March 26, 1985 ALBERTA HANSARD 183 LEGISLATIVE ASSEMBLY OF ALBERTA Title: Tuesday, March 26, 1985 2:30 p.m. [The House met at 2:30 p.m.] PRAYERS [Mr. Speaker in the Chair] head: PRESENTING REPORTS BY STANDING AND SPECIAL COMMITTEES MRS. FYFE: As chairman, Mr. Speaker, I request leave to present the report of the special committee appointed to prepare lists of members to serve on the select standing committees of the Assembly. head: INTRODUCTION OF BILLS Bill 16 Small Business Equity Corporations Amendment Act, 1985 MR. ADAIR: Mr. Speaker, I beg leave to introduce a Bill, being the Small Business Equity Corporations Amendment Act, 1985. The principle of this Bill is to remove the

section of the previous Act that dealt with the fixed amount to be used for incentives for the private sector. The success of this program to date prompts us to do this. [Leave granted; Bill 16 read a first time] Bill 31 Appropriation (Interim Supply) Act, 1985 MR. HYNDMAN: Mr. Speaker, I request leave to introduce Bill 31, the Appropriation (Interim Supply) Act, 1985. This being a money Bill, Her Honour the Honourable the Lieu­ tenant Governor, having been informed of the contents of this Bill, recommends the same to the Assembly.

This Bill is the traditional interim supply Act for the purpose of funding government operations after April 1, 1985, pending consideration of the estimates and the full appropriation Act to be dealt with later. [Leave granted; Bill 31 read a first time] Bill 205 Criminal Compensation Intercept Act MR. R. SPEAKER: Mr. Speaker, I beg leave to introduce Bill 205, the Criminal Compensation Intercept Act. The Bill covers the situation where a criminal has injured a victim either financially or physically and the victim is owed restitution.

The victim will be able to ask the Provincial Treasurer to withhold the criminal's tax returns as well as any provincial grants or other kinds of moneys payable to the criminal. Such money would be used to compensate the victim. [Leave granted; Bill 205 read a first time] Bill 210 Ambulance Service Act DR. BUCK: Mr. Speaker, I beg leave to introduce Bill 210, the Ambulance Service Act. The purpose of this Bill is to establish a uniform, high- standard ambulance service across Alberta.

The Bill sets out the mechanism for legislative approval for funding the service and establishes the basic standards which ambulance services would provide. This is a follow-up to a resolution this Legislature passed many, many years ago, directing the government to do this. There has been no action taken, so I'd like to introduce this Bill. [Leave granted; Bill 210 read a first time] head: TABLING RETURNS AND REPORTS MR. CRAWFORD: Mr. Speaker, today I would like to table copies of the annual report of the Department of the Attorney General for the year ended March 31, 1984.

Copies will be distributed to all hon. members. MR. TRYNCHY: Mr. Speaker, I'd like to table the annual report of the Recreation, Parks and Wildlife Foundation for the year ending March 31 and the annual report of the Department of Recreation and Parks to March 31, 1984. head: INTRODUCTION OF SPECIAL GUESTS MRS. KOPER: Mr. Speaker, it is my pleasure to introduce to you, and through you to members of the House, 27 grades 5 and 6 students from Brentwood elementary school. They're accompanied today by their teacher, Mrs. Alaine Skoreyko; their principal, Mr. Townsend; and parents Mrs. Hobbs, Mrs. Schlese, Mrs.

Kirkland, and Mrs. Doolan. You've noticed them in the members' gallery, Mr. Speaker, because they have special T-shirts on. These T- shirts identify them as members of the Society for the Prevention and Elimination of Discrimination and Stereo­ typing. This society was developed through the efforts of Mrs. Alaine Skoreyko to help elementary school students understand the concepts of cultural stereotyping and dis­ crimination.

On her own initiative, on her own time, and at her own cost, she introduced this program to Calgary and has been instrumental in developing the materials as well as providing in-service to her fellow teachers throughout Alberta.

The objectives of the program, as contained in the final report of the Committee on Tolerance and Understanding, are to teach the students to learn and retain the ideas that all people are unique but with common needs; have things they can and cannot do well; have different attitudes, ideas, beliefs, and values that are important to them; and have emotions and feelings and different ways of expressing them. This program is unique to Alberta, and I think many teachers throughout Alberta are using it. The students sang today for Her Honour the Lieutenant Governor and other members of the Assembly.

I ask that they, along with their teacher Mrs. Skoreyko, stand and be honoured by the members of the Assembly in the traditional welcome.

184 ALBERTA HANSARD March 26, 1985 MR. KOWALSKI: Mr. Speaker, it's my pleasure today to welcome 43 grade 6 students from Swan Hills, who are accompanied by their teachers Joyce Venables and Roger Manual. The parents in Swan Hills really care about their children, and eight parents are also with the group: Wendy Kosik, Maureen Emes, Betty Ann Loomis, Carol Junck, Pat Delesalle, Susan Schetzsle, Elaine Kyle, and Sharon Feduniak. I had a very delightful opportunity to spend about 15 minutes with these young people, in terms of questions and answers.

I was really impressed with their knowledge, good manners, and all-around interest in what's happening in the province of Alberta. However, one of the questions they consistently asked me was, "How do you get elected, and how do you come to this Assembly?" I said, "One of the things you have to do is work really hard." They wondered if anybody from Swan Hills could ever do it. I'd like to point out to my young friends that the lady who sits two chairs away from me, Mrs. Sheila Embury, worked in Swan Hills for a number of years, so there is an opportunity. Mr.

Speaker, I ask our guests in the members' gallery to rise, and I ask my colleagues in the Assembly to give them a very warm reception. head: ORAL QUESTION PERIOD Canadian Commercial Bank Support MR. MARTIN: Mr. Speaker, I'd like to direct the first question to the hon. Treasurer. Could the Treasurer indicate why, on the day of the budget release, he released a major statement dealing with the bailout of the Canadian Com­ mercial Bank at the same time as releasing the public accounts, and then scheduled a press conference during question period? Is this not showing a complete contempt for this Assembly? MR.

SPEAKER: Order please. DR. BUCK: That's a question. MR. SPEAKER: It's not a question at the end; it's an accusation. I am becoming a little concerned about that. DR. BUCK: Not as concerned as we are, Mr. Speaker, about the contempt for this House. MR. SPEAKER: I have the floor at the moment. We're about two weeks into these spring sittings. A great number of questions are overloaded with the baggage of accusation, and it's causing me some concern. As mem­ bers know, an accusation can be made in one sentence. It may take a whole lot of sentences to defend against that accusation.

A charge in court can be read in about a minute, but it may take a three-week trial to deal with it. The result of that has been that a lot of the answers have been extremely long, and I've had difficulty even reaching a short list of members who wish to ask their questions. That seems rather odd, because in a House of 79 members we have a 45-minute question period, and that's the same length of question period as they have for 282 members in the House of Commons. So I respectfully suggest that we ask questions and not weigh them down with accusations. MR. R. SPEAKER: Mr.

Speaker, on a point of order. [interjections] On a point of personal privilege. The Speaker has indicated that there are accusations being made in this Legislature, and I'd like that clarified. Are those accusations from me as a member, my colleague Dr. Buck, the Leader of the Official Opposition, or the government side? That was a very general comment, and I'd appreciate knowing that. I recall my statements up to this point in time in the Legislature, and during this session I certainly haven't led with my chin in that sense. Maybe that should be clarified, if the Speaker could. MR.

SPEAKER: I'm not going to go around and name names, but I don't recall ever having made an observation of this kind to the hon. leader of the Representative Party. I know that occasionally there are accusations or impli­ cations in answers given by ministers, and it's only fair that the questioner should have an opportunity to deal with it. It works both ways: if there are barbs in questions, then obviously ministers must be permitted to deal with them; if there are barbs in answers, then I think it's only fair that the questioner should be allowed to deal with them.

But let's not forget that the overall purpose of this period is to ask questions. MR. MARTIN: The question is simple: why were these three major events on the same day? MR. HYNDMAN: Firstly, Mr. Speaker, the public accounts for the year 1983-84 were tabled on the same day because it seems to me to be very appropriate that the whole picture with respect to the public financial position be laid in front of the Legislature at essentially the same time. They were ready to table, so they were tabled.

They can be debated, and I hope will be debated at great length, together with the fiscal matters with respect to this fiscal year and, in the budget, the next fiscal year. There was a press conference taking place during the time of the question period yesterday. That was in order to provide an opportunity for me to comment and answer questions with respect to the budget in the traditional lockup, which has been done every year for many years.

With regard to the situation regarding the Canadian Commercial Bank, the federal Minister of State for Finance put out a news release at about 7 o'clock our time yesterday morning. Insofar as the government of Alberta was involved, it seemed appropriate to me that there be a news release indicating and stating our position, which was done at 8 o'clock yesterday morning. The only other complaint I have received was from the people organizing the Academy Awards, who said that the number of viewers in North America was significantly reduced because the Alberta budget was scheduled for the same night. MR.

MARTIN: I'm sure not even our hon. Treasurer could manipulate the Academy Awards with media manipulation. My question deals with the Canadian Commercial Bank. When was the Treasurer first made aware of the severe difficulties of this bank? MR. HYNDMAN: It was about March 14 or 15 of this year. MR. MARTIN: A supplementary question to the hon. Treasurer. Did the fact that the Alberta government has some $70 million in deposits and the Alberta heritage trust

March 26, 1985 ALBERTA HANSARD 185 fund holds a $5 million debenture, I believe, in any way influence this government's decision about this bailout? MR. HYNDMAN: Mr. Speaker, as noted yesterday, the over-riding reason the government of Alberta was one of those involved in this package to support and ensure the viability of this bank was to maintain confidence in the system and to ensure the continuance and viability of a western Canadian, Alberta financial institution. Those were the stated reasons the Alberta government was involved.

As well, it indicates a show of confidence in the future of Alberta in the recovery, not only from our point of view but a show of confidence in this province and in the future of the west by others in other parts of Canada. MR. MARTIN: A supplementary question. The Treasurer said he was not aware of this problem until March 14. I'm told that in the House of Commons the Minister of Finance and the Canadian government knew in September. My question is: who in the Treasurer's department is responsible for checking out where our deposits are?

The federal Finance minister knew since September that this bank was in dif­ ficulty, and we still had deposits there. Who is responsible? Is it the Treasurer? MR. HYNDMAN: Mr. Speaker, this is a federally chartered bank, and the Inspector General of Banks, in Ottawa, is the person who has that responsibility under federal legis­ lation, pursuant to the Constitution. MR. MARTIN: A supplementary question, Mr. Speaker. Surely in this province it's the Provincial Treasurer's respon­ sibility to know where our deposits are and where our heritage trust fund money is.

Was the Treasurer not aware that this bank was in any difficulty, and was he not concerned before March 14 about the $70 million and the $5 million debenture? MR. HYNDMAN: Mr. Speaker, we're always aware of where all the investments of the government of Alberta are. For example, the $1.5 billion of interest on those good investments in the heritage fund are indicative of the fact that they've been wise and prudent investments.

So we learned of the situation, appropriate to the federal laws of Canada and the Bank Act with respect to this federally chartered bank, at the same time as was noted by the Inspector General of Banks, I think, on March 14 or March 15, 1985. MR. MARTIN: A supplementary question to the Treasurer, Mr. Speaker. Apparently, we are joining with the governments of British Columbia and Canada in purchasing up to $13 million of subordinated debt of this particular bank.

