from the other side are saying: "We've made up our mind on the bill." If that's the case, then why did the minister make the statement this morning? If she made that statement this morning, are those members from the government side contradicting their own minister? It seems to me quite obvious that they're contradicting their own Minister of Health, who made those kinds of concessions this morning. The more that hon. members from the government side talk and yack, and do all those kinds of things, the more they reveal that they cannot make up their minds, because they keep contradicting the statement by the Minister of Health. They can't have it both ways. But, of course, there does seem to be the tendency from that side to want to have it both ways. The minister comes here to say: "We need amendments, and the government is going to bring forth those amendments." Meanwhile hon. members are saying: "Oh no, we like the bill as it is." Well, puff my cheeks and call me "Gopher."

F. Gingell: Only if you insist.

A. Warnke: At any rate, it's interesting.

One of the ministers from that side, in addition to the Minister of Health, said that this particular bill is simply one about money, and the reason we're having difficulty -- and this seems to be implicit in the statement by the Minister of Health, too -- is that, simply put, the doctors want a lot of money, and they want more money than anyone else in British Columbia is entitled to.

[11:45]

I listened very carefully to the comments made by at least two of my colleagues, especially the most recent comments by the member for Richmond Centre and by my good friend from North Vancouver-Capilano. Did I get that straight? I congratulate myself. It's close enough, anyway. We all have trouble with that member's riding, it seems. Both members made the point that this is not simply a bill that revolves around the question of whether or not doctors should get more money. Indeed, I find it rather distasteful that the attempt is being made to put the onus on us and to castigate the role of the opposition as simply being one of crudely supporting the doctors having more money and that's all there is to it. I find that very objectionable, especially given the fact that the arguments have been made -- not only by my colleagues just moments ago, but over and over again on different amendments and on the main bill itself -- that the flaw in this particular bill is not one just revolving around money. In fact, while we have made references to letters produced by doctors and so forth -- and again, I guess it is worth reminding hon. members opposite, as I did on the second amendment -- what is read in the chamber from that particular part of the medical community is a very tiny droplet of an entire iceberg of letters that have been put forward. As my colleagues have pointed out very carefully, the flaw is also one involving the people of this province and the question: are they entitled to health care? Indeed, as I go over some of the statements by the Minister of Health.... I think it's important to do that, because obviously the statements made by the Minister of Health this morning were designed to be part of this particular debate so as to project the Liberal opposition as being nothing more than representatives of the doctors and of the medical community. In fact, that's not the case.

Take a look at that argument where the Minister of Health says: "What the government offered is co-management." On previous occasions I pointed out that what is being offered as a model here is nothing close to some of the other concepts introduced elsewhere in the world, such as co-determination and so forth. It's a nice fancy word, but what has really been the response of this government is to impose decisions on the medical community and impose policies with regard to health care on our province. That is the real essence of this government. Oh, they call it co-management, but what kind of co-management is it where you draw different groups into a so-called decision-making procedure, but the government has the majority and absolute control over that? How can one call that co-management? It certainly doesn't come close to the model of co-determination.

Another Argument: "What we need is some sort of settlement now, otherwise the government will be forced to bring in special warrants." Well, the government should have calculated that a long time ago. Why leave it to the eleventh hour of the last day, and then all of a sudden project on the opposition that, "It's your problem; the opposition is somehow creating a problem," when in fact the problem with this government is poor administration, not only in terms of this bill but right across the board?

This has not happened for the first time. Prior to April 1, it was the same doggone procedure with this government to leave it to the last minute, to develop a finance bill at the last minute -- leave everything to the last minute. Once again we see things being left to the last minute. Why leave it to the last minute? That is the problem with this particular government: it hasn't got its act together; it's an amateur government. I recall the hon. member for Nanaimo on Friday talking about grades and all that sort of stuff. I wouldn't give a C minus to this government, the way they handle things in this Legislature, the way it has handled legislative committees, the way it has handled the structure and process of government. The government's performance is darn poor.

Interjection.

