1985 Legislative Session: 3rd 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)

THURSDAY, MAY 23, 1985

Morning Sitting

[ Page

6243 ]

CONTENTS

Vancouver Stock Exchange Amendment Act, 1985 (Bill PR405). Mr. Ree

Introduction and first reading –– 6243

Medical Service Amendment Act, 1985 (Bill 41). Second reading

Mr. MacWilliam –– 6243

Mr. Howard –– 6244

Mr. Davis –– 6246

Mr. Gabelmann –– 6247

Mr. Lauk –– 6249

Mr. Cocke –– 6251

THURSDAY, MAY 23, 1985

The House met at 10:03 a.m.

Prayers.

HON. MR. McCLELLAND: Mr. Speaker, I'd like to introduce to

the House today a group of grade 7 students here — about 38 of them —

from Langley Central Elementary School, along with their teacher, Mr.

Luongo. I'd like the House to make them very welcome.

HON. MR. BRUMMET: Mr. Speaker, I would like the House to

accord a special welcome to the gentleman who led us in prayer this

morning. He was in Fort St. John some years ago; I worked with him on a

number of community organizations. He is now the minister at Oak Bay

United Church, and he was in Alberta for a while, so the House could

perhaps join me in welcoming him back to British Columbia.

Introduction of Bills

VANCOUVER STOCK EXCHANGE

AMENDMENT ACT, 1985

On a motion by Mr. Ree, Bill PR405, Vancouver Stock Exchange Amendment Act, 1985, introduced and read a first time.

MR. REE: Mr. Speaker, this bill, in essence, is to upgrade

the legislation of the private bill with respect to the Vancouver Stock

Exchange that was first passed by this Legislature in 1907, and to

bring it into the twentieth century, to a certain extent. At one time,

in the incorporating of companies and articles of incorporation the

terms and powers encompassed in the articles were very limited, very

short and very specific, but in practice, over the last number of

decades, it has been recognized that these should be expanded,

particularly with respect to.... I guess the practice has developed

because, of income tax applications. When the Vancouver Stock Exchange

was first presented and passed by this House, it had a restricted act.

This bill today will recognize the change in the times. One of the

aspects is that it now recognizes the powers of delegation or sets out

powers of delegation by the board which it did not have heretofore. It

now also brings us within the twentieth century by allowing the board

to have meetings by new methods of communications, which were not there

before. I commend this bill to the Legislature to allow our provincial

exchange within British Columbia to be more current with the times.

I move that the bill be referred to the Select Standing Committee on Standing Orders, Private Bills and Members' Services.

Motion approved.

Orders of the Day

HON. MR. NIELSEN: Mr. Speaker, adjourned debate, second reading of Bill

MEDICAL SERVICE AMENDMENT ACT, 1985

(continued)

MR. MacWILLIAM: Unfortunately, just when I was getting to the

best part of the delivery last night, I must have been so forceful in

my argument that the entire power went off. I don't know if that was

decreed from other powers.

Because the focus of the debate has been lost somewhat, I'd like to

go back and reiterate a few of the more salient points in the argument.

Originally I did rise to speak Against Bill 41, for a number of

reasons....

AN HON. MEMBER: And now you've changed your mind.

MR. MacWILLIAM: My mind has not quavered in the least from that original intention.

Bill 41 is another example of this government's lack of consultation

with the process of introducing legislation. The minister has not

consulted in the spirit of cooperation with the parties that will be

affected by Bill 41. It seems strange, as I mentioned earlier, that a

government which seems so committed to the spirit of unfettered free

enterprise continues to reach out its long arm to centralize and

control yet another group in this province. As mentioned, it's done it

many times before: with the teachers, with the school boards. Now the

physicians are the target.

Bill 41, as it is presented, is attempting to redress the problem of

regional disparities of the level of medical care throughout the

province. But it doesn't seem to address the problem. It doesn't seem

to solve the problem that it's designed to address. It's unworkable,

it's unfair, and it has many flaws, Mr. Speaker.

One of the major flaws is that Bill 41 will create two classes of

doctors: those doctors practising now with full medical rights who

received their billing numbers before the legislation was passed, and

those doctors with only partial rights who, when they receive their

billing rights, will be tied to a particular geographic area. If we're

trying to develop an incentive in order to get physicians out into the

more rural areas of the province and those areas that don't have

adequate health care, that's not going to solve the problem.

A young physician coming out of medical school today, when he's

faced with that type of decision, may in fact decide to leave the

province altogether. "Thank you very much, but I don't want to be tied

to having to practise in the north for 20 years." So it may in fact

cause a drain in the level of health care in the province as doctors

seek employment elsewhere.

[10:15]

It tries to solve the problem through compulsion, Mr. Speaker, and

not negotiation. The government has been using these buzzwords about

partnership and cooperation. It's trying to change the tune out there,

and yet we see another example of "play it my way or don't play the

game at all." It's another example not of cooperation, negotiation or

consultation but of the big stick. The physicians have become the next

target for the government.

Let me give you some arguments against the rationale of Bill 41.

Bill 41 represents a denial of the basic freedoms. What it comes down

to is the government telling the physicians — citizens — where they can

or where they cannot work. Because of that, many patients may be denied

a choice in health care delivery, because they will be restricted to an

[ Page 6244 ]

older, more established, limited pool of practising

physicians. Where do the young graduates go? It discriminates against

the young graduates.

It also amounts to a misuse of tax dollars, because if those

graduates coming out of the University of British Columbia medical

school decide, "Thank you very much, but I'm going to practise in

Alberta or Washington or California," then it's a drain on our tax

dollar and a misuse of our tax dollar. We're spending a lot of money to

train those individuals, and if we lose them, that's money that will

not come back to the economy of this province.

Most important — and I think this is the real challenge to the bill

— is that it seems to be in contravention of the Canadian Charter of

Rights and Freedoms. It seems to be ultra vires — outside of the

Charter. I'm sure that will pose a serious challenge to Bill 41 if

taken up in the courts.

What about some alternative proposals. Are there any other ways of

addressing this problem? None of us in the House, as I mentioned

yesterday, disagree with the fact that we need to do something to solve

the problem of regional disparity. In some areas we have too many

physicians — in the large metropolitan areas. In the outer areas, as my

colleague from the north has mentioned, the physician has to fly in and

put up a blue flag to let everybody know he's in town. That's a real

problem up there, and I sympathize with his comments, because something

certainly needs to be done about that.

Bill 41 will not address that problem. If anything, I believe it

will intensify that problem. So how do we reach a solution? How do we

reach a consensus? Firstly, we should be consulting with the very

people that this bill is going to affect to reach a cooperative

solution. There are other ways of skinning this cat.

We should take a look at the program that the province of Ontario

has come up with. It's called an underserviced areas program, and it

provides a number of incentives to encourage physicians to move into

the rural areas — to encourage them, not beat them over the head with a

club. They are incentives, not disincentives. The provision of medical

bursaries when a student is in medical school.... There are some real

financial hardships going through medical school. It's a lot of years,

a lot of time, a lot of commitment, and usually on very little funds.

Providing bursaries, if they will serve a number of years in a rural

area such as Atlin or Dawson Creek, or other points north.... The

military uses this in what used to be their old ROTP program — the

royal officers' training career program, or something to that effect.

Basically they would help defray the costs of a student going through

medical school if he served a period of time in the armed forces

afterwards. That was a real incentive for those young students — a

financial incentive — and they did not begrudge the few years they had

to spend in the services afterwards. That's an incentive, the provision

of bursaries.

Possibly the provision of portable medical aid — it was mentioned

before. The idea, I guess similar to a legal aid service, of doctors

coming into the community — flying in, like the flying physicians in

Australia; that's another method of servicing those areas.

