1984 Legislative Session: 1st Session, 33rd Parliament

Hansard

The following electronic version is for informational purposes only.

The printed version remains the official version.

Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

( Hansard )

FRIDAY, FEBRUARY 3, 1984

Morning Sitting

[ Page

3067 ]

CONTENTS

Routine Proceedings

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen)

On vote 44: minister's office –– 3067

Mrs. Dailly

Mr. Lauk

Mr. Blencoe

Mr. Rose

Mr. Cocke

Mr. Skelly

Appendix –– 3083

FRIDAY, FEBRUARY 3, 1984

The House met at 10:07 a.m.

[Mr. Strachan in the chair.]

Prayers.

HON. A. FRASER: Mr. Speaker, I would like to bring up a point

of privilege. Yesterday in question period the member for Atlin (Mr.

Passarell), I think it was, asked about opening certain motor vehicle

testing stations for buses. I replied that we were not opening stations

for testing buses and that we have never tested buses in this

particular station — the Victoria station — as I recall it.

I have checked and found that some buses had been checked in this

station. I apologize if I misled the House; it was not my intention to

do so.

MR. HOWARD: Mr. Speaker, it will also be recalled that the

member for Atlin raised this subject matter as a question of privilege

late yesterday afternoon before the adjournment and set before the

House certain instances. On behalf of the member for Atlin, who

regretfully is not able to be with us this morning, we want to express

our appreciation to the minister for taking the course that he has

taken in expressing his apologies. We commend that course of action to

all other hon. members of the cabinet.

DEPUTY SPEAKER: Thank you, hon. members. The Chair will consider the matter settled.

Interjections.

DEPUTY SPEAKER: Order, please. The Chair has been advised that the second member for Victoria wishes to be recognized.

MR. BLENCOE: Mr. Speaker, I rise under standing order 35 to

ask leave to move an adjournment of the House to discuss a definite

matter of urgent public importance. The matter relates to Conmac Stages

Ltd. Recent information from experts implies that a poorly adjusted

emergency brake system led to the fatal crash on Monday, January 30, on

Mount Washington. Furthermore, on CBC radio this morning a former

employee of Conmac stated that buses due for inspection with this

particular company were fitted with parts raided from other buses not

due for inspection in order to ensure a positive inspection for that

bus, and upon completion of inspection the old parts were put back on

the inspected bus. That is a serious allegation, Mr. Speaker.

Furthermore, due to the fact that there are now allegations that Conmac

was granted certain operating licences in 1979 by cabinet order,

overruling the Motor Carrier Commission, this issue can only be dealt

with properly by full public inquiry and is therefore an urgent public

issue and of urgent public importance. If the House so recognizes it, I

have a motion to put before the House.

DEPUTY SPEAKER: Thank you, hon. member. The Chair will take the matter

under advisement and, without prejudice, return to the member as quickly as

possible.

Orders of the Day

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

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 44: minister's office, $182,438.

MRS. DAILLY: First of all, I want to thank the minister for

giving an opening statement to the House yesterday; that was

appreciated. In my new role as health critic I have a number of areas I

would like to bring to the attention of the minister, but there is one

I'm going to start right in on. I realize that estimates are really

question period time, so I don't intend to make a lot of speeches to

you.

[10:15]

The first area I want to deal with this morning with the Minister of

Health is the area of prevention, which to my mind is the core of the

whole area of looking at a decrease in health costs. Relevant to the

area of prevention, I want to deal with something that is very

important to all of us, particularly this morning: that is, the whole

area of prevention of accidents in vehicles. That is why I want to ask

the minister a question in reference to the very serious and tragic

accident which recently took place because of inadequate safety

procedures. Traffic vehicle accidents which put people in hospitals

have a definite effect on health costs. I have always been an outspoken

critic.... I think Mr. Chairman knows of the inadequate moves of the

government towards the testing of motor vehicles. Therefore I ask the

Minister of Health: as a Minister of the Crown, does he not place

priority on ensuring that his government does everything possible to

ensure that motor vehicles, including school buses and buses for

charter for schoolchildren, are adequately inspected by his government?

I wonder if the minister would answer that this morning.

HON. MR. NIELSEN: Obviously the costs associated with the

repair of people after they have been involved in an accident are a

major concern to the Ministry of Health and to the provincial

government.

There are a number of reasons why accidents occur, one of which

could be the safety of the vehicle itself. I think it's agreed that the

majority of accidents involving motor vehicles occur because of the

person in control of the vehicle. But there are inevitably going to be

accidents because of faulty equipment or failure of a system on a

vehicle, some of which, I presume, could be noted by way of inspection

either by the owner, a mechanic or an inspector of some kind. I don't

think that you would reach a point where you would still prevent

failure. Perhaps if people were more diligent in the safety of their

vehicles, there could be some decline in the accidents, I believe the

methods used to inspect vehicles, particularly buses, should be

adequate to ensure their safety.

The particular accident the member and other members have been

referring to is under obvious review at this time — a coroner's inquest

and so on. Perhaps some recommendations will be made by that coroner's

inquest and there will be a response from the ministries in government

who have that responsibility. But I think that is somewhat premature in

that we have not had the findings of the coroner's inquest.

[ Page 3068 ]

Yes, of course, accidents of all kinds should be viewed with an eye

toward preventing them, whether in vehicles or other locations. A

significant number of people in our institutions now are there because

of accidents. Accidents will always be with us, unfortunately. But I

agree that in principle we should attempt to have methods whereby we

can minimize the effects of accidents whether they are motor vehicle

accidents or others.

MRS. DAILLY: I thank the minister for answering that for me,

Mr. Chairman, and I'm glad to hear he says we must have proper methods.

I just want to leave that for the moment by saying I hope the minister

will be a strong advocate in his cabinet for the restoration of proper

motor vehicle testing once again in this province.

Mr. Chairman, I have another question for the minister. It is, I

think, a very simple question. I wonder if he would give me the

courtesy of a reply. Would he tell the House if he believes in the

basic five principles of medicare.

HON. MR. NIELSEN: The basic five principles of medicare as

developed by whom, I would have to ask: whether it is the basic

concepts of medicare, Monique Begin version, or some of the other

folks. Bill C-3, I believe it is, the federal government's attempt to

intervene in the area of provincial jurisdiction, outlines what they

refer to as the "criteria" of medicare. I believe in our response to

Mme Begin we have told her that we meet the criteria as far as we

and so on, I think, are already met by us. But I'm not going to adhere

to some philosophical statement by an unknown author. I think our

program in British Columbia does meet the requirements of the medicare

concept in Canada. It is consistent government policy that they are

met. Mr. Chairman, the member might wish to specifically identify the

five points that she refers to if she wants further discussion on that

point.

MRS. DAILLY: The minister pointed out something which

concerns me when he made his first statement yesterday to the House. As

I said, I was pleased that he did speak, but underlying his opening

statement there was a grave omission. He did not give any indication to

the people of British Columbia that he has any basic philosophy or

principle re his ministry, particularly re medicare. When I asked the

minister if he agreed with the principles of medicare, I was somewhat

stunned to find that the minister said "whose principles?"

Medicare was first adopted in the province of Saskatchewan. I won't

go through the history of that now. I think most of us are aware that

it was through Tommy Douglas, former Premier of Saskatchewan, that we

had the first hospital insurance and then comprehensive medicare. Not

only the CCF at that time but also many leading advocates wanted to

bring about a proper comprehensive health system. They accepted the

fact that there are five basic principles. Those basic principles are

still accepted by the majority of recognized organizations concerned

about health today. The Registered Nurses' Association is one of the

leading advocates for those basic principles across Canada and in our

province.

Here are the basic principles which are accepted by the majority of

people who have been concerned about adequate health delivery in Canada

and in the province of British Columbia:

Public administration. To have a proper health care system it must be under

public administration, basically meaning non-profit. I'd like to ask the

minister if he agrees with that.

Comprehensiveness. Does he agree with the plan being comprehensive in that

it will involve all areas of necessary health care? I know the minister can

say to me: "What do you mean by that?" Well, at the moment, of course,

we would like to say dental care, but we will say all the necessary medical

services required by a person in need of those services.

Universality. Does he agree that it should be a universal health care program?

Portability. Does he agree that if you move from province to province there

will a portable scheme of health insurance?

HON. MR. NIELSEN: Since we're dealing in principle and since

words can be interpreted as to what they may mean, I would say that the

medicare plan in British Columbia meets all of those five points. Our

medicare system is publicly administered, it is comprehensive, it is

universal, it has access and it is portable. The discussions going on

in Canada at this time with respect to these five principles, or five

words, see different

interpretations of what they may mean. I can

assure you, Mr. Chairman, that the federal minister responsible for

health in Canada has a somewhat different point of view on what

In fact, the definition of those words is singularly lacking in the

proposed Canada Health Act, so it is subject to a reasonable amount of

interpretation. But yes, I believe the medicare program in British

Columbia does meet those five points. In fact, in some instances I

believe the medicare system in our province exceeds some of those

points. I think the action of the government over the years since

medicare was introduced in British Columbia clearly indicates that it

is the philosophy of this government that those points be met,

notwithstanding that there can be a tremendous amount of dialogue as to

what the words themselves may mean — words such as "comprehensiveness,

to by our system.

MRS. DAILLY: I am absolutely stunned to think that the minister could

actually say he believes that medicare, as it operates under the Social Credit

when his government has been imposing more and more user fees, higher premiums

and hospital user fees on the people of British Columbia. How on earth can you

call it universal and accessible to all the people of British Columbia? I don't

think the minister and his cabinet realize that when a person who is struggling

on a low fixed income, or who has had particularly bad times with employment,

has to come up with approximately $200 a year in premiums, as they are now imposed

have under a full medicare system. How on earth can you say that you have left

the doors open?

I know the minister will say: "We never leave anyone outside the

hospital. They can always be brought in." Mr. Chairman, I know now that

people are arriving at hospital

[ Page

3069 ]

doors and being asked: "Have you got your medicare card?" My God,

they suddenly realize, they haven't paid up their premium. They were not

informed. Maybe there are letters coming out from some employers in the province,

but many people in this province, particularly the young people out of work,

aren't even aware that their medicare premium has been cancelled. They may

be allowed into that hospital, but from then on they are going to be hounded

in one way or the other to get that money paid up, or they are going to be put

in a position where they are once more feeling like a charity case. The whole

idea of medicare coming into Canada and British Columbia was to remove that

old syndrome of it being a charity case.

We all pay our taxes, including that young man or woman who is out

of work. Suddenly they find they are second-class citizens because of

the high imposition being placed on them by the Social Credit

government. I say to that minister: you are eroding medicare in British

Columbia, and I ask you again to please explain to me how you can

possibly say that you are meeting all those criteria when you are

imposing higher and higher fees on the people of British Columbia.

[10:30]

HON. MR. HEWITT: Mr. Chairman, I ask leave to make an introduction.

Leave granted.

HON. MR. HEWITT: Mr. Chairman, I'd like to take this

opportunity to introduce my daughter Linda and her friend Andrew McKay,

who are visiting the Legislative Assembly for the first time. I'd ask

the House to bid them welcome.

