LEGISLATIVE ASSEMBLY OF MANITOBA THE STANDING COMMI TTEE ON LAW AMENDMENTS Tuesday, 11 June, 1985 TIME - 10:00 a.m. LOCATION - Winnipeg, Manitoba CHAIRMAN - Mr. P. Eyler (River East) AT TENDANCE - QUORUM - 10 Members of the Committee present: Hon. Messrs. Cowan , Desjard ins, Eva ns, Harap iak, Hon. Ms. Hem phill, Hon. Messrs. Lecuyer, Parasiuk, Plohman, Storie Messrs. Adam, Ashto n, Corri n, Enns, Eyler, Fox, Mrs. Ham mond, Messrs. Hyde, Johnston, Malinowski, Manness, Mercier, Nordman, Mrs. Oleson, Messrs. Orchard, Santos, Scott, Steen MATTERS UNDER DISCUSSION: Bill No. 2 -

An Act to Amend The Health Services Insu rance Act MR. CHAIRMAN: Commit tee come to order. We are considering Bill No. 2,

An Act to Amend The Health Services Insurance Act. I believe we have passed a minor amendment to Claus e 1. We're still on the detailed consideration of Cla use 1. Cl ause 1 - Mr. Orchard. MR. D. ORCHARD: We passed that late Thursday eveni ng. Wha t was the necessity of tha t mino r amendment? Wha t does it do? HON. L. DESJARDINS: The referral was wrong. Correct the referral, that's all it did. MR. D. ORCHARD: Oh, you mean it referred to the wrong sect ion of the statu te. HON. L. DESJARDINS: lt referred to Ch apter 1135 of the Revised Statut e. We corrected that. MR. D. ORCHARD: That's fine. MR.

CHAIRMAN: Clause 1. Any qu estions on Clause 1? Clause 1- pass; Cla use 2 - Mr. Orchard. MR. D. ORCHARD: Oh, I'm sorry. Which sect ion are you on? Are you on Sect ion 119{1)? MR. CHAIRMAN: Claus e 1 includes 119, 119{1), 119{2), and 119{3). Cl ause 2 is the Comme ncement of the Act .. MR. D. ORCHARD: Okay, well just hold it then. I thought you were dealing with Su bsect ion 119 repealed and su bstituted. I was waiting for 119{1), Mr. Chairman. 47 MR. CHA IRMAN: I will pass 119, and we'r e on 119{1) then. Mr. Orchard. MR. D. ORCHARD: Mr.

Chairman , in the cou rse of the presentations, the chiropracters made a case. They proposed an amendment that became part of their President's presentation, in which they proposed some specific amendments to Sect ion 119{1), 119{2) and 119{3). As I understand their proposal, that wou ld be a method that they saw in terms of amendment to exempt them from the act. Now the amendment they proposed, it would seem to me, wou ld apply to oral surgeons, etc., etc., as well who are partially of other groups of practitio ners. That may be too broad an exemption. HON. L.

DESJARDINS: There are optometrists also, and th ere could be others. MR. D. ORCHARD: Pardon me? HON. L. DESJARDINS: Optometrists also. MR. D. ORCHARD: So, Mr. Chair man, I wonder, is the Minister giving considerat ion to the amendments that they proposed? HON. L. DESJARDINS: Mr. Ch airman, I think I explained that at our last meeeting. The situation is that we are looking. This bill is a change to protect the individua l. lt is not certainly to penalize any providers of service, but the main reason is to protect the individu al.

On a bill, I think that it is obvious that if you'r e going to have a principle, we've always been in favour of the principle that there should be no extra billing. But then all thos e that are delivering services and are paid through this act should be covered. Now I also wish to repeat that the chiropracters made the point to me that under the present situa tion, it was very difficul t because everybody is in. There's no working outside the plan.

I'm tal king about the insured part of it now. lt wou ld be very difficul t for them if they can't withd raw their service and they have very little to say as to how they should pay. That was recog nized. That would be for all providers of service, the medical profession also. We considered the Quebec model, and as I explained at the time, the situation was that probably that would not be allowed by the Federal Government because there would be a real danger of not havi ng the universality and that is one of the main things of the plan.

As I announced again the last time that we recognized that they had a point and we informed them on different occasions tha t we would be ready to look at binding arbitration unde r certain conditions. They have this

Tuesday, 11 June, 1985 letter and I wou ld expect tha t they'l l start neg otiati ng fairly soon. Now, they find themselves in no different a position than the med ical pr ofession at all. The medical profession, there's no agre ement signed. They have the same request and because of the change, because of this act, then we're a litt le more inclined to accept binding arbitration which we weren't th ree years ag'o when it wou ldn't, in effect, be binding only on the govern ment.

So the situation is the same that we probably will have an agre ement with the medical profession and the chiropractors that there will be binding arbitration. MR. D. ORCHAR D: Mr. Chairman , the Minister mentions negotia tions with certain conditions. Are the Chir opractic Association and its members aware of certain conditions the Minister refers to again this morning as well as last Thursd ay nig ht? HON. L. DESJARDINS: Yes, th ey are. The main 'condition that I'm tal king about, they are.

Now I'm not talki ng about all the det ails. lt probably wou ld be we'd try to make it as uniform as possible like the agre ement tha t we've pr actically reached with the medical profession, that is, that it would be tried for three years or something and then it'd become permanent. I'm not talking about the detai ls, I'm talking about the main thing. They are aware of that condition. MR. D. ORCHARD: That main condition is? HON. L.

DESJARDINS: The main condition is that we wo uld have an ag reement with them on binding arbit ration providing that they would agree, because it's a package deal the same as the medical profession, that in this case that once they appeal to the arbitrators, if they feel that whatever the gov ernment is ready to pay them is not adeq uate, then it wou ld mean that they accept and we wou ld accept the finding of the arbitrators as fair fees. They would agree that this would cover the fees, not only of the insured portion, but any other visit once the insured part of it has been accepted. MR. D. ORCHARD: Then, Mr.

