1981 Legislative Session: 3rd Session, 32nd Parliament

HANSARD

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, APRIL 1, 1981

Afternoon Sitting

[ Page

4905 ]

CONTENTS

Routine Proceedings

Oral Questions

Mines inspectors. Mr. Segarty –– 4906

Dismissal of Bruce Donald. Mr. Macdonald –– 4906

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

–– 4907

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

Colenutt case. Mr. Macdonald –– 4908

Abbotsford veterinary laboratory. Mrs. Wallace –– 4908

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

On vote 156: minister's office –– 4909

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

Hon. Mr. Nielsen –– 4909

Mr. Cocke –– 4912

Hon. Mr. Bennett –– 4916

Mr. Hall –– 4917

Hon. Mr. Gardom –– 4919

Mr. Nicolson –– 4919

Hon. Mrs. Jordan –– 4920

Mr. Levi –– 4922

Hon. Mr. Vander Zalm –– 4923

Mr. Kin –– 4924

Hon. Mr. Nielsen –– 4925

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

section 6.

Mr. Cocke –– 4926

On the amendment to

section 6.

Mr. King –– 4926

Mr. Gabelmann –– 4927

Tabling Documents British Columbia Railway annual report, 1980.

Hon. Mr. Phillips –– 4 9217

Ministry of Consumer and Corporate Affairs annual report I'm the year ending

March 31, 1980.

Hon. Mr. Hyndman –– 4927

WEDNESDAY, APRIL 1, 1981

The House met at 2 p.m.

Prayers.

HON. MR. CURTIS: In the House today,

in the gallery and in the precinct on a tour are students from the

great constituency of Saanich and the Islands. It is the Islands

portion which is represented today with students from Gulf Islands

Secondary School accompanied by Mr. Bergstrome. Would the House make

them welcome.

MR. LEA: With us today in the gallery

is an ex-member of this House who served both as an MLA and cabinet

minister and served the public of this province for many years. I'd ask

you to welcome Dan Campbell.

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

Anyhow,

I'd like the House to join with me today in welcoming to Victoria a

young gentleman from the community of Kitimat, Doug Panton.

Oral Questions

MR. MACDONALD:

I don't see the Attorney-General (Hon. Mr. Williams). On a point of

order, it seems to me that a minister of the Crown should be in his

place, not in the precincts where he cannot be subjected to questions,

particularly at the present time. I'd like a ruling on that. What's the

use of a question period incorporated in the rules when the

Attorney-General, who has now committed

an act of serious public

consequence, does not appear to be responsible for his actions?

MR. SPEAKER:

The member knows full well not only the rules but the practice of the

House. I would suggest that perhaps during the 15 minutes allotted for

question period the minister whom the member wishes to question will

likely be here. Perhaps he could reserve his question until that time.

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

MR. SPEAKER: It's not a ruling.

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

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

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

MR. SPEAKER:

The member knows the rulings, standing orders and practices of this

House. They do not require a ruling, and to insist on a ruling is an

abuse of the forms of the House. We're in question period and time is

fleeting.

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

MR. LAUK:

On a point of order, according to the standing orders of this House

every member is required to be subject to the service of this House and

in attendance of this House when the House is in session. Therefore I

ask the Speaker to summon the missing cabinet ministers to their chairs.

MR. SPEAKER:

The member knows full well that the Chair does not have the authority

to summon people to this chamber. Up until this time the

interpretation

of the rule has been that members who are in the precinct are

considered to be in attendance of the House. I notice, hon. members,

that there are empty seats on both sides of the House, and I would

recommend we continue with what have been the practices of this House

to this day.

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

"6.

The presence of at least ten members of the House, including Mr.

Speaker, shall be necessary to constitute a meeting of the House....

"7.

Whenever Mr. Speaker adjourns the House for want of a quorum, the time

of the adjournment and the names of the members then present shall be

inserted in the Journal.

"8. Every member is bound to attend the service of the House,

unless leave of absence has been given him by the House."

becomes particularly important during the 15-minute question period,

when all members of the treasury bench should be in their places. We

always did that when we were the government. [Laughter.] It’s true.

Except when a minister was ill, we would all be present. I therefore

commend that to you, Mr. Speaker, as the provision by which the Speaker

has power to summon people to the attendance of the House.

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

HON. MR. McCLELLAND:

On a point of order, Mr. Speaker, I think the member has raised an

important point. I think the member might provide to this House a

written statement about where he was on March 11, 17, 19, 23 and 27.

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

MR. LAUK:

Even though it's not a legitimate point of order, that minister, if he

is implying that I was absent from the service of the House, has done a

dishonourable act. I ask him to withdraw.

MR. SPEAKER:

This is also not a point of order. I have reminded hon. members that

time in question period is fleeting. Is there a member who has a

question? I recognize the first member for Vancouver Centre; you have a

question.

MR. LAUK: On a point of order, I ask the

Speaker to demand that the minister withdraw any imputation that I was

not fulfilling my duties under standing order 8 of the rules of the

House.

MR. SPEAKER: Is there a question?

[ Page 4906 ]

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

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

MR. LAUK:

My point of order is that if the minister is imputing that I was absent

from the service of the House by making the statement that he made, I'd

ask him to withdraw that imputation.

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

MR. BARRETT:

Mr. Speaker, you made the reference that question period time was

fleeting. It is my understanding that the rules of this House are that

when points of order are raised they are not subtracted from question

period.

MR. SPEAKER: That is when the Chair has

intervened and whenever a lengthy statement is made which is perhaps

related to order in the House. I have asked on many occasions that the

time which the Chair has taken not be counted as question period time.

But, hon. members, the House can speak for itself. Is it the wish of

the House that the time we have utilized up to this point in points of

order not be taken from question period?

Leave not granted.

MR. BARRETT:

On a point of order, it is not the prerogative of the Chair at any time

to submit House rules to an arbitrary question of the House. Points of

order raised are points of order time; they have nothing to do with

question period. If you're ruling that points of order raised by any

member of the House subtract from question period, it leaves open the

whole question of the sanctity of question period. I would ask the

Speaker to reserve decision on this and come back with a ruling please.

MR. SPEAKER:

I will reserve decision. I will make this comment: to rule as the

member has required leads to an abuse of question period itself. A

question period could be distorted by continuous use of spurious points

of order, and the purpose of question period could be destroyed. I do

not think that that is the member's wish.

MR. BARRETT:

Mr. Speaker, that is exactly the point I wish to make. There are rules

governing spurious points of order. The point you made is that question

period could be distorted by spurious points of order, but that is not

the reason why it should cut into question period time; it is the exact

reason why it shouldn't. That is the danger to question period that I'm

addressing to the Chair.

MR. SPEAKER: I will reserve

decision. I will bring a decision to the House, perhaps with a

recommendation as to the procedure that should be used.

The second member for Vancouver East has a question.

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

SOME HON. MEMBERS: Oh, oh!

MR. MACDONALD:

I don't think it's particularly funny that a question period should be

cancelled, in effect, because we're practically through it. When this

order of proceedings was called, I rose on a point of order, because

the minister to whom the questions were to be directed was not in his

place. Somebody may say that is a spurious point if they want to;

nevertheless it was a point of order seriously made for the purpose of

conducting public business and scrutinizing the activities of this

government. It was a matter of substance. I wanted to ask the

Attorney-General questions, and the only way I could do it was by

raising a point of order. While that point of order relating to the

calling of question period was before Your Honour in the chair, the

time cannot be said to have begun to run.

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

MR. MACDONALD: Yes.

Interjections.

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

MINES INSPECTORS

MR. SEGARTY:

Mr. Speaker, I have a question for the Minister of Energy, Mines and

Petroleum Resources. With the amount of construction of new coal-mines

in the Elk Valley in the constituency of Kootenay, there is a need to

increase the number of mines inspectors in the municipality of Fernie.

The mines inspector at the present time is not able to keep up with the

demands on his time. I wonder if the Minister of Energy, Mines and

Petroleum Resources would be interested in doing a study on increasing

the staff at the Fernie office of the mines inspection branch.

HON. MR. McCLELLAND:

Mr. Speaker, we are experiencing this year in the ministry —

particularly in the mining sector of the ministry — a tremendous

growth, which of course places some severe restrictions on the

opportunity for the available staff to do their job. We have recognized

that in this year's budget, and there will be some significant

improvements in staffing. But as to the exact staffing numbers and

where they go, I'll take that part as notice and provide the member

with an answer about where that staff will be dispersed during the

course of our estimates.

DISMISSAL OF BRUCE DONALD

MR. MACDONALD:

I have a question for the Attorney-General, Mr. Speaker. There is a

private lawsuit going on, the Deputy Attorney-General against CBC and

Bird. The Attorney-General knows the case I'm referring to. Counsel for

the deputy is Mr. Peter Butler. Can the Attorney-General assure the

House that Mr. Peter Butler is not being paid directly or indirectly by

the government for his activities related to that case?

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

[ Page

4907 ]

MR. MACDONALD: The Deputy Attorney-General, in that

particular case, attended on examinations for discovery on four or five

occasions, when the evidence came out relating to Mr. Bruce Donald and

the release of certain public information. Did the Deputy

Attorney-General come back to the Attorney-General, report what had

been said by the witness relating to that matter — namely, Chris Bird —

and was that the information on which the Attorney-General acted,

leading up to the dismissal of Mr. Donald?

HON. MR. WILLIAMS:

Mr. Speaker, as I indicated yesterday — at least I thought I had; if

not I'll make it clear today — the information which I received some

two weeks ago or so was in the form of a copy of the transcript of the

examinations for discovery which was sent to me by Mr. Butler, in which

he indicated certain questions and answers which he thought significant.

MR. MACDONALD:

Did the Attorney-General question Mr. Bruce Donald on the phone in

March 1980 as to whether or not he was the source of this information

having come into the public domain? Was that conversation on tape? I

understand the Attorney-General asked Mr. Donald five questions at that

time, but did not ask him directly whether he was the source of the

information.

HON. MR. WILLIAMS: I had a telephone

conversation with Mr. Donald on March 8, 1980 — if my recollection is

accurate. As to whether there were five questions posed, I would have

to check my notes of that discussion. Yes, I asked Mr. Donald directly

if he was the source of information.

MR. MACDONALD:

Did the Attorney-General see Mr. Donald on Friday last, and did Mr.

Donald not say that he had not lied to the Attorney-General? Contrary

to what the Attorney-General said yesterday, he defended himself and

said: "I did not lie with respect to that matter." Is that not the case?

HON. MR. WILLIAMS:

I met with Mr. Donald last Friday afternoon. I never accused him of

lying. I simply asked him whether or not the evidence that was given by

Mr. Bird in the examination for discovery was accurate. He said that it

was substantially so, although he corrected some of what he considered

to be errors in the responses of Mr. Bird. I said to him that in March

1980 he had responded to questions that I posed to him and that those

responses were not accurate.

As to whether he had given the

document to Mr. Bird, he says he did not give it to him. He admitted

last Friday that he had engaged with Mr. Bird in the establishment of a

scheme whereby the document would be put in a place and Mr. Donald

would make Mr. Bird aware of where that place was and the means of

access to it. As a result of this, Mr. Bird got the document. Does it

have to be a semantic argument?