Can the Treasurer be a little more specific and indicate if we're writing off this debt for the bank, or is there any chance at all that any of this will be repaid? Are we looking mainly at second mortgages? MR. HYNDMAN: This is the situation, Mr. Speaker. The hon. leader is correct: it's up to $13 million, involving the governments of Alberta, Canada, and British Columbia. It's a situation where we, in effect, bought out the existing debenture holders.

There is still a legal obligation to pay back the interest and principal with respect to those invest­ ments, but those payments will be postponed until after the main members of the support group, which is the government of Canada, the government of Alberta, and the six other banks, are paid out with respect to their investment from the 50 percent of the profits of the Canadian Commercial Bank. I believe, as was stated in Ottawa today by the deputy director of compliance, that the long-term prospects for the [Canadian Commercial Bank] are now good . . . The bank will return to profitability.

There are no other banks in Canada facing a similar situation . . . The [federal] government is of the view that all banks in Canada are solvent, viable, ongoing operations. MR. MARTIN: There's no doubt they'll be solvent if governments keep bailing them out. Alberta's share of the basic support package is $60 million, which is a no-interest loan and ostensibly will be repaid out of 50 percent of the bank's future profits.

Given that this bank had an 88 percent decline in its net income in the year ended October 31, 1984, had a $1 million loss, my question is: what leads the government to believe there will be any profits from which we will be repaid? MR. HYNDMAN: Mr. Speaker, with this support package the bank is now in a strong position of solvency and ready to move ahead following the recovery, with confidence in the western Canadian economy, which has grown and which will be growing in the years ahead. Therefore, I see that the government of Alberta and others will be paid back the moneys they've advanced. MR.

MARTIN: That's what we call hope and fantasy. Perhaps they'll do as well as they did in the past. Besides a nondiversified economy in Alberta, one of the major problems facing this bank was its poor management decision to purchase all the outstanding shares of an Amer­ ican bank, the Westlands Bank. My question is: how does the Treasurer justify bailing out a bank because they made a bad decision in the U.S.A.? It has nothing to do with the Alberta economy. MR.

HYNDMAN: Of course, the hon. gentleman realizes that there were a number of problems in Alberta and North America over the last two years, which have been reflected in changes in values of real estate and other assets. The reality is that this was a situation where a problem arose, and co-operatively in Canada, between the private sector and governments, a support package was arranged which reflects confidence in Alberta and the west. That's why the overall move is so important.

I urge the hon. member to think just a little about that confidence, because it really does give a warm feeling to think about confidence in Alberta, and he'd find it feels good. MR. MARTIN: Well, I feel warm and fuzzy all over. Maybe they'll buy a bank in Ohio after the bank in California, so all the taxpayers can feel good about that. The $60 million for the basic support package joins similar contributions from the government of Canada and six other chartered banks, I believe.

Can the Treasurer elaborate on the repayment terms and, in particular, whether we'll be in the front or the back of the line of creditors? What I'm saying is: will we be paid ahead of the banks, or do we follow the banks in this repayment? MR. HYNDMAN: It was an important part of the arrange­ ment, Mr. Speaker, that we are in no way subordinate to

186 ALBERTA HANSARD March 26, 1985 the other parties; in other words, the position and posture of the government of Alberta as a province is exactly equal to that of the federal government of Canada and the six largest banks. In addition to 50 percent of the future profits of the bank being dedicated toward repayment of those initial supporters, there is the situation wherein there is a warrant, an opportunity for equity in the bank, should that appear to be appropriate at some future time. MR. SPEAKER: Might this be the final supplementary on this topic. MR. MARTIN: Mr.

Speaker, my final question to the Provincial Treasurer on this matter: is the money for this bailout to come from the Alberta investment division of the trust fund? If so, how does this fit in with the requirement in the Act that states that such investments will yield a reasonable return or profit to the fund? MR. HYNDMAN: Mr. Speaker, events moved rather quickly over the course of the last four days with respect to this arrangement, and no decision has yet been taken as to the source of funds. The heritage fund was one option, the General Revenue Fund would be another, and there may be others.

Certainly we would move only in a way which would reflect the laws of the province. Provincial Budget — Forecasts MR. MARTIN: We will move on to other matters. I know it's the Treasurer's day, so I'd like to continue having a chat with him. Now it has to do with general questions about the budget and the public accounts, Mr. Speaker. I know we both want to feel warm after this discussion. There were some questions yesterday about Fantasyland, so in that context I would like to ask the Treasurer about his magic calculator.

According to the public accounts tabled yesterday, our actual revenues in 1983-84 were 5 percent more than the estimates presented to this Assembly, while our expenditures were 4.6 percent less, thus reducing the so-called deficit by some $867 million. My question is simply this: has the Treasurer sat down with senior officials in his department to review ways in which estimates pre­ sented to the elected representatives of Alberta might be a little more accurate in the future? MR. HYNDMAN: Mr.

Speaker, the estimates in a province that relies on the sale around the world of commodities where the prices and volumes are determined elsewhere is always very difficult. It's much more difficult than a province where there is a great deal of predictability in revenues — where they have a sales tax, for example. In this province it's very difficult. Certainly, the hon. member is correct with respect to the happy situation of starting out with an estimate of a deficit last year and having a surplus in this fiscal year.

One of the reasons for that, of course, was the fact that the government restraint program, the increased efficiency of running government operations, was responsible in a major way for reducing that deficit. In fact, the public service of the province should be congratulated for their management and assistance in getting this government the leanest and trimmest in Canada on those figures. MR. MARTIN: Mr. Speaker, he seems to be saying he didn't expect them to do the job and that it was such a surprise that they did their job, they cut down the deficit.

Similar problems occurred during the budget speech last night. Somehow the 1984-85 estimate of a $233 million deficit has magically turned into a $613 million surplus. [some applause] You can clap or not, but we're talking about estimations. What assurances can the Treasurer give the Assembly that the estimates yesterday will not also be subject to a 10 percent margin of error? MR. HYNDMAN: The figure is 9 percent, Mr. Speaker. The hon. member is probably using metric.

The problem is that I don't think anyone could have foreseen last year, for example, that the value of the Canadian dollar vis-a-vis the American dollar would have changed as it did. That's one of the reasons the revenues went up, causing the change in the figures the hon. member talked about. The returns to Alberta with respect to our massive sales of natural gas in the United States, for example, increased our revenue. There's always going to be some margin of error. One percent in terms of a revenue situation means $100 million. In this province, with our resources, there are going to be those risks.

Depending on what we think will be the relative stability in the world oil price and depending on the stability of prices and volumes of our other products, we hope we will continue to be in that reasonable range of differences every year. MR. MARTIN: A supplementary question. I hope the Treasurer is a little closer on his household budget than he is on the provincial budget. Given that there was no energy agreement when this budget was drawn up, at least that we're aware of at this particular time, can the Treasurer advise on what basis the energy revenue and expenditure figures were determined?

Are they based on the elimination of the PGRT, for example, or did the Treasurer's officials just pick numbers out of the air? How did they come to these figures? MR. HYNDMAN: Mr. Speaker, we have to remember that the petroleum and gas revenue tax is a tax on the industry, not a tax which directly reflects the revenues of the province of Alberta. So that is not a factor. Therefore, with respect to that situation the PGRT and any modification of it is not something that would factor into the revenues of the province of Alberta, certainly not this year.

With respect to deregulation, there have been clear indications from the federal government that a deregulated oil price is in the offing, and the situation there would probably end up being awash with respect to what would happen to new oil and old oil. Therefore, we predicted and essentially used assumptions of the status quo and stability in those revenues. MR. MARTIN: A supplementary. MR. SPEAKER: Might this be the final supplementary. I know that will only make three, but I have a list here and we've come close to using half the question period.

I'd like to be able to reach all these members who would like to ask questions. MR. MARTIN: We'll ask one more question. We'll save some for the Treasurer another day. Certainly the PGRT would affect the profits of the companies, which would affect our treasury. I'm sure the minister is well aware of that. As the Treasurer is well

March 26, 1985 ALBERTA HANSARD 187 aware, the world oil price is in some state of flux. In preparing the budget and estimating oil revenues, what was the Treasurer's analysis of what would happen to the world oil price in the coming year? In other words, is this budget based on the status quo; that is, world prices remaining approximately where they are now? MR. HYNDMAN: Mr. Speaker, we see a general stability within a reasonable range. It's true that there have been suggestions that there could be a softening in the international price of oil.

Even if that did occur, Alberta is probably in the best position to take that kind of problem, insofar as deregulation would mean that our old oil price would go up. In our view there would not be a significant risk of a very significant change in revenue by reason of that kind of occurrence. Provincial Budget — Agriculture MR. R. SPEAKER: Mr. Speaker, my question is to Pro­ vincial Treasurer as well. On page 8 of the budget speech I found a statement that would be a rather startling revelation to not only the farmers but, I'm sure, the Minister of Agriculture.

The Treasurer said: A return to more normal weather conditions should increase agricultural output this year, which would strengthen farmers' balance sheets. Could the Provincial Treasurer indicate whether the source that was used as backup information there is the same source the Provincial Treasurer has been using to predict economic resurgence in the province of Alberta? MR. HYNDMAN: That's a statement which I believe is correct, Mr. Speaker. By the end of the year we'll know whether or not the weather conditions were normal.

If they are normal, which on average they certainly should be, we should therefore increase agricultural output, which would strengthen farmers' balance sheets. [interjections] MR. R. SPEAKER: Mr. Speaker, I know that's the same kind of research done into some of the predictions in this budget. But some of the experts in this field, the meteor­ ologists, tell me that 1985 could be as dry as 1984 and that because of the reduced moisture from 1984, 1985 could be a bad crop year.

Could the minister indicate whether any type of research such as that was done before making such an optimistic statement for the farmers of Alberta? MR. HYNDMAN: Mr. Speaker, for many decades this has been next-year country. Perhaps the hon. Minister of Agri­ culture, having had somewhat more agricultural experience than I, could comment more on the view farmers have with respect to the weather. But I think that statement is a fact: if there is a return to more normal weather conditions, then the problems associated with the drought last year should not be as difficult as this year. MR. R. SPEAKER: Mr.

Speaker, I certainly didn't see any "if" in the thing; it was a rather straightforward, direct statement. On a more serious side of this subject, though, the farmers of Alberta were looking for support from this budget. Was there any consideration by the Provincial Treasurer for support to farmers in terms of input costs relative, say, to reducing the cost of fertilizer for the farmers in the province of Alberta? MR. HYNDMAN: Mr. Speaker, perhaps I'll ask the Minister of Agriculture to comment. I would simply like to say that the amount of support that is in this budget is unmatched anywhere in Canada.

With respect to input costs, for exam­ ple, there is no farm fuel distribution allowance in any other province that matches the $73 million we have. There is the Agricultural Development Corporation . . . MR. R. SPEAKER: On a point of order. [interjection] MR. SPEAKER: Order please. The hon. leader of the Representative Party is on his feet on a point of order. MR. R. SPEAKER: The Provincial Treasurer may give me all that guff and all that side action, but I want the straight facts about the cost of fertilizer. Twenty-five percent of the cost of fertilizer is government tax and government take.

My question is: did the Provincial Treasurer consider reduc­ tion of that input cost? That's the answer I want. I can read that other stuff myself. MR. HYNDMAN: The unmatched record in Canada deserves to be repeated again and again, Mr. Speaker, but I . . . MR. SPEAKER: With great respect to the Provincial Treas­ urer, the question is very specific and direct, and ordinarily that would limit the parameters of the answer. MR. HYNDMAN: Perhaps my colleague the Minister of Agriculture could expand upon the answers I've given, if he wishes to do so. MR. R. SPEAKER: Mr. Speaker, on a point of order.