A. Warnke: Oh, somehow it is the problem of us 17 opposition members, and I'll add the other seven members as well. It's really us who are creating this problem of the government being so dependent on special-warrant spending and everything like that. What nonsense! What poppycock is being expressed by that other side! It has 51 members; it can arrange a government. It is due to the incompetence of some of the key members over on that side who cannot get their act together, who do not know how to meet deadlines.

Furthermore, hon. Speaker, to say as the minister did today that our government budget is going to grow if

[ Page 3200 ]

we do not pass this particular legislation.... That is connected to the previous point I made. It concedes, once again, that the government is incompetent if it has to worry constantly about the delay taking it into a situation -- I believe the minister conceded that this morning -- where it is going to be spending at least $50million to $100 million. That is a $50 million to $100million mistake generated by that side, by the government. It is unpalatable to suggest that somehow we in the opposition are responsible for that.

Time and again we have put forward reasonable amendments, which allow, first of all....

M. Farnworth: Name one.

A. Warnke: "Name one," says the hon. member from the other side. Let's name them indeed. The first amendment....

H. Giesbrecht: The hoist.

A. Warnke: They don't even understand. An hon. member on the other side thinks that the first amendment was the hoist amendment. That hon. member forgets it was the second amendment. You see, they don't pay any attention. It's very interesting to note that there are only half a dozen members at the most on that side. They don't show up; they don't discuss; they don't debate; they don't listen to a darn thing expressed on this side. Yet they think they are great know-it-alls. As has been clearly illustrated in the last minute or two, they don't know the amendments that have been put forward on the basic things.

Nonetheless, they said to name the amendments. Hon. Speaker, if they want to know those....

The Speaker: A point of order is raised by the hon. member for Okanagan-Penticton.

J. Beattie: I've wondered about this over a long period of time. The opposition very regularly makes reference to the number of members who are in the benches across from it. The member has done it again, saying that there are only six members here. Is it appropriate for him to be mentioning that? I understood that that was not appropriate. He continues to do that. I'd like to get some idea if that's appropriate.

The Speaker: Hon. members, in the practice of this House, it is not appropriate to mention the absence or the presence of hon. members in the chamber.

Please continue with your remarks, hon. member.

A. Warnke: Hon. Speaker, what you have just mentioned I will certainly take into the context of my remarks.

The fact is that the hon. members opposite said: "Name the amendments." What I was pointing out is that -- so I wouldn't have to waste time to go through the whole list again -- it would be appreciated if hon. members could at least participate in the debate a bit.

Just for the record, the first amendment brought forth in this House by the opposition dealt with taking it to a legislative committee, examining it, making the appropriate amendments and then it bringing back to this House -- simply put. If they want further elaboration on that, I would invite those hon. members to pick up their reading and look at Hansard

The second amendment that was put forward was to simply delay the implementation of this bill for six months. Again, if hon. members do not understand the nature of that amendment, it's a little bit too late, considering that those hon. members defeated it. But if they're interested in it, perhaps they should go back and once again read Hansard. I'm sure it will elaborate on and at least reveal to their minds what was actually being discussed. If the hon. members opposite do not know the amendments that have been introduced into this House and yet were willing to vote against them, then I think they should take a look at themselves and their conduct in this House as to how they go about voting. But I will leave it to their conscience as to how they represent their community. To be sure, we tried to represent our community as best as possible, and it's not just the BCMA.

Interjection.

A. Warnke: There they go again, hon. Speaker. They would be further ahead if they would be quiet and listen a little, because it's amazing what the ear can pick up if you don't talk. We're trying to concentrate on this particular amendment. Someone over there just said: "We're getting hungry." In true deference to all the members -- especially those who are hungry and want to get on with it -- I move that we adjourn this debate until later today.

[12:00]

Motion negatived on the following division:

[ Page 3201 ]

On the amendment.

The Speaker: Unfortunately, the hon. member who moved the adjournment motion which has been defeated therefore cannot speak again.

F. Gingell: As I said when I rose to speak on the second amendment to Bill 71, it really is not a pleasure. I think it is important for the government to recognize that its will in this matter cannot simply be unilaterally imposed upon the people of British Columbia. There needs to be a proper and meaningful process of consultation.