Incentives were proposed by the 1979 advisory commission on medical

manpower, otherwise known as the Black report. I don't think this has

been looked at adequately enough. It recommends a number of proposals:

undergraduate bursaries; as I mentioned; continuing education grants

for physicians practising in more remote areas; the provision of

housing or practice facilities for those physicians. When a physician

graduates as a newcomer to the practice, why not provide physician

establishment grants? Because they often face a very large overhead in

the purchase of equipment, materials and manpower needed to establish

their practice. Such grants would provide an incentive for those

individuals that practise in the more remote areas of the province, as

well as northern or isolation allowances.

There are a lot of different mechanisms we can use. I do not believe

that Bill 41 even attempts to look at these other mechanisms. Bill 41

is simply using the big stick once again. On that basis I rise to

oppose this legislation. I rise also to hope and to request that the

minister will look at these alternative proposals, these other

mechanisms of providing incentives, and withdraw Bill 41. It will not

do the job.

MR. HOWARD: Mr. Speaker, we're dealing with a very serious

question, a very serious matter. Not only is it the question of the

relationship of a government to a particular group in society — in this

instance the medical profession — but a question of the services of a

medical nature available to citizens of this province. We need to be

extremely cautious in dealing with the question of medical services

available to the people of the province, to ensure that we don't impair

the possibilities of first-class medical services to all areas and all

residents in this province and that we don't create animosities that

may take a long period of time to heal. Even though time is a great

healer of hard feelings, difficult feelings and the like, still and all

it does take time, and we don't want to impair that possibility of

people getting the services that they need and desire.

If there is an identifying symbol of this government's attitude

towards groups in society, I suppose it has to be one of continued

confrontation and continual attack against groups and against citizens,

as if the government knows no other course but the confrontational

course, knows no other way of dealing with serious problems than

exerting its authority in an authoritarian way. I've said on other

occasions that power demands that people exercise that power in

rational, sensible and respectful ways and not use it in authoritarian

and dictatorial ways. It's true that there are some elements in the

medical profession who have exhibited a confrontational style as well.

This is not a one-sided effort. But because government has the ultimate

power, it is the element of those two that needs to be more cautious,

that needs to be more respectful.

There was a bit of history to this relationship with the medical

association that many thought would be helpful, and it revolved around

what I suppose is generally called an inequitable distribution of

physicians throughout the province and a concentration of medical

people in more attractive urban areas versus rural areas. I know from

personal experience that rural areas get less consideration as an

attractive area for physicians to go to. Indeed, many professionals

look upon going to a rural area or a more remote area as being some

kind of punishment that they have to go through, and they're reluctant

to do it. There are many amenities of life in an urban setting that

attract not only professionals but also others. But this problem of the

inappropriate distribution of physicians throughout the province has

existed: too many in the lower mainland, too many in Victoria, too many

in the environmentally or climatically attractive areas of the

province, and too few in the isolated areas.

[ Page

6245 ]

I understand that at one time there was an agreement between the

government and the medical association whereby this distribution, or

this control of billing numbers, would function by regional and locally

oriented medical manpower committees. I understand that that worked

reasonably well for a while, but that in October of last year the BCMA

withdrew from participation in the program of issuing rationed billing

numbers. I think that's regrettable, because where cooperation will

work and can work, every effort should be made to make it continue to

work. It is cooperation that serves our interest more than

belligerence, attack or confrontation.

A subsequent development was a court case under the Charter of Rights.

Interjection.

MR. HOWARD: You see, the minister is now expressing a legal opinion.

It is a fact of life: there was a court case, and doctors are contemplating

court cases under the Charter of Rights. That's where I had the two mixed

up. The minister, if he wants to, can act like a deputy minister and come and

sit here and give me advice about how to proceed. I'm trying to deal with

a very serious question, where the government has exhibited a confrontational

nature with respect to this matter. I'm trying to do it in such a way that

we don't incur a wrathful debate in the House over it, because the subject

matter is too sensitive.

In any event, a doctor who had been denied a billing number took the

government to court and said: "This is improper." The Supreme Court, I

gather — let me look at the note here and see whether.... The Supreme

Court, in fact, said, "Yes, that's right," and as a consequence of

that, Bill 50 came into existence, which basically said: "We don't give

a damn what the court says. We're going to go our own way as well." At

least that was the attitude of the government: looking upon court

decisions as something to be flouted, ignored and overrun by a

government that's authoritarian in its attitude towards these matters.

That's just a very brief sort of history about it.

[Mr. Strachan in the chair.]

If we're to be faced — I don't know whether this would be the case

or not.... I understand some elements in the medical profession have

stated publicly that if this bill that we are currently debating

becomes law, it will be challenged in the courts as well. Whatever

basis they want to challenge it on would be their decision. I

understand, from looking at that, that they are claiming that they

would tend to opt under the question of the Charter of Rights — that

their rights were being infringed upon. That's where the two thoughts

got mixed up earlier.

[10:30]

I'd always thought that if there were some credence given to one of the

so-called laws of economics, if there were no restrictions on the issuance of

billing numbers or no restrictions with respect to numbers of doctors in the

province, regardless of where they might congregate, the more doctors there

were that existed, apart from the fact that there is

schedule of fees involved

in this that can be dealt with.... If there are more doctors around, somehow

or other that bespeaks of competition, and presumably you get better service

at a lower price. The minister is shaking his head. I know that's nonsense

too, but it's the type of nonsense that this government spouts as its economic

philosophy.

What I'm getting at is that it says to the general public on one

side: "Competition is what we need. If there is an increase in the

supply of an item, a commodity and/or a service, the price will go

down." It spouts that publicly on the one hand, and then shakes its

head on the other hand and says: "No, we really don' t believe that." I

agree with him: it's not a valid thought in economics that that occurs.

One thing that does occur when we restrict the numbers, licences or the

billing arrangement, when we restrict the opportunity of individuals to

practise a trade and/or a profession, is that we create thereby a

saleable commodity. The very fact of restricting billing numbers

creates a saleable commodity.

The member for North Vancouver–Seymour (Mr. Davis), when he was the

federal Minister of Fisheries, did that with the licence limitation

program. He said, "We're going to restrict the number of fishing

licences," and thereby the licences became more valuable than did the

fishing boat itself, in many instances. That's one potential side

effect of this approach. The minister, I'm sure, is going to refer to

the bill, which says that isn't going to happen. The reason I raised it

is that I know from past experience that this government has a

tremendous capacity to put something in a piece of legislation at one

time for political purposes and then take it out later on. That has

happened so many times over that it is becoming commonplace.

I'm just simply raising the question that, regardless of any

prohibition or sanction in the bill that's here now, this can be

altered by some subsequent legislature. If it is, then that process of

an increased value of the practice of the doctor with the billing

number.... It becomes a saleable commodity and adds value to that

office.

I have mentioned earlier the attraction of doctors to urban and/or —

to them and to others — more attractive areas in which to live than

might be the case if they located in a rural area. My colleague from

Atlin yesterday very appropriately, very correctly, made that point.

Perhaps there is not a constituency to represent in the province where

they are faced more stringently with this question of the lack of

medical attention, the lack of dental attention, and the lack of all

sorts of other professional attention than in Atlin. There may be some

areas in the mid-coast area of the province, as well, to which that

applies, but I think that Atlin is the epitome and exhibits that point

more than any other. The member for Atlin's comments have our complete

endorsement, in the making of that point and in clearing the matter

before the House.

We need a resolution of this, and we need the resolution of the

problem in an amicable and agreeable way. I suppose that it takes two

to tango. There was an agreement earlier between the medical profession

and the government tangoing together through the regional or local

committees of medical manpower. Having worked once, I think it can work

again. I would hate very much to see the bill proceeded with, and the

threat of some elements in the medical profession to challenge that in

court, and then to find that the court rules that it's invalid law. If

that occurs, then we're — as the saying goes — back to square one.