MR. LAUK: Mr. Chairman, I want to discuss the health and

safety aspects of the minister's portfolio. This debate has been going

on for some time. It's been going on for a year now — the question of

what role the Minister of Health should play. The delivery of health

care is one thing; health prevention is another. I think the minister

interprets health prevention as preventing the people from getting good

health. His role has been a passive one. He is a well-intentioned

individual but a very weak minister in terms of his responsibilities as

the Minister of Health. As a weak minister, he remained silent when

this government introduced legislation to do away with motor vehicle

safety inspection, when members of this chamber warned the government

that it would lead to more accidents, to injury and death and property

loss in this province that would cost the Ministry of Health increased

amounts of money to deliver hospital and traumatic service and other

services of health.

What was his position? I want the minister to stand up in his

estimates now and tell me what his position was in cabinet when they

eliminated motor vehicle inspection. We have heard this morning that

the bus accident up-Island, which caused the death of one person and

probably the paralysis and permanent injury of others, may have been

partly caused by the deliberate deception of motor vehicle inspectors

by the company involved. I'm asking whether the Minister of Health is

demanding that a charge of criminal negligence causing death be laid

against that company and those employees.

HON. MR. HEWITT: Why don't you wait till the investigation?

MR. LAUK: Await the investigation, my foot! Let me tell you

that if it was any other company or individual out there, those charges

would be before the Crown prosecutor right now — right now!

AN HON. MEMBER: Due process.

MR. LAUK: Let me tell you, Mr. Chairman, the due process is

that the investigation by the RCMP goes before the regional Crown

counsel. An inquest is always suspended or delayed when such an

investigation is underway. An allegation has been made that there was a

deliberate deception of the motor vehicle inspectors — a deliberate

deception which has directly caused the death of an individual. That,

under the Criminal Code, is criminal negligence causing death, if those

allegations of deception are true. I'm asking whether the Minister of

Health....

MR. PARKS: Let's wait for the inquest.

MR. LAUK: Let's wait for the inquest! This Clarence Darrow

from Coquitlam, Mr. Chairman, does not know that when a criminal charge

is being investigated, the inquest is delayed. If you don't know that,

I sentence you to one more year of law school.

Where was the Minister of Health last year when this side of the

House pleaded for the maintenance of motor vehicle inspections? We

predicted precisely what has happened as a result of the tragic

accident that has occurred on Vancouver Island. The reason I raise it

now, while investigations are still underway.... Can the Minister of

Health and his government assure the province of British Columbia that

our kids on skiing trips in this province aren't riding in unsafe

vehicles? What assurances can the people have today that your kids and

my kids aren't travelling on dangerous buses?

Interjection.

MR. LAUK: The hon. member for Maillardville-Coquitlam (Mr.

Parks) says: "Daily or hourly testing." That's his idea of a joke. A

person who hasn't the sensitivity or judgment to know when to keep his

mouth shut thinks it's funny. Daily or hourly testing. We found out

today that the bus involved was supposed to have been inspected six

months ago. We don't know the details of whether it was inspected or

not; we have no idea. The Minister of Highways (Hon. A. Fraser) is

standing in his place making assurances that he cannot make as an

honourable minister and member. He cannot make them; he doesn't know

the details.

MR. PARKS: You're playing on the tragedy.

MR. LAUK: I want to prevent other tragedies. Stop hiding behind that!

Mr. Chairman, the government should, with great deliberation, be

coming forward now with public statements of assurances. How do we know

whether these vehicles for hire or for public transit are safe? We do

not know from the minister's statements nor from the government's

general handling of this problem. It's one thing to say an inquest is

being held, but this is not an ordinary death. This was caused by.... A

grave suspicion of negligence has arisen, and if the allegations in

this morning's media about the deliberate

[ Page 3070 ]

deception of cannibalizing one bus to provide parts for another are

true, then an investigation by the Attorney-General's department under

the Criminal Code

section about criminal negligence causing death

should be underway today, without hesitation. Where was the Minister of

Health when the motor vehicle inspection legislation was eliminated by

the government of the day?

HON. MR. NIELSEN: The member's little outburst there.... I

wonder if Dick Vogel is having bad vibrations this morning. It seems to

me that we went through exactly the same type of allegations and smear

when certain media reports appeared about the former Deputy

Attorney-General. I'm not sure if that member was one, but certainly

members of that side called for all of these immediate actions,

including sealing the doors of the office, because of allegations made

by the media. Instant execution. Welcome to the Star Chamber. Mr.

Member, you can stand up and do your best imitation of a lawyer, and

try to politicize the tragic death of a child if you wish — that's your

privilege. Are you seriously suggesting that any member of this House

doesn't regret the death of a child in a bus accident? Are you

seriously suggesting that any member of this House would recommend and

permit fraudulent actions with respect to the inspection of vehicles? I

can't accept any media report that is purporting to offer evidence that

as far as I know has not yet been presented to any responsible body,

either the coroner or the RCMP or whoever may be investigating that.

I'm not going to respond to some media report of rumours and

allegations from a person who is not even identified. We've gone

through too many examples of that, and too many people have been

smeared with unfounded allegations.

I can certainly assure the member for Vancouver Centre that I share

the grief over the accident involving those youngsters, and I can

assure you, Mr. Member, that the grief I share is of far more concern

than the dollars associated with repairing these children. I believe

the minister responsible for transportation will investigate the

circumstances of this incident, and I believe responsible action will

be taken. I can't tell you what that might be at this time, because I

simply do not have the information or the details. I cannot accept the

attitude you've offered — and it's a difference of opinion — that

closing of inspection stations relates directly to this situation,

although I can understand an argument being advanced that there is some

type of correlation or relationship. We are advised the bus was

inspected. Perhaps that suggests buses should be inspected more often.

Perhaps it suggests that investigation should be underway into the

cannibalizing of other buses for purposes of inspection. That's to be

decided upon the evidence being offered.

But in the area of health we recognize that there are a number of

actions which should be taken by governments to try to eliminate as

much as possible the incidence of accidents, particularly fatal

accidents, be it with respect to motor vehicles, the workplace or

otherwise. The recent bus accident has received a tremendous amount of

publicity and it is on the minds of most people. We share in the grief

associated with that. But I think it's reaching slightly to suggest

that the accident can be directly linked to the closing of the testing

stations. It can be suggested, I appreciate, but I can't accept that

that is therefore evidence. So I'm not going to get into what I

consider to be a strictly political argument over the question. When

the information is before us, due consideration shall be given to that.

With respect to prevention — members have talked about prevention —

I agree that prevention is a very important aspect of our health care

system. Theoretically it should be one of the most successful areas of

controlling heath care and health costs, because theoretically

prevention is within the grasp of each of us. A tremendous amount of

health care expenditure and care is the result of personal lifestyle. I

don't know what the percentage might be but it's very high — the number

of people in our acute care facilities today who are there for reasons

of lifestyle. Many of our people who are undergoing various forms of

treatment are having that treatment because of their lifestyles, and

the results of those lifestyles can be prevented. If we as a society

were to be really successful in preventive health care, it would

require a massive change of attitude by the individual.

The medical profession and the scientific world have brought to our

society major steps in preventive health care. That which we treat

today is very different from what was treated a couple of generations

back, because of the introduction by science and the medical

professions of preventive methods, including some of the obvious: the

antibiotics, the ability to control infections, the ability to immunize

against communicable diseases. This has caused a major change. So

prevention is certainly working in the control of certain diseases

which were common not many years back. I can recall as a youngster the

yearly toll of polio victims, and we all, I think, remember the great

outbreaks of scarlet fever and other diseases which today are virtually

unknown. So prevention does work when science and the medical

profession can intervene. But the prevention that most people speak of

today is something that can be controlled by an individual to a very

large degree. Our society has not accepted that responsibility, because

I think our society — and I think we all share the responsibility —

expects not prevention, but cure; cure for ailments that many of us

have because of lifestyle.

Mr. Chairman, the preventive side of our ministry is not as well

known as the curative side, because the publicity is not there. Much of

the work is pretty routine and quite dull. But the preventive side has

always received priority within the ministry, although it may not have

the romance or the adventure. They're doing a very good job. I

recognize prevention as being very important in health. I just wish all

the citizens of our province and our country would accept their

individual responsibilities.

[10:45]

MR. LAUK: Mr. Chairman, in the heat of debate it seems clear

that the hon. minister and myself perhaps made remarks that were a

little sharper than we might have liked. I don't want to reiterate my

point and don't wish in any way to have my point set aside because of

some kind of feeling which was not intended: that someone was being

smeared in this kind of situation. If people are guilty of criminal

conduct, then we have a system for the administration of justice that

will determine that. But sometimes the vigorous investigation of such

conduct is required.

I have two points to make with respect to this minister's estimates

and this tragic accident. There's no doubt in my mind that the Minister

of Health is gravely concerned and shares, as must all of us as best we

can, not being the parents of the child lost, the grief at that loss.

That's not the issue. That's taken. We all understand that. What I'm

saying is, what is ministerial responsibility? What is the

responsibility

[ Page 3071 ]

of the Minister of Health? I draw the direct

connection between motor vehicle inspection and that accident. Does he

want us to draw that connection in future accidents? I don't want to

stand up in this House and draw that connection again, and that is why

I raise it now. Can the government assure the people of British

Columbia that the private and public buses of this province are safe

for our young people to be transported on for such skiing trips? My

guess is that most of them are. But we're not here to guess; we're here

to be sure. I think it's the responsibility of the Minister of Health

to assure the public of British Columbia that the buses our kids are

travelling on are safe and also to take a position with the

Attorney-General with respect to the vigorous investigation of the

conduct relating to the mechanical safety of the vehicle involved in

the tragic accident that has given rise to this kind of debate.

MR. BLENCOE: I want to indicate some deep disappointment with the position of the Minister of Health this morning.

The issue which I brought up under standing order 35 is indeed one

before the House, but it is also an issue that must be of concern to

the Minister of Health. The issue is not one of a court of Star Chamber

or of trying to smear anybody. What has transpired in the last 24 hours

is that there has been a serious statement made by a former employee of

this particular company that indeed there was serious cannibalization

to ensure these buses got through.

MR. CHAIRMAN: Hon. member, the Chair has listened very

carefully to the discourse that has been going on over the last 20

minutes or so. The matter to which you are now speaking is before the

Speaker, who is going to bring down a ruling on the admissibility of

the motion you brought forward to the Chair. Certainly the issue being

discussed is a very valid — and emotional — one, but I think it has

been reasonably well canvassed. May I suggest, hon. member, that this

committee would be well served if we could perhaps get to more direct

questioning with respect to the administrative functions of the

Minister of Health, which, in fact, is the vote we are discussing at

this time.

MR. BLENCOE: Mr. Chairman, your points are indeed well taken.

But there is an issue that is fundamental to the Health ministry, and

that is one on which there is doubt in terms of the safety and

therefore the health of children and others being transported in public

vehicles. This has to be a matter of concern to the Health ministry.