What does this amendment say? First of all, it calls for the bill not to be read a second time, because the powers of audit and inspection allowed for in the bill will seriously compromise every citizen's right to privacy. I know, and the government knows, that this is a problem to which there is a solution. If there had been consultation from the start, we would not now be arguing about this particular provision. I'm sure that it is easily resolved. The British Columbia Medical Association well understands and appreciates that the government needs a reasonable and proper means of auditing the billings of doctors to the Medical Plan. For anybody to suggest differently is clearly unreasonable. Surely there is a solution. Two or three have been mentioned. The bill, I appreciate, calls for the audit and inspection work to be done by a medical practitioner. If that work could be organized and arranged through the college, I'm sure there is a proper process that can be put in place that everybody will be comfortable with and that will ensure that the confidential information in patients' private files in the offices of their doctors and other medical practitioners can be sacrosanct. I'm sure there is a simple solution. But did this government look for it? No, they didn't. They just came in and imposed their will. There was no consultation. There's obviously a solution -- easily a solution. I mean, it's just so obvious, and I'm sorry that the member for Penticton does not appreciate it. It isn't a serious problem. Sensible consultation would have got that particular problem out of the way. But the whole story of what happened and the ongoing debate on the various amendments of Bill 71 deal with a series of problems, many of which I'm sure did not need to be there.

The second reason for our amendment is a statement we make that this bill will drive doctors, and especially specialists, away from the province. There are many doctors and specialists leaving, not only for this reason, but, as I understand it, because of concern about research funds in our medical universities. We need to have a situation in which everybody has comfort that there is some solidness to the program, that there will be continuity and that programs which are started will be followed through.

The third reason for our amendment is the most important one -- that the proration and capping of fees allowed for in this bill amounts to a rationing of health care and the introduction of a two-tiered system of health care in British Columbia. We all know and appreciate the fine work that was done by the Seaton commission, but it was the start. It created a blueprint for medical care in this province, one that I think is reasonably accepted and supported by all sides of the House. It is the starting point and it can be the foundation stone, but we then need to develop a process by which the recommendations will be brought into being. There needs to be consultation, and more consultation and discussion, not on what the programs should be, because that's now been reasonably clearly delineated, but on process -- on how it is going to be accomplished.

We all recognize that when important parts of our lives are affected -- or we believe that they will be effected -- we become afraid of change. Change brings fear, and it is very important for us to move with deliberate speed, sensibly and carefully, ensuring that there's clear understanding by all of the beneficiaries of our health plan, who, after all, come first. The health plan and medicare are not in place in Canada for the benefit of doctors; they are there for the benefit of the people of Canada. We developed a budgetary and funding process that has allowed all of the people of Canada to get first-class health care paid for by a mix of premiums, taxes and some user fees in the area of Pharmacare and certain physiotherapy treatments. But whenever there is change, it is very natural and understandable that people become concerned, and it requires us to act with even more diligence.

[12:15]

We have a serious problem here. There is an aging population; there is a movement of people of retirement age into British Columbia. That particular problem is compounded by a general population growth, inflation and a whole series of new medical procedures that are now available that were not available in the past and add the ability to perform new or well-established procedures on older patients with a high degree of success. All that is compounded by new diseases. This brings all kinds of pressures onto our medicare system.

We have to find a solution. We on this side of the House agree with the government and understand that there isn't a bottomless provincial treasure chest that can continually pay to meet these ever-growing costs. The proposal that is brought forward in Bill 71 is one that will clearly create a rationing of health care and encourage the creation of a two-tier system. That is not acceptable. That isn't the way medicare was built and developed in this country. We have to find better solutions. That takes input from beneficiaries -- the residents of our province who look to the medicare system to provide the health care that they pay for -- and cooperation and consultation with the medical fraternity so that they can bring forward their understanding of the problem and the kind of solutions they see as being the ones that will preserve the integrity of medicare.