Where are we in this relationship? We'll then be dealing, probably,

with the group who has won a victory — if that does come about — being

in the driver's seat. They'll want to flaunt to the government that

position of having a court decision in their pocket, to use it as a

lever against the government and against this Legislature and against,

probably, the interests of the people in this province.

[ Page 6246 ]

If they proceed in court and lose, that will vindicate the

government's approach by this legislation, obviously, but it will leave

the residue of hard feeling still in existence. As I started off saying

earlier, when there is hard feeling between groups of people who are on

opposite sides on a particular question, and there seems to be an

inability to resolve the difference and they have to proceed to some

other lengths to do it, difficult feelings and tensions develop between

those two groups. That injures very much the desired need to cooperate,

to work together and to get along together for the benefit of all the

people of this province.

Confrontation is not the way to go. Confrontation may be an

approach, for some immediate short-term political advantage, that the

government employs to indicate that by being confrontational and

authoritarian and authoritative in its way it comes off as being a kind

of hero in the minds of the general public. But that is a very

short-range approach, a narrow approach. Belligerence, no matter what

form it takes or how softly it is spoken, does not create the

atmosphere within which cooperation can function. If the government

would have listened.... The whole government is wrapped up right now in

one person sitting on the other side of the chamber here. That's why I

say it; the government is now one man. But if the government, in the

broad sense, would have listened carefully and paid heed to what my

colleague the Leader of the Opposition (Mr. Skelly) said — dating back

to last fall and shortly after his election to the post of leader of

this caucus and of this party — about the need for cooperation and the

need to work together and get along together, and had really believed

that and accepted that as a course of action to follow, we wouldn't be

in the mess that we're in now with respect to the relationship with the

medical profession. I feel confident of that.

The minister knows that cooperation is the best course to follow. I

wonder why he isn't trying it. I find myself in a position of having,

on those principal grounds.... Opting that cooperation is far more

valuable in our society than confrontation, belligerence and attack

upon groups, on that basis alone I must indicate my opposition to this

bill.

MR. DAVIS: I've been listening intently to the speakers

opposite. They complain about confrontation. They're concerned about

the regional distribution of doctors, but they really don't come up

with solutions. I think that the fundamental position of the NDP —

logically, at least — is that they would put doctors on salary. This

was the nature of the British health plan in the late 1940s when it was

introduced, and it drove a good many doctors out of the United Kingdom

— some of them for the wrong reasons, but basically doctors at that

stage, in the United Kingdom, and I think still to a large extent in

Canada, regard themselves as not only individual professionals,

practitioners, but entrepreneurs. They regard themselves as in some

measure competitive with their fellow doctors, yet they have found

themselves increasingly in plans which have been organized by

governments. In Canada we've moved from situations which were largely

doctor-patient relationships solely — that's 30, 40 or 50 years ago —

to situations where now the strict doctor-patient relationship is the

rare exception, certainly not the rule.

I happen to be a professional engineer. Professional engineers organize, nothing

like as effectively as the doctors have organized. The professional engineers

do endeavour in a lesser way to limit the intake of professional engineers.

It takes several years to qualify. You have to write a thesis on a subject which

is technically engineering. It has to reflect experience, and so on. There is

a limitation on intake. The numbers of professional engineers tend to grow with

the years, but there is a market: employment is limited by the firms which find

active work to do. This is true particularly in construction. There is a limited

demand for engineers. It varies over the years. While the engineers tend to

limit their intake, nevertheless there are times when there is a substantial

surplus of engineers. There is a lack of market for engineers in British Columbia

at the present time. There are over a thousand unemployed professional engineers

in the lower mainland.

The professional engineers, however, are in a difficult position

relative to doctors. Doctors now face what is, in this province at

least, a virtually unlimited demand for their services. The employer,

according to some — and it would seem to be the official position of

the medical profession — cannot resist the employment of yet another

doctor, yet another hundred doctors or yet another five hundred

doctors. Logically there has to be some limit.

[10:45]

Now under our tax-supported plans, there has been no substantial

limit. The attempt to limit numbers by limiting billing abilities is

one way of dealing with the problem of unlimited demand. As far as the

patient is concerned nowadays, there is no price for the service.

Health care is a common good, if you like. The patient, assuming

there's some reasonable indication of need, can demand unlimited

services. The doctors, the professionals, are quite willing and happy

to comply. As long as they have a fixed fee for each service they

provide, if anything they encourage these demands. There is no way of

limiting the demand. There is no market. There is no economics, simply

because all these health care goods, as far as the consumer is

concerned, are free. Therefore there has to be some way of limiting the

demands. When both the supplier and the consumer want to expand the

service — certainly one party, the doctor, has every reason to expand

the services, and the consumer has no monetary discouragement facing

him or her — the situation is out of control.

The opposition says: "Consult the profession." The profession

naturally doesn't want to police its numbers if it can get someone else

to police them. The profession in the last analysis will police its own

intake, but it has little incentive to do so under these comprehensive

state-supported plans. So the government is faced with a real dilemma.

It has limited funds. It must endeavour to limit the quantity of

service supplied to the public.

One approach could be to establish a limit to the total funds paid

for doctors' services annually. I suppose that would be defensible

under the Canadian Charter of Rights and Freedoms. All the government

would do would be to say a certain number of millions of dollars was

available for doctors' services in the coming year. The medical

profession would then, perhaps as a contracting party with the

government, endeavour to limit the supply of services itself. It would

then be faced head-on with limiting billing numbers, at least limiting

the number of doctors who practised professionally under the plan.

Now naturally the doctors don't want to have to do this to

themselves. They talk as if this must be a wide-open situation with no

limitation on the supply of doctors. The government, concerned among

other things with budgetary problems, has to set a limit. This bill

endeavours to set the limit, not by

[ Page 6247 ]

limiting the total number of dollars available to

pay for doctors' services under the health plan, but by limiting the

numbers of doctors or the numbers of billing numbers available to the

doctors.

I'm in something of a dilemma on this. I really don't like to see

government moving into any area and placing limits on activity,

particularly activities as valuable as the provision of health care

services. But the government has to be responsible. It can't go on

spending year after year rapidly increasing amounts on doctors' fees

when other areas — particularly in education, in support services for

doctors like the hospitals, in Human Resources support for those who

are unemployed, and so on — also must have priorities in the overall

scheme of things.

So we're faced at least with a scheme, a plan which makes some

sense, with some bite in it, in this present legislation: limit the

number of doctors by limiting the number of billing numbers. The

doctors will of course oppose, will never really agree, and won't —

unless they are forced to — police their own numbers themselves. I

wonder what the opposition is really saying when they say "consult."

You can consult and consult and consult. I don't think the doctors, in

the great majority, will agree to any scheme that limits their numbers

by fiat.

The obvious alternative, if you're trying to contain costs, if

indirectly at least you're trying to limit this area of expenditure

under health care, is to put the doctors on salary. If the doctors are

on salary, I doubt very much if the legislation would fall as against

the Charter of Rights and Freedoms. Logically, governments must be able

to control their expenditures. They must be in a position to set

priorities. They must be in a position to decide how much, as a

maximum, will be spent on this area of health care. That's been the

practice in the past; it will logically continue to be reasonable

practice in the future.

So I doubt if limiting the total expenditure would ever be contrary

to the Charter of Rights and Freedoms, but we have to go this

additional step. I can't see, really, the difference between the

government's limiting the total number of billing numbers and the

government's entering into some agreement with the doctors whereby they

limited the number of doctors coming into the system — the net number

of doctors in the system. We should graduate fewer doctors in future

from our own institutions, but a larger number tends to come into the

province from outside in any case, so that area of entry would still

have to be subject to some kind of control.