There is indeed serious doubt about this particular operation and

others. Where there is doubt, there is suspicion. It is incumbent upon

government to take immediate action to ensure there are full public

inquiries into this kind of thing. I would urge the Minister of Health

to have serious words with his colleagues, in particular the Minister

of Transportation (Hon. A. Fraser), to try to take this issue and this

emotion out of this chamber, to have an open inquiry into this

particular issue. The Minister of Health does have some responsibility

in this area, and he should make his views known to those who can bring

some serious consideration to this matter. I think it is a health issue

and should be dealt with very quickly, Mr. Chairman.

MRS. DAILLY: I know the minister was going to answer my

concern that the increased use of user fees in the province of British

Columbia is, in my opinion, doing away with the whole comprehensive

to remind the minister that the implementation of increasing costs for

individuals to even get into a hospital now is primarily affecting

those who can least afford it. That means that the minister and the

Social Credit government are abrogating basic principles of medicare,

which was supposed to create and should be creating an equal type of

access. I ask the minister how on earth that can still be with us if

people who can least afford it are having user fees imposed on them at

the same rate as you and I pay. Isn't it ridiculous, when you think of

it, that some senior citizens, some unemployed and the poor are the

ones...? They're paying exactly the same now in hospital premiums and

to get into a hospital per day as you and I, who with our incomes as

MLAs most certainly could not be considered in the low bracket. I ask

the minister: can he please rationalize for me and for many people in

HON. MR. NIELSEN: As I mentioned earlier, when you offer five

words and recognize them as being principles, because they're words and

because language means different things to different people, there's

going to be an argument.

people who may or may not have some difficulty in receiving medical

care because they're broke. The premium program, the per diems and

other charges are not intended to deny people access, and they don't

deny people access. Tremendous numbers of people that the member has

identified as a group are assisted by the government directly. When you

look at the premiums, we have a premium assistance program which can

subsidize up to 90 percent of the premium. We have a reasonable number

of people in the province who are the responsibility of the Ministry of

Human Resources and who are assisted for such costs. We have

approximately 700,000 people in the province who have extended medical

coverage, in which the per diem costs are paid as a benefit. The

majority of premiums are paid by the employer, not the payee.

You have a category of people who are not covered by a plan — either

they're not working or their collective agreement doesn't have a plan —

and are responsible for their individual premiums and for individual

payment, should they be unfortunate enough to wind up in a hospital. I

don't know what those numbers are precisely, but I do know that we do

assist a great number of those people. Please don't give me this "young

person comes to a hospital and they said, 'Where is your card?' and he

doesn't have a card, and he's being denied access." Sure, it can

happen. The same young person could get into his automobile and forget

his insurance had expired, too. That can happen.

We offer a program and a plan. We do not baby-sit every individual

in the province. There are personal responsibilities associated with

our system. But we do not deny care to the people. In many instances

people have gone to hospital to find that their coverage had lapsed

because they were behind in their premiums. They were invited to make a

back payment, and they were reinstated and covered. Who in this chamber

believes that we're going to hound a person to death over medical

costs? We're asking the people of the province to share in the costs.

I might mention that when it comes to health care and hospital care and user fees on the per diem basis, when

[ Page 3072 ]

hospitalization was introduced in the province, the

co-insurance concept had the patients paying approximately 7.5 percent

of the cost. Today they pay approximately 2.5 percent. Of course, if a

person is destitute, he can't afford 20 cents or $2 or $20, and he's

not going to pay it. But a person of reasonable income, I'm sure, is

not distressed. When he goes to a hospital for five days and is asked

to pay about $42, when the cost of their stay in the hospital is

probably about $2,000, he's extraordinarily pleased that the system is

in place.

That money coming in through premiums and user fees is used to

provide additional health care. In British Columbia we provide far more

health care than is required by way of agreement with the federal

government under the medicare scheme. I want to keep those additional

benefits for the people of the province. I tell you, Madam Member, if

we have to tailor our program to assist that individual person who's

broke and destitute, we'll do that rather than destroy the entire

system, which would deny the people of British Columbia these extra

benefits. That's what the feds want us to do. That's fine. We'll argue

with them later. We have additional care under our medicare services

for chiropractors, podiatrists, naturopaths, physiotherapists and

optometrists. We have a long-term care program, all of which is funded

by the people of British Columbia, with assistance of about 25 percent

from the feds. Every dollar we bring in in revenue, be it premiums or

user fees, is used for additional health care benefits, and we want to

retain those additional health care benefits. It's a very simple

matter, and I wish the people of the country would understand.

There is no reason to believe we in Canada can afford our health

care system at all. The federal government is in debt for hundreds of

billions of dollars, and they're pretending that we can actually afford

it. We can afford it as long as we can borrow the money, yes. That's

how they're running the country right now — by borrowing money. The

federal minister says, let's borrow more money to pay for a health care

system, which she describes as the best in the world, but she says:

"Let's change it to get a few votes." The NDP in the House of Commons

said: "Us too." You better believe it, boy. You go across this country

in the next federal election and you're going to tell the people:

"We'll protect your health care. We'll protect you." You're not going

to say: "We'll borrow money to do it."

Right now it's costing this province $2 billion a year as our share

of the interest on the federal debt. We could almost double our health

budget in B.C. with that $2 billion that's being drained because of the

socialistic attitudes of Ottawa that you can continue to go into debt,

to borrow money to try to buy the voter in the next federal election.

Read Bill C-3 and see.

For that member for Burnaby....

Interjections.

[11:00]

MR. CHAIRMAN: Order, please.

HON. MR. NIELSEN: Mr. Chairman, I am sorry I am elaborating

so much on this, but there is a myth in this country. I get a little

bit tired of listening to nagging members of legislatures and

parliaments who are pretending to the people that you can do certain

things and afford certain programs simply by adopting the principle,

with absolutely no consideration of where the money is going to come

from. I get a little tired of talking to federal people who say: "Oh,

all you have to do is raise taxes." That's the answer to everything.

It's endless.

The provinces have provided exceptional health care in this country.

Even the federal minister agrees it's the best in the world. But she

says: "It doesn't fit in with our plan." It doesn't fit in with the

Ottawa attitude toward health care, which is a provincial

responsibility.

MR. MITCHELL: It's not universal.

HON. MR. NIELSEN: Not universal!

There is no one in this province who is denied access to health care

because he's destitute or broke. We are, and always have been, prepared

to assist individuals who feel they could be denied health care because

of their circumstances. We're not going to throw out the baby with the

bath water or say, let's get rid of every other benefit in health care

in B.C. because we adhere to the socialistic attitude in Ottawa that

it's wrong to ask people to contribute, to a small degree, to their own

health care.

We're talking large dollars when we discuss the Ministry of Health

estimates. We bring in in excess of $300 million a year in premiums.

Throw that out? Okay, what do you cancel — the long-term care program?

Interjections.

MR. CHAIRMAN: Order, please, hon. members. The minister has the floor at the moment.

HON. MR. NIELSEN: In user fees, in round figures, we bring in

$80 million. The member for Esquimalt–Port Renfrew (Mr. Mitchell) I'm

sure would say: "Raise the taxes. Eliminate them." That's about $400

million.

Interjection.

HON. MR. NIELSEN: The leadership aspirant from Alberni says:

"What do the other provinces do?" I think it has been recognized in

Canada for some time that certain provinces were considered to be

"have" or "have not" provinces. One way of tracking that is by the

amount of money transferred between the federal and provincial

governments on the cost-sharing program in Canada. For many years

Ontario, B.C. and Alberta were considered to be "have" provinces. Those

three provinces all collect premiums and user fees of different types.

The other provinces may not, although they are considering it; some

have put in various things. The other provinces realize that they

haven't got the money, and Ottawa has told them: "We don't have it

either." You will see a province instituting a 12 percent sales tax and

other taxes — very high rates of personal income tax. They don't have

the money. And Ottawa's saying: "We're not going to allow you to

capture any revenue the way you wish to. Do it our way or we'll take it

away from you." That, as I said, is going to be the subject of some

debate. It's fine for you people to try to sell to people, hoping to

get their vote, the idea that everything in life is free, that there is

a free lunch. You know, I heard one of your candidates in the last

election say: "Medicare is free." It's not free; it's the biggest

expenditure in the country.

So we have a difference of opinion; fine. What's wrong with that? By their

action, the people of the province have supported premiums and user fees over

the years since each

[ Page

3073 ]

plan was introduced because they've always been there, and they have not

stood up in revolt.

MRS. DAILLY: They will.

HON. MR. NIELSEN . Oh, they will. In fact, Mr. Chairman, of all the communication

we receive in the Ministry of Health, probably the category that receives the

least amount is that of premiums or user fees. Of course, we get some correspondence

from people who say they disagree. The vast majority support it. We offer a

good health service in B.C., a service which goes beyond the agreement with

the federal government on medicare, and we're very proud of it. We have

the jurisdictional responsibility to provide it.

Interjection.

HON. MR. NIELSEN: Of course it is. It has been for years.

If we disagree, we disagree, but we are not denying access to

people. If there are individual situations, they can be remedied very

quickly.

MRS. DAILLY: I did expect in reply to my question that we

would get some right-wing rhetoric, and we really did get it,

full-blown, from the Minister of Health. And he's quite right: we have

to disagree on this because it is a matter of a basic difference in

philosophy. But I must come back on a few points the minister made. As

most right-wing politicians get carried away in their rhetoric with

myths and not facts, I think it is my duty to dispel some of his myths.

That minister and the Social Credit government, along with other

conservative governments — here and in the United States, of course —

are trying to scare the people into acceptance of paying more and more

money on an individual basis for medicare. It's a straight scare

tactic. The minister throws up his hands and says: "Where's the money

going to come from? Tell me that. If we don't have user fees, I can't

provide additional health benefits." Yet sitting right beside the

Minister of Health at this moment is the minister in charge of urban

transit. That minister, when a comment was made to her sometime last

year that ALRT, this system that is going to provide benefit for only a

certain sector of the lower mainland, was going to cost over the

original, what, $400 million...? In fact, it may reach $1 billion. One

billion dollars for a system that was rammed down the throats of the

people of Vancouver. We knew it was ridiculous and was going to cost

too much money, but we're stuck with it now. We accept that. But that

minister said to the press, when asked where she was going to get the

extra $400 million: "Oh, we'll find it; we'll borrow." And that

Minister of Health stands up and says to this House: "You can't borrow

your way into prosperity. You have to find money for medicare, so we're

going to put the money on the backs of the poor." And the minister

beside him blithely says: "We're going to find $400 million for a

transit system that is questionable in its costs."

So when that minister tries to scare the people of British Columbia by saying,

"We don't have the money, so we're going to put it on your backs

individually," that's the difference between the NDP and the Social

Credit government. First, we believe you should look into systems before you

bring them in and put all that cost on the people of British Columbia. Secondly,

we do not believe that people in the low-income brackets should pay the same

for their hospital and their premiums as the people in the higher, and that

we will never come to agreement on.