We can't allow the government to impose Bill 71 with its concept that here is a budget, carry on spending, off you go, and when the budget is spent that is the end of it. What happens if you are in the last month and all of a sudden you have a massive heart attack, the kind of heart attack that can be treated with bypass surgery -- the kind of surgery that saves people's lives and allows them to continue with a healthy,

[ Page 3202 ]

active, worthwhile life? You simply cannot go along for 11 months and then all of a sudden turn off the tap. To suggest to doctors that they should carry on working when they reach that cap and be paid at a very small per-unit rate or not paid at all simply isn't practical.

So how do we find solutions? I was really hopeful that solutions would have come out of the weekend meeting. I'm very sorry they didn't, but that is no reason to stop. Clearly, some progress was made. The report we received, prior to coming into the House this morning and hearing the ministerial statement, had left us, I must admit, in a more optimistic frame of mind than the message delivered by the Minister of Health. Just because they didn't find a solution on the weekend of June 27 and 28 doesn't mean that they shouldn't carry on with negotiations and look for solutions on June 29 and 30, and however long it takes.

The real problem is that this kind of consultation, this kind of discussion, should have happened before Bill 71 was crafted. We went through with the introduction of Bill 13 and Bill 14. We were under the impression that was the government's program. This was what they were going to insist on, and then all of a sudden Bills 13 and 14 were allowed to wither and Bill 71 was brought in two weeks ago. When we questioned that this had been brought in in a hurry and a great big rush when they realized there was public reaction and revulsion to Bills 13 and 14, we were suddenly told: "Oh no. This wasn't you. We have been working on Bill 71 from the beginning of the year." What kind of game is going on here? If Bill 71 was the real change to the Medical Service Act, why did they bring in Bills 13 and 14? It simply isn't logical. We on the opposition benches feel that there's a negotiating game being played. Medical care in this province is far too important for that kind of game-playing.

Let's get serious. Let's get down to the job of finding solutions to the problems of the ever-growing cost of medicare. It cannot be left. It is a matter of great importance. To us, the first amendment to move this bill to the Select Standing Committee on Health and Social Services made adequate sense. Here is a group of MLAs from all parties in this House who would have had a clearly defined responsibility to come up with some solutions. If you get everybody in this House working on the committee, that's how you get commitments for support. No one is going to win this battle without compromise. The BCMA is going to have to compromise; the government is going to have to compromise. Let's not compromise health care for the beneficiaries of the plan. That's the most important factor. I was really sorry when that first amendment failed, because it seemed to me that it was the compromise route that would force everybody to the bargaining table.

That having failed, we dealt with the second amendment to hoist this bill for six months to allow for time over the summer -- without a select standing committee dealing with it -- for the Minister of Health and her senior officials to have sensible negotiations. When you work 24 hours a day for three days in a row on negotiations, it doesn't work. We know what happened to the Meech Lake accord in that kind of environment. I would presume and assume from what was said by the Minister of Health this morning that that was somewhat the kind of environment in which the minister and officials from her office negotiated with the BCMA this weekend. I'm sure that they worked for most of the 48 hours that was available to them. That's not the right environment. You need to be able to discuss ideas, stand back and think about them and then come back the following day with adjustments and changes. The compromises are workable because they result from careful and thoughtful reflection, not from: "Let's get this dealt with and over with so we can all go home." Those kinds of negotiations don't work.

[E. Barnes in the chair.]

As you know, hon. Speaker, the government, I'm sorry to say, turned down the opportunity to find a sensible compromise over the summer that would allow us to come back in the fall and deal with a new Bill 71, one that would have the support of the beneficiaries and the health care practitioners. That failed too. So we're now on a third amendment. How do we convince the government that at the moment we're facing a no-win, no-win situation? I really believe that they need to recognize that this is a no-win, no-win situation. The only way to make a win-win is for everybody to stop for a moment, take a deep breath and stand back and then work for sensible compromises that will not only protect the provincial budget and allow the money that has been dedicated for doctors' fees to be spent in the most effective and efficient manner but will arrive at a solution that will protect health care for the people of British Columbia, the most important party in this whole discussion and the one party that is not sitting at the table.