I would prefer incentives to encourage doctors to practise in

outlying areas, less desirable areas from their own particular point of

view. I certainly would prefer bursaries for medical students to

encourage them not only to continue their courses but to practise for

some years in outlying areas as well. Incentives, in other words,

rather than direction.

But I think we have a real dilemma here. How can government put some

kind of control on a very valuable area of endeavour where there is

unlimited demand from the customers, from the users of the health care

services? I think we all regard doctors as immensely valuable citizens

in our community. If money weren't a problem, if other demands on the

treasury weren't a problem, I'm sure we'd want unlimited numbers of

doctors practising in this province. I'd like to hear from the

opposition what their plan is to control expenditure and, in order to

control expenditure, to. put some reasonable limits on the number of

professionals practising medicine in this province, in that we already

have an inordinate supply as compared to other provinces and other

parts of the world. Logically their position is: "Put them on salary;

we'll decide how many of them we then employ. We'll control our

expenditures, and we'll have a better handle on the situation." So why

don't they come clean and say what their position is, as opposed to

limiting billing numbers?

MR. GABELMANN: Having been asked the question, let me try to

give at least a partial response to the member for North

Vancouver–Seymour. I should say at the outset, Mr. Speaker, that I do

not pretend to be an expert in this particular area. I have some views

that come from representing a rural constituency and from having talked

to both consumers and practitioners of health care, and I want to

suggest some alternatives.

Before I begin with the comments that I want to make in terms of the

bill, the member for North Vancouver–Seymour suggests that the logical

conclusion of our policy is to — to paraphrase but quote — put all

doctors on salary. I don't think that's the case at all. I think an

argument can be made that through the use of community health care

clinics in various parts of our province which would employ doctors, we

can deliver health care in a very effective and probably more efficient

manner. That doesn't mean by extension that all health care services in

British Columbia would therefore be delivered through community health

care clinics; but that must be an element of a proper health care

system, and would automatically include having, in those cases, doctors

on salary. There are a lot of doctors who would like to do that. A lot

of doctors, particularly younger ones, believe in that kind of health

care service delivery and would welcome an opportunity to participate

in a salaried way in a community health care clinic structure. So

that's there, I think, for much more discussion among all concerned in

this province.

The member for North Vancouver–Seymour also said that the

opposition's position is to consult. In fact, more accurately I think

the word is that our position should be to bargain. Consultation

doesn't imply a conclusion or a process leading to a conclusion;

bargaining does. In this legislation, as in so much else that's been

introduced this session, one of the issues involved is really the

question of whether we have free collective bargaining or we have

compulsion.

I think everybody in this Legislature would agree that we have a

problem. Where we disagree is on the solution. It seems to me that the

legislation is attempting to deal with two kinds of problems. The first

is the cost. I think everyone would agree that there is not an

unlimited supply of money, and some controls need to be put in place to

make sure that the costs are within budget, and within a proper budget.

A second problem, one that I suspect is a little more complicated, is

the question of distribution. With the exception perhaps of places like

Atlin and some other more remote parts of British Columbia, the

distribution of general practitioners is not all that bad. Certainly on

north Island, the difference between today and, say, five or six years

ago in terms of distribution of general practitioners.... We don't have

the kind of problem that we used to have. The distribution is much

better. Doctors who make the argument that we don't have a distribution

problem are, I believe, not correct, but there certainly is less of a

problem now with distribution — in some areas at least — than there was.

Where it seems to me that we have a serious problem with

distribution is in respect of specialists. We do not have psychiatric

services, for example, in many parts of the province.

[ Page 6248 ]

I see the Speaker nodding his head, the non-partisan Speaker, who

might agree, for example, that in Prince George we have a serious

problem with the availability of psychiatric services. I know that's

the case in the north Island. Half of Vancouver Island is without

psychiatric services; Comox is the closest. But it's true also in terms

of other specialties. The distribution there is not, in my view at

least, adequate.

So yes, we have a problem with cost. There is a problem with

distribution; perhaps we don't all agree on precisely the nature of it,

but there is some problem. Therefore we have to find some solutions.

What are the solutions? It seems to me that in terms of the cost, the

minister himself gave us the answers earlier this session during the

estimates when he talked on April 25 of the agreement he had negotiated

or concluded with the medical profession which called for specific

finite limits on the cost of delivery of medicare in this province. It

was a negotiated agreement –– 104 percent, as I read it. There are

variations on how you deal with it, but in effect there is a capping;

under that agreement a maximum number of dollars are provided for

medicare. I have a lot of questions about how that works — what happens

in the final month of the fiscal year if the cap has been reached, etc.

— but I presume that in negotiations those kinds of problems have been

worked out.

That kind of negotiation deals with the first problem, the problem

of cost. I believe — and I guess this is a bit of an irony that

continues to present itself in this province — that free collective

bargaining, the logical extension of free enterprise, is the preferable

solution. The government appears to believe that compulsion, which is

the logical conclusion of state socialism, is the preferred

alternative. I think that tells us once again that the political debate

that goes on in this province is a false one and that, in fact, it's

the Social Credit Party that prefers to adopt the heavy hand of state

socialism — to use their words, the heavy hand of the state imposing

itself. I prefer collective bargaining. I make no bones about that.

I've done that in every opportunity I've had in this Legislature.

[11:00]

So you can deal with the question of cost by negotiations. The

government has proven it, and the minister proudly proclaimed that

during his estimates earlier this year.

[Mr. Ree in the chair.]

Let's look at distribution. That's been a problem for some time. In

the late seventies the government commissioned Wesley Black to do a

study of the question. He did, and he made a number of recommendations.

Flowing from those recommendations came a statement in the throne

speech of December 1980, almost five years ago now: "During this

session this assembly will be provided with details of the creation of

a B.C. rural health corps. It will be an agency that will assure

primary health care in all areas of the province." So back in 1978,

1979 and 1980 we have the government dealing with the problem of

distribution — setting up a commission, which made a number of

recommendations, and apparently recognizing the need for the government

to deal with the maldistribution and the serious problems affecting

rural areas in British Columbia by not only appointing the commission

but also stating in the 1980 throne speech that there would be a rural

health corps.

What has happened to the recommendations of the Black report?

Nothing. There has been no taking up of those ideas, which provide some

of the solutions that the member for North Vancouver–Seymour (Mr.

Davis) was proposing we should offer. Some of the solutions have been

offered already. There has been nothing at all in the years since

December 1980 about a rural health corps. Perhaps not all of the

answers are contained in the Black report or in the establishment of a

rural health corps, but at least it would solve some of the problems.

It certainly could lead to solving some of the problems mentioned quite

properly by the member for Atlin (Mr. Passarell). But what has

happened? Nothing at all.

Also, it seems to me that we could look at what other provinces do

in terms of the question of distribution. I've always been intrigued by

and interested in the idea adopted in Quebec, the idea of different

percentages of the fee

schedule for different parts of the province.

What's wrong with paying — and I pick the numbers out of the air, and

they're not numbers that are researched or necessarily the numbers that

should be applied –– 85 percent of the fee

schedule in Kelowna and 115

percent in Port McNeill? What's wrong with that as an idea? If the

numbers are off, fair enough. But what's wrong with the principle of

that kind of scheme? Perhaps in Prince George you'd pay 100 percent. It

would vary by.... And that would be done through negotiation with the

doctors. It seems to me that that would encourage the distribution of

services around the province in a way that does not happen now,

particularly, as I said earlier, in terms of specialists.