The person who prepared this budget is the Provincial Treasurer. The Minister of Agriculture did not have the final say on what went into the budget. The Provincial Treasurer should have the answer. Did he or did he not consider that kind of relief for the farmers in Alberta? If he didn't, say no and sit down. MR. SPEAKER: With regard to the point of order, I must say that neither the hon. leader nor I have any authority to tell the government which minister is going to give its answers. MR. CRAWFORD: And that was a point of disorder. MR. FJORDBOTTEN: Mr.

Speaker, I'm happy to respond, because we've been very sensitive to the health and viability of our agricultural sector. If you read this particular budget properly, not like some people have read it, you can go from estimate to estimate, and you'll find there's a 12.9 percent increase in the agricultural budget as well as a 26 percent increase in ADC's budget. I refer the hon. member to the throne speech and point number two of our priorities: we'll support the agricultural sector through these difficult times with a number of initiatives that we'll take at the most appropriate time. Of course, Mr. Speaker . . .

MR. SPEAKER: With great respect to the hon. minister, the question hasn't been changed. It's still very specific and direct, and I respectfully suggest to the hon. minister that he's talking about something that hasn't been asked. [Mr. R. Speaker and Mrs. Cripps rose]

188 ALBERTA HANSARD March 26, 1985 MR. SPEAKER: Perhaps we might come back to the hon. Member for Drayton Valley after the hon. leader has had a reasonable opportunity to ask supplementaries to his main question. MR. R. SPEAKER: Thank you very much, Mr. Speaker, for that courtesy. My next supplementary question is to the Provincial Treasurer. In terms of capital gains tax and the provincial portion, did the Provincial Treasurer give any consideration, in preparing this budget, to removing the provincial portion of the capital gains tax that now exists? MR. HYNDMAN: Mr.

Speaker, just a few days ago, I believe, the Minister of Agriculture set forth very clearly the government's position with respect to the ongoing mon­ itoring of that situation vis-a-vis statements that had been made by the federal government with regard to their upcom­ ing budget, so that was certainly a matter under consideration as well. MRS. CRIPPS: A supplementary, Mr. Speaker. Could the Minister of Agriculture indicate how much tax there actually is on the gas used in fertilizer production? MR. SPEAKER: It would seem to me that's a matter of public knowledge. Very few taxes are levied in secret. MRS.

CRIPPS: On a point of privilege, Mr. Speaker. That's what the member asked. MR. SPEAKER: If that's what he asked, it got by me. Provincial Budget — Municipalities MR. McPHERSON: Mr. Speaker, my question to the Min­ ister of Municipal Affairs relates to a budgetary item in last night's budget. It indicates $800,000 in grants to muni­ cipalities for the equivalent to municipal taxes on privately owned, nonprofit senior citizens' housing. Could the minister indicate when the municipalities may expect those grants to come forth? MR. KOZIAK: Mr.

Speaker, the funds that would be provided pursuant to that vote, when approved by the Legislature, would in all likelihood be paid to a municipality once it has set its mill rate and sent out tax notices. The province won't in fact be paying taxes, but it will be our goal to approximate the municipal portion of the tax with grants from this vote. That would be done once each municipality has set its mill rate. MR. McPHERSON: A supplemental, Mr. Speaker.

I also note that the unconditional municipal assistance grants for 1985-86 are to increase by 4.2 percent in the budget but that there is considerable discrepancy between the 4.2 percent number in the budget and the funding available to individual cities and municipalities in the element details of the budget. For the benefit of many members who represent consti­ tuencies across this province, could the minister explain the discrepancy in those numbers? MR. KOZIAK: Mr. Speaker, the 4.2 percent figure is a universal figure for all municipalities.

What happens with respect to each individual municipality is that the information from that municipality is plugged into a formula. There are two components to that formula for urban Alberta — cities, towns, villages, and summer villages — and those are population and assessment. The greater the population, the greater the entitlement; the lower the assessment per capita, the greater the entitlement. In other words, the more people a municipality has and the poorer that municipality is, the greater the unconditional funds that would flow to that municipality.

For rural Alberta — counties, municipal districts, and improvement districts — another component is added to the two points I've raised; that is, kilometres of road. The more kilometres of road a municipality has, recognizing that that imposes an expense upon that municipality, the greater the entitlement to grants under the unconditional grant formula. Now, when you plug in all those figures, you find that certain municipalities, based on previous years' entitlements, were receiving either less or more than — and in very few cases — the proper amount under the formula.

Our goal in this particular year is to get people who are below 90 percent of their entitlement up to at least 90 percent of their entitlement, so in some cases you have some fairly substantial increases. Our second goal is to bring those municipalities who were receiving substantially above their entitlement down to a figure of 200 percent of their enti­ tlement, so you would find some decreases shown there. Over time it will be our goal to get everybody to a 100 percent situation.

I know that's going to be impossible, but we will try to bring municipalities closer to what their entitlement is on a year-by-year basis. MR. McPHERSON: Mr. Speaker, one more supplemental. I don't see any decreases in this list, so I don't see anyone going below the level of last year. Could the minister confirm that? MR. KOZIAK: Mr. Speaker, there are a few isolated municipalities who have experienced decreases. MR. McPHERSON: Mr. Speaker, one other supplemental.

Could the Minister of Housing indicate to the Assembly if his department will also be participating in grants in lieu of taxes for municipalities on government-owned senior citizens' property? MR. SHABEN: Mr. Speaker, in the budget tabled yesterday, it was confirmed that it is proposed that the Alberta Mortgage and Housing Corporation pay municipalities the municipal grant in lieu equal to the municipal portion of taxes on senior citizens' self-contained units.

We would follow a similar course of action to that of Municipal Affairs: sub­ sequent to the striking of the mill rate and approval of these estimates by the Assembly, we will be in a position to respond. Provincial Budget — King's College MR. R. MOORE: Mr. Speaker, my question is to the Minister of Advanced Education. Many people across this province are interested in the economic well-being of King's College. I am wondering if the minister would advise this Assembly how much funding will be forthcoming to King's College out of last night's budget. MR. JOHNSTON: Mr.

Speaker, I am able to report that as a result of considerable negotiations among the private

March 26, 1985 ALBERTA HANSARD 189 colleges and the government, and in some significant response to the MLAs in this province, we will be providing $300,000 to King's College in the year '85-86. Provincial Budget — Consumer Incentives MR. GURNETT: Mr. Speaker, my question is for the hon. Treasurer.

We've heard about the ability to predict weather, and given the $800 million extra the Treasurer managed to find in each of the last two years, my question is whether he will be introducing legislation during this session to repeal the personal income tax increase instituted last year, which only brings in slightly over $200 million for the province. MR. HYNDMAN: No, it's not my intention, Mr. Speaker. Of course, the personal income tax in the province of Alberta is, by a wide margin, the lowest in Canada, and the take-home pay of Albertans is larger than anywhere else.

In carrying out the basic objective of prudent financial management, I think it's very important that we not get onto the treadmill of increasing the deficit. That would increase the deficit significantly, so it will not be my intention to follow that course of action this year. MR. GURNETT: A supplementary question. I have trouble trusting where the deficit will or will not be, Mr. Speaker. Last night the Treasurer informed us that projections indicate there will be practically no increase in real consumer demand this year.

My question — and I'm hoping I won't hear more about retail sales per capita as the answer — is whether or not the Treasurer has asked his officials to give him any estimate of the effect on real consumer demand of a rollback on the personal tax increase. MR. HYNDMAN: I haven't made that inquiry, Mr. Speaker, because it's not my intention to introduce that to the Assembly.

In terms of per capita retail sales in Alberta and as a piece of new information for the hon. questioner, we have the latest information for January, which shows that once again Alberta has the highest number of people per capita in Canada spending the largest amounts buying goods and services. I think that will continue, which is very much a source of strength and indicates the recovery is proceeding, and is a source of confidence. MR. GURNETT: A supplementary question, Mr. Speaker.

Since there are other economic indicators and the Treasurer told us last night that the unemployment rate will increase again this year compared to last, my question in connection with this whole problem of recovery is whether the Treasurer can advise what this government means when it talks about recovery if it does not mean a reduction in unemployment. MR. HYNDMAN: Mr. Speaker, this was dealt with at some length by the Premier on the Friday after opening day and on subsequent occasions. As we've indicated, in most sectors the economy is picking up.

But without question there is a serious concern with regard to the unemployment level, That is in the areas of building construction partic­ ularly, as distinct from industrial or institutional construction. We have responded. We responded in this budget to a larger degree than any other government. The recognition, though, has to be of the private sector creating the permanent jobs.

We've set the stage for that with the range of programs with a quarter of a billion dollars available, with the over 20 percent increase in support for students, and with the support for the private sector through the small business equity corporations Bill announced today. I think it can fairly be said that while we still have the absorption problem — the vacancy rate to come down with regard to apartments, the overbuilding, and the office space — the recovery is there. We're moving ahead to steady and durable growth, which is what Albertans need.

So it's a difficulty and a very serious concern that the unemployment problem is still there, but we are responding and doing everything that can possibly be done, at a record level in Canada. MR. GURNETT: A supplementary question, Mr. Speaker. In view of the concern we've just heard expressed for steady and continuing growth, I wonder if the Treasurer has reviewed the option of implementing a program of fixed low-interest, long-term loans that would be available to homeowners, business people, and farmers in the province as a means of sustaining this. MR. HYNDMAN: Mr.

Speaker, one of the reasons for the problem of the downturn of the last two years is the situation with respect to debt. What this province needs is not larger availability of larger amounts of debt but equity investment such as is available through the Bill introduced by my colleague today. MR. BATIUK: A supplementary to the Provincial Treasurer, Mr. Speaker, in reference to a news flash wherein the Leader of the Opposition stated that it would help the unemployed if the income tax were lowered. Could the minister advise whether the unemployed pay income tax? North West Trust Support DR. BUCK: Mr.

Speaker, my question is to the Provincial Treasurer. Yesterday I asked the Premier if the government had had any discussions with North West Trust or the Treasury Branch to help the Treasury Branch prop up North West Trust. Were there any discussions among those three parties before the decision was made by the Treasury Branches to help out with North West Trust's problems? MR. HYNDMAN: Firstly, Mr. Speaker, the words "prop up" are inappropriate, as I think has been noted. The Treasury Branch has been the banker for North West Trust for over two decades, just as other financial institutions have bankers.

It would be inevitable that in the course of the required regulatory responsibilities she and her depart­ ment have, the Minister of Consumer and Corporate Affairs — the hon. member said "the government" — would be advised of discussions with respect to the regulators in that department with any of the financial institutions of the province. If the minister wishes to supplement my answers, I invite her to do so.

It's my understanding that the facts that they wanted to look at alternate and optional methods of strengthening their company and that the preferred-share transaction approach was suggested with the Treasury Branches were brought to the attention of the regulators in the department by North West Trust. It would therefore be inevitable, and it was, that the minister of consumer affairs would be advised of that. She and I and others discussed the fact that a move was contemplated by North West Trust with respect to a

190 ALBERTA HANSARD March 26, 1985 preferred-share transaction. I would make it very clear that there was no direction by me, as Treasurer, to the Treasury Branches in that regard. DR. BUCK: Mr. Speaker, can the hon. minister of consumer affairs indicate if North West Trust expressed to her any concerns that they were possibly looking at having financial problems? MRS. OSTERMAN: Mr.