L. Fox: Hon. Speaker, I rise to speak in favour of the amendment and, like the previous member, I have spoken in favour of the last two amendments. The one I preferred the most was the first amendment which, in my view, suggested a course for this bill that was outlined in the throne speech by the Premier. I recall quite vividly the emphasis placed on the role that the standing committees would play under this administration. To that end, I was extremely disappointed when the government chose to vote against that amendment that would have allowed that process to gain some credibilty.

There has been much discussion over the cost of delaying this bill and, as I understand it, the costs and the impacts will be very significant, even from the day the budget was announced up until this time. Every day that the government insists on not concluding this year's budgetary constraints with the doctors, there is an additional cost to the taxpayers of British Columbia.

[12:30]

It's my understanding, in discussion with doctors and with the doctors' association, that there was the opportunity to conclude 1992's budget with the BCMA. The minister and the government chose not to deal with that issue; they chose instead to initially bring Bill 13 and Bill 14 to this House, which is really unfortunate. I wasn't in the House this morning when the minister

[ Page 3203 ]

made her statement, but I really believe that she sincerely attempted to bring the doctors back into the process over the weekend. When a group has lost trust in the minister and in the government, a two-day effort to achieve some kind of harmony in the process would be a terrific task. In my limited experience in bargaining, when two sides get as entrenched as we see now within the province with the stakeholders in health care and this government, what is really needed, in order to allow everybody to remove themselves and to step back from the process, is a bit of a break in the process. In most cases you see in industry negotiations with unions.... When we see them get to that point, quite often we'll see a cooling-off period put in place so that both sides can get out of their entrenchment and start dealing with the problems.

As I stated before, prior to the election and immediately after, the Premier promised this province that he was going to end the conflicts and that he was going to deal with these issues in an open and credible way, by involving the public and all the stakeholders, no matter what the issue was. I took him at his word; I took this government at its word. I supported that initiative, because confrontation breeds confrontation. We get absolutely nowhere if we continue in a confrontational mode.

This particular amendment motion identifies three areas of concern, but before I get into those three areas of concern, I would suggest that the main thrust of this motion is to allow the parties an opportunity to break away, deal with this year's budget constraints independent of Bill 71, and break away in an all-party and public process and deal with the future of our health care, because there are a lot of concerns.

I want to read for the record a letter, which is very timely, written to myself by PARI-BC, dated June 29, 1992. There are a couple of paragraphs in here.... I normally hesitate to read letters into the record, but I think this is an indicator as to what's wrong with this process. In the first paragraph it states:

"Thank you for your efforts in the Legislative Assembly to ensure that the concerns of doctors in training are addressed in Bill 71. As a result of your assistance, I am pleased to tell you that we were provided an opportunity to raise our difficulties with the minister personally at a meeting in Victoria Friday, June 26, 1992."

I think it was great that the minister finally saw that this was an important group. That was the first meeting with that group since this bill was tabled -- the very first meeting. I want to go on with another paragraph because this is the one that's really important:

"As a consequence, the minister assured us of her support for our contention that we should not be treated in a discriminatory fashion and agreed to seek an appropriate amendment to the act which would address our concerns. While this was accomplished to some extent, unfortunately the proposed amendment suggests that differential treatment would not be permitted on the basis of only age or gender. Needless to say, this does not address our problem at all. Frankly, I'm astounded that if the intent of this legislation is not to discriminate against doctors entering or in the early years of practice, it is so difficult to provide an amendment explicitly excluding them from such treatment."

Even after this meeting, this group is not satisfied that the minister either understood or was prepared to address their concerns. I believe that's not because of any wish by the minister; I believe it's because enough time has not been given to understand the difficulties.

Interjection.

L. Fox: There may very well be a fundamental disagreement -- the member suggests that. And that is fine. If after a lengthy process where both sides and all interested groups within this province are afforded the opportunity to make their concerns known in a fair process there is still disagreement, I would accept that, because that fair process would hopefully provide what is in the best interests of British Columbians, not what is in the best interests of this particular government or a particular group. I'm suggesting that if we are going to have meaningful dialogue and are really going to deal with the health issues in this province, we need to have a process which would allow all the people who wish to come forward within British Columbia the opportunity to do so, not with a hammer over their heads that they've got four days or five days or whatever the case may be to come up with something agreeable. We all know that if we're forced to deal with too short a time-frame, it becomes frustrating. Emotions come forward, and the main issues are forgotten.