Ontario has a whole series of programs dealing with their

distribution questions, such as the underserviced areas program. I'm

sure other members have talked about some of these things during the

course of this debate, so I won't go on in any detail. But having

programs that encourage people financially and also.... I think this is

an important thing. If we're going to be spending the hundreds of

thousands of dollars that we do on education, for someone who goes

through all the education required to end up as a general practitioner

or as a specialist, I'd say to them: in exchange for all of this you

have an obligation when you come out of school. You have an obligation

to do some service. You don't necessarily have to do it in the first

three years. In fact, I would argue that you shouldn't do it in the

first three years. I've heard it argued all the time that you should go

directly out of medical school and do your first three years in the

bush, and then you can go somewhere else. I suspect the first three

years should be spent somewhere where you can get some experience with

some other people who have some skills, and then go off and do your

obligatory service somewhere else.

I'm not proposing those kinds of things as universal panaceas. I

suspect, as with most things, there are no panaceas. But there are

creative ways to deal with the problem of distribution. I don't believe

that simply bringing in a piece of legislation like Bill 50, or now

Bill 41, which deals with it in a narrow billing number way, is very

creative at all. It may solve the problem in some respects, but I think

it's going to have the reverse effect — and here I would

part company

with my colleague from Atlin — in small communities. My concern — this

has been said before too, so I guess I'm repeating what others have

said — about the implication and the impact of Bill 41 is that we will

not get doctors setting up shop in some of the small, remote

communities, because they will fear that they will be there for life.

For a lot of people, jobs in the more remote parts of our province are

something you do on your way through life. You move on to something

else and

[ Page 6249 ]

go on to some other area. I'm not saying they're

locked in absolutely, because they're not, under this scheme, but the

real prospect is that a lot of them will in fact be locked in,

particularly once the crop of retirees the people who should be

retiring soon, if not already are gone, as may well happen as a result

of this legislation, hopefully. Once that crop is out of the way and

the number of retirements each year is down, and there are still new

doctors coming out of the school who are maybe brilliant and who may

take the place of the people who are retiring, you are going to have a

certain number of people who will be locked into their practices in the

remote communities. Because they will fear that, they won't go there in

the first place.

From all I've heard, that's a very real concern. I don't think it's

a bargaining position on the part of doctors; I think it's a very real

and legitimate concern. In saying that, that's not speaking for the

vested interests of doctors; that's speaking for the consumers of the

health care service in those remote communities, because those people

may, as a result of this particular program, end up worse off than they

are now. At least now, for the most part, in my riding at least, there

is a fairly decent distribution of general practitioners, if not, as I

said earlier, of specialists.

In conclusion, therefore, I just want to say again that we've got

two problems. The first is cost. You deal with that the way it has been

dealt with, by bargaining. The second problem is with distribution. You

look at the Black report, you look at Ontario, you look at Quebec, at a

variety of creative solutions that come from discussions with the

people involved, and I think if you do those things, Bill 41 is not

necessary.

HON. MRS. McCARTHY: I ask leave to make an introduction.

Leave granted.

HON. MRS. McCARTHY: I'm very pleased, on behalf of my

colleague from Vancouver–Little Mountain (Mr. Mowat), to ask the House

to welcome members of the Talmud Torah School in the Vancouver–Little

Mountain constituency to our Legislature today. They are accompanied by

group leaders Rabbi Samuel Bieber, Mrs. Sharon Quirke, Mr. Eric Lee and

Miss Linda Alexander. There are 35 grade 6 students with us this

morning. I would like to welcome them to Victoria and to the

Legislature, and ask all the House to join me in that sincere welcome.

MR. LAUK: Mr. Speaker, there are two ways to deal with a

problem in society. We have seen governments deal with problems such as

the problem that the Minister of Health is trying to deal with in two

basic ways. Those two basic demonstrations are clear in the various

countries. In communist countries we know, because we visit these

countries occasionally, that there are lineups for practically

everything: for shoes, for clothes, for food, to get transportation.

You need permission to get an apartment. You need permission to work

and you need permission to work in particular places. You need

permission to travel, to marry, to go to church. It's not enough for us

to stand in this chamber and say: "My goodness, doctors are very

wealthy people. They make upwards of $100,000 a year, and therefore we

should treat them differently than we treat anybody else in a

democratic system." It's very easy to solve the problem the way the

Minister of Health has done. It's a very simple-minded approach. These

simple-minded approaches are exemplified in totalitarian countries

around the world.

I think the opposition to this bill has been a little bit soft,

because it doesn't really come to grips with the civil libertarian

issues in the bill. Why am I a civil libertarian? Why do people take up

civil libertarian causes? Because I greatly sympathize with doctors

making $200,000 a year and living in Shaughnessy who drive past me in

their Bentleys while I'm waiting at the bus stop?

Interjections.

MR. LAUK: I take the bus. I leave my Bentley at home. I think

everybody's laughing because they know that I haven't got a great deal

of sympathy for people who are so comfortable in life. They don't need

my protection. But I'll tell you who does need my protection: me. If I

don't protect the basic standard of civil liberties for the doctors, I

don't protect the basic standard of civil liberties for myself, for

you, for my neighbour, for my kids or anybody else. You've heard the

expressions, "the thin edge of the wedge," "the foot in the door," and

all the rest of those clichés. The movement of this government towards

simple-minded totalitarian solutions to solve these basic problems is a

dangerous direction. It's an intellectually lazy direction to take.

We've heard hon. members in this Legislature suggest other solutions.

They've asked the government to look at the solutions provided in other

jurisdictions. Some of them work, some of them don't, but look at them.

I value the rights and the freedoms that I have. I don't want to be

told what to do day in and day out. Already government is on our backs

telling us what to do all the time. When the New Democratic Party was

in government, there were no lineups for food or anything else. There

was no legislation directing people what to do. There was no highhanded

legislation restricting mobility rights. There was no legislation

cutting people out of the mainstream of life in a simple-minded

directed way. But under this government we have lineups for food; we

have high unemployment — 15 percent — which is a restriction of freedom

beyond words. But to add insult to injury, this government's

cliché-ridden, simple-minded approach to problems is wearing people

down. It's taking away from them the only thing they had left. They

have no jobs, they're losing their homes, but they had hope that things

would change.

[11:15]

This government's solution to the problem of supplying medical care

to outlying districts is this bill. I don't believe that that's the

primary policy motivation of the bill, by the way. I believe that the

primary policy motivation of this bill is control over the costs of

medicare. Some might say: "What's wrong with that?" We've seen the

lists of some doctors getting $300,000 and $500,000 a year from the

medicare program. We ourselves.... A couple of weeks ago the hon.

member for Vancouver East asked: "Why don't you look at the list and

find out whether that kind of income is justified in relation to that

practitioner's costs and so forth?" There are ways to deal with income

and whether it's proper or not.

But what else I fear is that by this government putting these kinds

of conditions on billing numbers, there will also be complete control

of the medical profession and how they deliver their medical care. Not

only what place they go to

[ Page 6250 ]

practise, but how they deliver it out of their

offices, even what kind of advice they give, what kind of practice,

what kind of treatment they provide, will be controlled. There is a

hidden slander out in the community now against dentists and doctors:

that they're cheating on the system. There are slandermongers that are

perfectly willing to make that suggestion without a scintilla of

evidence. When you consider the hundreds of doctors and specialists in

this province, the one or two who are eventually prosecuted — after

constant investigation, by the way — is proof positive that the

profession is a sound and honest one.

I fear this government, for myself and for most ordinary people of

this province. They are altogether too willing to bring about the

simple-minded, totalitarian, centralist approach to solving problems.

They're affecting your freedom and mine, and no one is safe when there

is a government in power with that attitude; no one is safe from that

kind of interference. No right-wing or middle or leftist party of the

past would ever approach the problem in the same simple-minded way that

this government has.