Speaker, the information with respect to North West Trust, as with other financial insti­ tutions that are regulated by my department, comes to me on an ongoing basis in terms of a reporting procedure by the director of trust companies. For instance, in the normal course of reporting I recall the information with regard to North West Trust being passed. It isn't information I would be acting upon, because it's information that is managed and reported by the trust company. It's an integral part of their operation and wouldn't require any sort of condoning, for instance, by my regulator or the department. DR.

BUCK: Mr. Speaker, can the minister indicate if the minister and her counterpart in Saskatchewan had any dis­ cussion, or if it was brought to her attention that Pioneer Trust was having difficulty? Pioneer Trust does have branches here, with Albertans investing in it. MRS. OSTERMAN: Mr. Speaker, I was advised of the Pioneer situation at the same time, I am sure, as the public became aware of it. Provincial Budget — Tourism DR. CARTER: In the budget announcement last night, mention was made of significant initiatives of $7 million in expanded tourism. My question is to the Minister of Tourism and Small Business.

If the tourism advertising budget is to triple, will the funds in terms of advertising be targeted to the United States because of the favourable dollar balance at the moment or to the world because of building up influence with respect to having people come for the Olympics? MR. ADAIR: In essence, you've answered part of the question. The additional funds for advertising would be used in the traditional markets: primarily the U.S. west coast, the Pacific Rim, United Kingdom, Europe, as well as Canada.

The emphasis at the moment would deal with attempting to get as many of the visitors who might be going to Expo 86 in Vancouver in 1986 to stop in Alberta either going to or coming from other parts of Canada or the U.S. and leave some of their tourist dollars with us. DR. CARTER: A supplemental, Mr. Speaker, to the min­ ister. May members of the Assembly be assured that there is going to be a year-round thrust to this advertising budget, not simply directed at the good old summertime? MR. ADAIR: Mr.

Speaker, I can have you and the hon. members rest assured that the dollars used will be on a four-season, year-round basis. DR. CARTER: A supplemental, Mr. Speaker, with respect to the funding allocations for training courses. Would the minister assure the Assembly that the training course devel­ opment will be done in conjunction with Advanced Education and the industry, with particular emphasis on the hotel industry? MR. ADAIR: In general, I can give you that assurance; I might just change the order. In essence, we will be working with the industry.

Once the agreement is reached with the industry, then we will involve the Advanced Education procedures as well as all the other facilities or courses that may be developed to provide the kind of training, from "train the trainers", one of the program titles they're talking about, to others that would deal with general hospitality training. There has been a significant notification by the industry that there is a need for that, and we're responding to that need. DR. CARTER: A final supplementary, Mr. Speaker.

In his consultations, would the minister take under advisement that he will challenge the industry to bring in some of its own guidelines as to an assurance of the quite acceptable and beyond acceptable standards with regard to the whole indus­ try? MR. ADAIR: Mr. Speaker, I think I can give that assurance to the challenge. As a matter of fact, if you go back to the white paper that was produced and was evident through­ out the province of Alberta this past summer and fall, one of the points raised related to a challenge to the industry to do a number of things.

I don't have the particular wording with me, but it challenged the industry to ensure that, in co-operation with any of the other parties, it begin to develop those portions of the particular hospitality training programs and the likes of that on an ongoing basis and to monitor and control them within the industry itself. MR. PAPROSKI: Mr. Speaker, to the Minister of Tourism and Small Business. The budget indicates that a new tourism marketing development fund will be established. Would the minister advise the House what the purpose of this particular fund will be? MR.

ADAIR: Basically, that fund will assist the private sector by, in essence, using the term "co-op advertising" with them in their marketplaces to bring the tourists to Alberta for their particular industry. Some time ago we had in place a program of some co-operating basis. In this particular one we will be increasing the percentage paid by the province of Alberta in specific areas, once identified within the industry itself. MR. SPEAKER: The hon. Member for Edmonton White- mud, and since there was a fairly lengthy intervention on my part, with the indulgence of the House perhaps we might also reach the hon.

Member for Drayton Valley. HON. MEMBERS: Agreed. Small Business Equity Corporations MR. ALEXANDER: Mr. Speaker, having been treated as we have today to a scaled-down version of Wall Street Week by the financial analysts from the socialist opposition, I have what seems like an excessively simple financial question for the Minister of Tourism and Small Business. Can the minister advise whether any new dollar limits are being set, or have been set, for the new small business equity corporations fund?

March 26, 1985 ALBERTA HANSARD 191 MR. ADAIR: When I introduced Bill 16 today, Mr. Speaker, what happened was the provision of the possibility, by way of amendment, of removing the existing $15 million limit put in place and passed just a year ago, allowing us to respond more quickly to the private sector and those who will be involved in investing funds in private-sector pools of equity capital, and to do that by regulation. Yes, we're recommending a sum of $35 million. MR. ALEXANDER: A supplementary, Mr. Speaker.

Can the minister indicate how soon those funds might be available to people who are lined up to apply for the very successful SBEC program? MR. ADAIR: Mr. Speaker, the very first thing I would like to do is ask all members to co-operate in the passage of that particular amendment so we can get it in place as quickly as possible, for two reasons. One, it will assist those small business equity corporations that are public and will be going out with a public offering, so that they know where they're coming from. We're aware that there may be two or three of them out there in Alberta.

Second, once the session is over and we're in a position to provide the funds, because the amendment has to be passed first for us to be able to do that, we will proceed as needed — in essence, as required. If the small business equity corporations are approved and the need for dollars is there, then they will be drawn. It's the same principle as in the original Act. It's a four-year program, life dating back to last July 18 — four years from that date — or the expenditure of the funds, whichever comes first. MR. ALEXANDER: A supplementary, Mr. Speaker, just to clarify.

Do I hear the minister saying that the applicants now in line may have to wait until the session is over in order to draw those funds? Is that what he said? MR. ADAIR: Not necessarily that they would have to wait, Mr. Speaker. They may well have to wait for the actual cheque in the sense of the dollars that would be provided by way of the incentive. But as of today they can move and make their investments, and they can work from that particular point on. I guess that's what they've been waiting for — what kind of sum was in place and whether we were going to change the Act.

Introducing the amendment to the Act today provides the opportunity for us to do it. As quickly as we can get it passed, they will know they are, in essence, ready to go and to proceed with any of the small business equity corporation programs and cor­ porations that they have lined up at this point. MR. SPEAKER: The hon. Member for Drayton Valley has indicated that she is prepared to postpone her question. ORDERS OF THE DAY head: MOTIONS OTHER THAN GOVERNMENT MOTIONS 203. Moved by Mr. Oman:

Be it resolved that the Assembly urge the government to consider new systems for the delivery of medical services that would (

a) allow nurses and other health care professionals to authorize the provision of health care services, and (

b) recognize the use of private clinics and other services which might be more efficient and thus less costly than the traditional doctor/hospital orientation. MR. OMAN: Mr. Speaker, before we begin, I would like to indicate that we have a group of visitors in the balcony today who are interested in the motion at hand. I believe most of them are registered nurses who have come to listen to the debate today. I would like them to stand and be welcomed by the House. The motion before us today, Mr. Speaker, has been before this Assembly before.

I appreciate the action of the strategy committee devoting the whole afternoon to debate, which I think indicates some of the importance that's attached to it and also the interest we have felt out in the community with regard to it. I hope we can stand two hours of political debate on one subject. I'm reminded of a story I heard perhaps a century or more ago when there was to be a public hanging. [inter­ jections] That's right; I'm getting old already, Mr. Speaker. In those days they were quite the affairs, and people came from miles around to witness them.

It so happened that the local politician was also present, and out of courtesy they asked the man who was to be hanged if it was all right if the local politico said a few words. He said, "I really don't have any objection, but if you don't mind, I'd like the hanging to take place first, because I've heard him speak before." In effect, this speech has been given before, and if you want to go back to the Hansard of October 18, you will see the original outlay at least of myself and other members of the Legislature. I shall not, however, repeat all the things said there. [some applause] Thank you, sir.

I shall keep my remarks a little more brief. To start with, this is not to be a debate on the budget, Mr. Speaker, but just to set the perspective here, I would like to refer to a couple of sentences in our Treasurer's remarks concerning health care services last night. Our Treasurer said: Health care, like education and manpower . . . is an investment in our people. Albertans benefit from health care services that are among the best anywhere. However, these services come at a very high cost.

If we are to meet the objective of responsible fiscal manage­ ment, we must continue to address the difficult problem of reducing the rate of escalation of health care costs. Then he said: There are two aspects to the health care cost issue: the utilization of doctors' services and the use of hospitals. The cost arising from the services of phy­ sicians and other health care professionals has been climbing. Then just one more sentence, Mr. Speaker. He indicated that the total budget this year is going to increase by only 4.5 percent as compared to 10 percent last year.

But he did say: [Nevertheless], the Alberta health operating budget will move past the $2 billion mark this year and will account for approximately one-quarter of the total government operating budget. The continuing co-oper­ ation of all those who use and manage the system is needed to keep costs at a realistic level. There is the starting point, Mr. Speaker, for what I would like to say today with regard to my motion, which is, in

192 ALBERTA HANSARD March 26, 1985 effect, to look at the health care system, open it up, shift it, and move it in such a way that it will be more efficient and more effective. I think the hon. Treasurer has given us the incentive, and my comments are set in that kind of framework. As I said before, it calls for bold initiatives to improve the quality and at the same time reduce the costs. I'm not here to be critical of our present system, but I think all of us know it is oriented toward the traditional hospital/ doctor uses. It provides good care, probably the best care in the world.

But it is not the most efficient, and it's costly. I think the thing we often do in our medical system today is use well-prepared, qualified doctors to do such things as prescribe aspirins for flu or whatever in primary health care when they really ought to be using their skills in much more complicated procedures. My point here is that we ought to be using other health care practitioners who could do the job for less and, incidentally, do it as well. Of course, I'm talking primarily about primary care and simple medical procedures that don't need to be given in costly and complicated settings.

How is this to be done, Mr. Speaker? First of all, I would like to see a new point of entry given to the health care system. When the Canada Health Act was put into effect some years ago, the Canadian Nurses Association did a very effective job of lobbying. Rather than allowing the point of entry to be just a medical doctor, they had it changed to where it could be a health care practitioner or professional. It really opened the door rather wide, but it's up to the provinces now to take that cue and use it as they see fit.

It's always been my feeling that particularly the nursing profession has been underutilized for what it's trained to do. It seems to me that if we were to use the expertise that's already around us for some of the more primary tasks in our medical delivery system, we could find that our system would be not only improved but also less costly. I refer again to a study from McMaster University, which really took this under advisement to see whether or not there would be actual cost savings.

In 1982 they came out with what they said was a conservative estimate that at least 10 to 15 percent of medical services directly and from 16 to 25 percent of ambulatory care would be saved, for a total savings of some $300 million across Canada. That's a lot of money. If you were to take our own budget of some $2 billion and better in operating costs this year and cut it by a quarter, that would be a saving of $400 million. It's easy to say that; it's harder to realize it, I'm sure. But here are some people who did look into the aspects and said this was possible. Not only is that so, Mr.