MR. MACDONALD: I take it that the Attorney-General is not accusing Mr.

Donald of lying then, and I'm glad to have that assurance. Nevertheless, right

from about March 1980, did the Attorney- General not take legal advice as to

whether or not there wasn't some way he could get rid of Mr. Donald, because

he was embarrassing his department and was very upset about how the Attorney-General's

department had handled two particular prosecutions?

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

OMBUDSMANS COMPLAINT ON

BEHALF OF RESIDENTS OF DAISY LAKE

MR. BARRETT: I have

a question for the premier. I ask the Premier's response to the

ombudsman, who has publicly expressed his frustration at the lack of

response to his representation on behalf of Garibaldi residents living

near Daisy Lake. Has the Premier decided to take any action in response

to the ombudsman's complaint'?

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

MR. BARRETT:

Is the Premier aware that the Minister of Environment (Hon. Mr. Rogers)

has already stated that it was none of the ombudsman's business to

interfere with high cabinet policy. Can the Premier assure this House

that no cabinet minister has the right to instruct the ombudsman as to

what issue he may or may not comment about'?

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

MR. BARRETT:

Can the citizens of British Columbia be guaranteed that no cabinet

minister will interfere with the decision of the ombudsman as to what

issue he wishes to address himself or the cabinet to?

HON. MR. BENNETT:

No cabinet minister has interfered with the ombudsman, and I anticipate

no cabinet minister will interfere with the ombudsman. The government

will develop policy, and we look forward to receiving advice from many

people, including the ombudsman, but particularly from the citizens of

B.C. directly affected. In the case brought to mind, I myself have been

personally involved in interviewing some of the people, who were

reassured when I talked to them.

MR. BARRETT: I wish

to make this point perfectly clear, and I ask this question of the

Premier. Can the Premier assure the people of British Columbia that the

ombudsman is perfectly free to bring to the attention of the public or

the cabinet any issue he feels that, in the service of his office, it

is necessary for him to bring to the public's attention and the

government's attention?

HON. MR. BENNETT: Mr.

Speaker. I expect the ombudsman will be governed by the act under which

he was appointed, and the government will also be governed by the same

legislation.

OMBUDSMAN INVESTIGATION INTO

ELECTORAL REDISTRIBUTION INQUIRY

MR. MACDONALD: I

have a supplementary question. In addition to the questions that have

been asked by the Leader of the Opposition, I ask the Attorney-General

if he was approached by the ombudsman for a legal opinion with respect

to a particular investigation. If so, when was he so approached and why

has that particular inquiry into electoral redistribution and what

proceeded from it — namely, the Gracie's Finger matter — not been

allowed to proceed?

[ Page 4908 ]

HON. MR. WILLIAMS:

I had a discussion with the ombudsman with respect to that matter, but

it is not within my area of responsibility or jurisdiction to dictate

to the ombudsman whether he should or should not proceed with any

investigation. He does so in accordance with the provisions of his

statute.

MR. MACDONALD: Did the Attorney-General

offer any opinion whatsoever to the ombudsman as to whether he should

proceed with that particular investigation?

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

COLENUTT CASE

MR. MACDONALD:

Mr. Speaker, I have a question for the Attorney-General, of which I

gave him notice. A Mr. Colenutt of Vancouver was arrested on May 1,

1980, at 5 o'clock in the morning, although he had lived in his house

for six years, was working steadily, there was no police record and the

police protested at the arrest warrant that was issued. Why has there

been no public inquiry? There has been an investigation under the

Provincial Court Act. But why has there been no public inquiry into

whether or not there was bias on the part of a justice of the peace in

effecting that particular arrest and having a psychiatric examination

of Mr. Colenutt ordered?

HON. MR. WILLIAMS: Mr.

Speaker, the matter to which the member refers falls within the

provisions of the Provincial Court Act and the Police Act of British

Columbia. A complaint was made by Mr. Colenutt to the police, and that

was dealt with in accordance with the Police Act, and it is my

understanding that it has not been pursued.

With respect to

the investigation undertaken by the provincial court judge, it was

drawn to my attention in a letter from Mr. Colenutt on February 15 this

year. I responded that he should request the chief judge of the

provincial court to examine the matter further. I understand this has

been done.

Precisely what the outcome of that has been I

cannot advise the member, because the chief judge is out of the

province today; he will return this evening. When that occurs I will

ascertain from the chief judge the basis upon which he is continuing

the inquiry or not, as it is his responsibility under the act to do,

and at that time consideration can be given as to whether or not an

inquiry should be ordered. The inquiry of which the member speaks is

not a public inquiry as provided for under the Provincial Court Act.

MR. MACDONALD:

What I suggested wasn't an inquiry at all; it was an investigation

under

section 15. There's been no public inquiry whatsoever into this.

ask the Attorney-General if it is normal that a citizen in the

circumstances I've described, without any record, who had freely

confessed the facts of the incident, who had lived in that same place

and worked steadily for years, should be subject to a warrant of

arrest. Is that normal procedure, or does it indicate that there was

something very seriously wrong?

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

MR. MACDONALD:

No, I'm asking if that is the practice. Or does that indicate there was

something seriously wrong where the Attorney-General should have acted?

HON. MR. WILLIAMS:

As the member will I know — or he should have known, having been the

Attorney-General of this province — I would suspect the nature of the

process taken by the police would be dictated by the nature of the

offence.

MR. MACDONALD: Is it normal that a citizen

in those circumstances should be subjected on his arrest to psychiatric

examination when there was nothing to indicate that such was called

for? Who ordered it?

HON. MR. WILLIAMS: The member

indicates that he is possessed of information of which I am not. The

basis upon whether a psychiatric examination takes place will depend

upon the conduct of the individual who's arrested.

ABBOTSFORD VETERINARY LABORATORY

MRS. WALLACE:

I've a question for the Minister of Agriculture. It has come to my

attention that the cattle in Cowichan-Malahat are dying from what

veterinarians believe may be a deficiency of selenium in their diet.

Attempts to determine what is causing the problem are seriously

hampered by the long delay in obtaining test results from the

government veterinary lab in Abbotsford because of understaffing and

budget cuts. The addition of a temporary assistant as of today will not

provide adequate relief. I would like to ask the minister: will he

assure the House that he will take immediate steps to provide adequate

staffing to eliminate the severe backlog of work in that laboratory?

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

HON. MR. HEWITT:

Mr. Speaker, I'm not aware of any delays taking place, but I'd

certainly be pleased to check it out to ensure that we give proper

service to the agricultural community.

MR. SPEAKER:

Hon. members, there have been questions in the faces of some who asked

about the length of question period. Whenever a decision is reserved,

it is without prejudice to whatever order is in progress. Since

question period was in progress and a decision was reserved, the Chair

asked for the time to run the full 15 minutes. I trust that meets with

the approval of the House.

MR. LAUK: On a point of

order, Mr. Speaker, under the pressure of confusing points of order,

when I rose, I rose under standing order 38. I point out to Mr. Speaker

standing order 9. Mr. Speaker ignored the point of order that I raised.

I point out that under standing order 9 "Mr. Speaker shall preserve

order and decorum, and shall decide questions of order...." It's not

discretionary whether the Speaker decides whether or not there is a

point of order. He must make a ruling whether or not it's properly

within the standing orders, number one; and number two, he shall decide

the point of order. It's not discretionary and I point that out, with

respect, to the Speaker. The only point that I was rising on was to

correct any false impression given by the Minister of

[ Page

4909 ]

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

Interjections.

MR. SPEAKER:

Order, please. I will address myself to the part of the point of order

which was directed to the Chair: that is, whether or not the Chair must

determine whether or not a point of order is indeed a point of order.

That authority does rest with the Chair, else it would not be decided

what is a spurious point of order and what is a fraudulent point of

order. Therefore that power does rest and must rest with the Chair.

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

Leave granted.

MR. LAUK:

Mr. Speaker and hon. members, in the gallery today are chairman Pauline

Weinstein and many members of the Vancouver District School Board. On

behalf of the members for Vancouver South, Little Mountain, Vancouver

East, Vancouver–Point Grey and Vancouver Centre I'd like to introduce

Pauline Weinstein and Tom Alsbury and the other trustees — Wes Knapp,

Philip Rankin, and staff. I ask the House to give them a warm welcome.

Orders of the Day

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

ESTIMATES: MINISTRY OF

MUNICIPAL AFFAIRS

(continued)

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

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

The House resumed; Mr. Speaker in the chair.

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

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

MEDICAL SERVICE PLAN ACT, 1981

HON. MR. NIELSEN:

In speaking to Bill 16, the Medical Services Plan Act, I would like to

offer some information to members in the House and to those who may not

be as familiar with the circumstances which, in part, have lead to the

introduction of this legislation for consideration of the members.

Mr. Speaker, the concept of medical insurance, or medicare as we know it in

our province today, has a history of a significant number of years. For a large

part of that period of time, there have been a series of agreements between

the two principal parties involving the medicare program. The principal parties,

over the last 20 or 25 years, have gone by various names. We recognize the names

of the principal parties today to be the British Columbia Medical Services Commission

and the British Columbia Medical Association. In some years other terminology

was used.

early as the mid-1960s, there was a term used in the agreements that

referred to additional charges, additional billing or additional

moneys. Various phrases were used with respect to any amount of money

which a patient may pay to a medical practitioner in excess of that

which has been agreed to by the principal parties of the agreement.

Later renditions of the agreement elaborated somewhat on this concept.

believe in January 1971, these words were elaborated upon even further.

Terminology was used and described to express what is referred to as

"balance billing," "extra billing," "extra charging," "differential

billing" and other terms of the agreement. I would suggest that a

lay-person reading the language of that agreement would find it very

difficult to understand the differences between the various terms, and

perhaps even what each term specifically meant; although I know a

legally trained mind probably would have very little difficulty

appreciating the language.

The updating of that agreement

next occurred, I believe, in 1974. The

section which deals with this

situation whereby extra billing could take place was included, as it

had been in 1971. It was continued.

Many citizens in the

province today find it somewhat difficult to appreciate and understand

what this terminology — "extra billing" or "balance billing" — might

mean. There is an additional expression now finding its way into the

vocabulary of Canadians, and that is "patient participation." I believe

that some ad-man probably came up with that expression, because it

sounds as though it's something you probably would enjoy. Basically,

"patient participation" means that a patient would have the opportunity

of participating directly in the payment for those services he may

receive.

The problem before those who are responsible for

the delivery of medical health services in the country — those who are

responsible with respect to government action.... Right across Canada

today, the provinces and the federal government are concerned about

what is occurring in the medicare plan. The Federal Minister of Health,

Monique Begin, has indicated that she is very concerned that continuing

moves toward balance billing, extra billing or whatever terminology may

be used. endangers the concept of medicare. The federal minister has

indicated that in the future the federal government will probably

develop very rigid positions with respect to the participation of any

province which may permit balance billing, extra billing or similar

programs under their medicare program.