I have a copy of a letter sent to the Premier from a Prince George doctor. The date is June 26, 1992 -- very timely. I noticed that the Minister of Government Services and the representative for Prince George-Mount Robson spoke earlier in the House, and I was actually quite disappointed -- I say that sincerely -- that she would express that the doctors' only concern was about money. That shows a lack of understanding of what the doctors' concerns and the concerns of other health care stakeholders really are.

Here is a letter from a doctor. From the tone of it, I would assume that this individual was very sympathetic towards the New Democratic Party and a New Democratic government. I want to read just a couple of paragraphs from this letter as well.

"I can tell you the general public is not happy at all with your government, judging by the spontaneous remarks made by 80 percent of my patients. They are angry. The first thing many ask is: 'Is there something I can sign?' In fact, that is what inspired me to write this letter. By the way, I have not heard any positive remarks, surprisingly; there usually are two sides.

"In all my years in practice I have never before heard comments made by staunch NDP supporters and strong union members, who normally only gave a sympathetic ear. I have been overwhelmed by the concern my patients have expressed with the direction health care is going. One important union official said to me: 'We are with you, Doc, spreading the word around the province. The people are not stupid, and we will not tolerate this rationing and destruction of our medicare system'."

The doctor goes on to say:

"I am angered, disheartened and betrayed by a system and a party for which I had a great deal of respect. I can only say that this act has tarnished your

[ Page 3204 ]

party and cabinet and formed an air of distrust that will likely never be forgotten. I am sad. It was time we needed an honest change, but it seems we have gone from bad to worse. I was looking forward to an era of cooperation, not confrontation. As I see it, we have three parts to medicare: the people, the health care providers and the government, and we must learn to work together as a team to make it work, or the whole system will fall apart."

Hon. Speaker, that individual says it very well. We've got to learn to utilize the strengths and concerns of the whole province in addressing our future directions with respect to medicare.

The amendment has three sections. The first section deals with the powers of audit, and the inspection allowed for in the bill will seriously compromise every citizen's right to privacy. Members have stood up in this House and suggested that this is nothing out of the ordinary, that in fact it reflects what is presently taking place, that those particular folios are presently being audited and would only continue to be audited by doctors.

On June 11, 1992, the Supreme Court ruled in McInerney v. MacDonald that the information belongs to the patient. Doctors have the right to keep files in their offices, but no one else has the right to access those files without the permission of the patient or a court order. I think that says it all. I think that shows that the concerns expressed by this side of the House with respect to the rights of those files are legitimate concerns. This process and delay of the bill would allow that to be explored at some length. It would allow the public the opportunity to give their thoughts as to how their files should be utilized and what's in their best interests as well as the province's best interest.

[12:45]

Section 2 deals with this bill driving doctors, especially specialists, from the province. This weekend I drove to Prince Rupert from my home 620 kilometres away to have a firsthand view of the concerns of the people of Prince Rupert and the concerns within that hospital. We all know that this has been before us before in the Legislature. So that I could understand exactly what the concerns are within that hospital, I drove up there. I didn't want to be accused of using this for political advantage. I wanted to be sure that I understood the concerns within the smaller and more northern communities. I can assure you that the concern of driving the doctors, especially specialists, out of the hospital is in the forefront of the concerns of the doctors and the board, and it certainly is a concern of the community. I've had more letters sent to me, or copies of letters which have been sent to the Premier and the minister, and all of them want to increase the process. I haven't had one copy of a letter wherein they've asked for more money or said that they're not getting sufficient money. They all want a process which will allow them to put forth their concerns.

N. Lortie: You have to read between the lines.

L. Fox: Well, perhaps. The member says that I have to read between the lines. That brings me to a statement made by the member for Prince George-Mount Robson earlier today when she shouted across the floor that perhaps if the doctors were salaried, then we'd negotiate with them. Those are the kinds of comments that breed contempt, and I don't think that they should be shouted out in this House. I really believe that we have a need to understand one another here; we don't need a continuation of this confrontation.