Loffmark was the Minister of Health. You remember he had talked

about this problem. He suggested aloud one day one of the solutions may

be to direct doctors to particular areas, and I think that there was

such an outcry that he hasn't been heard from on the political scene

since. The Black report would not even begin to suggest this kind of

solution. There are other solutions: there are community health care

clinics, properly funded, attracting practitioners; there is sitting

down with the doctors, as my friend from North Island has suggested.

From my discussions with the physicians and the groups of people

involved, they will go into a voluntary program of providing this kind

of health care to remote districts. But that's not a concern of this

government. This government isn't concerned about health care in remote

districts. Come on! Everybody knows the Social Credit Party is not....

They don't win any medals for social policy, for heaven's sake. They

couldn't care less. They know that they'll cut back on social programs

to the extent where they can get away with it in their constituencies

and with the voters. They couldn't care less about it, so don't tell me

that the policy motivation of this bill is to provide health care to

remote areas. Nonsense! It's to get control over doctors, to tell them

what to do, when to do it and how much they're entitled to get.

If they make too much money, let's deal with that. Let's start

asking about costs. You endanger the whole system, the whole

independence of the practice of medicine in this province when you

start interfering with it at the government level, when you start

telling people whether or not they should receive certain treatment.

You should tell people whether or not they are sick enough to go to the

doctor or the hospitals. It's no longer a question of freedom of

movement and freedom of choice. It's dictation from government at the

central level.

One of the things I was opposed to when I was in the cabinet of this

province was the regional prosecution system. One of the reasons I was

opposed to it then and am opposed to it now and always will be opposed

to it is that it's an encroachment upon the independence of the bar,

which is absolutely essential to providing independent legal advice to

people who are facing laws against them — interfering with their

business, political, religious and social lives to the extent where

they need an independent lawyer who is not controlled by the banks, by

government bureaucracy or by any kind of betokenism to any fundamental,

established group in society. They need the independence of the bar.

I won't be uncharitable enough to say how bad the record of regional

prosecutors is in major crimes in this province. It's getting worse

every day. It was never that way when ad hoc prosecutions used to take

place, because Crown counsel used to be appointed on an ad hoc basis

around this province, on an individual basis on skill and merit, not on

how much brownnosing they can do within the bureaucracy, to work their

way up in the system. It was a terrible mistake to bring in regional

Crown prosecutions. You could have had a director of public

prosecutions and worked an ad hoc system in the province and maintained

the independence of the bar.

That is a drop in the bucket compared to what this Health minister

is doing to the medical profession; a drop in the bucket compared to

the usurpation of that independence, that delicate balance, that sacred

privilege and responsibility between an historical and traditional

medical profession — the healers — and the public, their patients. If

you'd said ten years ago to me that the government, which was always

talking about individual liberty, would be opposed on this bill taking

away individual liberty by the NDP, which the government and this

member in particular — the Minister of Health — during election

campaigns.... Strident rhetoric against the New Democratic Party for

its socialistic policies and its socialist philosophy, which will take

away your freedom: it will nationalize your fridge and your stove; it

will shut the churches down.... I mean, that's true, isn't it? Isn't it

true ?

That's the rhetoric of the Social Credit Party, and more and more

we're convincing the people of this province: "Don't listen to what

they say; look at what they do and look at what we do." We've had more

people of the cloth, who have religion, in our party elected to public

office across the country than any other political party. The people of

religion belong to this party.

We have never brought in, wherever we have been government,

totalitarian legislation taking away individual liberties. The Social

Credit Party does so almost consistently. That is their solution to

problems: make the trains run on time, just like Mussolini. Everybody

is forced into the model that this simple-minded government has in mind

for them. You've heard of the Procrustean bed. Procrustes was the king

who devised a bed with sides that moved. If you put the body into it,

the body would be shaped by the way you cranked the sides in. It was a

torture situation. That's the thinking of this government. All of their

statutes are Procrustean beds: fit people into them and squash them

into the shapes and sizes that you have in mind for them. The

syndicalist, Mussolini-type, totalitarian approach is the simple-minded

cure.

No one said that democracy is an easy way to go about things, or

that negotiation is an easy way. If you want to introduce democracy and

you want to know how difficult democracy is, look at the transition in

the family that has taken place since the last war. We've moved from

authoritarian families to democratic models. Do you realize you can no

longer go home with impunity and beat your wife and your kids? Isn't

that shocking? You can no longer whip them into shape. Do you realize

that your word is not law? That a man's home is not his castle? Do you

realize that, Mr. Speaker? You no longer have a fiefdom at home. The

authoritarian model at home is gone. Try introducing democracy, and see

how difficult it is. You can no longer make the final decision. You

have to come to an agreement with your

[ Page 6251 ]

spouse. Can you imagine anything so bizarre? Some

who couldn't come to an agreement are still with us. They came to a

different agreement.

Do you see my point, Mr. Speaker? It's very difficult to be

democratic, because you have to respect the other side. Equality isn't

just a buzzword or rhetoric. It has to mean something. You can't just

respect somebody you agree with; you've got to respect people you

disagree with too, because they have rights. You've got to balance it

off in society. You can't say, simply because it's popular.... Good

lord, all kinds of injustices are popular. As a matter of fact, if the

majority is for something, you can be darned sure there's something

wrong with it. Every schoolboy has known that since the crucifixion of

Christ. The majority was wrong then, and the majority has been

consistently wrong ever since. The civil libertarian role in a

democratic system....

Interjection.

MR. LAUK: It's not a question of elitism. He's talking about

elitism. Isn't the difference in choice of words strange? I'm talking

about the protection of minority rights and the Minister of Health says

I'm an elitist. I'm an elitist because I want to protect those people

who are in weak minority positions in society. I want to protect those

people, even if I disagree with them, against the heavy hand of

centralized government. Therefore I am an elitist, says the Minister of

Health. Where have you heard that before? I've read that in statements

from the presidium and the politburo in the Kremlin. They say that all

the time. Read what they say: these people in Poland who are fighting

for workers' rights are elitists; they are capitalists, imperialists,

yellow running-dog lackeys of the Chase Manhattan. We've seen that

before, the very rhetoric....

DEPUTY SPEAKER: Order, please. I think we're straying a

little bit far from the principle of the bill. Possibly, hon. member,

you could get back to Bill 41.

MR. LAUK: Mr. Speaker, you may disagree with what I'm saying,

but I'm right on the principle of the bill. The principle of this bill

is that it's totalitarian. As soon as I make that charge against the

Minister of Health, he uses the same language against me that the

Kremlin uses against its dissidents in the Soviet Union. He calls us

elitists when we defend minority rights.

HON. MR. NIELSEN: You're on their mailing list; you should know what they say.

MR. LAUK: I'm also on the mailing list of the Trilateral Commission,

the B.C. Catholic and the Jewish Western Bulletin. And I receive Liberty magazine

from the Seventh-day Adventists. That's the only reason for me to be stopped

at the border and sent back — me and Farley Mowat.

Interjection.

MR. LAUK: Oh, you see, this is the kind of cheap shot you get

from this schoolyard bully. Here is the little member from Vancouver

Centre trying to do his best....

HON. MR. NIELSEN: I take it back. I'm sorry.

MR. LAUK: I appreciate that he at least has the graciousness

to know that he's gone too far by picking on the little member for

Vancouver Centre.

AN HON. MEMBER: The good little member.

MR. LAUK: The good little member, thank you. But it's the

kind of bullying attitude that the government is taking against the

medical profession. I think the medical profession needs a lot of

reforming; but it can do that in a democratic society. We can bring

pressure to bear on them in a democratic way, not by the heavy hand of

legislation.