Speaker, but it has been shown by various experiments in Canada and other places that have health care professionals that nursing practitioners can do very well in certain primary care settings. There was, for instance, what is known as the Beaverton project in Ottawa, sponsored by the Victorian Order of Nurses, in which a nurse and a doctor copractised in the area. The doctor was left to look after the more complicated cases,

whereas the nurse went out and did a lot of home-care visits and some screening. It was found that the usage of hospitals by that particular group of people decreased sig­ nificantly and also that diseases were caught in early stages. So it was both a preventative and a saving factor. In the province of Newfoundland two control groups were taken, one operated by nurses and one by physicians. It was noticed that in the control group that was being ministered to by the nurses, hospital entries decreased by 5 percent,

whereas for the group that was ministered to by the doctors, hospital usage increased by 39 percent. I don't want to make a generalization out of a single incident. There have been some failures too, which I shall mention a little later on. But I think there's enough here to indicate that this can work, has indeed worked, and that it ought to be looked at. That's what I'm asking for today, Mr. Speaker: consideration of this method. It is indicated that in 1982 upwards of 40,000 nonphy­ sicians, nurse practitioners, and physician's assistants were practising in the United States.

By the late 1970s most states had modified existing medical and/or nurse practice statutes to permit entry of qualified nonphysicians into medical practice. Studies done in the United States indicate that nonphysicians hold considerable potential for cost control in health care delivery, particularly when used in an insti­ tutional setting. Further, Mr. Speaker, the Graduate Medical Education National Committee has recommended that med­ icare statutes should be changed to allow for direct reim­ bursement of nurse practitioner and physician assistant services.

It's felt that this will provide cost savings and increase utilization of nonphysicians. I move on, Mr. Speaker, to another area of expanded settings. I'm talking not about bringing the people to the hospital so much as bringing the delivery to the people in community-oriented settings such as community clinics, free­ standing medical clinics, and physiotherapy clinics. These have become very, very popular in the last decade or so. In fact, it's estimated that by 1990, 25 percent of primary care in the United States will be done through walk-in, extended-hours clinics. This could be expanded.

Most of these, of course, are doctor-oriented. I want it to be clearly stated that I'm not here to pull down the physician's position. I think he's always going to be on the top, if you will, or in control of medical delivery. What I am saying, however, is that we now have too much of a monopoly. I think we ought to spread this out and provide not necessarily competition but alternate forms of ministry to those who are in need of health care. Incidentally, I came across some figures today which are significant. The government of Alberta has encouraged private physiotherapy clinics in our province.

Since the introduction of these private clinics, the cost of physiotherapy hasn't gone down overall. In fact, it has increased, more so for the hospital setting, incidentally, than for the private practitioners. But the interesting thing I call to your mind and the minds of the members here, Mr. Speaker, is that in 1983 the cost per service in a private clinic was $4.90,

whereas the cost in a hospital was $11.33. That's more than 100 percent more costly for the same service. In 1984 that cost went to $5.50 for the private clinic and $13.13 for the hospital-centred clinic. What I'm saying is that there are cheaper ways of health care delivery than we presently are using or have emphasized. There's no question that the freestanding medical clinics operate at a fraction of the cost per patient. Again, oftentimes we use very complicated systems, such as we have in our hospitals, for very simple procedures. What I'm asking for is flexibility in our health care delivery systems.

Something else I want to emphasize here is the increasing emphasis that is going to be placed on preventative medicine in our society. I think the community clinics are increasingly going to come into play in this educational aspect. People are becoming more aware of their health needs. There is an explosion in physical activity to keep our bodies in shape and a greater awareness of the harm that's being done to

March 26, 1985 ALBERTA HANSARD 193 us through such things as smoking, drugs, alcohol, or whatever the case may be. Obviously, nursing practitioners and others who are trained to be specialists in these areas could save us a lot of dollars with the principle of a stitch in time saving nine. A word, too, about the aging or retirement factor in our society. I believe seniors in Alberta now comprise something like 8 to 9 percent of our population. In a matter of a couple of decades that figure will have risen to close to 15 percent.

It's estimated by the statistics people that if the present trend continues, if our present methods are put into use, by the end of the century or the beginning of the next century every hospital bed now existing in Canada will be filled by the aged. Mr. Speaker, I recognize that I cannot any longer qualify myself as a youth. SOME HON. MEMBERS: Agreed. MR. OMAN: I've begun to move towards middle age at least. AN HON. MEMBER: Old age. AN HON. MEMBER: Be honest. MR. OMAN: Mr. Speaker, the hon. member makes some accusations I'm not quite ready to live with.

In fact, I understand that there are three characteristics of aging. The first of those is the loss of memory. The second is . . . [laughter] It doesn't really matter; it wasn't important. The point is that this particular segment of our society, which we see as an important segment, is going to become a very costly segment, not only from the area of pensions but also from the area of health care. But many of these illnesses, if one could call them that, are not of the serious variety; they're of the ache and pain type.

Again, it has been demonstrated that nursing practitioners in senior citi­ zens' settings and developments do as well as, if not better than, physicians in taking care of most of the needs of the elderly. Furthermore, if it is recognized that they can go and receive help in a community clinic or whatever, it's quite likely that people might be able to stay in their homes for a longer period of time, rather than be put in a hospital, or that their families may be more willing to take care of them. Mr. Speaker, there are problems, of course, and one can hear objections.

Obviously, the medical profession is going to feel a little bit threatened, because people will be moving in on their territory. One could expect, as has happened in constituencies where these issues have been raised, that they're reluctant to see it happen and are going to indicate some reasons why it shouldn't. A friend of mine had a son who had some problems with his teeth. They tried to get him to see a dentist. He simply didn't want to go, because he thought it would hurt too much. So they found a gentleman called a painless dentist and persuaded the boy that it wouldn't hurt so he should go. He did.

His mother took him during the daytime, and when his father came home that night, he said: "Well, son, how was it? Was the dentist a painless dentist?" He said, "No, not at all. When he was working in my mouth, I bit his finger and he yelled like anybody else." Change is always a threat to us. There's always some pain involved with it. It's not strange then that there should be resistance, particularly when practices are so entrenched.

One of the criticisms is that these things become add­ ons to a present functioning system and therefore actually cost more, because you have, in effect, two systems working and competing with each other. Incidentally, I think some of you subjected yourselves to that argument in the letters you sent out in response to the support letters that came in. I don't know if my reply to that is simple, but I think it's adequate; that is, whenever you introduce a new system, there are always going to be overlaps, and there has to be a working out of those systems until there aren't any more overlaps.

I think you can expect add-on costs in the begin­ ning, but if you control it and adapt it over a period of time, like any new system the bugs can be worked out of it. As I said before, there's no question in my mind that there are systems in play today that are much cheaper than the traditional systems. I know that when my friend Dr. Cassin opened his walk-in clinics in Calgary, the kind of service he was rendering and the numbers of people who took it were phenomenal.

The emergency departments in some of our hospitals found that their patient care numbers went down significantly, and probably they could be doing more. Perhaps we should establish these clinics in places where there aren't hospitals rather than build new hospitals in some areas. It's a matter of working out these principles over time. So I don't really accept the add-on principle in the long run. We're not talking about 10 years here.

Incidentally, I can understand some of the uneasiness the physicians feel, because there is a prediction of a significant surplus of doctors in our province by the end of this decade. But we're in this for the long pull, not only for today. I also recognize that a pilot project that was put on board in Saskatchewan about six or seven years ago was quickly and quietly dropped. I don't know what all the details were in that, but there were obviously some problems. The suggestion is made that nurses may not be qualified to do some of the tasks that would be given to them. I think that's easily handled.

You give them the tasks for which they are qualified, or you qualify them for the tasks by specialized training. Some have raised such things as legal and ethical perspectives. What if a nurse or a medical practitioner performs a service for which she is not qualified? All I can say is that it could happen, but I don't risk getting up in the morning because of all of the things that might happen that day. If you consider all the possibilities and allow that to stop you, I think anyone would have a nervous breakdown.

We're all aware, as well, that there is a doctor or two who has been accused of malpractice and has gone beyond his area of expertise. The interesting thing I find is that nursing practitioners and others have been doing these things for years in the northern areas of our country where the doctors haven't been too willing to go. Nobody seems to have raised any objections to that. I see that our minister is now providing incentives by way of extra tens of thousands of dollars to get our doctors to go into some of the more rural areas of our own province.

Why not set up a model of a medical clinic that's staffed by medical practitioners in one of these areas and see if they couldn't function as well? If they need to bring people into areas where they need specialized equipment, we've got planes and helicopters and ambulances that can transport them rather quickly. Incidentally, I don't mean to indicate here that doctors have closed minds about this issue. I just got this today. There is a very interesting thing taking place right here in

194 ALBERTA HANSARD March 26, 1985 Edmonton, sponsored by a Dr. Morcos, who is chief of the Misericordia's obstetric department. He's well known for his work in mother/child bonding and progressive atti­ tudes. He has a study which will involve 100 voluntary participants, expectant mothers with normal pregnancies, who elect to have their prenatal and postnatal care as well as their labour and delivery handled by a qualified midwife rather than an obstetrician. That's going to be very inter­ esting. I believe that so far some 30 women have volunteered to participate in this study.

As you recall, I said in my last speech that I couldn't see why midwives in a hospital setting could not take responsibility for the whole procedure. If they need a backup, there's always an emergency doctor on staff in the hospital anyway. I commend the doctor for that step, and I must say that there are many doctors who have seen the value of using nurses as copractitioners. But I don't think they've been willing yet to allow them to have the freedom to operate on their own. Mr. Speaker, I'm not asking for implementation of this program. I could have gone into many more details as to how it could be used.

I'm only asking in this instance for consideration, a study. Who knows what we'll end up with? Maybe the study will say it isn't feasible, or it may be entirely different from what I envision today. A number of years ago one of my four daughters came home from school and said: "Daddy, I've been asked to participate in the school program that's coming up in a couple of weeks. Could you help me?" She knew I had done some speaking and preparation, and I said: "Why sure, honey. Let's get together and we'll make something up. It will be original, it will be yours, and you can use it." She was a little hesitant.

She said, "Well, I'd rather that it be good than just original, because this is going to be before the whole school." Finally, she had something in mind, which we used. You all know it as that little ditty: "I'm a little teapot, short and stout; this is my handle, and this is my spout." We worked on that, perhaps more than worked on it, getting inflection and everything right. The appointed night came. We were sitting in the audience, and finally it came time for my daughter's performance. She came up to the mike, stood there with her hands on her hips, and began.

She said, "I'm a little teapot, short and stout; this is my handle, and this my . . ." She forgot to put that arm out. She looked a moment, and she said, "Well, I'll be; I guess I'm a sugar bowl." You could recognize her father, because he was under the chair. But the point is, sometimes what you get at the end isn't exactly what you expect from the beginning. That shouldn't stop us for a moment. I'm so convinced that something is operative and possible here and that we should be in on it.

We can scream and struggle against those inevitable forces that will put us into the future, or we can catch the tide and harness it and make it work to our ends for a better delivery system in Alberta. The province of Alberta has been a leader in many fields, Mr. Speaker. In the medical services area it's time to lead. Thank you. DR. REID: Mr. Speaker, the Member for Calgary North Hill has been his usual eloquent self In fact, he reminded me of a story about three persons who were discussing which was the oldest profession.

One said, "I'm a physician, and we were first because we created Eve out of Adam's rib." The second one said, "No, we were first; I represent the ministers and the person who created order out of chaos." And the third one said, "Well, I'm the politician; who do you think created the chaos?" Mr. Speaker, today I'm not going to represent the counsel for the prosecution or the defence. I never felt threatened in my professional career before I entered politics. I enjoyed all the changes that occurred during some 30 years since I graduated and, indeed, took

part in some of those changes. I'm not here to be a spokesman for the Alberta Medical Association or the College of Physicians and Surgeons, because for three decades I happen to have been a staunch believer in the team-care approach. I'm no more representing the medical profession than the Member for Calgary North West was representing the nursing profession when she spoke in the debate last year.