The minister asks where we're going to get the money. I pointed out

one area where money is being wasted, but unfortunately that government

has set us on that track. He keeps talking about the millions of

dollars of debt of the federal government, and yet the Social Credit

government of British Columbia always fails to mention the fact that

their debt has tripled since they came into office. And what is each

person in British Columbia paying for the financial bungling of the

Social Credit government? Increased debt loads — and he has the nerve

to talk about the federal government and their debt.

To try to bring this to, I hope, a more positive debate, I agree

with the minister that we have a responsibility in prevention. He asks

where we are going to get the money that those premiums are bringing in

if we dispense with them. I pointed out one area: more efficient

handling of their present finances. I also want to point out that there

are many areas of prevention that I think the minister and I would

probably agree on. Lifestyle definitely has a tremendous amount to do

with the increased costs of hospitals. But there are a whole list of

other areas of preventive medicare and new systems of medicare which I

would like to discuss with the minister in more detail. I know that we

will have that chance in the next estimates, when they come, because

the money we're debating now is already spent. So I'm just threshing

around here talking about moneys that have been spent. But that's why

I'm using this opportunity to talk about some basic philosophy with

that minister. The whole thrust of medicare in this province and in

Canada is at stake, because of right-wing rhetoric that is trying to

convince the people of Canada that they can't afford their medicare

system anymore.

I want to read to the minister a couple of facts. I am not using

rhetoric; I'm using facts. Mr. Chairman, I must give the minister great

credit; he's a master of right-wing rhetoric. It scares people, because

most people in British Columbia are struggling so much today with just

trying to get by under the oppressive economic situation that they

can't take time to dissect some of that right-wing rhetoric that keeps

coming forth from the Social Credit cabinet. My job as a member of the

opposition is to try to bring some reason and light to the public of

British Columbia and cut through all that myth and rhetoric that pours

out of the Social Credit members.

This is for the benefit of the minister. When he meets with his

federal counterparts, I hope he will bring this up to them. We hear the

complaint that health care costs have become excessive and must be

controlled. This is one of the prevailing myths about medicare. The

truth is that the cost of Canada's health care system, as a percentage

of the GNP, is lower than that of most other industrialized countries.

Canada, over the past several years, has spent annually just over 7

percent of its GNP on health care, compared with, on an average, the 8

percent spent in Australia, France and Sweden and the 9 percent spent

by West Germany. The United States does not have medicare. I'm sorry to

say it, but I really believe some of our Social Credit members would

like us to revert to that barbaric system which exists in the United

States, where people today still are being stuck with these enormous

$100,000 hospital bills. The United States, which is the only major

western nation without public health insurance, has spent between 9 and

10 percent of its GNP for a much less fair and accessible system than

ours.

[ Page 3074 ]

I leave those facts at the moment with the minister. All I can say

to him is: please stop using that right-wing rhetoric to try to scare

the people, and give them some facts.

[11:15]

MR. ROSE: I would love to get into this sort of general

argument about whether user fees are fair or unfair. I'll resist the

main impulse to do that, but I'd like to tell the minister that some

people who are very close to my own family who have been out of work

have lapsed in their premiums. While they may not write the minister

and admit that they can't afford their premiums, they wouldn't look

forward to having health care on the basis of charity rather than

right. I would also like to remind the minister that it's been our

party's, I suppose, pet project for the last 50 years, ever since the

Liberals promised it in about 1919. They promised medicare as part of

their platform. As a matter of fact, I think it passed this

Legislature. That, incidentally, was the same year that they composed

"I'm Forever Blowing Bubbles." But that is probably incidental to the

argument.

What I'm talking about, Mr. Chairman, and what I'd like to raise

with the minister is a local matter. The minister knows what I'm going

to talk about already. It has to do with the opening of the Eagle Ridge

Hospital in Port Moody to serve that area that I represent, which in

the paper recently was called the "ozone capital of the west," having

to do with its difficult occlusions in the matter of air purity. One of

the reasons for that particular distinction is that it probably is the

centre of the most intense traffic pattern anywhere in the lower

mainland. Any traffic going up the Fraser Valley on the north side has

to go through the Coquitlam-Moody area. I don't think there's another

community or small city comparable to Port Moody through which more

cars flow every day. In addition to that, Port Moody is a seaport. Port

Coquitlam is a railhead. There are thousands of trucks carrying

dangerous cargos through there every day. At some time there could be a

very tragic accident. We had one near-tragedy recently in Mississauga.

I think that if we had an accident in the Port Coquitlam–Port Moody

area during rush-hour traffic....

If a dangerous cargo of propane, butane or something like that

carried by truck or rail blew up, I think it would make Mississauga

look like a Sunday-school picnic. It is a very dangerous and

potentially inflammatory area. That is why we need certain facilities

that were recognized by the community as long as ten years ago.

When the residents of that area organized to request a hospital....

That goes back at least ten years; as a matter of fact, the person who

perhaps would be more in tune with what is happening is my colleague

the member for Maillardville-Coquitlam (Mr. Parks), who was the

chairman of the foundation to raise money. The point is that this was

money raised by the community; this was the demand voiced by the

community. Ultimately the Ministry of Health, aided by the efforts of

those citizens, built a very fine hospital worth millions of dollars. I

don't know precisely what it cost, but it's all finished. It came in

something like $100,000 under budget. It's about ready to be staffed.

The staffing contracts for the emergency service have been arranged for

and let.

I don't know whether to stop while the minister is being briefed.

We are told that we can expect an opening by October 1, which means

that until then that building will sit idle. From that point on we're

told to expect a phase-in situation while that building is allowed to

fill up and while decisions are made regarding what share the Eagle

Ridge Hospital in Port Moody — the brand spanking new, fully equipped

Eagle Ridge — will have with St. Mary's and the Royal Columbian.

First of all, I would like to ask the reason for this long delay in

opening the Eagle Ridge Hospital. Is it a matter of money-saving?

Certainly it is not a matter of the facility not being there or being

equipped. What is the reason that we have to wait another full year

beyond its proposed opening date and its completion date?

HON. MR. NIELSEN: The plans at the moment are to open the

hospital in the fall, and I don't think there's a great amount of

disagreement with the board about that. They would like to have seen it

opened earlier, sure. But it's because of money, yes; we've had to make

some adjustments. We've delayed the opening of some facilities and made

modifications in others. It is an economic reason — a fiscal reason.

I appreciate the member's comments about potential disasters that

could occur in certain areas. Obviously a hospital situated nearby

would be of major assistance. However, all hospitals are not going to

be able to do all things for all people, as we can appreciate. Citing

the example the member used, in a situation such as that you probably

would have a great need for intensive care with respect to burns. I

would think they would utilize Vancouver General Hospital for that

purpose, rather than expect Eagle Ridge to be able to respond in that

precise expertise that is available at the burns unit at Vancouver

General. We expect Eagle Ridge to be a fine hospital for the community.

We don't suggest they're going to be able to do all for all. Yes, they

will be working closely with Royal Columbian and St. Mary's; all three

hospitals will be working very closely.

Eagle Ridge hospital was originally planned some years back. When it

opens in the fall it will be quite different from the original ideas

and concepts. There have been changes. But still it will be a fine

hospital, and I believe it will meet the requirements of the community.

At the moment, Mr. Member, the only area of argument — and argument

really is too strong a term; the only area of disagreement or

discussion — is the role of the emergency room. They refer to it as an

ambulatory care unit. We're into discussions now: what should the role

be, or should Royal Columbian accept a greater role in emergency and

Eagle Ridge accept a greater role in community hospital needs? That's

where the discussion is right now.

It will be a fine hospital, and I think we can accommodate most of

the desires of the board. I hope we can. Hopefully it will open up this

fall, and it will be a fine facility, The reason it was delayed rather

than opening in the spring was the consideration of our budgets and the

fiscal problems we've had. So I can assure the member that the

situation is in reasonable shape. We've had many discussions with the

board, and they are continuing; I think one is scheduled a week or so

from now. We'll try to provide that community with a very fine

facility. We hope we are in a position where if we can identify them

now, perhaps we can avoid situations that would have to be remedied

later. We'd rather not put something into that hospital that later

should be removed. That's what we're trying to work out with the board,

the Royal Columbian and St. Mary's.

MR. ROSE: I thank the minister for his response, and I'd like to comment on two or three things.

[ Page 3075 ]

I suppose the first thing is the last thing he mentioned: that he

wouldn't want to put something in the hospital that later would need to

be removed. I take it that this would be outfitting or equipment of

various kinds. My information is that the emergency unit as planned is

all complete. The question is whether we're going to be able to use

that emergency equipment. I quote from the letter of the chairman of

the board, who is certainly, so far as I know, not a supporter of my

party: "Emergency service staffing at Eagle Ridge is fundamental to the

community program role for which Eagle Ridge was designed and built."

If it is fundamental, that means that there should be no question as to

whether or not we should have it. Earlier in his letter he wants to

reassure the friends of Eagle Ridge Hospital: "I would like to assure

all of you that the situation at Eagle Ridge Hospital is basically

unchanged from our approved planned general hospital role."

I think the minister can appreciate that there is some distinction —

if not major, at least slight — between what he has told us and what

the chairman of the board has told us. I've received what I suppose you

would call expressions of concern through various avenues, but

emanating from the local police in Port Moody, who are extremely

worried because of the traffic volume in that area and the fact that

the place is a bottleneck; that if you don't have the emergency role,

they would probably never get to the burn unit — if it happened to be

that kind of accident — at the Vancouver General Hospital. Furthermore,

if you go along at any time from seven o'clock until nine in the

morning, or during the rush hours in the afternoon, it's virtually

impossible for anybody to get along the Lougheed to Riverview. So

there's an ever-increasing population of families building up that

slope right above there. We've got a highly industrialized Port Moody —

the Ipsco plant, the Neptune Bulk Terminals, the Esso refinery, B.C.

Hydro. There's an application being considered for B.C. Hydro to burn

natural gas to boost power volumes during peak periods. I would say the

place is a tinderbox.

[Mr. Strachan in the chair.]

So you've got all this trucking with dangerous cargo. I'm urging the

minister.... I'm making as strong a representation as I can to have

him and his officials alter their view about the emergency unit.

Certainly it may not be as good as the emergency unit in Bellevue in

New York. We know that. But just because it doesn't have everything,

including the ribbons and all the other stuff that is extremely

sophisticated, is no reason it can't do part of the job. It'll need to

do part of the job if there is ever an accident there, and I think

we'll have to anticipate one. That's why we have emergency procedures

under the fire chiefs in those areas. That's why the police are

concerned; that's why the industrialists are concerned for their people

in those areas. Six hundred people went through Eagle Ridge last

Sunday. The community is vitally interested. The traffic is not going

to get less, because the ALRT is not going to Port Moody. I urge the

minister and his officials not to turn a blind eye to those people. Let

them phase it in. They can operate for eight hours a day starting

October 1 and going to 12 and later 16. Certainly everyone agrees it

can't do everything — but they'll be able to do something, and a hell

of lot more than they're able to do right now if that thing doesn't

open.

MR. COCKE: I realize that much of the in-depth estimate

procedure will be happening again not too long from now, and I noted

there was a bit of a philosophical thing going on. Not one to evade

that sort of situation, I thought I would say a word or two along that

line and also make some suggestions for the future, and maybe ask a

couple of questions.