Chai rman, what the Minister is att empting to say here is that there is no difference between the MMA and the chiropracters. HON. L. DESJARDINS: Not quit e, it varies. As far as the agreement, there wou ld be no difference. Like with the MMA, there was an early settl ement for this year. That was understood, because of the situation this year. The only difference is - and there is a difference - that presently the MMA visits are all covered,

whereas there is a limit of 11 visits for a chiropractor. MR. D. ORCHARD: Mr. Chairma n , there is a very subs tantive difference in that the chiropractors are not included under The Canada Health Act. As such, the penalty clause doesn' t have any effect on the transfer payments to the Pr ovince of Manitoba . They are different from the standpoint that the Chiropr actic Association has only very recently had the opportunit y, I believe wit hin the last 10 days, to have discus sions with .. . 48 HON. L. DESJARDINS: That is not correct. That is absolutely false. MR. D. ORCHARD: Mr.

Chairman , you know, the Minister says that's absolutely false here tod ay. lt was put on the record by the president of the association, and the Minister sat silent and did n' t challenge him on that. HON. L. DESJARDINS: Oh no, that also is absolut ely false. MR. D. ORCHARD: Wel l, Mr. Chairma n , you had the pre sident of the assoc iation here on Tuesda y approximately two weeks ago, pointing out that the Minister had not allowed discussions with the MHSC. That's in his brief. I can dig it out for the Minister if he wishes. HON. L. DESJARDINS: Oh, I'm not debating that. MR. D.

ORCHARD: The Minister did not make any effort to challenge that, to correct it or anything. Now when they're not here, he's saying oh well that's not correct. The time to do it was when he made the statement to commit tee and correct it then, and he didn' t. Now the dif ference betwee n the MMA and the Chir opractic Association is that the MMA has been working with this go vernment for approximately a year­ and-a -half or two years now on this agreement. lt is, as the Minister now says, linked together . The two are part and parcel, binding arbit ration in return for a ban on extra billing.

The chiropractors have not enjoyed any negotia tions with this govern ment over the last little while. As a matter of fact, Mr. Chairman , the chiropractors had so little negotiation and discussion with this Minister and this go vernment that there is a lawsuit. They are indeed a lot different than the Manitoba Medical Association. They haven't been treated in a professional way by this Minister or this gover nment. They have concerns about that treatment. Once this act is passed with them include d , they have absolut ely no recou rse. That is why they proposed the amendment.

That's why the spokesman for the association last Thursday night st ill wanted to see the amendment in place, because without it they have no ability to deal in a reasonable fashion with this gov ernment. lt's not that the past record says that they can deal with this gov ernment. If anything, the past record says they can't, because they're cu rrently having a great deal of difficult y with this Minister.

So the Minister's casual explanation this morning that there is no difference between the MMA, that they're being offered the same thing, is not exactly a reasonable stat ement for him to make, basis the situ ation he's faced with rig ht now in dealing with that association. Now, Mr. Chairman, without any penalty clause to the Provincial Government, which is one of the major arg ument s for the haste in which we're passing this act, because we are losing something like $1.5 million per year in transfer payments. That doesn't exist, that

Tuesday, 11 June, 1985 doesn't apply to the chiropractors, and I understand from one of the briefs the other night that six out of some 90 or 100 of the chiropractors do extra bill right now, which is the same relatively small portion that is pr esent in the MMA. lt isn't going to make the subs tantive difference to the individuals who are using those chiropractors who are curr ently extra billing if no extra billing existed , and in the long run, it could be qui te beneficial to the chiropractic patients to not have them included now so they can maintain some sembla nce of rea sonable bargai ning with this government and reasonable negotiation with this go vernment. lt was only after mobilizing a massive protest of the Minister's unilateral change in the number of office visits and the way those are billed and reimbu rsed by the MHSC, only by a massive protest by the patients that this gove rnment backed down slig htly and changed their mind and reinstated $300,000 of the $600,000 cutba ck.

That was only done by harnessing the patients, who themselves, some of them , would have been extra billed. They obviously weren't concerned about that. They were more concerned about the way their association and their medical pr ofes sionals, the chiropractors, were being treated by t his gov ernment. They can sti ll be treated as shoddily by this gov ernment, particu larly if this bill is passed as is without an exemp t ion to them. Ther e's no onus on the gov ernment once they have them under them under the um brella of this to neg otiate with them in good faith. The past record isn't good.

That's why I believe that they need the protection of an exemption and as they have said, Mr. Chairman, when their negotia tions have been comp leted and they have a binding arbitration agreement with the gove rnment, they're qu ite willing to become part of Bill No. 2. HON. L. DESJARDINS: Mr. Chairman, as usual, the honourable member is making statements that are not correct, that are absolut ely wrong. lt is implying motives.

The situation is that I certainly went through every single step during the Estimates with my honourable friend. lt is true that the situa tion was that the first meeting that we had, when the president spoke, that there were statements made, we were looking at delega tions at that time, and my honourable friend didn't follow the rules that were set up by this Commit tee qu ite as well as I. The qu estions were for information. I knew that I had other occasions to correct that. A few days before we'd had another meeting and it's obvious that some of the things that he said were prepared long before.

In fact I was told that. Now the situation last Thur sday, there was another spokesman for the association and I corrected him. If you looked on Thu rsday's, you will see that I corrected him. I told him that on many occasions they had had a chance to discus s. Now, it was a year ago that the announcement was made that we would bring in legisla tion to prevent binding arbit ration. I don't know of any Minister of Heal th or of any minister that go es arou nd the street, knocking at every door and asking people if they want · to meet with them. The request usually comes from the people that want to meet with you.

I repeated that there was never any deal made with them. They talked 49 about binding arbit ration amongst other thi ngs. That has been going on, it is true, for awhile. But we'v e never, not once, refused to meet with the Chi rop ractors' Associ ati on. As I said before, the relat ionship was very good. In fact I don't know how many people were successfu l in bringing the Colle ge of Physicians and Su rgeons and the chiropractors together at the same table and that was done. The situ ation, Mr. Chai rman, is that they were invited to meet with the commission. On two occasions they refused.

The only time that I ever refused - it wasn't a refu sal, it was a postponement as I mentioned, there was a three-day meeting of the Cabi net during the Est imates time. They wanted to meet immediately. I sug gested that they meet with the deput y minister and I would meet with them a few days after that; I did meet with them. There was some discussion. They were sup posed to send a brief at that time to the commission and that took a couple of weeks or more before that was done. They met with the First Minister.