Nor — and I should make this clear in my capacity as the minister with the respon­ sibility for professions and occupations — are any of my remarks any attempt to prejudge the issue of the drive by the nursing profession to have a standard of a baccalaureate degree. I'm not in any way negative to the legitimate attempts by that profession to increase their standards and the quality of the care they deliver and to expand their scope of practice as much as they feel capable of doing.

It's an interesting thing that professions, by and large, never get into expanding their scope beyond what they feel they can cope with. The concern of the Member for Calgary North Hill is unwarranted. I know of no profession that has ever attempted to do that. It has been said that there are Scots and there are those who would like to be Scots. It has been said that there are physicians and those who would like to be physicians. Well, there are many physicians who would like to be other things once they get into the practice of medicine and find out that it is no sinecure.

That is partly because you have to look at the health care standards across this planet of ours, and we have to do that if we're going to look at the motion that's before us today. There are countries where there is a physician for every 100,000 people, and there are countries like Austria, where there's a physician for every 200. Canada is currently somewhere in the middle with a physician for about every 700 people. There have been other experiments in this world to try to spread out limited physician resources: the Russians with their feldshers and the Chinese with their barefoot doctors.

I don't think we're considering anything like that in addressing the motion that's before us today. This motion is before us for two reasons only: one is costs, and the other is quality of care. If we look at quality of care across the world, in most countries it depends very much upon availability of trained people, whether they are nurses, physicians, or any other practitioner of the healing arts. It might be the witch doctor or the equivalent. If we look at Great Britain and the United States, they have both achieved a split system from opposite directions, as I've said before in this Legislature.

In Britain they had a health care system. They nationalized it; they had socialized medicine. They found that didn't work, and they therefore developed a freestanding, free-enterprise health care system to compete with the government system. In the United States they started with a wildly free-enterprise system. People couldn't afford it, so the government moved into the vacuum that was produced. As a result, Britain and the United States now have very similar systems, and they are both very different from the current system in this country. In Canada we have essentially, one health care delivery system.

In Alberta we have a spectrum of care available

March 26, 1985 ALBERTA HANSARD 195 through the Alberta health care insurance plan that is larger than in any other province. We have included oral surgery, chiropractic, podiatry, optometrists, and, more recently, physiotherapists. No other province has attempted to achieve that level of spectrum. In Alberta I think we have consciously gone away from delivering just basic health care through the system. I hope we can continue to have one system. As I said earlier, I believe in the team approach; I think most physicians do nowadays. Let's look at the cost items.

In this province the cost is now approaching $1,000 per head per year, $4,000 a year for a man, spouse, and two children. I have no quarrel, as a taxpayer and with my Scot's instincts, with anybody who wishes to address the issue of cost containment and trying to restrict the growth in costs. There is some early evidence that the increase has slowed down, thanks to the implementation of user fees in the hospitals and some indications that people are at long last beginning to realize that when they go to their physician's office, it's going to cost them money as a taxpayer.

We have some indications that there is the beginning of a drop in the rate of increase in health care costs, but we've nowhere near got it stabilized to being the same as the increase in the cost of living in general. Let's be realistic, though, about why we've had this increase in costs. I would like to go over a period of four decades from when I first considered going into medicine, which was in 1945 when I was still a schoolboy. I'm going to address what has happened to the treatment of a series of diseases at decade intervals.

At that time anybody who got renal failure, whose kidneys packed up, had to go on a low-protein diet. They stuck perforated tubes, called Southey's tubes, into them every now and then to drain off the accumulation of water, dropsy as it was called. If we looked at the problems of congenital and rheumatic heart disease, all we could do for those children was give them some pills, digoxin, the very early injections of diuretics, and oxygen, and in many cases they subsequently died.

For the overweight, smoking, overeating, inactive, type A per­ sonality, aggressive male who got a coronary, all we could do was give him nitroglycerin for the pain and advise him, if we knew enough, to change his life-style. For the elderly person who developed cataracts, all we could do was give him a white cane. And for thyrotoxicosis, an overactive thyroid, the only thing we had was what was then very dangerous surgery. None of those are particularly high-cost modes of treatment. Thirty years ago, when I graduated, we had the very early forms of dialysis for the renal failure patient.

The cost had gone up a bit. For the children with congenital and rheumatic heart disease we had the very early heart surgery. It wasn't open-heart surgery, but it was expensive surgery. We had even begun to try to avoid the development of rheumatic heart disease by the use of penicillin prophy­ laxis. And believe it or not, we were resuscitating some of the gentlemen with coronary artery disease, heart attacks. If we just happened to be around when they had it, we managed to save some of the people who previously would have died. But the mortality rate was still very considerable.

For the cataract patient, we had the early operations for extraction of a cataract. The success ratio was not as high as it is now by any means. A fair number lost eyes from infection and other causes, but we could at least give them a modicum of useful vision, albeit with very thick lenses in front of their eyes. For the thyrotoxic patient we'd learned that if we gave them iodine in advance of the surgery, it was a bit safer, but it was just as expensive. Halfway through this era I'm talking about, 20 years ago, was when the costs really started to skyrocket.

For the renal failure patient, by and large, we had the availability of dialysis on an ongoing basis. It was beginning to be available in most major centres. But of course it's a long- term treatment and it's expensive. For congenital and rheu­ matic heart disease we now had open-heart surgery with the heart/lung pumps and the availability to open up the heart, stop it, and do more complicated surgery. Of course, the costs went up, but the results were better. For the coronary or heart attack patient we'd developed the early critical care units. Some of you may remember Dr.

Talibi at the Alex, the "mad Turk" as we used to refer to him. Talibi's results showed that by and large, if you got to the hospital, there was a significant chance of surviving a heart attack. And the costs had gone up considerably. For the cataract patient we'd developed cryosurgery. It enabled us to do cataract surgery with a much better record and much fewer losses of eyes, but we still had the thick lenses in front. Of course, for the thyroid patient we'd developed a good way of treating them with radioactive iodine.

For the first time we had the indication of a treatment that was cheaper than its predecessor. Ten years ago — now we get to the era of modern medicine — for renal failure we had a cost reduction available if we could find the kidneys: renal transplantation. But for the vast majority of renal failure patients, we were still looking at dialysis — admittedly much safer dialysis. Rheu­ matic heart disease was beginning to disappear because of the penicillin prophylaxis I mentioned earlier. For the chil­ dren with congenital heart disease we were beginning to really get to modern open-heart surgery.

We were doing major reconstructive work within these small hearts. For the coronary and heart attack patient we'd developed bypass surgery and a small number of heart transplants at a cost that was astronomical, with results which have only recently begun to improve in the hands of a very few experts like Shumway in California. But bypass surgery had begun to arrive on the scene. For the cataract patient we had a much better result. They no longer needed the thick lenses, because we could put an implant in the eye. But of course the cost was greater.

For the thyroid patient we had developed beta blockers to make surgery safer if it was indicated or to allow them to survive until the radioactive iodine was working. What are we looking at today? We are still looking for kidneys for the renal failure patient. Most of them are still on dialysis at very high cost. For the coronary artery patient we may have some inkling of a reduction in the costs, because we may be able to abandon many of our open- heart surgery units for bypass surgery. We now have a technique developing for dilating the narrowed coronary artery.

It may be that that second unit at the Royal Alexandra hospital that the hon. minister has mentioned will never happen, and the costs are less than for open-heart bypass surgery. For the cataract patient, of course, we now know that work is going on in Calgary and elsewhere, where, indeed, we don't admit the patient to hospital. We are getting some indications that modern technology can in fact reduce the costs of health care. But they're early indications, and the problem is that in the meantime, during this 40-year span, we've had a few things which have happened with technology.

Hip replacements have probably done more good for more people than coronary bypass surgery. If you look at the senior citizens who used to spend their last years in bed or in a wheelchair — they

196 ALBERTA HANSARD March 26, 1985 now literally are going out dancing. But it's expensive. It requires hospital facilities that are second to none to avoid infection, and of course there's the time in hospital and the physiotherapy requirements associated with it. It's much more expensive than the aspirin that used to be all we could do for them. We've got corneal transplantation. With flexible gastro­ scopes we can look into people's stomachs and see just how bad their ulcer is or what else is the matter.

It's a good bit more expensive to do a gastroscopy than to do an X ray of the stomach, but the results of the examination are better. We've got the CAT scanner — a mere million dollars a machine by the time you get it installed. Then to crown everything, they've improved that with another gen­ eration of machines which do not require X radiation, the nuclear magnetic resonance machines. The trouble is that they cost a few million. Cobalt bombs for cancer treatment, chemotherapy, the incredible cost of running modern burn units — people with 80 percent burns used to die.

Now they survive, but their hospitalization lasts for years, in some cases, if you add it all up. Intensive care nurseries for babies. There are units at the University hospital and the Royal Alexandra and similar units in Calgary. The results justify the cost in that babies who would have previously died now survive. But they not only survive; the results of the long-term follow-up done by Dr. Charlene Robertson and others indicate that the vast majority of them survive as absolutely normal physical and mental specimens. They are not damaged by the process of the intensive care.

Of course, we've got the costs of automobile accidents and the new specialty of traumatology, where we look after the people with multiple injuries at very considerable costs. But again they survive; sometimes, though, they are not physically capable. The reason I've gone through that litany is to indicate that the increase in cost has been justified in most cases by an increased quality of life for the patient. With the increased quality is an increased duration, and as we know, our senior citizens by their very nature tend to be heavier users of the health care system.

So in other words, people are living longer and, without all the dramatics I've men­ tioned, they have increased costs. You just need to look at the treating of senior citizens for hypertension, osteoarthritis, and the other degenerative diseases they suffer from. Some lower cost things have happened. We can now treat hypertension with drugs that cause depression or potas­ sium depletion. Some of them will cause heart failure if they are abused. But they've resulted in a marked decrease in strokes and the disability and costs that come from strokes. We now look after diabetic patients much better.

The results are better, but again, of course, they survive until they develop the long-term complications of diabetes with the costs that go with that. In the last 40 years we've developed vaccines for diseases that used to be major contributors to health care costs — polio vaccine, Sabin's vaccine in particular, the live virus vaccine that gives long-term immunity. Think of the costs that accumulated over the last 40 years, of the successive outbreaks of poliomyelitis in the '40s and early '50s; those costs have disappeared.

Measles vaccine has avoided all the problems of the sequelae of measles, the chronic chest conditions that went on for the rest of the person's life. Of course, rubella vaccine, if it were properly implemented, would eliminate the congenital rubella syndrome with the ear, eye, and heart defect that again have cost us so much. The difficulty with the motion put forward by the hon. Member for Calgary North Hill is that there have been attempts before to consciously reduce the cost of health care. He mentioned some of them.

The freestanding emer­ gency clinics and freestanding medicentres — although we shouldn't use that word; I understand it's a copyright name for one particular chain, but everybody knows what we mean when we use the word "medicentre". Are the emer­ gency clinics really cost-effective? If they are going to deliver true emergency care, such as can be delivered at a major hospital emergency department, then they are going to have to be equipped and staffed the same way. I'm not at all sure that the freestanding true emergency clinic is a valid concept.