The minister talked about prevention and said that side receives

priority. I'm not sure it receives the priority it deserves. I

recognize that public health and the people involved in public health

are most important. I also recognize that they can't do an awful lot

about lifestyles, but they can try. A lot of the people I consider to

be in the preventive area have suffered some of the worst cuts.

[11:30]

There's another aspect to prevention. That's the whole question of

early treatment of an incident — whether it be an accident or a

cardiovascular incident or a cerebral incident. One of the ways that we

dealt with that in this province....

Of course, I go back a little way. I can remember that when we first

were government we found a province that didn't even legislate the

standard of equipment, nor did it legislate the standard of training

for any person in the emergency system — and that's mainly ambulance.

There were many ambulances running out of mortuaries. After all, the

businesses sort of coincided — under those circumstances they certainly

did. I suggest to you that when the legislation was brought in

determining standards of procedure, standards of training and standards

of equipment, we had a new outlook altogether. We also found that we

had a province where most areas could not meet those standards.

Therefore a provincewide ambulance system was put in place, a system

which is relatively inexpensive. I understand it's going to be cut

again, and Lord only knows, it's near the bone now.

As a matter of fact, in many areas such as Surrey, where you haven't

yet got — in that vast area of Surrey, with a relatively heavy

concentration of people — a paramedic service.... That's absolutely

shameful. There is no paramedic service in Surrey. The EMA3s are not

out there. They stop at the Fraser River. They don't get into the areas

around the Fraser Valley — on either side — in any number at all. They

are even scarce in Vancouver — scarce enough now, Mr. Chairman, that if

the accident that happened to a former minister of the Crown happened

again, I would wonder whether or not that three or four minutes of

potential survival would have been met. I have heard far too many

reports saying that the service is becoming less and less available in

terms of that necessary time. I think the system is part of prevention

from this standpoint: the earlier the intervention, the more likelihood

of not only survival but also reduced morbidity and a less lengthy

hospital stay. I think that the emergency service, rather than being

cut, should be beefed up.

Way, way back when the cuts began to fall, we talked about the

idiocy of cutting back on home care. The minister, of course, told us

that there was some fat in the system. But the fat in the system didn't

justify the generalized cuts. If you want to keep people out of

hospital and you want to keep them at home, give them the support

system that they require. My office, like the minister's office and

every other MLA's office that's listening, gets calls with respect to

cuts and calls which tell us that the cuts have generated another user

for a bed in an acute-care hospital. It is a crazy way to act. Our

whole system should be aimed at keeping people in the least alienating

of climates. When they built the new children's hospital, did

[ Page 3076 ]

they think then, with all their planning, of the need for what the

minister sort of talks about as being preventive? I think part of being

preventive is keeping people at home wherever possible.

In that relatively new facility we have a huge radiology department

that is certainly not full. I'll guarantee that the radiologists will

fill it as fast as they can. However, we have the out-patient

department that's so small that it's unbelievable in this day and age

when hospital care is extremely costly. What we should be doing at

every opportunity is keeping them out. Yet by virtue of the way we're

doing it, without planning and without thought, that's what's

happening. Enough of that for the moment.

I would like to refer to some of the things that I heard the

minister roaring about. He was talking about the socialistic attitude

of Ottawa. Ottawa is a strange place with the Liberals there — the

chameleons of the country. That's one of the reasons their survival is

so great. In a way that used to be the Socred situation: they could

respond to people's needs or attitudes. I gather they did a job of

polling. One minute they're right-wing, one minute they're left-wing

and one minute they're on the fence, but that's neither here nor there.

I don't think it's a matter of questioning the attitudes of Ottawa.

It was the Social Credit government that went down to Ottawa after we

lost as government. They continued the negotiations with Ottawa, caved

in and went the route of Ontario and Alberta, which had high tax bases

at that time, with no thought at all for the areas in this country that

were then have-not. We had a good high tax base. The grant and the

percentage tax points would be beneficial to us. We could see that.

Selfishly we went down there and negotiated and took the Ontario and

Alberta line, and that's the way it has gone. Now they squawk about the

federal contribution. If you had fought as hard as we said you should

fight to maintain the 50-50 operation, then maybe there could have been

a federal-provincial partnership that would have recognized that we're

all in this bag together. You could have done something about it.

From the standpoint of these three provinces that have user fees and medicare

premiums, the minister says that he prefers this to taxation. What an irresponsible

remark to make. Taxation, if fairly applied in raising those same funds, do

not unfairly subjugate some of those people. Let's talk about user fees

for a second. The person most likely to be least able to afford the user fees

is the person who is going to be attacked by those user fees. If somebody could

show me where user fees were actually a deterrent, then I think we could have

a little argument around that. But the deterrent in our system is purely the

deterrent that is mounted in the doctor's office. I've never seen a

hospital yet that admits a patient upon request. A patient does not walk into

a hospital and be admitted, except in emergency, but they're still not admitted

to the hospital unless the doctor makes a request for that bed. Unfortunately,

they're not having a lot of success in some instances, but that's neither

here nor there. Other provinces have said: "Let's take this whole question

and make it fair across the board. Let those who are well share." That's

the whole idea of insurance: sharing the risk. When you have the authority to

say that everyone share who can share, then, for heaven's sake, isn't

it a far better world? As far as I'm concerned, with medicare premiums you're

going to have to raise the $300-and-some-odd million someplace. We're doing

it right now. We're disadvantaging a lot of people. The percentage of unemployed

young people under 25 out there without medical coverage is astronomical. Many

of those people will eventually be one heck of a charge on the health system,

because they will neglect care that they feel they cannot afford because of

the fact that they haven't got coverage. It's pure and simple. Even

the advocate of the great gem of the Social Credit government, the university

Health Sciences Centre Hospital, would agree with that.

The fair way is to go the route of the distribution of the

obligation to the widest number of people, and particularly to those

who can afford it. Somebody from over there said that everything is

free; nobody suggests that. I'm prepared to pay more in order that

somebody else down the line who isn't as well-fixed can be covered. We

have to do that anyway in the long run. The only problem is that we

take it over to Human Resources, with all the indignities that that

brings into the situation.

I think the arguments for increased user fees and increased medicare

premiums are not solid enough to really sell. The larger the proportion

of individuals who are ill or paying their own shot becomes, the least

effective the whole medicare system is. Certainly it cannot be

universal.

Tommy Douglas, a name that would be well-loved on that side of the

House, said not long ago: "Unless those of us who believe in medicare

raise our voices in no uncertain terms and unless we arouse our

neighbours and our friends and our communities, we are sounding the

death knell of medicare in this country." Tommy Douglas started the

fight. Let's not kid ourselves. We all know about the legislation and

the motions that were in the House of Commons and also in British

Columbia. I think the first motion calling for a medical system was

somewhere around 1929. The real fight to get this recognized was with

Tommy Douglas and, of course, his successor the then Premier Lloyd.

They had a fight. They didn't have quite such a fight in terms of the

hospital insurance issue, which came before, because of the fact that

most of them were community owned or operated in any event. They would

have that same fight in the United States, however, because of the

number of private hospitals there.

[11:45]

In any event, I agree with those who say that nothing in life is

free. It's how you distribute the obligations. I think that we're crazy

unless we really study that carefully, and I think we're on the wrong

course here. The minister told the world during the campaign that I was

a prevaricator for having said that there would be increases, but they

happened immediately after the government was re-elected. They'll go on

happening, and the larger the percentage of the total they become and

the less involved government becomes, the less access people have who

need it most will have.

The member for Burnaby-North (Mrs. Dailly) was talking about the

percentages of GNP. Those percentages read out were 1979 percentages,

as I recall. I've talked to a couple of economists who have said that

even our percentage has increased, probably by one percentile. But the

United States has also increased to somewhere close to 11 percent of

their gross national product. So we may be somewhere up in the

staggering 8.5 percent, but they are still significantly higher than we

are. I make the charge that their system is not nearly as efficient as

ours, yet our system is being taken in that direction every day by

these conservative-minded people who think that privatization, free

enterprise and all those other pretty words are the way to go to

deliver health care.

It's not something that should be left to chance. It's not something that should be regarded as anything short of a

[ Page 3077 ]

human right, which is exactly what I feel health care delivery is.

The access to that health care delivery system should be universal.

With a little nerve we would do a little more experimentation; we

would do a little bit more work in terms of alternatives. I know, when

you're up against that medical profession.... They are a tough

bunch; they're the only game in town, so to speak, and so on and so

forth. When you mention community health centres or health maintenance

organizations, they shudder. We made a very small start on that.

Interjection.

MR. COCKE: The Foulkes report is only buried because we have

a conservative, stupid Social Credit government. I'll tell you who

they're burying right now, Pat, before you leave here. I was going to

mention this anyway, someday. They're burying your UBC Health Sciences

Centre Hospital. They hit them badly to begin with. As I recall,

there's at least 97 percent occupancy right now with three or four

wards closed — I've got it somewhere. But they're hitting them again,

because the pink slips are flying over there like confetti. It's a

shame. It really is.

HON. MR. McGEER: It is a shame.

MR. COCKE: No, it really is. Not that I have ever agreed with

the placing of that hospital; I think it's the dumbest place that you

could have ever selected. If you've got a health corridor like we have

in Vancouver — you know, that Fairview corridor stretching all the way

across False Creek to St. Paul's.... You had the marvellous

opportunity of bringing gown to town. Instead of that, you took town to

gown. That's imbecilic. They've tried it elsewhere and it didn't work.

But now you've got it, you're stuck with it. So being stuck with it,

for crying out loud, don't make it into a community hospital for Point

Grey. At least make it into a tertiary hospital that can do some good.

Too bad you couldn't move it lock, stock and barrel to where it

belongs. But you can't. You're going to have trouble with that forever

and three weeks. Anyway, that's your problem. I didn't make that

decision. I resisted it for three years and four months, and I was glad

I resisted it. I resisted it on some of the best advice in this

country, and then immediately that promise was made when the new

government was elected. So there you are. But I'll tell you, the

demoralized state of affairs out there is really something. It's all

over. Helmcken Road was another mistake, in my opinion. The doctors

around this town are having an awful time. They're saying: "Well, gee

whiz, maybe someday there'll be a need for a hospital out there, but

why wasn't it down on the original spot that was suggested?" It's a bit

remote. But it's not near as bad as that university situation.

Getting back to these community health centres — I was only trying

to get in a word before our eminent authority on brain research left —

I believe that we should look seriously at all the reports,

particularly reports of HMOs that are close to us. For years one of the

success stories has been the Puget Sound — the health maintenance

organization that centres in Seattle and is around that county. One of

the good things I think they did, at the suggestion of the then

governor of the day, was include a number of quite poor and

poverty-stricken people as a percentage of the HMO there, which would

reflect the total state in terms of comparison, and of course they got

the state's help from that standpoint. It gives them a good

cross-section in terms of age, it gives them a good cross-section in

terms of economic status, and so on. They are doing such a lot better

job than the state at large, or anywhere else, virtually, that I know

of. One of the major benefits, of course, is the reduced amount of

surgery, the reduced amount of hospitalization required, because

they're Johnny on the spot.