Interjection.

MR. LAUK: The Minister of Health asks: "Is legislation

contrary to democracy?" Yes, some of it is. Quite often it is. As a

matter of fact, that's why we now have the Charter of Rights that the

Minister of Health and I opposed so vigorously in the past. But it's

there. The Charter of Rights is to protect us against bullying

governments, and before then.... And it's struck down because it's not

democratic or legal under democratic principles. As a matter of fact,

Aberhart, the founder of your party — remember him? — passed all kinds

of laws, in the spirit of Social Credit. I don't know what he was

nationalizing or who he was executing at the time, but the

Governor-General, in his wisdom, disallowed the legislation under the

then constitution of Canada.

[11:30]

Yes, sometimes legislation is undemocratic, illegal, heavy-handed

and dictatorial; certainly this is legislation that fits into all of

those categories, Mr. Speaker.

I must say that the member for Atlin (Mr. Passarell) is misguided on

this issue. For him to attack the medical profession as being wealthy

is one thing; but for him to suggest that this legislation is a

solution is wrong. I think he has misinterpreted the bill to the extent

that he doesn't realize that the real motivation of this government is

to gain complete control over the medical profession; that means that,

one way or the other, ordinary people may be discouraged from and even

afraid of going to their physicians and specialists for proper health

care. That's why I'm opposing this bill.

[Mr. Strachan in the chair.]

MR. COCKE: I had a nightmare, and I thought I wasn't going to

be able to participate in this debate. It's a problem. When you listen

to the Socreds, Mr. Speaker, and how they like to cooperate, and the

Whips won't call a bill when the debate leader is here....

Incidentally, Mr. Speaker, I am the designated speaker on this. In any

event, Mr. Speaker, when they call a bill knowing full well that I'm

tied up in Hyack in New Westminster and had some difficulty getting

over.... Anyway, I was able to fly over this morning, and I have some

things to say about this bill.

In the first place — this is for the member for North

Vancouver–Seymour — he suggested somehow or another that the Minister

of Health put so much money into the system and that's all there is,

and that's one way of doing it. He's already done that. He has already

done that with the contract that he signed with the medical association

of the province of British Columbia. He's already limited the supply of

dollars going into medicare in this province, period.

[ Page 6252 ]

AN HON. MEMBER: But he didn't tell Jack Davis that.

MR. COCKE: He didn't tell the member for North

Vancouver–Seymour that. As a matter of fact I'm sure he hasn't told

anybody that, because it makes this bill look like an astonishing piece

of invasion of human rights. You know, according to the Socred

consciousness all you have to do is pretend to save a few dollars, and

then you're looking pretty good. But when you're shown up as being

quite wrong, then it's just the way it is. This bill is nothing more

than a PR stunt to make it evident to the public — or hopefully make it

evident to the public — that you're doing something in a frugal way.

You're doing nothing of the sort. The one group of people that knows it

best are the doctors in this province who have seen their own agreement.

"Budget allowances:" — this is No. 11 of the agreement

— "over actual '84-85 planned costs (base budget), an increase of 2

percent for general utilization, plus 1. 5 percent for population increase in

B.C." That's all there is, over last year. That's all the bucks there are

in the system over last year.

So what's this bill all about? Well, Mr. Speaker, now that we've

found out that the doctors have been capped — and they also had a

section in this bill saying that there would be nothing in legislation

about capping, because they'd already agreed to it. The doctors have

been capped, so the minister had to figure out some other way of making

sure that they know where they stand in our society. He says: "I'm

going to lock them in. I'm not going to put them on salary, but I'm

going to lock them in so that they will do my bidding."

Mr. Speaker, this new bill is a licence to steal. It's a licence to

make taxicabs out of doctors in selling their practices. A car worth a

few thousand dollars suddenly becomes worth $100,000 when it's got a

taxi licence on it. The minister says you can't transfer a billing

number. So what? It just so happens that the opportune guy has a

quarter of a million dollars in his pocket, ready to pay for a doctor's

outfit that would have cost $30,000 until recently. If he's got a

quarter of a million dollars and he can go to the old doctor with the

sinecure, he's assured that he gets another number from the commission;

then he buys the practice. Yes, he doesn't buy the billing number, but

he can buy the practice, and just by happenstance he gets a number.

Here he is, Johnny on the spot, and he gets that number because he's in

the right place at the right time, they say. There's no control

whatsoever in this bill against that kind of practice.

It's a ridiculous piece of legislation, ridiculous from so many

standpoints. The member for North Vancouver–Seymour (Mr. Davis) talked

about bursaries and helping young people get into medical practice, and

so on and so forth. Mr. Speaker, the young, worthwhile, hard-working

doctors, particularly women, will be denied access, and they will be

denied access because everybody's hanging on to what they've got unless

they can really get something for it. So despite their brilliance,

those without the substance, without the money, are not going to get

into practice.

I can tell you right now that you're not going to be able to support

200 or 300 doctors in Atlin. There is only one way you could handle

that one, and that is with a rural medical corps. There is no other

way. People are too far apart. You can't have doctors looking after

three patients. You have to have them available. The Black report was

very clear on what to do about that, and there hasn't been a move in

the direction of a rural medical corps. Mr. Speaker, that's just

ridiculous.

Isn't it a strange world that we live in as well, from this

standpoint. The Science minister — some call him the mad scientist — is

increasing our numbers at medical school as quickly as he possibly can,

and we've got the Minister of Health, or sickness, trying to make sure

that there's no way they can practise. Now that is a bit ironic, isn't

it, Mr. Speaker? Just a trifle ironic. We know that we've been behind

this country for years and years in terms of the numbers of graduate

medical students that we produce. So suddenly the Minister of

Universities, Science and Communications (Hon. Mr. McGeer) comes along

and suggests that we have to double the numbers we're graduating —

which, under most circumstances, would be a good idea. The problem is,

you've got two universities in Alberta graduating infinite numbers of

doctors over the last number of years, you've got large institutions

all over the country graduating doctors, and then suddenly we want to

catch up.

If the Minister of Health really wants to do something for this

country, then he will negotiate on a national level a reduction in the

supply of graduate medical students. We can't carry the ball here. His

legislation is not going to work. His legislation is at best a poor

piece of totalitarian, right-denying legislation. Mr. Speaker, if he,

can't make an agreement across Canada, then we are in some trouble;

there's no question about that. But I can't imagine a minister going to

a health ministers' conference, gracing the place for a few hours at

most — he certainly didn't take

part in the entire discussions that

went on down there — said, "We're going to look after things at home,"

and came flitting back to British Columbia. He hasn't even tried to

negotiate this particular situation. As a matter of fact, I don't think

he cares. He wants to be seen as a big, tough Health minister who has

guts enough to take on the doctors. Well, take on the doctors where

they are overcharging and overbilling, and take on the doctors whose

patterns of practice are suspect.

One of the problems we have in this province is that the

patterns-of-practice committee has been practically null and void. They

just haven't been around. In the first place, this businesslike

government transferred the medicare computer to the Systems

Corporation. Now it's back, but they transferred it over to the Systems

Corporation. Without access to the computers, the patterns-of-practice

committee is quite useless. So they have not been looking at these high

billers, these high rollers. That's one thing that could be done.

Rather than attacking the bright, young, new people we should have

in the medical profession in this province, we're protecting the older

doctors with the sinecures with this bill. We're seeing to it that no

woman is going to have access to the practice of medicine without a

tremendous amount of trouble to get a billing number. One of the

reasons that they want to keep women out is that if a woman doctor

establishes a practice tomorrow, a year from now she has a full

practice, and they know it. That worries the hell out of some of the

male doctors, and it worries the Minister of Health too. But the fact

of the matter is that many women want to go to female doctors, just as

many men want to go to male doctors.