The federal minister

has not communicated that information directly. It has reached various

provincial governments indirectly through the media. It would appear

that the federal minister is perhaps suggesting what we may see at the

next round of bargaining, with respect to various cost-sharing

arrangements with the federal government.

In British

Columbia I have stressed over the past few months that while

negotiations were underway between representatives of the Medical

Services Commission and representatives of the British Columbia Medical

Association — the negotiating teams — the government of British

Columbia has a great respect for the medical practitioners. In no way

should it be considered that we are fighting the medical practitioners.

We were engaged indirectly, by way of our negotiating team, with the

negotiating team on behalf of the

[ Page 4910 ]

British

Columbia Medical Association in attempting to reach agreement on a new

fee schedule. My understanding in the reports to me was that the people

who made up those teams were conducting their negotiations in a

responsible and professional way. The government, Mr. Speaker, is not

directly involved in the negotiations where representatives of the

government are actually bargaining. It is the Medical Services

Commission who are actually conducting the bargaining; the government,

of course, is responsible for the Medical Services Commission and also

for the settlement that may be achieved.

During those

negotiations which occurred during the fall and winter months of last

year a series of meetings had been scheduled. The entire demands of the

Medical Association were presented to our negotiating team. They were

responded to by the members of our negotiating team and many problems

were resolved, many modifications were suggested, and there was a

certain amount of give and take, as negotiations demand.

the question of the fee

schedule adjustment, Mr. Speaker, I'm advised

by our chief negotiator that that which was sought by the British

Columbia Medical Association was calculated to represent a 47.8 percent

increase over the printed

schedule fee, or the

schedule fee of 1980.

The representatives of the British Columbia Medical Association

interpret their increase demand to represent approximately 41.6

percent. I'm quite prepared to suggest that the answer perhaps lies

between the two figures, because of the lack of exact science in

calculating costs and because there is no way of determining precisely

what medical services will be conducted for one year's period of time,

but I think that we can agree that the demands of the British Columbia

Medical Association, as put to our negotiating team, represented a

global fee increase between 41 percent and 47 percent or fractions

thereof.

After all the smoke had settled and negotiations

reached a conclusion, our representatives on the negotiating team

finally offered a global figure of 15.2 percent. Representatives of the

British Columbia Medical Association had agreed and followed through by

presenting that figure to their members — to the practising physicians

or the medical people. The process took many weeks before a response

was known, and we had been advised that it would take a period of time

for the 4,000 doctors — or whatever the precise number is — to respond

to the referendum. Mr. Speaker, the referendum stated basically: "Are

you in favour of the offer — yes or no?" Included in the literature

which was distributed to the medical practitioners was a suggestion

that they should not vote on the offer until the president or the

executive director of the BCMA or their legal representative had the

opportunity of speaking with them. Included in the information which

was distributed to the medical practitioners was a series of

statements, one of which suggested that to reject the offer did not

force a medical practitioner to balance bill. Another suggestion was

that balance billing would be a way to force the government to come up

with more money. It was also suggested that there was more money

available. It was emphasized several times that rejecting the offer did

not commit any practising physician to balance bill.

Mr.

Speaker, I would suggest that in my opinion the information which was

sent to doctors offered a good case for not accepting the 15.2 percent,

but I think it's very important that the question put to our physicians

in British Columbia did not ask them if they were demanding 47.8

percent or 41.6 percent, but rather: "Do you accept 15.2 percent?" They

overwhelmingly said no — to the surprise, I'm sure, of no one. In fact,

I was advised at approximately 11 p.m. March 30 this year that the

doctors in British Columbia who are members of the British Columbia

Medical Association voted 93.71 percent against accepting the offer of

15.2 percent; in addition, 86.5 percent of the doctors indicated that

they would consider the concept of balance billing at their discretion

as of April 1.

Mr. Speaker, it was my belief for a period of

time that the provincial government or the Medical Services Commission

would be advised of the outcome of the vote by the members of the BCMA

at noon, March 27. I had been advised of this by our negotiators, and

it was also the belief of the chairman of the Medical Services

Commission. I was also told that this has been the tradition, although

I didn't have the opportunity of confirming that.

I believe

it was on the twenty-seventh, or perhaps the twenty-sixth, when we were

advised — at least the information reached me — that the information

would not be made available on March 27, but rather the week following.

I attempted to see if it would be possible for me to receive the

information, as Minister of Health, either on the Friday or perhaps the

Saturday, so that I might have the advantage of knowing the results of

the vote and could seek opinions from my colleagues as to what

alternatives the government might consider. I was unable to obtain that

information on the Saturday. I did not have the opportunity — nor did I

make the attempt — to receive it on theSun day, but I was advised that

the information would come to me by telephone on Monday evening. A

suggestion had been made that perhaps it would be better to personally

communicate the information, and that occurred, as I mentioned

previously, at 11 p.m. last Monday. The representatives of the British

Columbia Medical Association met with me and two of my colleagues to

present us with the information.

I know that this subject is

highly controversial and is receiving a tremendous amount of attention

throughout the province and probably across the country, but there are

a number of facts of the matter which I think members of the House

should be aware of. At the meeting last Monday evening, upon receiving

the letter addressed to Dr. David Bolton, who is chairman of the

Medical Services Commission, which advised Dr. Bolton of the result of

the vote, representatives of the British Columbia Medical Association,

two colleagues of mine and I discussed the opportunity of any

alternatives to what was apparently being demanded, in part, in the

letter. The final paragraph says: "In accordance with clause 5 of our

agreement with the commission, our members are now at liberty under the

terms of the agreement consented to by government to commence balance

billing effective April 1, 1981."

I asked representatives of

the BCMA if there were any alternatives they might suggest, other than

balance billing, to begin April 1. I was advised by the representatives

that the alternative, authorized by way of a motion of the BCMA board

that evening, for them to give to government was basically that, unless

government or the commission agreed to meet the association's

schedule

— their fee guide — and unless any future agreement retained the

protective clause.... The protective clause they referred to was 3(

e) of the agreement which basically says that extra billing shall not

occur if the offer of the commission equals 90 percent of the

association's demand, or words to that effect. We were

[ Page

4911 ]

advised that this was their minimum position. If

the government or the commission were to accept the demands of the

association, which we interpreted to be 90 percent of 47.8 percent —

which perhaps the association interprets as 90 percent of 41.6 percent

— and we guaranteed that this so-called protective clause would be

continued in any future agreement, then they would not invoke balance

billing on April 1.

I might add that this was for a very

good reason. If we agreed to 90 percent of their demands, we would have

an agreement. Therefore the balance billing would not come into effect.

I asked if there were any other alternatives. I was advised that the

board offered them no other mandate than making this demand to prevent

balance billing. I asked if there was any room for negotiation or

arbitration. I was advised that the only mandate provided to the

spokesmen was, as they previously advised, that unless the government

or the commission agreed to meet the association's

schedule and any

future agreement retained the protective clause, then balance billing

would occur effective April 1, 1981.

I think it's important

for those persons particularly concerned about this situation to know

that members of the cabinet who met with the BCMA did not — as I was

asked today — threaten the BCMA with legislation, nor did any of the

members threaten the BCMA with anything. We were not in a position to

make a counteroffer, because we had been advised by the representatives

that they were not in a position to negotiate. So no counteroffer was

made. I attempted to recite very carefully for my own edification what

they were demanding of us.

We were advised that negotiations

were acceptable at any time, except the minimum required would be

balance billing but they had no mandate to offer more than that at that

time. We accepted their information; we accepted the letter. It was

decided the next day to respond by this legislation.

The

legislation before us basically provides that the terms of the

agreement which expired March 31, 1980 be continued for an indefinite

period until such time as, by way of negotiation or arbitration, a new

agreement is achieved. During that period of time, Mr. Speaker, the

legislation prohibits the concept of extra billing, balance billing or

extra charging. A physician who is a participant in the plan and who

would choose to extra-bill, balance-bill or extra-charge could be

removed from the plan by the commission. Any charges to patients by

that physician would be available through the Medical Services

Commission as a direct payment to the patient, rather than to the

medical practitioner.

The present regulations and plan

provide the opportunity for a physician to opt out of Medicare. That

has been the case for as many years as I understand the plan to have

been in effect. There was a remark by a former Health minister in

British Columbia, Ralph Loffmark, to the effect that the clause which

seems to have caused so much difficulty of late was introduced to allay

the fears of doctors that perhaps they may be forced to provide medical

services under a medicare plan. I interpret that to mean that there

would be an opportunity for doctors to have a choice and to opt out of

the plan. That opportunity is before them, and it always has been

before them.

The clause referred to, the one which seems to

permit balance billing, is a very different clause and a very different

philosophy. I think the difficulties of that clause have been

recognized by many people now. When it was introduced in its earliest

days, perhaps there was the thought that it would never come into play.

But the clause is so awkward: it simply permits one of the two

participating principals to make such an excessive demand that the

other could not respond to that by achieving 90 percent. Therefore.

according to the clause, balance billing could then occur. because it

is expressly prohibited if 90 percent is achieved. When one side is

asking for what amounts to 47.8 percent, I think it could be understood

that the Medical Services Commission would have great difficulty in

coming up with 90 percent of that. Thus, according to some legal

opinion, balance billing may occur.

In the negotiations

between the Medical Services Commission and the BCMA, the commission

does not attempt to advise doctors as to what the fee should be for

specific medical procedures. The Medical Services Commission believes

that the BCMA is perhaps in a better position to determine the relative

values of certain medical procedures. Basically, the negotiations

involve a global increase in the medical services payments which will

be made. with the Medical Association able to determine any

equalization or equity of payments for various medical procedures. This

must be vetted by the B.C. Medical Services Commission, but basically

it is the BCMA who are given that opportunity to determine how that

global amount of money will be distributed. We believe that's probably

the best method.

We do receive complaints from some medical

practitioners that perhaps a general practitioner should receive a

higher increase than a specialist, or vice versa. In the negotiations

this year it was recommended that, indeed, there would be a higher

percentage increase for general practitioners than for specialists.

Going

back to the bill in some detail, as I mentioned, the legislation

provides for an extension of the present agreement and the present

rates. at least to this time. It also prohibits the practice of extra

billing, balance billing or extra charging, and permits that

negotiation could continue. It permits that arbitration could be

brought in by order-in-council by order of the cabinet, and permits the

cabinet a certain amount of ability to determine the terms of reference

in effect of the arbitration board or the arbitrator. An example would

be how long it may take to come up with a resolution of the problem of

the medical-fee services. It also provides, with the ability of the

commission, to have a doctor no longer part of medicare should he

choose to violate other sections of the bill. It also provides the

opportunity of reinstating a practising physician.

Most

importantly. the legislation specifically says that any agreement

achieved through negotiation, arbitration or whatever method may be

available under the act shall not include the ability of extra billing,

balance billing or extra charging. The reason for this is that it was

felt by myself and others that the problem is not just one of today but

one of future agreements as well. If we were going to move in a

legislative manner to prohibit extra billing, balance billing or extra

charging this year then it would be foolish not to ensure that the

problem will not occur year after year.