One of the things that's counterproductive — and eventually we're going to have to come to this conclusion....

It's not going to happen for a generation, it's not going to be

easy, but sooner or later we're going to have to come to the conclusion

that the least cost-beneficial way to do business is on a

fee-for-service basis. Having said that, I don't suggest that we make

public servants out of doctors, because that would be even worse. But I

think that we should have that community opportunity to get involved,

and slowly make the transition to alternative delivery systems.

I think I've said this before in this House, but I'll bet you that

in the United States they're going to be going to that system before we

are, in a different way. You know who's going to make that thing stick?

The insurance companies. They're even more powerful than the American

Medical Association.

Interjections.

MR. COCKE: No, they will just set up their group practices.

It won't be on that.... There's Omineca hopping around. You know

what I'm talking about, too. Too bad we talked about it in the detail

that you don't understand.

Mr. Chairman, in any event, notwithstanding the member for Omineca

(Mr. Kempf), this is an area that should be studied and should be

talked about in some great detail with the profession. Younger people

coming into the profession surely will have a more progressive attitude

toward where they are going in this respect. I think, for an example,

alternative areas of health care should be available for those who are

prepared to pay at the present time. For instance, we set up the pain

clinics in acupuncture for one reason and one reason only, and that was

to study it. They haven't progressed one inch. They are still pain

clinics. There have been no standards set. Doctors are now learning how

to do acupuncture and denying access to that procedure to any eastern.

I was in China. I have taken acupuncture, and I'm dead sold on it. The

one thing that was able to bring my blood pressure to normal was

acupuncture, for crying out loud. Yet the only way you can get that

procedure is counter to the law of the land — not our law but the law

that we've given the physicians to go out harassing these people. I

believe that they should be brought in under umbrella legislation — I

notice this is happening in Alberta now — along with others who have

something to offer the health system.

A lot of things have to be looked at if we really want to provide

the alternatives and bring down the costs, and we just must. I agree

with the minister: you just can't go on living with the way things are

going in health care. But I say there are alternatives, and we'd better

get on the course as quickly as we can in order to save what we have,

which is, as he says, one of the best in the world. But it's going to

become less and less one of the best unless we give it a lot more deep

thought and research and dust off the Foulkes report just for fun.

The member for Vancouver–Point Grey jumps out of here and talks

about the Foulkes report. That was one of the best reports that's been

made in Canada. It's comparable to the

[ Page 3078 ]

Castonguay report. It is far superior to the Hastings report, not in

any way deprecating the Hastings report, which was narrow in its

outlook and needed to be so. The Foulkes report has something to offer.

Anyway, Mr. Chairman, I see that the red light is on. I could get an

intervening speaker, but I'm sure that my colleague would like to carry

on with her estimates.

MRS. DAILLY: Mr. Chairman, I'm sure that the minister may

want to comment sometime this morning on some of the good points made

by the previous speaker.

I would like to ask the minister some questions on the financing of hospitals.

I'm sure that there must be great confusion out there in the

public's mind when they know that for a number of years now they have

been subjected to some serious cutbacks in hospital services in our

hospitals in varying degrees. We have to pay tribute, of course, to the

staff of these hospitals — physicians and nurses, etc. — who have done

their best to cope with what we consider a fairly stringent lack of

financing. I think that most of the hospitals are now operating down to

the bone. This is what we understand. But the confusion comes in the

taxpayers' minds when they know that many of their relatives have been

put in corridors in hospitals and suffered some of the embarrassment of

having to lie there in a hospital corridor instead of having a room,

because of bed shortages. I don't think there is any MLA in this

Legislature who hasn't had a great number of letters detailing these

problems.

[12:00]

But my question to the minister, to start off the debate on the

matter of hospital financing, is simply this. How can you explain how

some hospitals apparently are racking up surpluses at the same time as

we have these complaints — and many have been validated — on extremely

unfair conditions to patients and staff because of cutbacks? I'm not

zeroing in on any hospital. I know that that minister has his list and

I have mine of the present situation of deficits, surpluses and those

who say they are just holding at breaking even. I'm sure the minister

will be getting letters on this, too, and I would like to know how you

can explain this in the area of overall planning, without singling out

any hospital: that some can have surpluses, some deficits, and so on. I

would like to hear the minister give an explanation for this, please.

HON. MR. NIELSEN: As the member would know, the forecasting

of hospital expenditures is not a precise science and is subject to

some variation when the actual amount is totalled at the end of the

fiscal year. At the end of March 1983 the financial statements that

were gathered, modified and reviewed, and which reflected the accruals

for labour settlements known to date, and so on, gave us a figure of

approximately $50 million in surplus throughout the system. Why that

would occur is a very good question, and I think there is an answer to

it. The hospitals were advised that they could retain any surplus for

purposes of expenditure in the next year, and I think some of the

hospitals felt: "Well, if we can retain that surplus and offset next

year's expenditures with a portion of it, then perhaps there may be

less need to dispose of the budget this year for fear of seeing a cut

next year if we didn't spend all our money." That's human nature, I

suppose.

A very important factor, however, has been the tremendous

cooperation by the hospitals in the province, recognizing very serious

times, from a fiscal point of view. A tremendous amount of work has

been done by the hospitals. I think all members in the House should

know that many administrators, members of boards and staff have said

they really didn't appreciate how serious the situation was and they

are surprised they were able to develop innovative programs in their

hospitals which resulted in the saving of money. Many of them, speaking

to me, said: "We've really never had to give that area consideration

before." So they've done a pretty fair job, as they should.

Some hospitals have seen surpluses and others deficits, and the

others fall slightly in between. I think where the public can become

confused is when a hospital is making some noise, particularly at

election time, while sitting on a $2.5 million surplus, and screaming

about not having enough money to open a couple of beds or a ward or

whatever it may be. I certainly do not condemn a hospital if they have

achieved a surplus at the end of the year, provided that surplus is not

excessive to the point that we would have to examine the people in our

ministry's capability of forecasting budgets. Similarly, if they suffer

a deficit far in excess of what we might have anticipated, we would

have to look at their own in-house management.

We have developed some slight changes in funding of hospitals over

the past few years which I think have resulted in far better and more

efficient management of the funds and the hospitals themselves. We

offered them what we refer to as a global budget rather than a line

budget, and we have made some modifications. We also review their

budgets on a quarterly basis, which allows them to respond to the

unknown factor much more realistically. I think that basically the

hospitals have done a pretty good job over the last couple of years;

this reflects in their situation.

One of the great problems is hospital facilities which are

functioning throughout the province and serving a need, but in some

instances serving a need which was there at one time but today may not

be; yet the facility is still there, designed for that purpose. Perhaps

an example of that would be, as the member from Moody (Mr. Rose)

mentioned earlier, the changes that can take place in a hospital from

planning to actual opening. At Eagle Ridge Hospital, originally the

plans would have included a pediatric ward and a maternity ward, but

they're not going to be there, because there has been a change in

attitudes.

The Vancouver General Hospital, with the opening of the other

facilities, eliminated certain wards. But we were still in a position

in the province, as late as December 7 — that's the last date I have

before me — of having 1,344 acute-care beds open but not occupied.

This would suggest that in many communities, because facilities have

been there and were opened in time when the need may have been somewhat

different, we have a surplus of space in some areas while in others we

seem to have a lack of beds. I think that all in all in the balance

we're doing pretty well with respect to that.

We still must seriously address the number of acute-care beds which

are open and available but are not being occupied, because the cost is

still there for the hospital: December 7, 1,344 such beds; December 1,

1,380; October 25, 1,509; August 11, 1,597. We're not condemning the

hospitals for that; we're simply reflecting on the situation. We have

to balance it off; we have to realize where the priorities are. Where a

hospital has surplus space, we either convert it to another use which

is needed, close a ward, or see that the funds go to a hospital that

requires it to pick up in a deficit position of space. But on balance,

Mr. Chairman, I think they've done a first-class job.

[ Page 3079 ]

MRS. DAILLY: I appreciate the detailed answer the minister

has given, but I do want to make this point to the minister and see if

he agrees with me. We realize that hospitals vary in the way they

operate, just as schools and districts do — as you know, Mr. Chairman —

in their management policies and how they handle the money given to

them by the taxpayers of British Columbia.

The minister pointed out one case of one hospital that has

questionable management. I'm glad he didn't bring it up, because I

think it is unfair to bring up the name of the hospital here. I think

we have to be very careful — and this is the thing I want to discuss

with the minister — in raising that, that there is a spectre in the

public's mind: "My God, maybe this is all over the province." This

minister did back up his remarks by saying, and I was pleased, that by

and large most hospitals are operating well. But my question is:

considering that the hospitals receive their money from the provincial

government, and I know they vary in authority and control from school

districts — with which I am more familiar — I am aware of the fact,

nevertheless, that the internal policies of a hospital are by and large

governed by the policies of the provincial government and particularly

by their financing policies. Therefore I say to the minister: when you

mention the fact that there are some acute-care beds not being used, it

does raise, to my mind, a question about the overall planning within

the ministry. If I recall, Mr. Chairman, the minister suggested that

some hospital boards bring out the worst cases during an election.

There was an implication by the minister that they were using their

problems through a political mechanism. I ask the minister: because

officials simply respond to what is being asked by politicians, is it

not true that the cabinet is responsible for building hospitals on a

political basis or making promises about them where they were not

really needed? I think we had better face the reality that the majority

of problems faced in hospitals today primarily emanate from the

policies of the present government. What kind of planning facilities do

you have in the ministry at this time that work with hospitals to avoid

misplacement of beds in certain areas and capital construction at a

time when we have other areas of hospitals that desperately need more

attention? Yet we find you are embarking upon or approving new capital

construction. What do you base all this on?

HON. MR. NIELSEN: There's a very general statement in B.C.

and in our society that if politics stayed out of health care we would

be able to make advances much more rapidly. Unfortunately that's asking

a little too much. But if politics really stayed out of health care, we

would be able to advance much more rapidly than is possible.

The member would be familiar with a very serious problem in health

care with respect to hospitals. Hospitals are built to last forever,

and when they get old, we can't properly utilize them. One of the

really serious problems is what to do with some of the older buildings

which cannot even be renovated. They have to be knocked down rather

than renovated. But some of the facilities in the hospital itself have

become badly outdated simply because of advances in technology.

I guess over the past few years one of the more common areas of

discussion and argument with the hospitals has to do with CAT scanners

and other forms of scanners. There are situations in which you may have

a well-stocked radiology department in a hospital, but the pressure is

for other than that type of equipment. You wind up with situations in

which a hospital is built for a community need and therefore included

all of the standard wards, and then another facility is perhaps built

in the proximity. The specific need in that one hospital becomes

redundant. They may or may not be able to convert it to another use.