I met again with them a few days before the opening Session of this committee; again they received the message. They were going to gi ve me some information which I did receive. They chose not to mention that in their brief, that is th eir affair. When that was mentio ned again last Thur sday, I corrected them and Hansard , I am sure, will show that. Now the situa tion, Mr. Chairman , we' re tal king about two or three different things. We're talking about an anomaly that we chose- to correct this time.

This is the party that is always talking about having things running smooth ly, worrying about the deficit one day, and the next day they want something else. That was an anomaly that now is accepted by the chiropractors. That had nothing to do with this bill. We've always made it clear that a principle is a principle and we deal with everyone. Now the chiropractors, of cou rse - and I don't blame them. The member today is making a point that they' re not covered in this act, therefore we don't lose any money, and that means that you don't worry about the principle because you don't lose any money.

At no time did we say that the only reason - of cou rse we acknowledged the reason that money was lost that we cou ldn't afford - but we've always said, the party did, the go vernment did and l.did, repeatedly, that we were in favour of the principle of no extra billing; exactly the same as my honourable friend's party in Ottawa did, exactly as all the parties did, that there wou ld be no extra billing. Now to say, well, you don't get any funds so therefore the principle doesn't count . If we would carry that all the way then they shouldn't be paid throu gh Medicare.

We should follow the example of five other provinces where there's no benefit to the patient of a chiropractor at all. We 're not doing that. We've expanded , and even my honourable friend said because of pressu re we put some money in. That part was open for negotia tion and they chose to go ahead - I don't blame them , that's their affair - and organize a strong lobby and they did very well to put pressure on the gover nment before discussing that. The misunderstanding started not with the Minister; the misunderstanding started with the Manitoba Health Services Commission, something that I was unaware of.

I think that was explained on a number of occasions.

Tuesday, 11 June, 1985 The chiropractors feel tha t the Commission should have a mandate to change political principle and that was not the case - it never will· be. That cert ainly is not the way a government is run. The Comm ission tried to discuss with them and, as I say, finally there has been some discussion and things seem to be on track, that they know exactly what we're going to do. Of cours e, they're bringing this resolution the same as the psychiatrists, the same as the ophthalmologis ts. They're making the same point and so on.

They are going to be covered, and t hat was explained very clearly during the closing debate of this bill. My honourable friends voted in favour of this bill, the principle of this bill. If they want to change that now, tha t's their business. I'm not going to stand here and have a member talk about things that he doesn't know about and try to imply motives to me and accusa tions that are not correct. MR. D. ORCHARD: Mr. Chairman, you know the Minister, he is always very sensitive when things don' t · go exactly the way he wants. HON. L. DESJARDINS: No, when you lie. MR. D. ORCHARD:

Part icularl y, Mr. Cha irman, when this Minister had delegations here from the Chi ropractic Association that said exactly as I said and he sat dumb and deaf and did n't even ask . . . HON. L. DESJARDINS: I did not. I corrected it last Thur sday. MR. D. ORCHARD: You did n't correct it. HON. L. DESJARDINS: I repeat that I corrected it last Thu rsday. MR. D. ORCHARD: You did n't correct a th ing. MR. CHAIRMAN: Order please. MR. D. ORCHARD: Mr. Chairman, well, he didn' t correct Tuesday's. - (Interjection) - He did n't correct it.

He waits until they leave and then he puts his case out, one-sided , and then accuses me of doing the same. HON. L. DESJARDINS: Mr. Chair man, on a point of order. MR. CH AIRMAN: Order please. Mr. Desjardins on a point of order. HON. L. DESJARDINS: This Commit tee; first of all, looks at delega tion. You let the delegation talk. The debate takes pla9e after the delegation leaves. You're sup posed to ask que stions for clarificatio n. As soon as they left the second time we had a meeting, I corrected that and I'm correcti ng it now.

I had already said the story exactly the way it happened during the Est imates repeatedly. MR. D. ORCHARD: Mr. Chairman, thank you. Now, the Minister says we just want to have everybody treated fair ly. We ll, Mr. Chairman, you know this 50 governm ent and our go vernment before them has , system for the chiropractors tha t has extra billing whe1 their number of visits run out. So, he's talking abou a principle. He's tal king about a principle he's no following thr ough on completely.

So, don't have the Minister confuse this issue b· saying we ju st want equity in the system, because witi the chiropractors it's partial equit y until you exhausl as an individual patient, the number of insured visits After that it's completely extra billed and this Ministe has no problem with that. HON. L. DESJARDINS: lt's not extra billed at all. HON. L. DESJARDINS: We ll it's not extra billed because it's not covered. SOME HONOU RABLE MEMBERS: Oh, oh! MR. CHAIRMAN: Order please. Mr. Orchard. MR. D. ORCHARD: Mr. Chai rman, the Minister want! to play with words.

Extra billing means that the patien· contrib utes towards the visit. The patient pays 10C percent of the visit when his number of visits arE exhau sted. HON. L. DESJARDINS: That's not extra billing. ·MR. D. ORCHARD: Mr. Chairman , in the Minister'! definition, that's not extra billing, but ask the patien� if it isn't coming out of his pocket. lt will still come oul of his pocket with or without Bill No. 2. So the principlE goes out the window of not having people pay fo• medical costs. HON. L. DESJARDINS: We ll, make you r motion. MR. D. ORCHARD: So, Mr.

Chairman , the Minister ha! got a request even after his meeting of late last wee� with the association to establish theoretically a proces! by which binding arbit ration . . . HON. L. DESJARDINS: Correcti on. I'm to ld that I should correct things immediately. I did not meet late last week with the association. MR. CHAIRMAN: Order please, order please. HON. L. DESJARDINS: My honourable friend tells me I should correct things immediately. I am. MR. D. ORCHARD: Mr. Chai rman, the Minister met last week. Is that a good enough statement for the Minister? Wi ll that suit his pu rposes?

I believe it was Thur sday morning he gave them a phone call. HON. L. DESJARDINS: That's not a meeting. A meeting MR. D. ORCHARD: Is that the last half of last week, on Thursday morning? MR. CHAIRMAN: Order please.