I want to indicate

in the strongest terms that the government and the Ministry of Health

do not consider themselves to be engaged in a fight with doctors. We

believe the negotiations which took place during the fall and winter

were legitimate negotiations and were conducted in good faith. That we

were unable to reach an agreement is not that unusual in any form of

labour-management negotiations. We were unable to reach an agreement.

The offer was put to the members and it was rejected. Therefore we must

look to whatever alterna-

[ Page 4912 ]

tives

are available. We were advised by representatives of the British

Columbia Medical Association on Monday evening that apparently

negotiation was not an alternative nor would arbitration be an

alternative. The only alternative is: "Please agree to our demands and

guarantee us the right to extra bill in the future should we deem it to

be necessary." We chose what we felt was a reasonable alternative for

government, and it is before us — Bill 16.

I believe we can

achieve an equitable settlement with the British Columbia Medical

Association and the doctors they represent. I don't believe it's

necessary for spokesmen for government, the Ministry of Health, BCMA or

others to indicate that medicare may be at the point of destruction. I

think we're into a situation whereby we must achieve a settlement

through some method which is available to us. I'm not quite sure what

that method may be other than the method which is provided for in the

legislation.

I might report to the House that I have had no

communication from the BCMA since our meeting Monday night. My

understanding was that the Monday night meeting indicated the only

mandate they had to offer was that we accept their demands and

guarantee that balance billing could occur in the future. We responded

by introducing Bill 16.

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

have one final point. In speaking with the negotiating team over the

last number of months I was advised that for much of the time in

negotiations it appeared that a settlement was possible and that a

percentage of increase in the fee

schedule could be agreed to. In this

type of negotiation, of course, the numbers are never constant. There's

give, there's take, there are modifications throughout. I was told by

our negotiators that it appeared a settlement was within reach at one

time, and then suddenly they detected what appeared to be a change in

attitude. My negotiators advised me that they felt at that time it was

clear an agreement could not be reached based on a percentage increase.

For the first time it became evident to them, in their opinion, that

the purpose of this year's negotiations was to see that balance billing

began, and the negotiations ended.

MR. COCKE: Mr.

Speaker, it's a sad day that we have to arrive at a conclusion of

negotiations in such a manner as we are doing now. I think probably the

unfortunate part of the scenario is that all we hear is one side of the

negotiation process. The minister didn't sit in on those negotiations,

of course; he was informed. I think what we are looking at today really

is almost like the result of what happens when an irresistible force

meets an immovable object. Put yourself on either side of that

equation, on either side of that table, and hence we are here.

Mr.

Speaker, I certainly agree that in a province where we are now paying

35 percent of the entire cost of the medicare system, courtesy of the

government of the day, to expect the patient to pay at the other end of

the line would be expecting far too much. As far as I am concerned,

extra billing, balance billing, double billing or any other kind of

billing is totally unacceptable to this party, and that's our policy.

would like to underline that statement by reading to you a portion of

an order-in-council passed on June 6, 1974.

Section 3(3) of that

order-in-council said as follows: "Subject to subsection (2), where a

practitioner renders an insured service to an insured person he shall

not be entitled to receive in respect of that service a fee in excess

of the prescribed cost under the

schedule of costs in relationship to

that service." That very definitely put our position on the line.

have been upset over the last while upon listening to the radio and

reading the papers from time to time, and have noted that I have been

charged as the one who introduced this question into the agreement.

Now, of course, the Premier has told us — and, as a matter of fact, I

have the 1971 agreement — that it was introduced by Ralph Loffmark, or

the commission that he was responsible for. Poor Ralph — it wasn't him

at all, it was Wesley Black, because in those days the Provincial

Secretary was the minister responsible. That changed, as we all know,

when we reorganized the whole medical service of the province — in

Victoria, in any event — and moved medicare to where it rightfully

belongs in the Ministry of Health. Anyway, Mr. Speaker, I'm certainly

not going to dwell on that.

I agree that this kind of

provision means that one can make an inordinate demand. If the

government, commission or whoever is responsible cannot meet that

demand within 90 percent, then we go to extra billing or balance

billing. Certainly we support the situation. We also support the

situation where a doctor in free enterprise B.C. who wishes to opt out

may do so. In la belle province, the province of Quebec, if a doctor

opts out the medicare commission doesn't pay a dime. So really we are

being more than fair here with a patient. However, a doctor is not

likely to do as well, in my view, if he or she opts out.

Mr.

Speaker, as I stand here now, having listened to Dr. Mandeville for the

last number of days say on every level of media, "I have been

double-crossed," I am wondering just precisely what Dr. Mandeville

means by "I" or "we" have been double-crossed.

Does it mean,

Mr. Speaker, that he was under the impression that the doctors would be

allowed to extra-bill, and that there has been some kind of a change of

heart, strategy or what have you, of this government that would bring

him to a point in time and a place where he would say: "I have been

double-crossed" or "we have been double-crossed"? Was he ever given an

undertaking or was he ever given the impression that they would be

allowed to extra-bill? It is very strange that we are at a point in

time when we have seen a change of ministers at the crucial point. So I

wonder, could that have contributed to the resignation of the former

minister? I just wonder because I keep hearing it, including this

morning on that great public network, the CBC, which is not even

remotely related to General Motors, Mr. Member for Dewdney (Mr.

Mussallem). I would just like to know why he keeps saying it.

Why

do we oppose extra billing? Let me put it very clearly: we didn't have

access in 1974 when we made the decision about what has been referred

to as Canada's national-provincial health program for the '80s, and

this is dubbed the Hall commission report. The Hall commission report,

in part, states a number of reasons one would be opposed to extra

billing. To modify any position that he might take prior to stating why

his opposition to extra billing, Justice Hall says: "The state has not

the right to conscript the services of physicians. The efforts to

harmonize those conflicting concepts have been unsuccessful in every

province." He goes on to talk about his solution, and in talking about

his solution he quotes the Stoddard-Woodward study. What did that study

say? That study said: "The effect of extra billing on patients' access

to care and attitudes toward the Ontario

[ Page 4913 ]

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

"In

areas of Ontario where there is a relatively high general practitioner

opting out and medium- to high-specialist opting out, approximately

one-third of the households have experienced extra billing by

physicians. A comparison of income of households which have and have

not experienced extra billing supports the suggestion that physicians

with relatively high income patient populations are more likely to opt

out and extra-bill their patients. Some households respond to extra

billing by using multiple physicians. They may go to another general

practitioner who has not opted out."

But in

any event, what they did find here was that the low-income people, the

elderly, the people with fixed incomes — most often in need of the

services of physicians — were the ones most affected.

Now they did a survey:

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

"Sixty

percent of those extra-billed indicated that they would be embarrassed

to ask a doctor to reduce his fees. There was no difference between the

poor and the non-poor in that particular question. There was no

difference between the poor and the non-poor in terms of attitude.

"The

poor who are extra-billed are significantly more likely to report that

they have reduced utilization or delayed in seeking medical care

because of the cost.

"In the absence of extra billing no difference was seen

in the proportion of poor and non-poor delaying or failing to see a doctor because

of the costs. Nearly twice as many poor as non-poor report the cost of doctor

services creates a financial problem for them."

On and on it goes. It goes to a point where Mr. Justice Hall says: "I totally reject the idea that physicians must accept what

any given province must decide unilaterally to pay." Having gone all through his opposition to extra billing, he says that he rejects

the fact that there should be compulsion.

We're in the same position. We reject it. We also listen to what's

going on in the province. We've heard from 70,000 members of the

federated council of senior citizens whose representative body voted

against extra billing. We've heard from the 100,000-member Royal

Canadian Legion (Pacific Command) and their representative body voted

against extra billing. We've heard from such allied professionals as

the RNABC — the Registered Nurses Association of British Columbia — who

opposing extra billing. We're offended by the thoughts of doctors'

offices being equipped with Master Charge and Chargex. We are totally

in opposition to this form of billing.

We see before us a situation that is most unfortunate. I go

back to June of last year, and I noticed the headlines "Doctors Unveil

Drive for More Money," and "Patients Will Pay if Victoria Balks."

That's one of the first headlines, and that was a number of months

before negotiations. I thought the strategy then was not all that

great. I thought the doctors, who were enunciating the policy of the

association — that is leading their strategy — got off on the wrong

foot. I don't think that was a great way to start off, saying that if

we don't get our way, we're going to extra-bill. That is unfortunately

how it happened. That was the foot we were off on long before the

association did any real negotiating.

Mr. Speaker, am I to

believe that Dr. Bud Lott and his group presented to the

representatives of the medical commission such a hard-line position

that there was no possibility of negotiations? It's almost

unbelievable. I believe that the vast majority of physicians in this

province wanted a negotiated settlement. I believe it was achievable,

and I'm very sorry that their ends were not met by what occurred

subsequently. Of course I've heard from the minister, but also from

those very close to the negotiations, that the government was guiding

their negotiators — that is the negotiators of the commission — in a

very tight way. In other words, I believe there was a great deal of

resistance of both sides to make any kind of deal. I've also heard the

rumour that they were close at one point. That rumour also includes the

fact that there was more on the table for a moment. Obviously something

happened, and it didn't occur.

I have gone through

editorials and news stories from all over this province, and read

letter after letter, and people have been advising for a long time that

we were in trouble in this respect. At all costs we must conserve

medicare — this most productive form of payment and receiving services

from physicians. We thought the fight was over in 1964 when Tommy

Douglas fought it out in Saskatchewan. Now we're back to fighting

again. On that first

part I will suggest that we would be most opposed

to extra billing.

I want to ask some questions about this

legislation. I believe, in the first place, that this legislation could

have included — or could have been used as and might yet be used as — a

means to get negotiations going again, rather than resorting to any of

the aspects of this, other than the aspect of getting rid of extra

billing as a threat. I believe that the doctors should have been

offered some form of arbitration before this whole piece of legislation

was brought in. The Hall commission suggests arbitration, but it

doesn't suggest the clause that's in this bill.

Section 6 of this bill

isn't arbitration at all.

Interjection.

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

MR. LEGGATT: My way or no way.

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

They

even have the nerve to dub it the "arbitration" section. It's not

arbitration., The cabinet appoints an arbitrator or an arbitration

board, dictates the terms, provides the turf, and then they wonder why

the doctors arc a little bit peeved. How would you feel if you had had

your legs cut off at either the ankles or the knees — at some joint,

I'll tell you.

[Mr. Davidson in the chair.]

took time out today — we've only had one day to really study this — and

I talked to a number of people who have done a number of arbitrations

over the years, some of the most outstanding mediators and arbitrators

in the province. When I read the

section to them they say: "My, that

certainly is a one-sided sort of affair, There is no room in this,

unless the government gets up today and says there is some way that

they're going to give a commitment that the arbitrator or arbitration

board be negotiated."

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

[ Page 4914 ]

forward

an amendment in committee and amend this section." In amending that

section, then they've got to go to the last

section of this bill; that

is more tyranny. This is the trouble the opposition has with this

government. They bring in a basically good principle: that is, the

principle of protecting the people from extra billing. But then they

make such a tyrannical implementation that it's very hard to justify

and very difficult for us to live with. It's a government of extremes.