The numbers I referred to — and I did receive a later one on January 26

and the number was 1097.... In many instances some of these beds

are maternity or pediatric and the need simply is no longer as it was

when the hospital was designed for that purpose. The ministry planning

division works very closely with hospitals and with long-range planning

of the regional hospital districts to try to determine what will be

required at a certain point in time and to try to work toward it. But I

would suggest that it is quite an inexact science. We can only

anticipate what will be available at some time in the future. I think

the record would suggest that a reasonably good job has been done.

[12:15]

But like everything else involved in provinces and countries, there

are decisions made by government, whichever government it may be, which

may not be the absolute result of the technicians within the ministry.

Sometimes that's good; sometimes it's not good. That's our system. But

the planning is, I think, adequate. I think it's regrettable, and I

suppose people get a little distressed when they see a brand-new

facility open and the first thing that seems to happen is some

redesign. I don't know what the reasons would be. It could be the

specifications received in the construction or planning were

inconsistent with the actual size of the equipment. That can occur. I

think we could relate it to the idea of building our own home, and the

day we moved in we realized that we didn't build enough closet space.

That can occur. But one of the problems is that some of these hospitals

age very fast — an example is St. Paul's Hospital in Vancouver. A very

large portion of that hospital is going to be demolished and replaced

by a new facility because it was built at a time when it would appear

they had never heard of running water or a reasonable electrical

system. Air-conditioning was yet to be discovered. It simply cannot

provide the level of service that people in our province expect. So

there is always going to be a situation in the health care field with

respect to facilities where you're going to be utilizing the decisions

of the past, and if we're going to keep building hospitals to last

forever, we're going to have to use them for that period of time.

I think Helmcken hospital is an example of new ideas in hospital

construction. According to the people who advise me, the new Helmcken

hospital could actually be completely gutted and redesigned in whatever

configuration you might need in the future without modifying the

structure of the building itself, rather than, as in the past, built

for one specific use, and that's basically it. But they have improved,

thankfully.

MR. SKELLY: I'm sometimes surprised at the minister's

statements. When he says that politics should be kept out of health

care, I remember what one of my teachers told me when I was going to

school. He was trying to teach me something about ancient history. He

said there are two different words in Greek. One is "politics," which

relates to the polis , the life of the city, to involvement in public

life. In Greek terms involvement in public life was one of the highest

of ideals. He told us what the word meant that was the opposite of

polis , or involvement in public life. The definition is one person to

himself. Id iota . In modern terms it translates to "idiot." So the

opposite to involvement in public

[ Page 3080 ]

life, in the polis or politics, is idiocy. I think that applies to

health as well, because health concerns all of us. It concerns our

constituents. It concerns us as representatives of our constituents. If

it doesn't concern politics, then nothing should.

HON. MR. NIELSEN: It doesn't have to be partisan politics.

MR. SKELLY: I'm going to try to be as non-partisan as

possible, but I think once you get involved in politics, then you get

involved in some partisanship; it's hard to avoid; it's not necessarily

a negative thing unless positions get so hardened on both sides that

nothing gets done and nobody is listened to or heard.

One thing that has concerned me about the debate so far today is the

emphasis on the treatment side of health rather than on prevention or

the maintenance of a positive approach to health. Going back to the

throne speech, which is, I guess, why we came to this session on June

23, 1983, on page 7 of the first Hansard of this session it says:

My government will introduce a new fitness program this year that

will encourage British Columbians to partake of regular physical

activity to maintain good health and well-being. The program will have

an indirect beneficial impact on productivity across all sectors of

society.

Yes, it does have an impact on productivity: healthy people are

productive people. Also, healthy people make fewer demands on the

provincial economy — on the budgets for medicare and on the hospital

budgets. I just wonder what happened to that promise made in the throne

speech for a new fitness program to encourage British Columbians to

take

part in a program of regular physical activity. I haven't seen it

materialize anywhere in the province. I wonder if the minister could

explain to me what happened to that promise.

Reading through last year's annual report of the Central Vancouver

Island Health Unit, under the topic of prevention it says: "The Only

Way to Go. With ever-rising health care costs, the only method to

arrest these costs is to expand preventive programs. The public have to

be educated in the principles of preventing disease. As the majority of

Canadians are now non-smokers..." It goes on to discuss non-smoking.

Health education is a slow but very productive field. We need to

expand it dramatically to improve everyone's health and to reduce the

ever-escalating cost of health care. It seems to me that the preventive

aspect of health care is one of those areas that politicians don't want

to get into because you can't build big edifices or take credit for

things done on a very low-key, face-to-face individual basis. If they

can't build monuments, politicians don't seem to be much interested in

the preventive aspect of health care.

Our Central Vancouver Island Health Unit is now complaining that

they're very short-staffed. In fact, they were grateful for the

recession because it cut back on the number of new buildings and new

restaurants being opened, so they didn't have to do as many

inspections. It also cut back on the number of subdivisions in the

central Vancouver Island area, and they could catch up on the backlog

of sewerage and septic tank inspections that they were required to do.

So the recession was a good thing for preventive health, because it

virtually ground the economy to a halt. But if a recovery takes place

in the coming year, then even more pressure is going to be on the

preventive health system than during the last little while. Yet we're

running short-staffed in many areas. There is a freeze on the hiring of

nurses. We're short of audiologists and speech specialists in the

Central Vancouver Island Health Unit: all those positions that can help

us to identify health problems before they become serious; all those

positions that help us to educate the general public on how they can

avoid becoming a charge on the health care system by improving their

lifestyles and changing their health habits.

Those things appear to be cut back or to have less priority — not

with the minister, I would say, but with the people who establish the

budgets in the province. The minister did write a letter to the Central

Vancouver Island Health Unit during 1982 in which.... "We are

pleased by the minister’s written and verbal commitment to make public

health the first priority of his ministry. We look forward in 1983 to

the money and staff to match this commitment." Unfortunately, the money

and the staff didn't materialize within the Central Vancouver Island

Health Unit to match that stated commitment. I wonder what the minister

is planning to do in order to demonstrate his commitment in financial

terms and in terms of staff. For example, we're short of psychiatric

social workers on the west coast of Vancouver Island. We had a position

open because of a number of juvenile suicides in that area. There are

serious problems in public health that we need to get on top of and to

prevent. Although the minister states the priority, it doesn't seem to

be there in terms of placing the money where the priority is said to be.

There's an

article in a public opinion magazine I was reading a

short time ago which says that we even have to go beyond the relatively

negative goal of prevention of sickness. "There are two positive goals:

the maintenance of positive health and the pursuit and promotion of

physical, mental and social fitness. This will require another new

breed of health specialist, experts in education and especially in

advertising, marketing and propaganda for health." This is a new thing

that's happening in the health field: people are actually going out,

promoting it and marketing it, and delivering the message to people

around the province and the country that health is actually a good

thing. I think the ministry is missing the boat a little bit if we're

not putting much more emphasis on the promotional and preventive side

of health care. I don't see the ministry in the province of B.C. doing

that. We got the promise in the throne speech; we have the minister's

verbal commitment to the Central Vancouver Island Health Unit; we have

people all over the world and in the professions talking about this

new, active marketing approach to public health; we have changes in

lifestyle, and yet this ministry seems to have fallen behind quite a

bit in that approach.

I'm also concerned about the minister's comments on medicare and the

premium-based medicare we have in British Columbia, on how we're going

to pay the costs, and on comparing the costs of our system with the

income tax-based system — and I know exactly what he was talking about

when he was talking about the have and the have-not provinces. I'm

wondering if any studies have been done within his ministry to show

what the options are. What would it cost the people of British

Columbia, individual taxpayers, if the system were based on income tax?

On the other hand, now we have temporary premium assistance and premium

subsidies and a number of administrative measures to make sure that the

poor, if they humbly approach the ministry and show that they don't

have the money, will have their premiums paid. What is

[ Page 3081 ]

the administrative cost of doing that? There are staff involved,

forms to be filled out, processing, and you have to do that processing

every year. So there is a cost to that.

Also, on the issue of user fees, whenever a person approaches a

hospital, they have to fill out the necessary forms and pay the

necessary few bucks a day for hospital care. If they don't pay, then

they have to be billed, and there are staff and forms required to do

that, postage that must be paid and collection agencies that must

pursue the people who don't pay. So there is a cost attached to the

premium system, just collecting the premiums and making decisions

between those able to pay and those not.

Has the minister done a study of the whole system and a comparison

with the income tax-based system, which doesn't require a separate

collection organization? Clearly, if you're watching the debate in the

federal House of Commons, they do have a collection system there no

matter what your opinions are on how it works. Has the minister done

that kind of study, and is that study available to the public? Will the

minister table it in the House? It's hard to debate a tax-based system

as opposed to the premium-based system if we don't have the facts upon

which to base that debate and if the ministry hasn't done the necessary

studies and made them available to the public. So that's a question I'd

like to ask the minister.

[12:30]

Also, on the issue of user charges, it seems to me that this

province spends a tremendous amount of money building hospitals and

providing those hospitals to the public, and when we think of the

public we always think of the patients. Yet the people who send

patients to hospitals are doctors. It's difficult for a patient to send

himself to a hospital. So it appears to me that it's really the doctors

who use the hospitals as places where they can practise. I'm told that

often doctors will send a patient to the hospital when it's not really

necessary. In order to get the patient out of the doctor's office,

he'll have him committed to a hospital. Is there any user charge on the

doctors for practising in a facility that was established and paid for

by the public? Have user charges on physicians been considered? Those

physicians use material that's purchased by the hospital for patient

care and treatment, and it seems to me that possibly the patients

aren't abusing the hospital but in some cases the doctors are abusing

the hospital or the health care system by sending the patients there.

I'm wondering if that aspect of medical care has been examined by

the minister, and if there has been any consideration given, if we're

to agree to the principle of user fees at all, to those user fees being

assessed against the doctors. Now I know that what's going to happen is

that those fees will then be transferred back onto the public through

the medicare system, and we'll end up paying for it ourselves one way

or the other. But it seems that part of the abuse of the hospital

system can't be blamed on the patients but can be blamed on doctors who

are very busy and use the hospital system as a way of diverting

patients until they have time to go back and see them.

[Mr. Pelton in the chair.]

This minister has been a Minister of Environment as well as Health

minister. A number of concerns are being expressed nowadays about

environmental health. When we were talking earlier today about the

tragic accident up on Mount Washington with a bus, these are really

health issues because they relate to public facilities which if they're

abused or improperly used will result in people becoming a charge on

the health care system. But the same applies to a number of other

things: the introduction of hazardous chemicals into the workplace, the

use of pesticides and the distribution of those chemicals into our

environment, the way people work and the equipment that they work with.

So there are a number of things involved here. I guess that relates

back to the positive health care system.

They say that much of the disease that's present in society today is

environmentally caused. It's caused by things that we insert into the

environment that can ultimately lead to some pretty serious diseases.

Yet it seems to me that in no aspect of the province's jurisdiction,

and very little in federal jurisdiction, do we really go after these

environmental causes.