Tuesday, 11 June, 1985 HON. L. DESJARDINS: That is not a meeting. I didn't meet last week at all. MR. D. ORCHARD: Fine. So you didn' t even have the cou rtesy to meet with them. You phoned them. Is that what you 'r e saying? SOME HONOURABLE ME MBERS: Oh, oh! MR. CHAIRMAN: Order please, order please. I would like to ask the members, Mr. Cowan , Mr. Parasiuk, Mr. Desjardins, I would like to ask the members to conduc t this committee hearing in a reasoned and an orderly manner, and not interrupt each other when they' re speaking. Please wait to be recogni zed by the Ch air. Mr. Orchard. MR. D.

ORCHARD: Thank you, Mr. Chai rman. After the Minister's contact with the Chirop ractic Association last week, they were here Thursday evening exp ressin g, I beli eve, some app reciatio n wit h a movement by the go vernment. "While we appreciate the recogni tion by the gov ernment of our position and their willing ness to now negotiate a compu lsory binding arbitration, we maintain that at this time the chiropractic profession be exclud ed from the scope of Bill 2." There was stil l their request Thur sday night after the contact they had with this Minister and this go vernment. Mr.

Cha irman, I will propose an amendment later on to achieve that. MR. CHAIRMAN: 119(1 )- pass; 119(2) -p ass; 119(3)­ pass. Cla use 2 - Mr. Orchard. MR. D. ORCHARD: Mr. Cha irman, I wou ld like to propose an amendment which would add

Section 119(4). I make the motion: THAT Bill No. 2 be amended by adding thereto, immediately after proposed new Subs ection 119(3) to The Health Services Insur ance Act as set out in

Section 1 th ereof, the follo wing subs ectio n: Non-app lication to chiropractors. 119(4) This

section does not apply to a duly qu alified chirop ractor, practising under and in accordance with The Chirop ractic Act. MR. CHAIRMAN: Do you have that motion in writi ng? MR. D. ORCHARD: Yes. I'v e just got one copy, Mr. Chairman. Mr. Cha irman, the reason we've discussed for the amendment, I think it 's fairly ob vious that the chiropractors are not part of The Canada He alth Act. This act, by and large, is to make the province in compliance wit h The Canada Health Act .

The Chirop ractic Association has indicated that, when they com plete their negotiati ons with the go vernment and the Health Services Commi ssion, that this clause 119(4) could be deleted , and they would become part of Bill No. 2 and The Health Services Insu rance Act after the ir ag reement with binding arbitration has been reached with the go vernment. At that time, the gov ernment wou ld have as they wished that they would be part of the ban on extra billing.

In the meantime, they believe 51 tha t th eir neg otiatio ns ar e essential wit h th e go vernment, and wou ld not want to be part of Bill No. 2 whilst their neg otiations are ongoing. MR. CHAIRMAN: Is there any discussion of the motion? Mr. Scott. MR. D. SCOTT: Thank you. Mr. Cha irman, I would speak very st rongly against this motion put forward by the Mem ber for Pembina, the Opposition Heal th Critic. I think it 's a funda mental violation of the principle that Bill 2 provides, and that is against the idea of extra billing. I do not support it personally. lt's not the party position or gov ernment position.

Of course, I can't speak for the gov ernment, but I personally do not sup port the coverage and expanded coverage towards 100 percent coverage or complete coverage of chiropractic care in the Pr ovince of Manitoba. That's not what his amendment is calling for , but tha t's what th e chiropractors feel that the amendment will do through binding arbitration. They want the same sort of coverage that other medical practitioners have in this province. I do not believe that they should have it.

There is presently in the Province of Manitoba, we have another group of health professionals whose tr aining is every bit as wide. As a matter of fact, it's qu ite a bit broader as far as treat ment of extremiti es, because chiropractors and their tr eatment and their tr aining is primarily oriented towards spinal injuries. Unfortunately, in my opinion, they attempt to carry that forward far broader than spinal injuries themselves, and offer treatment for things that are not necessarily spinal-r elated . When I qu estioned last week - what's his name? - Mr.

Marcoux, who was here representing his own opinion again as a chiropractor, I qu estioned then as to what kind of professional limits they had on people practising. How many people have been reprimanded whatsoever for what could be termed going beyond the scope of their ability to practise chiropractory. He said there have been none in the last five years to his recollectio ns. We have the physiotherapist , and the physiotherapy training I beli eve to be broader and mo re comprehensive, as well as done locally.

We have full control over the level and the qual ity of the tr aining that physio is offered through the University of Manitoba and in conjunction with the hospitals and the medical professionals in the Province of Manito ba. lt's my understanding as well that cu rrently there are significant wai ting peri ods in mo st of our hospitals for physiot herapy treatment. Private physiotherapists also have left hospitals and gone off to practise on their own. They get very little coverage other than that which is directly referred, I believe, from a physician to the physiotherapist for coverage.

For people who want to go back at other times, depending on the various clinics that are available, the people pay the full fee. I visited one this morning where the fee is $19 for each visit. There is no coverag e, not even up to a limit of $140 a year for an individual towards getting physiotherapy tr eatment. I think that the ir treatment is every bit as high, if not higher, and I think that the phy siotherapists themselves

Tuesday, 11 June, 1985 recognize more clearly the bounds of their competence. To me, that is a mark of professionalism when a health professional knows what limits they are trained for, trains to those limits, ·and then refers elsewhere for treatment beyond that.

There is very little evidence from what I can gath er, and I would like to present to the committee a copy of a letter first written by a pu blic relations officer for the British Colum bia Chirop ractic Association and the Cana dian Chirop ractic Association, and the response to that written by a woman, Pauline Sum mers, who is a physiot herapist in British Colum bia. I'd like to table this for the information of the committee if a Clerk wishes to come and collect it.

In this short response, the y relate to some of the studi es that are referred, in particu lar, one done by Kane in 1974, that shows that chiropractors had no better record of patient satisfaction than did medical doctors. In relation to physiotherapists, it points out that "All phy siot herapi sts are tr ained in passive movements of joints in their underg raduate studies and the re's an excellent prog ram at the post-grad uate level ·in man ipula tive te chniques or manua l th erapy .

Physiotherapists work in close relatio nship with the medical profession and my experience so far there has been trem endous co-operation between the medical community, the physicians, the osteo paths and the physiotherapists." lt goes on in this

article to specify that "Chi ropractors have limited training in diag nostis of known mus cu lar skeletal problems, and delay of establishing a correct diagnosis or instituting appropriate care can be serious, especially in treat ment of child ren where disease may be acute, severe or even life-t hreatening. Chirop ractors have made claims in their pamphlets to be able to treat epilepsy, croup, cross-eye, rheu matic fever, bronchitis, pneumonia, appendicitis, leu kemia and other diseases affecting chldren.