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

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

far as I'm concerned, if they bring in a proper arbitration system....

I've got something here to help the Attorney-General (Hon. Mr.

Williams) or the House Leader (Hon. Mr. Gardom), if they would like to

have a look at it. I'd recommend the education system of arbitration

where each side has a chance to pick a person and those two have to

agree on the chairperson. What's wrong with that? What's wrong with a

little democracy? It's good enough for the education system, but it's

not good enough for this government. I wonder what would have happened

in the education system if this power-hungry group had a chance to redo

what was done years ago in arbitration for the school teachers. Heaven

help them!

Mr. Speaker, I have the greatest respect for the

medical community of this province, and I don't see why the medical

community of this province should be treated as shabbily as they're

being treated in these two sections of this bill. That regulation

section of this bill could very easily be amended. All you'd have to do

is delete (a), (

b) and (d). That makes it reasonable. The

Lieutenant-Governor can regulate the rest of it. But just to give you

an idea, suspending or varying provisions of an agreement in the

process....

What is an agreement, when a cabinet by

order-in-council can suspend or vary the provisions of that agreement

unilaterally? Mr. Speaker, we have had experience with what this

government does with that kind of tyrannical power. Will we vote

against this section? We sure will, unless the government will use

their noggins now and give us an undertaking that they're going to

amend. We can provide the wording, because the wording is in many old

acts.

Mr. Speaker, this is a very serious situation, an

extremely serious situation, a situation that can develop into the kind

of confrontation and antagonism that we see today. I can show the

ministers, who are responsible for legislative drafting, a number of

acts; but I just take them to the education act — that one would do. As

far as

section 8 is concerned, all you have to do is a little deleting,

and that deleting will do just fine, thank you.

Mr. Speaker,

there is one other way, but I think it's a little too — as some of my

colleagues might say — loose, and that is where the parties agree to

accept an arbitrator, and failing an agreement among the parties they

go to the chief justice. In a way, that's the Hall commission, except

that he starts with the chief justice. But in any event, if the

government could give us some sort of an undertaking that they're going

to amend, this House can be very happy that we'll proceed with the

legislation, the government can get on with other business and the

doctors and the Medical Commission can hammer things out.

Now,

Mr. Speaker, let me suggest some aspects of what I see. I have been

careful not to suggest that the doctors were asking too much up until

today or that the government was offering too little, because

negotiations were in process. I suggest that if you go across this

province, you will find that the doctors have been seen to be getting

too little in the offer of the government; they have an extremely good

case for getting more.

MR. BRUMMET: How much would you give them?

MR. COCKE:

Mr. Speaker, the member for North Peace River with short tenure — he's

a one-timer all the way — asks the question: what would I give them? Of

course, one can't answer that, even with a great deal more knowledge of

the situation than I have. It's something that should be determined at

the bargaining table — and it can be determined at the bargaining table

if given a chance. He wouldn't understand that; he supports this kind

of totalitarian situation.

There is a tremendous amount of

support for the doctors, and if we could see to it that half-decent

negotiations go on, we would all be much more satisfied in this

province. Wouldn't it be lovely if we could go away from here today and

say: "No arbitration; get back to the bargaining table; get it done;

get back to work, everybody, and let's get this thing over with." That

would be what I'd like to see.

The minister said that the

doctors demanded 47 percent, or they interpreted their own demand as 41

percent. He said they were hard-line on that. If that's the case, then

that's the first time the doctors have ever come to the bargaining

table not prepared to negotiate. On the other hand, we hear that the

government was equally hard-line. I saw no offer during the time I read

the press other than 15.2 percent. Did anybody see it go from 7 to 10

to 12 to 14 to 15 percent? No, one offer, take it or leave it. That's

negotiations.

I'm not being an apologist for the doctors. I

think they made some mistakes. But I'll tell you right now that the

average doctor across this province wants to get this resolved, and

you're not going to get it resolved if we leave a tremendous amount of

residual anger.

I'd like the minister to table the letter

that he mentioned. I think I can demand that he table the letter, by

virtue of the fact that he used it as part of his opening remarks. On a

point of order, I would ask that that letter now be tabled.

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

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

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

Hon.

members, if the member who was just speaking has concluded his speech,

I would have to suggest that if the member takes the point of order at

this particular time he would lose his place in debate. I would suggest

that he could raise that particular point at the conclusion of his

speech.

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

during the course of the remarks of the Minister of Health he referred

substantially to a letter and read from it extensively. I would ask

that under the rules of the House the minister now table that letter

before completion of debate on this bill.

[ Page 4915 ]

DEPUTY SPEAKER:

Hon. member, I have just indicated that that request may be made at the

conclusion of the speech of the member who is now speaking. The actual

time for making such a request is either at the conclusion of the

minister's address or at the conclusion of the member's address. I

would respectfully suggest the motion would be in order at the

conclusion of the address by the member for New Westminster.

MR. LAUK: A point of order.

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

"Another

rule or principle of debate may be here added. A minister of the Crown

is not at liberty to read or quote from a despatch or other state paper

not before the House, unless he be prepared to lay it upon the

table.... This principle is so reasonable that it has not been

contested; and when the objection has been made in time, it has been

generally acquiesced in."

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

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

MR. LAUK: ...and

a point of order can be raised by any member, even to the point of

interrupting his speech. I do so under that standing order and

especially to point out to Mr. Speaker that under the rules you’ve just

mentioned, the minister has not seen fit to table such a letter. We've

been waiting patiently for him to do so, which is the usual course, and

he has not done so. I ask, Mr. Speaker, that the minister table that

letter immediately; and I respectively submit that it should not, need

not, nor can it wait to the end of any other member's speech. It has to

do with the minister's speech.

DEPUTY SPEAKER: Thank

you for the point of order, hon. member. I have indicated that in that

case I would have no alternative but to indicate that the member for

New Westminster would then lose his place in debate.

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

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

MR. COCKE:

No, Mr. Speaker. I would like to resume my remarks, and I'll ask for

the document at the end of the remarks. I would hope the document

doesn't dissolve, disappear or go up in flames during the period that

I....

Mr. Speaker, we were treated to a rather fascinating scenario by the minister.

He said — and I have great difficulty with the statement that he made — that

three members, or a number of members, from the medical profession came in the

dark of night recently and met with three cabinet ministers: himself and two

others. He asked at that time whether the medical profession were in a position

to make a counter-offer. Under those circumstances, how could that be possible?

There were three members of the cabinet asking for a counter-offer when the medical

profession was supposed to be negotiating with the Medical Services Commission

— three cabinet ministers at midnight or something — and they started discussing

whether or not there could be any kind of negotiating. You can't negotiate

with three cabinet ministers. They don't have the right to negotiate, in

any event. We know they call the shots.

I just find I'm apprehensive about the whole situation. I don't like the way it's gone. I'm also worried about.... For

instance, we're talking about an agreement, and I wrote down carefully

what the minister said. He said: "We're talking about an agreement that

was terminating on March 31, 1980." That's a year ago. I thought the

contract probably ended on March 31.1981, but maybe we're not looking

at the same contract. I'm quoting him. and I would suspect that there's

going to be an answer that maybe he's even talking about a different

contract.

He was talking about the whole question of opting

out, and I didn't have any access to any quotes of what Ralph Loffmark

had to say about that. Ralph didn't do very much with respect to

medicare because it wasn't his responsibility. I recognize he was on

Treasury Board at that time and so may have made some remarks about

opting out and a number of other things, but he certainly didn't do it

as the minister responsible. The minister responsible was the Hon.

Wesley Black at the time, who, incidentally. has done a report on the

distribution of doctors and so on and so forth, and I haven't seen very

much implementation of that report.

I believe that the

government is in a position now where it can give us some assurance. It

can give us some assurance that it will clean up this mess that this

bill creates with respect to those two clauses that I'm dealing with.

Those are

section 6 and

section 8, which I contend are a real problem.

Just to review our position with respect to the whole question of extra

billing, I'd like to quote a paper that is edited by Dr. J.

O'Brien-Bell called the Western Medical News .

It is probably not one of the most left-wing papers that's ever been

put on the face of this globe. However, it's quoting my discussion when

Hon. Rafe Mair asked that he be excused from speaking to the Medical

Association, and they decided to ask me in his place. I'm quoted here

as saying: "I should also remind you that during my ministry the BMA

was recognized as representing the medical profession at the

negotiating table." Then he goes on to quote me again: "We are not in

favour of extra billing, extra charging or balance billing." That was

in the paper in July 1980. I think it was in June last year that I said

it.

I said then: "However, I am willing to consider a real

safety valve" — incidentally, this is before the Hall commission —

"with real meaning that will impose discipline on both government and

profession in terms of pay. I am willing to consider arbitration or

some other method that will satisfy both parties."

Unfortunately.

Mr. Speaker, what we see before us today is not something that

satisfies both parties. It gives the government the gun. It's bad

enough for any government, but this government particularly should not

be allowed to have this. If they have any common sense and any

sensibility about what they're doing, they will today amend this bill

to give a little bit of balance in

section 6 and

section 7. Let's hear

from them very soon. Will the minister — and the Attorney-General (Hon.

Mr. Williams) — nod if they feel that we're making a point with respect

to this whole question of sections 6 and 8?

[ Page 4916 ]

DEPUTY SPEAKER: Is the member the designated speaker?

MR. COCKE:

The member is about to finalize his remarks, Mr. Speaker. We might need

one later on. I ask that in the next few minutes the government

sincerely rethink what they've done. They've done one good thing:

they've outlawed extra billing. The bad thing is

section 6 and

section

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

DEPUTY SPEAKER: Is there any comment from the minister?

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

DEPUTY SPEAKER:

Hon. members, for your benefit I will read once again from May, page

460,

chapter 14; Maintenance of Order During Debate, entitled "Citing

documents not before the House:" "A minister of the Crown is not at

liberty to read or quote from a dispatch or other state paper not

before the House unless he is prepared to lay it upon the table. It has

also been admitted that a document which has been cited ought to be

laid upon the table of the House." I can do no more than cite the

information for the member.

HON. MR. NIELSEN: Mr.

Speaker, I have no hesitation upon following that directive. I wonder,

perhaps, if Mr. Speaker could see that I have the opportunity of

obtaining a copy of the letter for use in concluding my remarks this

afternoon. I have no objection to tabling the letter, either at this

time or following conclusion of my remarks later this afternoon, but I

would like to make use of the document in my subsequent remarks.

DEPUTY SPEAKER:

If the minister would be good enough to forward the copy to the table,

a photocopy will be made and the original returned to the minister.

HON. MR. BENNETT:

Mr. Speaker, speaking briefly in support of the bill, I think all of us

are concerned about the climate in which the bill is introduced today.