MR. MACDONALD: And many men want to go to female doctors.

MR. COCKE: Yes, that's a possibility too.

But, Mr. Speaker, this bill denies access to the very people we need

to bring us into this decade and the next decade of medical care in

this province. So what will the end

[ Page 6253 ]

result be? The end result will be that we will be

sending our doctors, our fresh, young, bright doctors, away from this

province to another jurisdiction.

Mr. Speaker, it's crazy. It's absolutely crazy to bring along a bill

like this and expect that somehow or other you're going to achieve the

goal — and this should be the goal of a Minister of Health — of better

health care for the province. You're not going to get better health

care for the province by protecting dinosaurs. You're going to get

better health care for the province by bringing young, well-trained,

up-to-date minds into the practice of health care in British Columbia.

That's how you're going to improve our health system.

AN HON. MEMBER: Is that true of politicians?

[11:45]

MR. COCKE: There's one politician down the way, Mr. Speaker —

I say as an aside — who says that maybe he should get out because he's

too old and draggy in the business. Well, that's on his head, or maybe

his constituents will make that determination.

We must have a way to provide that access to our young doctors in

this country. Had the minister really thought about it a few years ago,

or had his predecessor, who is sitting in the House today...? Had they

thought to negotiate a pension plan for doctors, who are not the very

best investors in the world, by and large, many of whom, in this last

bit of a slump, have taken quite a bath.... That will determine that

they will stay in practice whether they should or not. When we were

government, we did negotiate a disability plan. That disability plan

made it possible for some doctors, who should not have been practising

because of a disability, to get out. The same thing goes for the

pension plan. Had that pension plan been in force for the last ten

years, it would have done two things, of course. It would have given

more investment money for the government to husband, to care for, and

it also would have provided a way out for some of these doctors that

should not be now practising. If we've got 300 too many doctors, I

predict that had we had that pension plan, by now those 300 doctors

wouldn't be practising.

The minister also uses, when he says we've got 300 too many or we've

got one doctor to X number of population.... I can't remember his last

figure, but it's probably somewhere in the one to 500 area. It's argued

that it's not true, because many of those doctors are part-time

doctors. If you're talking about full-time doctors, it's one to 703 in

this province. I contend that what we're doing here is just seeing a

mistake made by the ministry, by the government, in thinking that

somehow or another they're going to fashion a health system that's

going to be better for their own needs.

They wanted to do some positive things. Why did they permit five

community health centres to disappear in this province? It's an option,

and it's an option that ultimately will prevail. We've watched our

neighbours to the south. We know, for an example, that they are

spending around 11 percent of their gross national product on health

care. We know that we are around 8 percent, which sure isn't bad. They

are 3 percent higher than we are in terms of the delivery of health

care. So something good must be said about the system. Had the United

States, in the late fifties and early sixties, adopted the bill that

Bobby Kennedy put forward to Congress, today they would be the leading

health-care country in the world. That system is going to be difficult

to sell here, because we have a plan here that people feel they have

access to; therefore they're not terribly motivated to change. It's

going to take a long time for us to, first, regionalize. That's

absolutely necessary. Regionalization takes care of a number of the

concerns of the member for Atlin (Mr. Passarell). Regionalization gives

you more flexibility. You've got an urban population, and you don't

treat an urban population the way you treat a rural population. You

gain some flexibility.

You see, Mr. Speaker, our problem is that we're centralized. This

bill further centralizes our whole system. It makes the minister a

czar, but so what? Is that going to improve anything? I don't think so.

What will improve our whole health system is sitting down and talking

with all of the groups that are involved. On a number of occasions I

have called for a health planning council for the province of B.C. The

reason you need a health planning council is so that you get the

geographical differences of opinion. With that council you are able to

set up the decentralized plan. It would be less expensive in the long

run.

Eventually we're going to move toward the community health centre —

call it what you like; resources centre or whatever — and we're going

to do that because we're going to find that we have to. Sickness care —

that is, paying for sickness — is very expensive. Health maintenance

organizations in the United States — there's one as close as Seattle,

the Puget Sound co-op — have found that they cut costs dramatically

because you're paid a per capita to look after people. Our

fee-for-service structure motivates....

AN HON. MEMBER: Greed.

MR. COCKE: Exactly — greed.

If I'm paid to keep someone well, that will be the test. If I don't

get a nickel more when that person gets sick, then the motivation

begins to go the other way. Now I know you cannot turn our system over

overnight. But we should be experimenting in that direction and we

should be providing that concept and giving it an opportunity to work.

The Queen Charlotte Islands was a good example. They had two doctors

for that whole area in 1973. We established a community health

organization for that whole area, and what did that community health

organization do? They gave a good supply: four doctors and health

workers, to the point that the whole island chain was served properly

and thoroughly.

Then you say: "Well, it works in remote areas, but what do we do in

the urban areas?" It can work just as well in the urban areas, and

particularly if there is an emphasis on prevention. I don't care what

anybody says. I've heard the university guys — the guys with the gowns

— say that there's no proof that prevention, or this, that or the other

thing, has very much influence on the cost of health care. I disagree

with them totally and absolutely, because we've all seen just in the

last few years a reduction in coronaries. The reason we've seen that

reduction in coronaries is people are changing their lifestyles. Less

people are smoking, more people are going for long walks or running —

the kinds of things that are beginning to make an impression in our

consciousness. And that can be emphasized and increased. Nutrition —

all these things are important. Mr. Speaker, that's the kind of forward

looking minister I'd like to see, rather than somebody who says: "We're

going to restrict the supply of doctors and thereby cure all the ills

of a costly health system."

I'm surprised to see him so worried about the bucks that he spends on medicare. Roughly 48 percent this year, or I

[ Page 6254 ]

should say for the last fiscal year, was paid for

by the feds; 38 percent was paid for out of our premiums, leaving a

grand total of 14 percent out of our actual treasury of this province.

Now, Mr. Speaker, the most expensive aspect of health care is

definitely the hospitals. So what did we see in 1981, even before

official restraint came in? In 1981 we saw them putting the boots to

home care. Oh, sure, it still exists, but that is the least expensive

aspect of providing health care, and that was the one that was first

restrained. Oh, they said that there were abuses. If there are abuses,

eliminate the abuses, but don't just reduce across the board 15 percent

or whatever. That is not the way to go about it. They have forced

people into acute care in this province by lowering the level of home

care. We have to....

AN HON. MEMBER: Mismanagement.

MR. COCKE: It's true; it is mismanagement. What we have to do here

is look toward reducing the costs, improving our health care system. But we

don't do it by bludgeoning one particular group — and the most important

ones. I can't imagine us not really thinking about who we're denying

access. We're denying access to the fine young minds that are coming out

of those medical schools right now. We've trained them. If you're training

too many, then cut down on the numbers, but for heaven's sake let's

use the resource that we have now. Put some of them to work in developing better

and more useful philosophies of the delivery of health care. But we're going

about it quite incorrectly at the moment.

Mr. Cocke moved adjournment of the debate.

Motion approved.

MR. PARKS: Mr. Speaker, I ask leave to make an introduction.

Leave granted.

MR. PARKS: I'd ask the house to join me in making welcome a

group of 64 students: firstly 32 exchange students from Donnacona,

Quebec, along with two teachers, Mme. Marcotte and M. Baudry; and a

very special welcome also to the 32 host students from Maillard Junior

Secondary School in Maillardville-Coquitlam, and their teacher, Mr.

Jiwa. Thank you very much for coming, and may the House welcome them.

Hon. Mr. Nielsen moved adjournment of the House.

Motion approved.

The House adjourned at 11:59 a.m.

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