Spinal manipulation has no effect in healing any of t hese problems." lt is further related here - and this is one of the things that I must cong ratu late the chiropractors for the excellent job that they do in pu blic relations and legisl ative lobbying and they've been doing it for a trem endous length of time. As a matter of fact , their fou nder and their fou nder's son are in a paper presented by a person by the name of Haldeman as referred to in thi s paper just tab led for the committee, states that in relation to B.J.

Palmer, who was one of the foun ders of the chiropractic movement in the 19th Centur y that "His charismatic leadership, his ability to attract and retain a loyal group of followers, his organizatio nal talents and especially his skill in developing pub lic and legisl at ive suppor t were dec isive in perpet uating chiropractic.'' The report go es on following a quo te by Hal deman goes on to say, and this is Ms. Sum mers comment here: "In this day, patients are used for political leverage. Promotional pamphlets are widely distributed including in preschools, a fact which alarms the pediatric hospital staff.

Chiropr actors have enjoyed an amazing freedom in their licensing and practice taking the ir training into consideratio n. In spite of this not being in the publi c's interest, they seek to make even more inroads." We have seen an example of this and I've made reference to it earlier both I believe in this Commi ttee and in my comments in the House of the idea of medical 52 ethics and the qu estion of medical ethics as practised by chiropractors.

I do not think it is ethical for a medical professional or a person that claims to be a medical professional to have in their offices pamphlets or, in particu lar, petitio ns to send to go vernments for the purpose of lobbying for the sake of enhancing the status of that professional group of people.

To me, if I'm a patient, if I go to any kind of a professional - be it medical, legal or whatever - and I see in that office a petition and the individual, the professional person I'm seeking advice from requests me to sig n thi s petition so that I wou ld be able to have more coverage and thus be able to visit this person more frequently at the expense of the taxpayer. If I did not sign that, I wou ld feel under some dur ess toward sig ning that document, towards sig ning that petition and participating in their pu blic pressure tactics.

If I did not, I would wonder whether or not that professional person would give me the same level of care as someone else who enthu siastically sig ned it. I do not think that is all professional. I think they are more or less a self-reg ulating body under legi slation - they have their own act I believe - I can' t imagine th at happening in most other professions. I can gr ant you that it does but I believe as well that where that does happen, you will find that being add ressed at the annual meetings of those associations que stio ning the practitioners who have used those tactics.

Especia lly when you're dealing with medical where people are at your mercy - you are the person that they are seeking advice from and trying to use that patient for political ga in, I think is most unprofessional. We see that presently with the chiropractors and what they have atte mpted to do to be excluded from this legisla tio n, as well as to move towards full coverage. I thi nk, Mr.

Cha irman, instead of expanding the level of services or the level of expenditu res on behalf of the pu blic pu rse toward chiropractic care, we should be doing a thorough review of osteopat hic practices in the Province of Manitoba, including the osteopaths, including physicians - general practitio ners, including physiotherapists and including chiropractors as well to see what levels of services are being provided, to see what confidence there is behind those services, to see who is providing the services that are beyond the scope of their professional competence, in proven medical methodolo gy as well.

I wou ld very mu ch like to see a review of that before we move to any kind of extension services which may well sho w us th at perhaps in the case of the physiot herapists, the services that they are providing are more appropr iate medic ally than the services provided by chiropractors. I say "may" - I'm not sure that it would. But they are trained extensively not just in spinal injuries and spinal conditi ons, but also the extremi ties;

whereas the chiropractor is not towards the extremities but everything is more or less centred, from my unders tanding , on the spine and the manipulation of the spine towards the curing of not only physical disorders but also disorders that are non­ spinal related at least in other medical professionals' points of view. So, in stating that, Mr. Cha irman, I am very firm in my belief that we should be taking a much sounder look at the way medical practices are performed,

Tuesday, 11 June, 1985 especially when the publ ic is paying for those services, because the publ ic deserves to receive the best possible services and the most honest possible services that can be provided to them. Thank you , Mr. Cha irman. MR. B. CORRIN: Mr. Cha irman, I wanted to jus t briefly comment on a personal basis, with respect to the observations and concerns raised by my colleague from lnkster. First of all, with the highest deg ree of respect, I wish to disassociate myself personally from his comments as they pertain to the chiropractic profession.

I have the opportunity to work with members of that profession on a week-to-week basis and I do not share a lot of his particula r concerns about the calibre of the people and the training of the people involved in that particular profession. As a matter of fact, I daresay that I feel that many of them have been - for too long scapegoa ted by other medical professionals for alleged lack of qu alificatio ns and tha t that is, in fact, a myth which is perpet rated in an eco nomi cally and fin ancially comp etiti ve professional environment.

I know they are concerned about their role in that respect and I share that concern. I am not suggesting that the member's concerns aren't heartfelt and possibly deeply believed , but I do think that there is a lot of de-mystification that's required with respect to the role of medical professionals.

I share that concern and I want to share that with members a concern, by way of extension in the context of th� bill that's before us, becaus e I do feel that, once again , chirop ractory, as a professional science and activity, has been to some extent denig rated unnecessarily, without an absolute and comprehensive study of the role of chiropractic medicine in any sort of perspective or professional policy context. I was concerned about the obs ervatio ns and state ments made by the two chiropractic doctors who attended before the committee.

I think that it wou ld serve the province well to have a study of the role of chiropractic medicine, and for that matter, perhaps physiotherapy and other related medical sciences, so that th ere was an objective overview and analysis and point of view attained and achieved for the bett erment of health care in this province. Having said that, th ose are my comments. As I said, they' re personal, jus t as the Member for lnkster's comments, I am sure, were personal observations, mine are equall y subjective. MR. D.

ORCHARD: I certainly hope that the Member for lnkster, although I didn' t catch whether he said he was speaking personally or on behalf of the gove rnment, but I hope those are personal remarks and not the opinion of the Treasury Bench in the Government, because, Mr. Chai rman, the chiropractic profession serves a lot of Manitobans and tho se Manitobans are, I believe, by and large, qu ite happy with the service they're getting. Mr. Cha irman, that's all I have to contribute to the debate on the amendment. HON. l. DESJARDINS: Mr.