Hopefully, in all negotiations — whether in the private sector, between

labour and management, in the public sector or in this area of doctors

with the medicare system — it is always the first preference that a

successful conclusion come from the bargaining system. As we have often

seen in the past in other areas, this is not always the case. This time

we have the further complicating factor that within the contract — and

I agree, it has been in since 1971, reinforced in 1974 — there was a

clause that allowed for balance billing to be undertaken, should the

rate

schedule not be 90 percent of the fee

schedule set by the doctors.

There was nothing in there to preclude the doctors' fee

schedule being

arbitrarily increased by 50 or 100 percent, thus making it impossible

for the 90 percent to follow. That is the difficulty that we were faced

with.

This government very clearly has as its policy that we

are not in favour of balance billing, although I understand balance

billing does take place in a number of provinces. I don't know whether

the province of Saskatchewan is one of those provinces.

HON. MR. McCLELLAND: It is.

HON. MR. BENNETT:

The Minister of Energy says: "Yes, it is." British Columbia has never

had balance billing. We're one of the fortunate provinces that, to my

knowledge, does not at this time have any doctors who have opted out of

the medicare system. The doctors in the medical profession in this

province deserve a lot of credit.

I remember — and the

member for New Westminster (Mr. Cocke) took a lot of pride in it — the

major fight over medicare in Saskatchewan under Tommy Douglas. There

were hostilities. A lot of things were said and acts undertaken that I

wouldn't brag about, but would regret. I look back on the way medicare

was brought in in this province — the second province to bring in

medicare — and it was with great cooperation from the doctors. Because

of them, it came in peacefully. I can remember the high opinion the

late Premier W.A.C. Bennett had of Dr. McCoy and others for the way in

which they assisted in developing the medicare system in British

Columbia. They're to be given credit that over the years they have been

in large measure responsible for our having an outstanding health

service within this province.

It is not with any great glee

that we're here today passing a bill that apparently has us in conflict

with one of the important ingredients in the delivery of health care in

this province. Nor is it a time when partisan politics can be usefully

employed in debate to assist the situation. Of course, negotiations do

not take place through the newspapers. Responsible negotiations by

professionals within the system — whether they're employed by the

government or the medical profession — take place at the bargaining

table. The publicity game is for those who would play politics with

bargaining. We've seen that in other areas in this province; but we

certainly don't want to see it played here, nor do I believe it has

been played. There is a case to be made, because public funds are being

employed, that the public should be informed on how much the medical

plan will cost through taxation. It's their plan; it's being assisted

by public funds.

Some mention was made by the member for New

Westminster that the people of the province pay 35 percent of the

insurance program through premiums. I was not sure whether he was

suggesting — because his other remarks were dealing with those on low

or no income being unduly burdened in this way.... I want to say that

in this province there is assistance for....

MR. COCKE: Read your budget.

HON. MR. BENNETT:

Certainly it's 35 percent for those who can afford it, but the member

well knows that for those who have low income, part of the premium, or

in some cases all of the premium, is paid for them in this province. I

wouldn't want the implication to be left that the unfortunate in this

province are penalized with an unaffordable premium, because that too

would defeat the principle of medicare. While there are premiums that

do relate to the cost of medicare, the poor and unfortunate in this

province are assisted by government, and in many cases totally assisted

so that there is no cost to them at all.

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

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

[ Page 4917 ]

want

the implication left that somehow the poor were being hard done by in

this province, because our system has assisted them at no cost for many

years. I only want to clear that up in case a misconception may have

been spread, and to assure them that this will continue.

Now

what do we want to achieve? Obviously, the best thing to be achieved

would be to have an agreeable conclusion without hostility. I fear from

the tenor of the argument taking place — not in this House but outside,

as I had the opportunity to hear some portions of radio shows — that

people have missed the point. I don't think we should encourage some of

the discussion in which people are either attacking doctors or saying

that they're getting poor service, because I believe that by and large

in this province they get the best service in this country. I would

hate to see the argument extend beyond how we're going to finance

medicare in the future and how we will deal at this time with the

policy of no balance billing.

Hopefully, because there are a

number of options contained within this bill, we'll get a conclusion —

whatever option is chosen — and the manner in which it's carried out

will give satisfaction to both the public at large, who pay for the

scheme through taxes and fees, and the medical profession, and the

working relationship we've had for these many years since the inception

of medicare will continue.

I think this is not a time to

inflame the situation. I hope that from today, with the passage of this

bill in this House — and I'm hopeful it will be unanimous and go on

record as opposing balance billing — the contract settlement can be

achieved on those other matters that are contained in the negotiation

without that being a complicating factor. I take it from what I've

heard from the other side of the House that their position today is

that they are not in favour of balance billing, although that is not

the position of all the New Democratic Parties in this country. So, Mr.

Speaker, in that vein I would hope that the debate will not be

confrontational or picky, but that it will, in fact, try to help us

create a climate in which a very positive conclusion can be achieved.

only comment to the people of the province whom we represent — and

amongst them the doctors of this province, whom we also represent — is

that we recognize that this Legislature and the government have a

public trust: on one side to ensure the provision of health care, on

the other side the responsible management of that health-care program

by the moneys sent by the taxpayers of this province to government. The

government does not intend to be cheap; in fact, the government intends

to be able to provide the best healthcare system with fair compensation

to the medical profession in this province. Sometimes, to achieve that

in dealing with a dispute between different parties requires the wisdom

of Solomon, and in any dispute not all parties are happy. When the

agreement is concluded, I'm hopeful in this area that most of the

people in the province will be happy — happy, at least, that we have

ensured the medicare system and enshrined the principle that balance

billing will not be a part of it.

Mr. Speaker, I don't

quarrel with sections of this bill, because there are a number of

options open for a successful conclusion. I support the bill

wholeheartedly, and I would hope that during the rest of the debate we

perhaps could focus on what we're trying to achieve — and that is a

successful conclusion to a very difficult problem that is brought in in

a difficult climate. I would hope that no member of this Legislature

will take the opportunity to try and make that situation worse.

MR. HALL:

Mr. Speaker, the Premier never fails to amaze me. He'll catch it on the

squawk box, I'm sure — one of his many executives assistants will tell

him what I've said. But he said he didn't want politics injected into

the argument, and then tries to slide them in himself, when he said

that he didn't know whether our opposition today was the same as other

New Democratic Parties across the country. Our opposition to this bill

is what we will say it is today, Mr. Speaker. Within the confines of

the debate on this bill, I don't give a damn what other New Democratic

Parties across this country have said. This is the position we have,

Mr. Speaker,

If I wanted to, I'd go and try and find out

what the position of the other Social Credit Parties — if there are any

— in other provinces is. Perhaps I could go to the library and find out

what the policy of the Edmund Burke Society is in Ontario — it provides

most of the Ontario Social Credit candidates, who by most normal human

standards would be banned from seeking public office. And he says don't

introduce politics into the debate!

He couldn't even

understand the reference to what has already been provided to pay for

medicare in this province. The Premier of our province, architect of

the budget, I presume, couldn't even understand that 35 percent of the

cost of medicare is provided by direct premiums already and his own

Minister of Finance (Hon. Mr. Curtis) will tell us that. What the

member for New Westminster (Mr. Cocke) was saying is: "Enough is enough

— no more dollars from ordinary people's pockets to pay for the cost of

medicare."

What the member for Langley (Hon. Mr. McClelland)

is trying to say when he says that the provinces may or may not do

something is all very well and good, but other provinces don't have

premiums for medicare. May I also say that it wasn't this side of the

House that tried to inject politics on the "Webster" show on Monday

morning about where the balance billing came from. It was the member

for Okanagan South (Hon. Mr. Bennett) who introduced politics...

MR. BARBER: And he got it wrong.

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

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

Interjection.

MR. HALL:

We're just straightening out the record because you don't do much

reading. You haven't been here that long, so you will learn something,

When

W.A.C. Bennett introduced medicare in this province, to his credit,

without very much trouble whatsoever he put it under the charge of a

minister whose administrative capabilities he was sure of — he put it

no higher than that — Mr. Black. It remained in those capable hands of

the Provincial Secretary of this province from the day of its inception

until I, as the Provincial Secretary in 1972, instituted an

order-in-council transferring it to the Ministry of Health. For the

Premier to suggest that somebody might interject politics into this

debate seems, as I say, a little strange — coming from somebody who has

himself on three separate occasions tried to interject politics into

this debate...

MR. BARBER: And made two separate mistakes.

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

[ Page 4918 ]

remember attending meetings of the Medical Services Commission in the

winter of 1972 before I handed it over to the Minister of Health, and

saw the members of the Medical Services Commission who were responsible

for the clauses that the present Minister of Health has read to us

today. Who were those members? There was Mr. Jeffrey Stewart, a

longtime senior public servant in the 1960s into the 1970s. Another

member of the Medical Services Commission at that time who saw the

incorporation of that kind of thing was Mr. Jerry Bryson, Deputy

Minister of Finance. The lawyer who dealt with the negotiations of the

Medical Services Commission at that time was Mr. Jerry Cross — a

long-time public servant in this Legislature at that table, and

latterly Deputy Provincial Secretary in your administration. So for the

Premier to try to suggest those kinds of things is really not very good.

The

negotiations that have gone on, if one can so describe them, between

the doctors and the government, through the agencies that they both use

have obviously been long, difficult and — perhaps more to the point —

unsuccessful. I thought we would have been treated today — and I think

the House should have been treated today — to a

chapter and verse

account by the Minister of Health, new though he is in the portfolio,

of what has happened. We didn't get that. We got one passing reference

to the fact that somewhere along the line some accommodation was made;

there were some things settled. There is nothing at all in the way of a

report, as we face the Draconian measure. There is nothing in the way

of a report at all about what has happened in those bargaining sessions.

The

agreement that we've talked about already goes back some 15 years. We

saw the first mention of what we're trying to outlaw today in January

1971. Both sides of this House already through the Minister of Health,

the Premier and the critic on our side have indicated to you, Mr.

Speaker, that they are against the concept of extra billing — the

federal government too. We are, however, in favour of better

negotiations. It is obvious from the figures the Minister of Health has

quoted that there has been no movement on either side. If there had

been some movement, I think we would have heard about it. If there has

been movement there is still time for us to hear about it when he sums

up second reading in this debate.

[Mr. Strachan in the chair.]

was phoned by a couple of doctors today, one of whom has already been

mentioned today, Dr. O'Brien-Bell. He happens to be a constituent of

mine, has run for political office, has been an alderman in Surrey and,

I think, ran provincially in one election — although I think it was in

the Delta riding he ran provincially. He rang up to discuss this bill

with me. One of his calls was for fairness, and I think that's the call

that should go out today — for fairness. I think what the public

expects to be produced today is fairness.

I have little in

common with Dr. O'Brien-Bell politically. I remember his District 6

newsletters and many conversations I've had with him. But he too was

disappointed by the arrival of this bill yesterday; he too has

characterized it in strong language. The other doctors have

characterized it in the language used by my colleague, and I think

we're entitled to ask again why the word "double-cross" was used. Why

was such a strong, harsh word used when this bill was introduced? What

was the understanding of the doctors that they would seek to use a word

as strong and with such implication as the word "double-cross"? Those

are the questions we'd like the Minister of Health to answer when he

sums up on second reading.