We have already heard that 50 doctors are looking outside this province for employment, and several have found employment. Two neurologists from North Vancouver are moving.

B. Copping: Neurosurgeons.

L. Fox: Neurosurgeons, sorry. Thank you to the member from Burnaby for straightening me out there.

We only have 23 of them in the province, and two are leaving. That in itself should be a reason for concern. In every letter that I have received from northern and rural parts of the province, their number one concern is losing specialists and doctors and putting more demand on fewer people. In my community we are served by nine doctors, and they all work extremely hard.

I have a copy of a letter sent from the Omineca clinic to the Premier, and the only thing it states is: "We urge you and the Health minister to enter into meaningful negotiations with the medical profession." That's all they're looking for: meaningful negotiations.

I see a smile from across the way and the thinking that perhaps they're playing politics. They may very well be. But I know each and every one of these people firsthand, and I can assure you and this House, hon. Speaker, that they're well-meaning people, and they do not enter into a politic role. I suggest, however, that on Thursday and Friday of this week, we'll see the doctors in Prince George, Vanderhoof and perhaps Fort St. James -- it wasn't confirmed earlier today -- walking out for two days. They're going to have a study session in Prince George. Historically those people have not been radical. Historically they have enjoyed the lifestyle of that area, they've enjoyed their positions in life, and they certainly work hard in order to give the residents the best possible medical care that they can provide. That is their goal. When I see them withdrawing their services for two days when they haven't done that in the past, that in itself tells me, without even going to those meetings, about the level of concern of those individual doctors. It is not like them to do that.

The last issue in this amendment is the capping of fees. I have spoken to many doctors. I have phoned several of them to try to get a handle on exactly what this means, particularly in a remote part of the province. I can tell you that each one of them has a different theory of what it would mean to them. There is no consistent theme among the ones I have spoken to -- there have been about a dozen -- as to what the capping will do. All of them are fearful. They're concerned that it will limit their opportunities to provide tests. They're concerned that it's going to expose them more to public liability, because they may have made a decision somewhere down the line not to order a test, in the best interest of saving money, and they erred. They could possibly err in that decision.

[ Page 3205 ]

That has been a concern with virtually every doctor I've spoken to, but they're really not sure how the overall capping is going to affect them. That in itself tells me there's a need to sit back and assess it, so that all these stakeholders have good knowledge of the intent of this bill, particularly that section.

The process has been talked about by members of my party and of the official opposition as well. Any legislation which takes time to develop usually is the best legislation. This legislation is being brought forward in the dying days of this session because this government finally decided that Bill 13 was raising too many hackles and causing too much flak for government. So they tried another avenue: bringing forward Bill 71. The members on the government side said: "Well, this has been around for a long time." Perhaps it has, hon. Speaker, but this government hasn't been around for a long time; this opposition hasn't been around for a long time; this House as we know it today hasn't been around for a long time. We have not had the benefits of examining this legislation -- not for more than about two weeks. Anything that's going to create new directions the way this bill is going to deserves a whole lot longer process.

I would encourage this government to address the financial aspects of this bill independently of the other issues within the bill. Every day that goes by -- the government knows and I know -- it's going to create a hardship for someone. So why not address the funding for 1992? Get that done and then allow us to go through a standing committee, a public process, and come back with a consensus not only of the three parties within this House but of the province as to what's in the best interests of health care. That is what I believe should be done and what I think many British Columbians believe should be done. I would urge the government to give it some consideration.

D. Mitchell: Mr. Speaker, I am pleased to rise and speak on this amendment. I wish to make some remarks about the amendment itself, which is the third amendment that has been moved in the second reading stage of Bill 71. But seeing that it is close to one o'clock and that the House desires to adjourn for an hour before coming back at two this afternoon, I would be pleased to move adjournment of this debate until later today.

Motion approved.

Hon. G. Clark moved adjournment of the House until 2 p.m. this afternoon.

Motion approved.

The House adjourned at 12:55 p.m.

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