Chai rman, I would like to make a personal observation also and then discuss 53 and again take

part in this debate. I might say that personally I am a client of a chiropractor. I challenge anybody here - I'm sure that I go to chiropractors more often than any member in this committee. Having said that I also recognize there's other - I go for a purp ose. I go for a pu rpose to be relieved, not to be cured. To be relieved because it is difficult to get an orthopedic surgeon. When you get up in the morning and you can' t even straig hten out and there's nobody that will help me except a chiropractor, and I'm very pl eased with their services. But there's also a responsibility here.

I object to the fact that we are told they are not treated properly. Ask the dieticia n, the psychologist, the pediatrici an, the chiropodist , the physiotherapist, the nurses; ask them if they feel that the chiropractors are not treated properly. These are all people that have a role to play and we could all say the same thing about these people, the value of these people. Now with the way this cost in care is goi ng, I think we have to be very carefu l not to dup licate the service that we give, and then also for the remuneration to be fair.

As I said, I tried to bring the medical profession, the chiropractors closer togeth er. I think it was working well, un til the chiropractors started talking about all the things that they could cur e, including mental illness. I take objection to some of the things that Dr. Marcoux said and I think that this is the situa ti on. Where he's tal ked about writing a book, that certainly is rig ht and I wish him luck, But the situa tion is when you 'r e talking about food and proper nourishment, I don't think a chiropractor is qu alified to do that. He certainly has the rig ht, like anybody else.

If you feel that this is something - and he's talking about prevention - I think he mentioned - I'm su re that when Medicare came in there was no intention of having a person - he's saying that 80 percent of his people need more visits than are allo wed. They need more than 16 visi t s. My chiropractor tell me he sees his people on an average of three-an d-one-half times. Now thi s situa tion tha t thi s Dr. Marcoux - it 's wonderful. He's talking about prevention, but I don' t think it was ever intended that you were covering the chiropractors to prevent at this time, especially in a way that Dr. Marcoux was.

That is something that should be looked at before you. jus t deal with one, because it might be political expediency. I think that you have to look at the dieticians very seriously and I think that my honourable friends received a visit from them in their caucus . I think that now, more than ever, when you 'r e talking about fitness, you 'r e talking about lifestyle changes and you 'r e talking about proper nourishment and these people are exclu ded all toge ther. The physiotherapists are also doing a wonderful job and there's a waiting list in the hospitals. The people are criticizing us for that.

They are covered only in the hospitals; and the nurses are not on fee for service and they'd love to be. So I ought to appeal to the members of this committee to be very carefu l before the y start jus t worrying about the one profession. I have no compla int about the chiropractors. I am, as I say, a steady, a good patient of the chiropractors. I us ually go over my limit, and I don't apologi ze for that at all. I think that we have a responsibility, and I think it is absolutely wrong to say that they have not been treated

Tuesday, 11 June, 1985 fairly. They admitted here jus t on Thur sday that they had the best act in the countr y. This is

an act that was passed not too long ago at their request, because they felt that they were abused. I'm not going to exagger ate, because there is abus e probably in all professions, including politici ans. But they wanted to be able to deal with it. Now Mr. Corr in talks about studi es. We've had more study , and I could go out and du st the shelves and gi ve you another study that was do ne by the Con servative Party that recommends th at you exclude the chiropractors altoget her. That was never made known publ ic. There are other times in other areas where the Commi ssion at one time has said the same thing.

I happen to think that they play an important role. I happen to think that they were extended the same privilege. Our office is open to discuss with them , and I think it is improper not to look at the field of health in general, the whole field of health before we start talking about that. So of course, I' m not go ing to sup port this motion. lt would be a pretty sad day when you can't bring a bill on principle, and it's the same principle dealing with these people, that you must say well we'll pass the bil l only when you're sat isfied tha t you have something else.

So of cou rse, you try to satisfy them as much as possible, but you can' t always do it. You have other responsibiliti es. lt would be completely irresponsible on our part to say we've got a bill that we believe in, but we're go ing to wait to pass it . If it's ready to pass for the medical profession, for the psychiatrists , for the other specialists, I think it's ready to pass now. We have no agreement with the medical profession. There is no agr eement sig ned. There has been some discussi on, and we're ready to di scuss wit h the chirop rac tors. So I think tha t thi s is fa ir.

Thi s is something that we all voted for, the principle. lt Was explained in second reading. Mr. Ch airman, before I close, I would like to refer the mem bers of th is commi ttee to the Standing Commi ttee on Law Amendments, Hansard of Thursday, Jun e 6, 1985, on Page 45 where I'm qu oted as saying: "I jus t want to make one correction to the state ment made by Dr. Bohemier.

I'm sur e that this was done purposely by the Chi ropractic Association or the officials of the association, who were informed that we wou ld discuss the binding arbitration - that was done at their request, and that was only mentioned on that day - as early as Febru ary 2nd and also at a meeting before the initial meeting of this committe e." So, Mr. Cha irman, I certainly wou ld not recommend to members of the committee that we vote for this. We'll keep on working with the chiropractors and the dieticia ns and all the others to bring the best health possible to the people of Manitoba.

We'll also do this in a responsible way to look at the costs also, and protect the patients also. MR. CHA IRMAN: Are you ready for the qu estio n? All those in favour of the motion, please say, aye. All those opposed, please say, nay. In my opinion, the nays have it . MR. D. ORCHARD: Count ed vote, Mr. Ch airman. 54 MR. CH AIRMAN: Count ed vote? All those in favour please raise their hands. All those opposed, please raiSE their hands. A COUNTED VOTE was taken, the result being at follows: Yeas, 10; Nays, 11. MR. CHAIRMAN: I declare the motion defeated. Clause 2, Commen cement of the Act - Mr. Orchard MR. D.

ORCHARD: Mr. Cha irman, I have a few genera que stions on the intent of the bill that I want to clarify Can we do that before it's reported or rig ht now, or what's the Minister's pleasure? HON. L. DESJARDINS: lt doesn't matter to me, anytimE you want. MR. D. ORCHARD: Mr. Chairman , I am still somewha1 confus ed as to what the physicians' position is goin!; to be when thi s bill is passed. Opting out is permittec with this bill, providing the physician follows the feE sched ule tha t's prescribed by MHSC.