A 93 percent rejection vote is

one thing, although I've been around labour negotiations, acceptance

votes and decisions to take certain courses of action for long enough

to know that oftentimes one should get a strong vote in order to

strengthen the hands of one's negotiators. It seems to me that

something must have been in the doctors' minds when we got such an

outrageous statement, considering most of these kinds of meetings are

at such a high level. On the other hand, when we examine the history of

the relationships that have been taking place between this government

and the doctors over the last six months, perhaps it's no surprise.

don't know what the previous Minister of Health led the doctors to

believe; he's gone. I don't know what promises he made or whether the

ministers on the other side know what promises he made. I do know that

he wouldn't see them, and that's hardly the start of good negotiation.

That hardly sets the stall to allow your people to do a good job for

you if you at least don't give them a good launching-pad — if you don't

do the normal, human, courteous thing. I read in theVancouver Province

on March 9 that Dr. Alex Mandeville says he has only met our current

Minister of Health once, when he spent 12 minutes with him and had the

opportunity to speak to him for about 15 seconds. Far be it from me to

tell the Minister of Health how to conduct his portfolio, but that

seems to me to be an awfully short period of time to exchange a few

pleasantries with the leader of the doctors of this province. If Dr.

Mandeville's wrong.... If that's the best our new Minister of Health

and Dr. Alex Mandeville could do in terms of meeting each other, then I

don't think we're being particularly well served. That's what I'm

saying: that the public — doctors and patients alike — should expect

from this bill and this Legislature fairness and better negotiation,

and it's got to start somewhere.

We've all had enough

material from the BCMA to read into the record all sorts of things. I

saw the minister hold his copy up, and I suppose if we took a federal

government proposal seriously we could now file this with the Clerk and

have them all printed, if I understand what's happening in Ottawa to be

correct. Nevertheless it was a good package of material that was sent

to us and reminded me of some of the wars of the clippings that used to

take place in this House before we had a Hansard .

May

I now turn to the bill and the offensive sections that my colleague for

New Westminster has talked about. They are contained in sections 6 and

If the negotiations have failed as miserably as they

obviously have failed, then either somebody is going get stiffed on

this or somebody isn't going to get stiffed. It seems to me that one of

the ways to avoid that is not to follow the course of action as laid

down in Bill 16. The only way in which we're going to get fairness, the

only way in which we're going to be observed to be fair and the only

way in which the public, the taxpayers, the doctors — the participants

in all of this — are going to really feel as though they've had a last

gasp chance of coming out with a meaningful package, is to alter

section 6. I heartily echo the words used by the member for New

Westminster that this is really kangaroo court, Star Chamber stuff.

These are tyrannical, sweeping powers. It's all of those things that I

remember hearing so often between 1972 and 1975.

[ Page 4919 ]

I'm

going to tell the member from Vernon (Hon. Mrs. Jordan), for instance,

that if this had appeared in a piece of New Democratic Party

legislation, we wouldn't have heard the end of it for days and days. I

want to go to Vernon, Mr. Caucus Chairman, and walk around with

section

6 and tell the good people of Vernon what has happened and what kind of

deal is going on in terms of the new Social Credit administration. If

ever I saw the kind of awesome power — jackboot legislation — that they

used to fondly and shrilly cry about, it's contained in

section 6. I do

hope that the Attorney-General and the House Leader will take whatever

last looks they can at this legislation. Frankly, it's not necessarily

doomed to failure, because they've got the numbers over there — they've

got this huge majority that they can sweep all this through whenever

they want — but it will last and taste in the mouths and the minds and

hearts of people in British Columbia when they see a Star Chamber

arrangement like that.

HON. MR. GARDOM: Mr. Speaker,

I support the legislation, but I want to say that it is saddening

because I regret, as certainly does my colleague, the Minister of

Health, that the impasse is occasioned and that the impasses had to

result in Bill 16 being in front of this Legislative Assembly this

afternoon. I do concur with the sentiments of my colleague, and we in

government do have the duty — and indeed the responsibility — for all

of the people and taxpayers to represent the public interest. As such,

we are trustees for the taxpayers in our province and for their

tax-paid clear dollars.

I also sense some very

understandable frustration in the minds of certain of the medical

profession that their historic income leadership has been affected over

the past years, and indeed I think it is a fact that some doctors

today, by virtue of overhead increases that are beyond their control,

are perhaps incurring a loss of personal return for that which they

earned and enjoyed some few years before. They express concern about

this.

What they're facing is what I would call the "income

compression syndrome." I've heard said to me — and I hope this is

correct — that the house calls of a plumber, or a veterinarian or

whatever are in excess of that allowed for a general practitioner.

Everyone in society would raise some questions about that. Should a

baseball player make a million dollars a year? Personally, I don't

think so. I think that this is perhaps a sign of a society fast

becoming decadent, and particularly when those kinds of returns are

never really related to essential activities, but perhaps most of all

to hedonistic activities. Are there going to be cures for that type of

thing? I don't know, but I do know that the pediatrician of this world,

the general practitioner, the heart surgeon, the minister and the

priest are worth a dickens of a lot more to this society than these

people who are receiving these outlandish returns at the present time.

have to pose a few questions to which I don't know the answers at all.

I doubt very much whether anyone in here has the answers to them, and I

don't know if the medical profession has the answers to them either,

but they're matters which the profession will find itself debating —

and correctly so — over the years to come. They will deserve debate and

will indeed deserve consideration, because we are living in our country

under the most highly commendable philosophical and sociological

direction of making medical aid, treatment and care affordable and

available for all of our citizens. I think that's a commendable route

for a country to take, and I don't think we should move back from that

one iota. We are also aware of the fact that that kind of care,

treatment and aid imposes a huge impost upon the taxpayer and upon the

public purse. It cannot be open-ended. It has to be shepherded, and

that's the responsibility of the trustees for the taxpayer. That's what

the government is. What the market can afford only refers, in this

instance, to the one market — the Canadian taxpayer. Hence we're facing

these inevitable tugs and pulls. We're going to be facing those, not

just today, not just in this debate in this Legislature in 1981, but

insofar as medical care is concerned we're going to be facing these

tugs and pulls right across the country over the years to come, unless

— God forbid — we ever decided as a country or as a province that we

would not have the taxpayer receiving the kind of medical treatment

that he's receiving today with payment from the source being taken care

of.

I pose this question to the medical profession. I'm not

advocating it, but it's a question that in my view they should be

debating. Maybe the fee-for-service system is anarchistic. Maybe the

payment for skills should not relate to specific parts of the human

body or for special services to specific areas of the human frame.

Maybe there should be hourly rates with pay for certain specific

skills. I don't know. Maybe it should be taken into consideration where

those skills are performed — in a facility that is totally publicly

supported and paid for or in one that is privately supported and paid

for by the doctor himself.

MR. SKELLY: Lawyers too?

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

Maybe

the process of taxation or the review of accounts should be more

carefully looked at than is done in the medical profession at the

present time. My friend across the floor refers to lawyers. We do know

that there is a process of taxing bills of lawyers. Lawyers are doing

work on the basis of hourly rates and on the basis of documentation. I

think the legal profession has a similar responsibility to check into

that to see whether or not their processes are anachronistic.

think these are the problems that the profession across the country is

going to have to pay more care to. I think they themselves often

question whether a gall bladder should have a greater degree of return

than a tonsillectomy or whatever. These are problems in which we in

government and the citizens of our country are going to have to receive

some guidance from the profession.

Mr. Speaker, I've said at

the outset that I'm supporting the measure. I'm looking forward to the

closing remarks of my colleague. I would close by repeating that it is

regrettable that this type of legislation is before the House, but

unfortunately it is necessary.

MR. NICOLSON: We heard

some very stimulating thoughts from the previous speaker: however, he

didn't really address this bill. This bill with its

section 6 and

section 8, while it seeks in principle to redress an emergent problem

that we're faced with, certainly has two aspects that are very clumsy

and very unfair. In fact, to give credit to my colleague the second

member for Victoria (Mr. Hanson), this is an unbalanced bill. We have

heard leaders of the medical profession say that they were

double-crossed.

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

[ Page 4920 ]

pected

way. I can't think of a member I ever saw come into this House who was

more suited in terms of actually enjoying this House; a person who fit

in, not in terms of my agreeing with his political philosophy, but who

was at ease in this House and almost seemed to be moulded to sit in

here and present the conservative point of view in the Legislature. Why

would a person such as this, who obviously enjoyed his political role,

depart in such an unexpected manner? We have the people in the medical

profession, and I think that like my colleagues who would seek to lead

the teaching profession, in dealing with this government they have been

a rather naive group. When they say that they've been double-crossed, I

believe them. I think I know why they've been double-crossed. I think I

know why Rafe Mair left under such unusual circumstances.

During

the budget debate I referred to some of the questions that were

enclosed in a Martin Goldfarb public opinion sampling, taken late in

December and, I think, submitted to the government in early January.

One of the questions in it was: "Do you think any of these groups are

carrying more than their fair share of the tax burden?" Does, does not.

One of the groups identified was professional people — that is,

engineers, doctors, lawyers.

More specifically, there were questions such as:

"Under

our current medicare system people are not charged when they go to see

their doctors or for the medical services they receive. Some people

have suggested that this has led to rapidly rising medicare costs,

because people abuse the system or are encouraged to seek medical

attention more often than they need to, because it is free. How much of

any abuse of the medicare system do you think there is — a lot, some,

only a little, none?"

A little more specifically, question 4 (

c) asked:

"Would

you like to see the government impose a nominal fee on each patient

each time he or she visits his or her doctor, in order to discourage

abuse of the medicare system — yes, no, no opinion?"

[Mr. Speaker in the chair.]

Most important and, I think, most alarming is:

"In

most provinces doctors fees or rates are set by the province in

conjunction with the provincial medical association representing the

doctors. In some provinces some doctors have decided to opt out of the

medicare plan in order to increase their fees. Instead of being paid

directly out of the province's medicare plan, these doctors ask the

patient himself to collect from the plan and then pay the rest of the

higher fee on his own. In this way, opted-out doctors can charge fees

higher than those set by the province's medicare fee schedule. Do you

think the provincial government should permit or prohibit this

practice?"

Permit, prohibit — those were the two choices.

It's

strange that the results of this questionnaire — which I believe was in

the government's hands probably just shortly before the resignation of

Rafe Mair — should come in. It's strange that the profession should say

that they've been double-crossed. Yet it does make some sense. There is

a little bit of an explanation here, when we see that the government

right at that time was sampling public opinion. It probably got a very

resounding "prohibit," when up until the time that this questionnaire

came into their hands they had probably agreed to allow some kind of

balance billing.

As one who has seen this operate in the

United States — I am fairly well versed on how it works down there —

it's something I certainly don't want to see here. I think that is why

the government is in trouble. When you do not bargain in good faith,

when you move the goal post — as we have heard said was done; I believe

that that is what was done.... That is why, I think, that type of

collective bargaining process — such as it was; it's not complete

collective bargaining — failed.