If it is, then it probably is just an add-on, because they will probably refer most of the patients to the hospitals eventually anyway. There is a problem to some extent with quality control at the medicentres. Many of the physicians who work there have no hospital affiliation, so there is not the normal peer review that goes with hospital affiliation. There's been some problem of continuity of care. Many of the medicentres employ doctors on a shift basis, so you go one Tuesday evening and get one doctor and you go the next Tuesday evening and get another doctor. That's not the best quality of health care.

Private physiotherapy was mentioned by the member for Calgary North Hill. In spite of his impressive figures of $4 and $11 per treatment, in actual fact it would appear that private physiotherapy has by and large been an add­ on cost. Some very useful changes have been made. Day hospitals have been tried to avoid night care when it's not necessary. Home care is certainly a good application of health care personnel. If we can keep people out of nursing homes and extended care facilities, surely that has to be a more efficient use of the dollar. Preventative health care, of course, is a two-edged sword.

If you speak to any physician who's indulging in primary care now, you will find that our fitness freaks are prone to certain relatively high-cost injuries. They frequently dam­ age their knees and require major reconstructive surgery. They get stress fractures of their legs and feet. Again, that is a two-edged sword: it may well be that what the coronary artery gains, the locomotor mechanism loses. I must say that every time I see an obese 50-year-old jogging on concrete or asphalt, I get a pain in my knees looking at him. There is a problem as well, Mr. Speaker, with adequate training for primary care.

I have been critical to previous deans of medicine in this province about the present choice of students for our two medical schools. We really train two types of physicians. We train those who are primary care physicians — and this is the area we're essentially talking about today — and we train specialists. But it doesn't matter which one you are training; you start off with a premed course, four years of medical school, and two to five years of postgraduate training.

Recently the medical schools have tended to take the applicants with the highest marks, with no real addressing of the issue of what type of person is being recruited. At long last we have got away from the concept of medicine in North America being a male-only profession. Just over a quarter of the class I belonged to in Aberdeen was female. I came to Canada in 1955 and was somewhat appalled to find one token female in each year of medicine at the University of Alberta. Nowadays we've had some

March 26, 1985 ALBERTA HANSARD 197 classes in medical schools in this country where the majority have been women, so at least that's gone out the window. Unfortunately, we have tended to pick students purely by brainpower and not by personality. Primary care, whether it's delivered by a physician or a nurse, requires a large amount of humanistic, caring attitude, and you don't get that with an IQ of 190 in every case. Currently nursing training is three years, or four years if they take the baccalaureate course. I'm not at all convinced that that is enough to cope with primary care in the present era.

The hon. member for Calgary North Hill mentioned treating the flu with a couple of aspirins. The problem is not saying, "Take a couple of aspirins." The problem is making sure that the symptoms are due to influenza and not to encephalitis or acute gastritis or pneumonia. I'm not sure that four years' baccalaureate training in nursing school is adequate for that. We may find this an add-on, because the insecurities these practitioners may have may result in their referring the vast majority of their patients to other areas of the health care system. The hon. member mentioned the legal liability problem.

That's getting horrendous in this country even for the physicians. We're not talking about the problems in the United States, where some specialties have liability insurance fees of $100,000 a year. But we have got to the stage in this country where for some practitioners it is now $3,000 a year. I'm going to encourage the Legislature to be cautious in accepting this motion. My real reason for this is that at long last we're seeing the possibility of having an adequate supply of physicians in this country.

I've addressed the cost issue, and I don't think we can realistically expect to bring costs of health care down with the increased technology and what it can achieve for us. At long last we're going to have an adequate supply, which means a surplus, of physicians in this country. For me that would have meant that in the small community I practised in for almost 30 years, I wouldn't have been working seven-day weeks and 16-hour days and getting up during the night during the other eight hours. I might have been able to have some more time off with my children when they were young.

I also might have paid considerably less taxes. That would have been a two-edged sword, because I'd have had less in my pocket. In actual fact, there is still a shortage of physicians' services in rural Alberta. I'm not at all sure that this motion will result in alleviating that problem. First of all, I object to the concept that rural health care should be of a lesser quality or calibre than urban health care.

I also have a vague discomfort that just as has happened in every other profession, if we introduce the nurse practitioner concept in this province, we will find once more that most of those nurse practitioners will want to work in the large cities. In other words, we may add another layer to the umbrella where it is already adequate without doing much to resolve the issue of rural and small­ town health care delivery. I said at the beginning, Mr. Speaker, that I encourage nurses in their legitimate concerns, in their striving for excellence and expanding their scope, and I really do.

I also said I believe in the team approach to health care. The staff at the hospital where I worked in Hinton — the nurses, the physiotherapists, the lab technicians, and every­ body else — had coffee together every morning. We talked about patients as equals, and we delivered a quality of care that I think was appreciated by the people of that community. We behaved like an orchestra, not a series of prima donna soloists. The orchestra did not really have a conductor at all. But I'm not at all convinced that putting five conductors into an orchestra adds to the quality of the result in any way. Thank you. MR.

McPHERSON: Mr. Speaker, I rise and welcome the opportunity to participate in the debate on Bill 203, intro­ duced by the hon. Member for Calgary- North Hill. I find myself on perhaps a slippery slope. On the one hand, I feel that the comments from the Solicitor General, who is obviously eminently experienced in the area of health care, raise some of the arguments and defend some of the positions relative to cost considerations.

On balance, while I wouldn't want to put words in his mouth, I think he is suggesting there are concerns — indeed there are concerns — but that these areas must be considered at some length. Then on the other hand, I hear a most inspired speech, done in his own inimitable way, by the Member for Calgary North Hill, in an almost evangelical sense, and perhaps that's appropriate. It calls to mind the story of the well-recognized minister who had developed a reputation throughout the land of being able to give the most extraordinary extemporaneous speeches on almost any subject.

But as he got older and older, he found that he could no longer give these speeches simply from the cuff, and he started to use notes. He started to go to the pulpit using a looseleaf. One day at church he got up and walked from his place over to the pulpit, and on the way he dropped the looseleaf but didn't notice it. There he was in his pulpit reading this terrific speech, and he said, "And Adam said to Eve — gee, there must be a looseleaf around here somewhere." Mr. Speaker, I sometimes wonder if there isn't a looseleaf missing in the debates we have, but I don't think there is in this debate.

I welcome the opportunity to participate in it. I welcome it for at least a couple of reasons. Perhaps the most important reason is that frankly I think it's an important issue to debate. Surely we as legislators, as custodians of the public purse, must be ever diligent in our efforts to examine realistic alternatives that will save health care costs or at least constrain the increase. I consider that to be the basic thrust of this motion before us, and I commend the Member for Calgary North Hill for doing that. I welcome the opportunity to participate for another very important reason, Mr. Speaker.

It gives me the opportunity to acknowledge the very, very effective leadership of the president of the Alberta Association of Registered Nurses, Ms Gerry Seymour, RN, who happens to be a resident of the city of Red Deer. In my dealings with her, Ms Seymour has personified the meaning of professional. I congratulate her for her exemplary leadership to the Alberta Association of Registered Nurses, and I wish her and the whole asso­ ciation well in their pursuit of excellence and holistic health care.

While I have no way of knowing if Miss Seymour is in the gallery today, there are a number of people in the gallery who I assume are of the profession. If Ms Seymour is in the gallery, I ask her to rise and be recognized by the Legislative Assembly. I don't see her. Mr. Speaker, as you and all members sit in your places, you are no doubt aware of the considerable lobby advanced by the nursing profession relating to this motion. While I was initially somewhat cautious with the thrust of the recommendations in the lobby, for some financial reasons I will allude to later, particularly in the area of broadening

198 ALBERTA HANSARD March 26, 1985 health services, I can say that my research and, most importantly, the meeting I and other members participated in last Tuesday morning with a number of the nursing profession have led me to believe that it is quite clear in the minds of the nursing profession that the adoption of this motion will not result in overnight changes to the health care system or to the health care delivery system. They are under no illusions. The Member for Calgary North Hill mentioned that.

He is simply urging the government to consider new systems for the delivery of health care services that would . . . I don't have to go into the content of the motion; it's before everyone. So, Mr. Speaker, we're dealing with a request to consider alternative vehicles. From my discussions with them, I think the nurses are fully cognizant of the economic and practical implications such a radical departure from established prac­ tice might have but genuinely feel that sufficient empirical evidence exists in terms of possible cost efficiencies to consider the motion.

As a layman, I think such empirical evidence does exist. Perhaps through developing a model of some description or some kind of controlled studies, we may indeed be able to convert empirical evidence to irre­ futable evidence that demonstrates cost efficiencies and, at the same time, broadens our health care system with more focus on prevention. I'd like to touch briefly on that area of prevention, Mr.

Speaker, but before I offer what I hope might be some helpful criticism, let me say that the province of Alberta provides a very credible array of community health services and programs that are among the best in Canada. The Alberta home care program is providing effective, cost- efficient services to thousands of Albertans who might otherwise require institutional care. These services are pro­ vided in the comfort of their own homes, which allows families and friends to assist on a voluntary basis.

Moreover, last year's budget expanded the program to include senior citizens with medical conditions who require only home- making services, and the budget increased by 55 percent, to over $28 million, to accommodate this expansion. The aids to daily living and the extended health benefits programs were likewise increased by 51 percent. In addition to that, it must be mentioned that Alberta shares with only one other province in the Dominion of Canada in terms of supplying similar medical benefits and appliances to the chronically ill and disabled under the extended health care benefits program.

These are just a couple of examples, Mr. Speaker. I suggest and submit that we make no mistake, that the citizens of Alberta possess preventative community health programs unmatched in perhaps any jurisdiction in North America. But in my view, we have a need to encourage more preventative health care mechanisms in the delivery system. I premise that belief on rather startling data that exist under the Alberta health care insurance plan. While a great deal of emphasis is put on preventative health, the vast majority of funding is directed to acute care or to curing disease as opposed to preventing disease.

The funding for health care represents one-quarter of the provincial budget and is increasing at a rate that frankly is causing alarm. In the last five years the benefit rate for physicians covered under the Alberta health care insurance plan has increased at the rate of 12 percent. Total health care spending over that same five-year period has seen an average annual growth rate of nearly 25 percent.

While I recognize that the Minister of Hospitals and Medical Care has come down with a budget this year which indicates a lessening in the increase, if it's permissible to use those kinds of words — the increase has been reduced in the estimates for this budget — nonetheless, we're looking at health care costs that are getting to a point where they almost cannot be tracked. I mentioned that our services are unparalleled anywhere in Canada when one considers that we have a system in this province where there are few, if any, constraints. There is full accessibility to the system.

I want to trot out, for the benefit of members, some figures that I think are revealing. Last year 91 percent of the population of Alberta made use of at least some of their medical benefits. The average Albertan seeks medical services 9.5 times per year. The vast majority of these people, 80 percent, use benefits adding up to less than $400 a year. That's accessibility. So we have an accessible health care system. However, Mr.

Speaker, in considering the debate, I could not help but notice that along with the letter from the Alberta Association of Registered nurses seeking support for this resolution, which I'm sure was received by many members, there was enclosed an

article by the president or chairman, I'm not sure, of the Canadian Nurses Association, Miss Ginette Rodger. There were a couple of comments in that

article which frankly caused me some alarm: Most people close to the situation recognize that our health care system is now in danger of being deformed beyond recognition. She goes on to state: The introduction of user fees is spreading rapidly and, if left unchecked, will make a mockery of the principle of accessibility identified in the 1964 health charter as one of the cornerstones of medicare. She goes on to say: But the way out of our problems does not lie in the introduction of user fees, premiums, or extra-billing. We can make our system work. Perhaps we can, Mr.