Now what is the circumstance of a physician who wishes to establish a practice, and he's going to perform services that are cu rrently insured. He and his patien1 or she and her patient don' t want any reimbu rsemen1 whatsoever from MHSC . In other words, the patient is going to pay 100 percent of the cost . Two que stions: first of all, is that allowable under the act ? Secondly, if it is allowable under the act, does the ban on extra billing still apply? HON. L. DESJARDINS: Mr. Cha irman, this is what I've tried to explain.

This is commonly known in the trade, if you want to call it that, or the profession as the Quebec model. In the Quebec model, the people can opt out completely. If he has opted out and does not extra bill, it's the same thing as here, the patient gets the cheque. If he opts out and extra bills, then the patient is not covered, nor is the doctor or the provider of services. That is, as I say, known as the Que bec model . This is something that we looked at. This is something that we felt that maybe we should go with.

But in discussion with the Federal Ministers and discu ssion amongs t ourselves, we felt that the most important thing of all - in fact, the plan wou ld not exist with that and the re was fear from the present Federal Minister of Hea lth and ou rselves th at we would lose the universality of the plan, and then that could not work. In other words, you can have the doctors arou nd Brandon, for instance - I'm giv ing that as an example - even the G.P.'s in Brandon might say well let's stick together and let's get out. The people will have to go without the plan, we're out of the plan.

Then you could not offer the service to the people of Brandon, so the plan would not be universal. That would not be possible. lt would not be accepted by the Federal Government for one thing. This is something that they're very protective of. Then you might have a specialty that might decide that we'll all opt out and we will extra bill. There ag ain, yc'J could not offer the service of that needed specialty

Tuesday, 11 June, 1985 to the pub lic in general, therefore you would not have a universal plan. There was a lot of effort to find out if there was a way tha t that could be modified, but it cou ldn't. Call it the lesser of two evils, if anything, because I think we all would like to see them be able to work outside the plan if at all possible, but if they do not deliver, one of the conditions to practice medicine or whatever the service in the health field in Manitoba here wou ld be that they work wit hin the plan. Nobody will prevent them from saying, I don't want to be paid by the gov ernment.

In fact, that's what opting out was; some people from Day 1 - not too many, mind you - who opted out as a qu estion of principle. They didn't want to soil their hands, or call it what you want, and I believe in their sincerity. They didn't want to have anything to do with the govern ment. Alrig ht then, that cou ld still be done, the opting out, although now, they' re saying there's no point. I think that has changed , but I think there's probably the odd one that's stil l opting out. But extra billing, it 's very clear this act would not permit that. MR. D.

ORCHARD: Then, jus t so we'r e talking about the same sc enario. Let 's use the specific example of a psychiatrist. If a psychiatrist were to opt out under the provisions of Bill 2, the only fee

schedule he/she cou ld charge wou ld be the prescribed fee by MHSC. They could charge the patient that fee and the patient could then go to the MH SC for reim bur sement, theo retically. But if the psychiatrist , for whatever reason, in the relationship with the patient wanted to be entirely outside the plan and provide that service - because here's an example that was given to me and I'll share it with the Minister and the committee. A prominent pu blic fig ur e is availing himself of psychiatric care periodically.

That might have some influ ence on his employer's decision to keep that person in that pu blic position, so everyt hing is done outsid e th e plan. There's no record of it over at MHSC that that person has ever received psychiatric treatment and that's this person's gu arantee of confidentiality. Now, I take it that that sort of circums tance would not be allowed under thi s bill. Does the Minister und erstand the scenario that I'm putting forward ? HON. L. DESJARDINS: Let me see if I unde rstand. We 'r e talking about something completely different now.

We 'r e talking about somebody that wants to see a psychiatrist, but his main fear is that no one should know about that. Therefore he is ready to pay the full cost himself. We 'll check into that. I certainly think that he should be acco mmoda ted. I think the psych iatrist would certainly have to report that he's seen a certain patient for income tax pu rposes, but the Income Tax is not inte rested in any record on anyone els e. This is somet hing that we would have to discuss with the Colle ge of Physicians and Su rgeons.

But I certainly can't see - I'll check - but I'm of the opinion that we would try and accommodate somebody like that. Now there might be something I don't know, and I say this · without prejudi ce and I'll try to find that out. You see, if there's not a bil l submi tted to th e Commi ssion, we would never know about it.

The only 55 thing is if th ere is a discussion later on or a misu nderstanding between the patient and the doctor, and the doctor would want to come and be reimbursed, he would have to understand that he is waiving this; he's not going to be reimbursed, and he shouldn' t come later on if there's a misunderstanding and he wants to get paid or anything like that, there wou ld be none of that. We cou ld look at that. I wou ld personally think that we should try to bend over backwards to accommodate them, but I want to talk to the Col lege of Physicians and Sur geons on that too.

I think if the people are ready to bill, providing of cou rse that it 's not extra billed. I think you said he wou ld be charging ju st the same as anybody else as is ag reed. I want to say another thing on the first qu esti on. We are looking at the possibility. There won't be any extra billing, but maybe of deinsuring psychoanalysis. We have had psychiatrists - and I think that's the big concern - that have seen seven, eight, ten patients and they'v e been billing hundreds of thousands of dollars. That is a request. We 'r e discussing that with the university and the psychiatrists.

So that might be if it's deinsured, well then it wou ld be something different. That wou ld no longer be covered. That's a possibility to see if we could arrange that. We also want to look at the possibility of getting the psychiatrists in sharing some of the responsibility of looking at the patients that are already needed. it's very hard as you know to recruit psychiatrists in certain hospitals and that. it 's more gla morous to work with the private sector. lt could be that they might be in ag reement that part of their time they would with a sessional fee give us some of their time.

So that's another possibility. That would be on sessional fee, not on fee for service. So these are things that we want to discuss when this is over. There's a lot of discussion that'll take place, not only wit h the chiropractors, but with the medical profession in certain specialities. MR. D. ORCHARD: Okay then. Let me just make sure that I understand. HON. L. DESJARDINS: Excuse me, before you do I will check to make sure. ·ru check with the Col lege of Physicians and Sur geons and I will check with the Commi ssion.