I am in favour of the

aspects of this bill which will prohibit extra billing. Sections 6 and

8, particularly

section 8(d), in which the Lieutenant-Governor, if they

impose and pick an arbitrator, and then have their arbitrator impose an

arbitration.... If the government doesn't like the arbitration under

section 8(d), they will then be able to change the agreement as they

like. In other words, there is no agreement. The

Lieutenant-Governor-in-Council will be able to change it any which way

he pleases. I don't think that is the way to prohibit balance billing

in this province. I think it can be done in a much better way. The

sooner we get back to fair treatment and trust on both sides, the

better it will be for all people in this province.

MR. SPEAKER: The Minister of Tourism.

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

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

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

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

HON. MRS. JORDAN:

Well, Mr. Speaker, as a delicate flower from the countryside of this

province I have to maintain my sensitivity in order to serve well those

people who send me here.

It was interesting to hear the

comments of the opposition, and to see their opposition to

section 6 of

this act, which only serves to reinforce the fact that it's very

evident that they're not listening or thinking or doing their homework.

It has been said by the minister in this House that as late as last

Monday at 11 p.m.... After many hours of negotiations and many

overtures by the government negotiating team and the minister to ask

the physicians' negotiating team if they would come back to the table

if there was an avenue through which this could be resolved, and being

told no, the government is forced to take the position it is taking

today.

It is hard to rationalize the position of the

opposition when one thinks that their own members stood up in this

House when they were government.... The then Minister of Transportation

said in the ferry settlement: "What could I do? They had a gun to my

head." Today we hear those members saying: "Don't be too firm; don't be

too tough; tippy-toe on forever." This government will not let anyone

put a gun to its head, because it represents the interest of the people

and we have a responsibility to take a position. Secondly, every effort

has been made to meet a reasonable settlement with the physicians. They

themselves have endeavoured to cut off and have cut off negotiations.

Therefore, if we're going to deal with this bill and we do not believe

[ Page 4921 ]

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

am breaking a silence that I've kept in this House for 14 years. I have

never spoken in relation to physicians, or any areas that would affect

my family in that sense, probably unlike many other professionally

associated people in this House. I rise today to address this debate

with considerable concern and great regret, because in this province we

have and enjoy the highest standard of medical care for the most number

of people anywhere in the world. In this province we have the greatest

opportunity for the trained and scientific mind and artistic abilities

of the physician to live one of the highest standards of living in the

world, to practise in the greatest area of freedom in the world, and to

have an assurance that his returns will be guaranteed if not the

greatest in the world.

That came about not because of the

type of frivolous debate we've heard in this House or some of the

statements that have been made outside of this House, but because of a

genuine desire of a government of the day and a profession of the day

to meet their obligations to the citizens, and because of a genuine

time-honoured till the end of the earth — that no family should be

wiped out financially by the devastations of illness. We'll never cure

all illness, but at least we can go to great lengths to try to cure the

financial complications that exist in many areas of the world today,

including our good neighbours in the United States, and which existed

in this province until the time of W.A.C. Bennett, the Social credit

government and the practising physicians of the day. Mr. Speaker, that

is intolerable. The devastation of illness in its narrowest and

broadest implications — as you yourself know, sir — is most difficult

to bear. It's because of this that I stand,

I must first

address myself, as probably no one else in this House can, to the

leadership of the British Columbia Medical Society and team. I was

appalled when I turned on the radio at 6 o'clock today to hear a

representative of one of history's most respected professions use such

words as "double-cross" and liken the situation of the practising

physician in British Columbia today to that of the workers in Poland.

To be most charitable, I could suggest that those statements and many

others, which I don't intend to quote, were intemperate. In making

those statements, I suggest a gentleman of a profession of great

honour, representing hundreds of people in this province in terms of

their dedication and their families' dedication, not only removed

himself from the realm of a responsible, knowledgeable leader and

negotiator, but he took with him those families and those professionals

who were relying upon him to represent them.

Mr. Speaker,

the position of the physicians in their negotiations at this time has

not only been greatly weakened by ill-advised negotiating teams, but

has been almost devastated by the statements of its leader. Part of the

art of medicine and part of the ability of the physician to cure today,

even in this highly sophisticated time of medical practice, depends

upon the confidence the patient has, not only in the profession but in

his or her own physician. I suggest to you that today's display has

weakened that confidence and that many a citizen will say: "Good

heavens, if a responsible doctor — not only a scientific and artful

physician but a leader of the physicians — behaves in that manner and

reacts in that sense under duress, is that a characteristic of the

profession and is that a characteristic of my physician?"

Mr.

Speaker, this is purely a personal statement, but I must tell you that

I, as a member of a family whose money is going to support that leader

and that negotiating committee in the best interests of health care the

patients and the physicians of this province, am ashamed and

embarrassed, and I can only hope that the public will understand.

I'd

like to make it very clear, in supporting the position of our

government and being part of the decision-making process, that I firmly

believe that 90 percent of the physicians in this province — be they

researchers, family practitioners, public health physicians or

specialists — are very hard working and dedicated gentlemen who have

spent years of their lives in a highly intensive program which has

precluded them from other enjoyable activities and other economic

benefits that are open to other processions and trades.

MS. SANFORD: No women, eh?

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

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

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

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

MS. BROWN: They are all men, eh?

HON. MRS. JORDAN:

Mr. Speaker, behind and beside those people are families, wives,

husbands and children who by and large have themselves contributed

greatly to the professional development of those individuals, who

themselves have known simple interruptions that few other families

know, such as looking forward for months to a picnic and, once again,

finding it interrupted just as the family is ready to leave. The

average physician in this province is not concerned with the dollar;

they're not businessmen and they're not investors. They seek no more

than to practise good health care in a healthy climate, have enough

money that they can enjoy some of the nice things in life, as others

do, and take a holiday once in a while if they can get off, and not

have to be worrying at the age of 55 or 60 or 65, when their best years

are gone — and their best years are least long of almost any profession

— how they are going to live and support their families.

suggest that average physicians in British Columbia today are deeply

distressed by what is happening. They are finding themselves way over

their heads in understanding this. I can't forget, nor can we not

mention at this time, that too often the physicians in society have

been everyone's favourite indoor sport. It's been very fashionable —

whether you're Reader's Digest ,

members of the opposition or perhaps even from time to time members of

my own party — to make sweeping statements about physicians and their

incomes, their dedication or lack of dedication. But I put to you that

there are certainly those in the profession that cause embarrassment,

but no more and perhaps much less when one looks at the stresses of the

profession than anywhere else. I put to you that this has been very

offensive to many physicians and their families. It's been very

difficult for their

[ Page 4922 ]

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

The

blue book — and I mention it because I don't overlook it — has been,

and is, a constant embarrassment to the physicians, not because they

resent having their returns from the Medical Plan published, but

because of the manipulation that goes on with those figures and the

misinterpretation that is left there. Those are gross figures. Most

physicians hire registered nurses, cleaners and any number of people in

their offices, to help provide a plant at their own cost that contains

the best possible climate for the practice of medicine.

MR. NICOLSON: Who published it in the newspapers?

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

HON. MRS. JORDAN:

We're again hearing foolish comments from the opposition, who, as is

their custom, have not yet in this debate been able to be open and

frank.

The member for New Westminster (Mr. Cocke) might well

own up, during the debate in this House, to the fact that he was the

man who, when he went before the medical society and promised the moon,

caused some of the confusion the average doctor is experiencing today.

He promised pension plans, dental care plans, increases in wages and

freedom of movement between patient and physician. He promised

everything, but he didn't tell them he didn't believe in balance

billing. So perhaps the physicians would be wise to look at those

promises made by the opposition, who are constantly moving back and

forth in this debate.

I don't think that in this debate we

can overlook the fact that there are many inequities that exist within

the payment system as designed by the physicians themselves, and that

this matter should be addressed within the profession. But it should

not part of the thinking at this time.

I believe there is

ample room in this province for the patterns-of-practice committee of

the physicians to have more opportunity to take action where abuses and

inequities exist. But that should not be part of the discussion at this

time.

When we address ourselves to the bill before the House

today and the current situation we experience in British Columbia, I

think that, on the average physician's mind at first blush is the

thought that balance billing is an answer. I believe many of them out

there sincerely thought that this could have appeal, that it could

provide less burden on the taxpayer, that it could lead to control of

abuse, that balance billing in itself would be controllable in its

escalation and that doctors would make more money or be able to receive

a fair return for their efforts. But I would suggest this is not so,

because many of the costs built into medical care today go much further

than the doctors' daily billing practices. Part of it goes back to the

training, and this is something we as a society must address if we're

not to develop a system which we can't afford to use because of its

cost. The training in medicine today leans very heavily on expensive

practices and technical diagnostic aids rather than artistic diagnostic

aids. This is something we must think about when we talk about the cost

of medicine.

Billing procedures and faulty payments in themselves will be very cumbersome

and costly to the average physician. On the whole they are not business people,

and I believe many of them appreciate this and are very concerned about it.

Will it keep the cost of medical care down? Mr. Speaker, the cost of operating

a balance-billing service is such that it will build in its own increases regardless

of whether the physician has a desire to keep it down. A deterrent to those

who would abuse the system? I suggest not. Those who are not able to pay would

still receive the service. Those who would abuse will continue to abuse, because

the abuser generally tends to be a person who doesn't have a conscience

in terms of his responsibilities, and those would fall into the area of uncollectable

debts. Therefore, ever more a burden would fall upon the taxpayer. Abuses on

both sides should be curtailed, but not through these negotiations.

my mind there's no question that balance billing would see the

introduction of a two-tier medical care system in British Columbia.

This would eventually lead to one system for the rich and those with

influence, and another for those who are not necessarily poor, but with

no influence. We learned, after experience rather than before, through

reason and research, that a balance-billing system can lead to the

destruction of a medicare system.

Mr. Speaker, as I

mentioned before, I've broken a 14-year silence. I would reaffirm my

belief that the government, through our minister and the negotiating

committee, has acted in good faith. The minister had said publicly that

he would not negotiate through the media, and he hasn't. I don't

believe there was any doubt in anyone's mind in British Columbia who

has followed the medical-care system in this province through the years

that the government simply could not permit balance billing. I suggest

that for the head of the negotiating committee to say that Mme Bégin

really doesn't mean anything when she says that she's concerned only

exemplifies the naivete of that individual. It's my personal conviction

that the federal government would be concerned.

Today the

doctor and physician in training do not experience the poverty days of

the past. They receive a reasonable stipend for their training period,

and therefore they can enter into their income-earning days in a better

financial position than they could previously. There is the opportunity

for a physician to treat a patient and to be sure that he has an

income. I believe that the patients want to see their physicians fairly

paid in British Columbia, but I must reaffirm that I believe that no

family or patient should be wiped out by the cost of medical care. The

responsibility for this government at this time is to guard the future

of medical care in British Columbia, to protect the taxpayer and, as

much as possible, to see that the medical-practice climate in this

province is as free and as healthy as possible and that the physician

does receive a fair return. Earlier in my presentation I rejected

comments made by the leadership o