Speaker; however, my concern lies in history, where we've been and where we expect to go. It was in 1948 that Nye Bevan, the British health minister, established the first comprehensive national health service promising unlimited free medical care of the best possible standard to the entire [province]. One year later it was replaced with something entirely different from what was promised. The costs soared out of control. Nye's budget became a disaster.

Stafford Cripps announced in his 1949 budget that henceforth the treasury would set an annual ceiling on the national health service spending, and Britons would be allowed as much free health care as could be afforded. That's called "capping", Mr. Speaker. We've seen the results of some of the circumstances developing in areas that have decided that by allowing absolutely no constraints in the system, none whatsoever, in fact what we end up with is often diametrically opposed to the kind of situation those who argue for unassailable free rights in the health care system . . .

With no personal responsibility, no constraints attached to the system, abso­ lutely no opportunity for individuals to react on an individual basis under a contract with their health care professional, it has developed into a system of totally free access and escalating costs that all of us as members of this Legislature, who have to try to balance the kinds of things we're dealing with here, have to be concerned about. I don't want to make any mistake, Mr. Speaker. I make no allusions to the importance of the medicare system or to the health care system. No one wants to see medicare

March 26, 1985 ALBERTA HANSARD 199 undermined or hospital services eroded. Yet what are the long-term prospects if no brakes are applied? I mentioned the British scenario. I could go on to the Swedish scenario. I could go on to every country that has developed total socialized medicine and has failed. The system is a failure; it's a bankrupt idea. We're witnessing it in Britain; we're witnessing it in many other countries.

As an example, in Britain the national health service is being decimated by extensive lineups for service, erosion of service, and overworked state physicians practising a turnstile type of medicine. In Britain, Mr. Speaker, a second tier of hospital and health care is now emerging. Private hospitals are being constructed at a faster rate than public hospitals, and the British health care system is applying the brakes on the supply side of the equation by rationing services, limiting accessibility, and reducing the amount of access to the overall system.

It strikes me that when you restrict the supply of any discipline, regardless of the discipline, the rich will always find a means to that supply, and so in fact they do. This will inevitably lead to a two- tiered system, and that's the paradox the well-intentioned people who argue to remove any and all constraints in the system and demand utilization, first dollar, immediately, on the basis of unassailable rights, have to consider. I make no suggestion, Mr. Speaker, that health care is not an essential service. There's no question that it is an essential service.

But would anybody suggest that food isn't an essential service? Perhaps we should arrange our affairs in this country so food becomes an essential service and is insured on a first-dollar basis. Clothing is an essential service. Housing is an essential service. All of these things are important, and one has to beg the question: when we provide a system that allows first dollar, no constraints whatsoever, should we not at least be investigating the demand side of the equation? That's where I think there is an opportunity for public debate. Surely no one has placed a higher value on health care than this province.

Indeed, society has put enormously high value on health care. One view suggests that in light of our aging population — the member for Calgary North Hill referred to it — our lifestyles, our sometimes inflexible manpower requirements and their relatively increasing costs, and the advancement of medical technology referred to by the Solicitor General, we have absolutely no choice but to allocate whatever resources are necessary to the health care system to accommodate the unassailable right to be treated on a first-time basis. But having done this, Mr.

Speaker, because governments like individuals have finite resources, we can allocate whatever is left over to other of our scarce societies. The other view, I suppose, would be that as long as our resources in society are finite, society is going to have to make some choices. In Alberta I believe we're going to have to make some choices, and the choices are before us.

At this time we need to seriously consider all implications and all alternatives that can come to bear to reduce the incidence of costs in the health care system but at the same time provide a humanistic, holistic health care system to this province. On balance, Mr. Speaker, I can say that I view this particular motion as one that is asking the government to seriously consider the implications, the possibilities of pro­ viding a broader health care system, but at the same time seriously considering whether or not there can be realistic cost efficiencies implied into the system. And it strikes me that there can.

I don't have all the details, but surely it's been said already today. At this very moment, nurses provide many, many services across this province that could be done on a direct-provider basis. I understand it's happening up north. They monitor the health status of many, many people who are stabilized, who are chronically ill. Nurses co-ordinate the care of different levels of services of many health care providers when they are required. I suspect that there are a variety of services that can be done, but there are cautions. I have trouble squaring the concept.

If the provider of a service who has direct input to the health care service is providing that service for a lesser cost than the provider of the same service, how long will it be before the provider of the service at a low cost is going to say: "There's something wrong here; it's not just. I'm providing the service at this cost; the doctor's providing this service at that cost. Surely if my professional capabilities allow me to perform those particular functions, my remuneration should be identical to that." I don't know how we square those kinds of things, Mr. Speaker.

They're only questions in my mind, but I think they're going to have to be considered very carefully. On balance, Mr. Speaker, I'm saying that a variety of concerns must be considered and put forth. They were mentioned by both previous speakers. Level of competence: surely that can, be overcome through consideration and perhaps a particular standard. Certainly, public safety dictates that prime providers must be legally and ethically respon­ sible. I don't think there would be any question from nurses or any other health care professionals.

If they are going to provide a service, they must be held fully accountable and responsible for it. These are questions that are implicit in the motion before us today. They can be answered, I think. The motion simply urges the government to consider new systems of health care delivery and an expanded role for professional nurses. My communication with nurses leads me to the conclusion that they're quite prepared to co­ operate and communicate with government and other interest groups in a conscientious effort to analyze the cost benefits of the proposal before us. Mr.

Speaker, I'm persuaded to support the motion despite the questions that it raises, because surely we must be fully cognizant of all alternatives that are available within our health care delivery system to allow some brakes to perhaps be applied and also to constrain cost increases and to try to view the overall health care system not just as a means of providing service for every individual at every opportunity unless — I shouldn't say it that way. That system is there now, but our system must be designed so that the benefits are made available to the patient who needs the service.

I think that can be accommodated through serious investigation of this Bill. Thank you. MRS. KOPER: Mr. Speaker, I rise to speak on Motion 203 and wish to commend the Member for Calgary North Hill for again bringing this before the Assembly. I didn't have an opportunity to speak last time, and while I am not directly involved in the health care professions, as an ordinary citizen of Alberta I feel that the kind of involvement I have had is very important to the debate at this time. I also wish to commend my colleagues the Solicitor General and the hon.

Member for Red Deer for the great job they do in speaking and conveying their opinions to our House. In speaking to this motion, hon. members, the timing and the strategy at this point in time seem rather unfortunate. The other speakers have already referred to the possible

200 ALBERTA HANSARD March 26, 1985 surplus of medical practitioners in our province, and this type of service has usually been considered in this regard. For instance, last year when the Public Health Act was introduced, one special clause had to be written into the Act to cover the area in the north of our province where there was no doctor, where the nurse practitioner had to undertake exactly the kinds of duties referred to in this motion.

Because of this kind of practice — I think it's called feldsherism — where the availability of physicians is not high and other health care workers must take over, the rest of the province is now looking at this in quite a different light. But I feel that nurses and other health care professionals have an important part to play. People are rapidly becoming far more responsible for their own health habits, their own environment, and their own lifestyles and are taking personal control over the mysteries of life and death. That's far different from the usual medical establishment over the years.

We have a great abundance of evidence of this in the hospice movement, where we're looking after terminally ill people at home, natural childbirth — the midwifery move­ ment that was described by the hon. Member for Calgary North Hill — birthing centres, nutritional clinics, and the jogging phenomenon that the Solicitor General outlined.

There is the decline in cancer of the lung as it relates to smoking, the change from hard liquor to wine in our province, the rapid increase of health food stores, and fitness programs that are being put on by businesses such as Nova, where the staff is encouraged to keep fit and look after their own health. Recently in Calgary one of the television stations was an active proponent of alerting people to the dangers of bowel cancer so they could be tested and get any early warning signals and be referred to outpatient units at the hospitals — a most successful project.

This kind of awareness of the health and well-being of individuals, the positive state of wellness rather than just the prevention of disease, is important to us in our discussion today. Regular exercise, a good diet, appropriate rest, no smoking, the management of stress: all of these things are keys to personal habits and personal responsibility, instead of the traditional role of the doctor's responsibility that our population formerly looked at.

This kind of big brother syndrome — the government and the doctor will look after us — is finally being replaced, I believe, by a real wish by people to look after themselves in this aspect. Last year in our discussions in our work on the Public Health Act, this House was very responsive to suggestions, largely from public health nurses, that there was an emphasis on health promotion and education and maintenance pro­ grams. This was so important that that role had to be written into the Public Health Act.

This was all for the purpose of reducing the need for hospital and physician services, just as this motion is meant to. So I believe, Mr. Speaker, that we've gradually shifted from institutional help to a self-help system. Central to that idea, of course, is the wellness of the whole person. This is the most important part of the role that I see the nursing profession taking in the future: looking at holistic health — the body, the mind, and the emotions. So often you'll be referred to a specialist and you won't know all the factors of the particular problem you have.

The physicians don't have time, and I don't think the people always understand the total dimension of their particular illness. An example of this is Norman Cousins in Anatomy of an Illness. He was diagnosed as fatally ill, and because he worked hard to gain insight into his problem, he overcame it with the kind consideration of a medical practitioner who spent a lot of time with him explaining how to look after his personal life and to move from there. Mr.

Speaker, another event in our society that I think makes the kind of suggestion that nurses and other health care professionals become more involved is the entry into our lives of the computer, keeping track of people and the things they do. This would make it infinitely more possible to have several people looking after you and still maintain a holistic approach. For instance, I am aware of one Calgary Foothills constituent who had a serious illness diagnosed. She was sent to a specialist and found that the specialist had no previous records and had a short conversation with the family doctor.

Because there was a significant medical file, the constituent decided that she would collect the medical file and take it to the specialist. It was very hard for the constituent to be confident in the health care system when she seemed to have to take that kind of initiative herself, that it didn't happen automatically. When I think of the implications of this motion, I see it being very important that the kind of support the patient needed be provided by the nurse who would assist the doctor in the referral.

I believe that other things happening in our province now are recognized as proving the capability of nurses to conduct themselves in this way. We've already talked about home care and its implications in our province. It's been proven by many studies that home care actually decreases the need for hospital and institutional care and makes it possible for people to stay longer in their own homes. It identifies at early stages problems that would otherwise go unnoticed and, I think, adds to the well-being of any patient. For many years, Mr.

Speaker, the VON has advocated an increased role in our society for nursing professionals. When we talk about their abilities, about 67 percent of all patient visits to a doctor can be handled without demonstrable detriment to the patient's well-being. Because this motion is in two parts, I'm a little dis­ appointed that it isn't two motions. While the second part of the motion, dealing with private clinics, emergency clinics, and other services, does contribute to the eventual lowering of health care costs, I believe it is a different issue. They seem to be found primarily in Calgary.

There are two in our neighbourhood that are very well used. One type of facility is an emergency department, while the other is a medicentre. I think both these types of clinics reflect the mobility of our society. Many of the people who come to them don't have a doctor. These clinics aren't meant to encourage return visits. It's interesting that these clinics have answered a need in our community that has certainly justified their existence. Mr.

Speaker, one of the studies that was recently done in these clinics found that emergency clinics saw a very much younger patient population than hospital emergency clinics, and the hospitals saw a greater proportion of people over 60. In this study it was also in