Port Alberni, just in the last year, has been advised by the

Ministry of Environment that MacMillan Bloedel's emissions permits from

their mills in Port Alberni are going to be revised. The company

apparently does not have the funds to bring its pollution control

equipment up to the required standards in their pollution control

permit; therefore they'd like a revision to reduce their requirements

under the pollution control permits. The people of the city of Port

Alberni, in exchange, are asking for a study of the health impacts of

those emissions on them. A study was done in the mid-1960s by a former

Deputy Minister of Health for the province, and by a doctor who's now a

Baptist minister in Burnaby. They found that there were indications of

health problems that resulted from the air emission system in Port

Alberni. They didn't go into very much detail. But the people of Port

Alberni are making what I consider to be a legitimate request for a

health study to be done prior to any revisions in the pollution control

permits which may result in an increased incidence of health problems

in Port Alberni.

Has the minister been approached by the Ministry of Environment? Is

the minister willing to fund the health study in Port Alberni? I

understand that on February 29, the Central Vancouver Island Health

Unit is holding a meeting in Port Alberni to discuss the health study.

There seems to be strong support for it. Is the minister willing to

finance this study so that the people of Port Alberni will have

adequate information upon which to judge whether or not the company,

MacMillan Bloedel Ltd., should be entitled to reduce its permitted

requirements under their pollution control permit? I would urge the

ministry to finance that study. It seems to me that that's dollars well

spent.

Could the minister address some of those questions for me?

HON. MR. NIELSEN: Mr. Chairman, I think if we are going to

have a health study to find out whether MacMillan Bloedel should modify

their emissions, they should pay for it. It's an interesting idea — not

novel, but interesting — to charge doctors for using hospital space.

Think of all the money we would capture from that. Then we could charge

teachers for using classrooms, professors for lecture halls and

policemen for their vehicles. The idea has been suggested previously.

The doctors are not overly enthusiastic about the idea.

We could even charge our members here for using the Legislature. If

an audit were done on the advantage to the citizens, the fee might be

very high.

On your physical fitness question: within our health promotion in the ministry we have programs established.

[ Page 3082 ]

They are certainly not in a final position, because it is quite

experimental. We have demonstration projects in the workplace with

respect to low-back injuries and casual absenteeism. We have

demonstration projects in the community with respect to health care

utilization by seniors; projects in the school system; obesity;

cardio-vascular health; fitness components for the ministry manuals and

publications; perinatal guide for health professionals; leadership

training sessions; pre-retirement seminars; lifestyle workshops;

educational materials, audio-visual and so on; development of fitness

standards; screening procedures for high-risk employees, health care

workers, dietary workers, deputy sheriffs; consultation referral

services to companies and corporations regarding development of

workplace fitness programs; social marketing studies; understanding

attitudes and influence on behaviour of at-risk population; identifying

strategies for encouraging and supporting change; consultation to

public health nurses, nutritionists and allied health professionals

regarding fitness issues. So a fair amount is being done and being

organized.

As a very quick comment, in speaking with the people responsible for

assisting people in high-stress areas of work, apparently it has had a

significant successful appearance. In being able to speak with people

who are in high-stress positions, not only the individual working there

but also members of the family, it has been apparent that it has

resulted in a respectable amount of breakdown prevention, particularly

— if there is such a thing — of minor mental problems.

Mr. Member, when you first introduced the subject of physical

fitness, I was thinking of the orthopedic surgeon who has advised me of

the incredible increase in cases that he has seen since jogging has

become as fashionable as it is, particularly in the knees. He has some

very strong attitudes toward that, which I won't repeat, because it's

his own idea.

The collection of fees, whether by way of an income tax system, by

premiums or otherwise. I think the opinion I have, which I expressed

earlier, is that using income tax itself — just increasing income tax —

to cover the premiums and the hospital user fees, rather than

collecting them from a different source, if you like.... The

technical aspect of using an income tax filing system for their

collection, rather than the submission of premiums through payroll

deduction and other methods of collecting fees, has been considered and

examined by the ministry from a technical, administrative point of

view. Mr. Member, as an example, let us say we were to attach a tax or

a fee as part of the income tax form and collect it at that point,

rather than by way of submission of premiums. There could be some

savings in administration. There are some serious problems in

attempting to do that, but there could be savings. That's a technical

aspect. I believe Quebec has been doing that. There could be

considerable savings in administrative costs for our Medical Services

Plan. That's if we could keep up with the technology available today as

well, because there's no question that there are improved systems.

We've been speaking with the providers of health care, as I think

they prefer to call themselves, as to how we can modify the system. In

many areas our system is in need of major renovation from a technical

point of view — communications and so on. We still rely very much on

the telephone to doctors' offices and others to get some very basic

information, which could be readily available through a very

inexpensive computer system, if terminals were properly located in

doctors' offices, hospitals, and so on. That's coming. It's just a

matter of time and finding the dollars.

Public and preventive health. We recognize the need for public

health, and we recognize the various difficulties health units have in

maintaining their staffing. Primarily there are two reasons for that:

one is a matter of having the necessary funds; the second is the

recruitment of suitable people. In many areas of the province those two

aspects can be almost equal as to why we have some difficulty.

Specialists in public health are sometimes quite difficult to locate

and then maintain in their position. We do have a large number of

people who pull out of an area after a period of time, and sometimes it

is very, very difficult to find another person for that position. As

well, we must took at the dollars, and one of the frustrations, I

suppose, is that we recognize that the health care system probably is

adequately funded. One of the great frustrations is that we see it

going out at this one end, which means we may not be able to provide

what we would like to provide at the other. It's a situation that can't

be immediately corrected. We recognize that if we can provide more

preventive health care and public health, we might be able to cut down

the costs of the acute care level and so on. That's what is consuming

all the money at this time, however, and we must cut down that

tremendous cost of the hospitals' medical services if we're going to

have those funds available to provide some of these others.

It's an unfortunate reflection, Mr. Member, on our society — and I'm

not criticizing our society, because we're all part of it — that we do

expect our health care system to cure our problem rather than to join

with the system in trying to prevent the problem from ever occurring.

Unfortunately that is the way people are.

I hope our ministry will have an opportunity to provide some

specific information with respect to prevention and what prevention has

actually meant to our health care system over the years. Perhaps a lot

of people are simply unaware of how health can be affected by

preventive health care, so I think we'll have a slight project with

respect to that — at very low cost, I might add. I think that covers

most of the areas you spoke of.

Environment and health. Of course we've recognized the

interrelationship. Possibly the best example in our province would be

the availability of our water supply and the relative security of our

water supplies. As the member knows, from an environment and health

point of view I suppose there are far more illnesses and diseases

caused by the lack of purity of water than almost any other

environmental aspect. Of course, the purity of the air is equally

important and can contribute to many problems, particularly respiratory

problems.

Because it's approaching adjournment time and because it's a Friday

afternoon, I would move that the committee rise, report progress and

ask leave to sit again.

Motion approved.

The House resumed; Mr. Speaker in the chair.

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

MR. SPEAKER: Hon. members, earlier today the second member

for Victoria (Mr. Blencoe) rose under the provisions of standing order

35, sought adjournment of the House

[ Page 3083 ]

for the purpose of discussing a matter of urgent public importance

and handed a written statement of the matter to the Chair together with

the appropriate motion that he intended to move should a prima facie

case be established. The statement handed to the Speaker referred to

recent information, statements on CBC radio and certain other

"allegations." The matter raised fails to qualify under the provisions

of standing order 35 in that it would appear to rely heavily on media

reports and accordingly is offered from facts that are in dispute or

before they are available. See May, sixteenth edition, page 370. The

motion would also fail in that an ordinary parliamentary opportunity

will occur shortly to discuss the subject matter of the hon. member's

motion. For the stated reasons, the Chair is unable to find the

member's application in order.

Hon. A. Fraser tabled answers to questions standing in his name on the order paper.

Hon. Mr. Schroeder moved adjournment of the House.

Motion approved.

The House adjourned at 12:46 p.m.

Appendix

WRITTEN ANSWERS TO QUESTIONS

5 Mr. Stupich asked the Hon. the Minister of Transportation and Highways the following questions:

With respect to the Gabriola Island Ferry—

For the year 1982 and to date in 1983, how many cars and how many passengers

were carried and what was the annual net loss on this route?

What was the deficit or subsidy required to support the Gabriola Island

ferry during these time periods?

What is the estimate of the magnitude of this cost or subsidy for the fiscal

year 1983/84?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

40 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following questions:

1. Is there a cost overrun on the Greenville Bridge construction? If the answer is yes, what is the cost of the overrun?

2. What was the cause of the collapse of the new bridge which was

under construction on Highway 37 between Meziadin and Bob Quinn?

3. Does the Minister have plans for highway construction during

1983/84 between Cassiar and Highway 37 junction? If the answer is yes,

what are the plans?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

49 Mr. Blencoe asked the Hon. the Minister of Transportation and Highways the following questions:

With respect to the B.C. Steamship Company, operators of the Princess Marguerite—

1. What are the names and head office addresses of all companies,

Canadian and foreign, which supply the services and commodities to the

Princess Marguerite for the fiscal year 1982/83 and 1983/84 (to date)?

2. What is the detailed dollar value to each company, Canadian and foreign,

which supplies the services and commodities to the Princess Marguerite for the

fiscal year 1982/83 and 1983/84 (to date)?

3. What is the purchasing policy currently in use by the B.C. Steamship Company?

[ Page

3084 ]

4. What is the complete listing of quotations received for all services and

commodities from companies, Canadian and foreign, supplying the Princess Marguerite

for the fiscal year 1982/83 and 1983/84 (to date)?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

67 Mr. Reynolds asked the Hon. the Minister of Transportation and Highways the following questions:

1. On July 27, did any members of the Public Service in the Ministry

of Transportation and Highways leave their positions to attend a rally

at the Parliament Buildings, and if so, how many?

2. In reference to No. 1, how many of these public servants will be paid for: (

a) the whole day and (

b) for part of the day?

3. Will any money be saved by Government as a result of No. 2, and if so, how much?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

85 Mr. Reynolds asked the Hon. the Minister of Transportation and Highways the following questions:

1. On August 10, did any members of the Public Service in the

Ministry of Transportation and Highways leave their positions to attend

a rally at Empire Stadium, and if so, how many?

2. In reference to No. 1, how many of these public servants will be paid for: (

a) the whole day and (

b) for part of the day?

3. Will any money be saved by Government as a result of No. 2, and if so, how much?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

88 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following question:

On recent highway construction on Highway 37, was the construction

equipment used from Fort St. John? If so, and if similar equipment was

available at Centreville and registered with the Dease Lake highway

office, why was not local equipment hired instead of highway equipment

from 400 miles east?

The Hon. the Minister of Transportation and Highways stated that, in

his opinion, the reply should be in the form of a Return and that he

had no objection to laying such Return upon the table of the House, and

thereupon presented such Return.

89 Mr. Passarell asked the Hon. the Minister of Transportation and Highways the following questions:

With respect to the Atlin Airport—

1. What is the cost to date of the construction?

2. What contractors have been retained for construction of the project?

3. What amounts have been paid to date to the contractors on this project?

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3085 ]

The Hon. the Minister of Transportation and Highways stated that, in his opinion,

the reply should be in the form of a Return and that he had no objection to

laying such Return upon the table of the House, and thereupon presented such

Return.

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