We 'll try to get before the end of the session anyway to get a direct answer on that particular point, the last point th at you made. MR. D. ORCHARD: Mr. Cha irman, the Minister made an interesting point there that he's going to check on it, but basically the principle of the circums tance I laid out of patient and physician, the patient pays the fee, no record of it , MHSC, the Medicare plan, is not at all involved. That is something that may well be accommoda ted providing, and I want the Minister to confirm my understanding, that the fee charged is only the fee as set by MHSC. HON. L.

DESJARDINS: Well, of course. If you don't do tha t then you 'r e breaking the thing. All you have to say is I don't want any record and therefore you 'r e allowing somebody to charge more.

Tuesday, 11 June, 1985 The main reason why there is no extra billing, and nobody seems to be talking about that, is that you do not want two-tiered service. You want everybody to be treated the same, because if not, especially when there's a shortage such as a speciality and so on, it 's going to be tem pting to go to the people that can pay you a little more. You might want to take 10 patients instead of 15 or 20, and there are certain people that won't be able to afford that. Of cou rse, I don't have to remind the members of that. That's what Medicare is all about. MR. D.

ORCHARD: That brings us to the interesting circums tance that it may be possible, depending on wha t the Minister fi nds out from the College of Physicians and Su rgeons and discussions with MHSC for a physician and a patient to enjoy a one-on-one relationship where gov ernment dollars are not involved providing the fee

schedule is followed, and the patient pays the entire fee for whatever reason; whether it 's the circums tance I laid out of a psychiatric visit, or whether it 's someone who wants to protect his/her confidentiality as it applies to STDs, for instance, you never know. The one principle that for certain cannot be sacrificed is, if it 's an insured service that's provided by MHSC, that that private relationship between the physician and the patient can only exist if there is no extra billing. That's the overriding principle that's giv en. HON. L.

DESJARDINS: Yes, I would say that you would defeat the plan altoget her. Ther e would be some underst andings. Of cou rse, we might never know, but this is something that wou ld have to be accepted. Why not look at the possibility also, and I say this completely without prejudi ce, it might be impossible - but why don't we look also at the situation that somebody for some good reason do es not want anybody to know of this, why it might be possible to still do it under the plan, still covered. lt might be some kind of added protection or something. lt would maybe some declaration.

I don't kno w if it 's possible, but I think we should look at that also. I certainly wou ld not encourage anything that will be a roundabout way to de feat the pur pose of th is principle th at we're announcing toda y by passing this bill. MR. D. ORCHARD: Mr. Chairman, I'm not trying to HON. L. DESJARDINS: I'm not saying you are. MR. D. ORCHARD: . . . controvert the principle of the bill, but what I'm trying to establish because the particular circums tance I laid out first was brought to my attention and that becomes very important to that patient and his physician to know what their position under the act is.

The other area th at becomes rather important is . . . HON. L. DESJARDINS: Not only the act, it 's the ethi cs of the profession also. MR. D. ORCHARD: The other thing that becomes kind of a very interesting offshoot of thi s Bill No. 2 is Mor gentaler's situation in Manitoba where he is 56 prov iding an insure .d serv ice , but is charging su bstantially more than MHSC allows.

Now with the passage of Bill 2, are we to assume t tiat Morgentaler will become su bject to the penalty clauses in here and conviction by The Sum mary Conv iction Act, which is much, much simpler than the process the gov ernment is curr ently wrestling with? HON. L. DESJARDINS: Morgentaler is not providing a service that's insured. MR. D. ORCHARD: Yes he is. HON. L. DESJARDINS: No, he isn't because that service is not insured any other place than in a hospital . That is why at the present, and if that was ever legalized, then he would be su bject to any claus es or anything thi ng.

Now he hasn't got the rig ht legal ly. He hasn't the rig ht to provide the service, because it 's not permissible outs ide of a hospital at this time. If the clinic was declared a hospital that might be something else, but he is not providing a service that's insured. MR. D. ORCHARD: You know, Mr. Cha irman, now that's very interesting because that allows anyone who leaves Montreal and says, I'm coming to Manitoba and 1 know I'm go ing to be breaking the law and I'm going to do it anyway, and this cou ld be another specialty practice physician.

Is the Minister saying that he's go ing to be powerless to prevent that from happening? HON. L. DESJARDINS: I'm not a lawyer and I think we all know that this is in front of the cour ts now. A lot depends on what the courts do. lt might be that the federal might have to rectify that or the provinces with some new legislatio n. Right now when Morgentaler performs the service, it is something that normally is covered, but it has to be done in a certain place like a hospital and, in fact , his licence was taken away from him by the Colle ge of Physicians and Sur geons, not us.

Now, he's doing something and it 's qui te clear he's doing something that is illegal. He 's challenging the system and the courts will have to rule. As I say, lawyers would be in a better position to . . . . But, the principle will be the same. We will always fig ht to jus t have one tier, not two tiers of patient or services. Rig ht now, that is not an insured service at all. MR. D. ORCHARD: Mr. Chai rman, I think we'r e into subt leties here and I won't pursue it .

In Cali fornia, for instance, one of the advents in their competitive medical delivery system down the re is basically medical vans that are moved from place to place with a semi-trailer and these medical vans have a complete diag nostic clinic including a CAT Scan in it. Now, is the Minister saying that although CAT Scanning is done at Health Sciences Centr e and at St.

Boniface, that if one of th ose gr oups decided tha t Manitoba was an underserved market and moved into Manitoba and set up on the Polo Park Shopping Mall parking lot, which they apparently do in the United States, to provide service on a walk- through basis to patients, that if those patients wished to pay the MHSC fee for CAT Scanning that they wou ld not be su bject to any penalty under this act either, or prohibitio ns?

Tuesday, 11 June, 1985 ON. L DESJARDINS: My honourable friend is talking >W about concern that we have, and there'll always � these concerns and some of these will be looked :. For instance, rig ht now these corner clinics cou ld � a detriment to the plan as such. It'll be very hard 1 explain that when people feel that they can go and �t a qu art of milk and go and get an examination at 1e same time, but it 's dup licating and it's bringing 10re doctors where there's no need. That is something se.

Now the situation is, I can only repeat what I said efore, that certain services are insured only in certain catio ns. That's what I said about Morgentaler and n saying the same thing about the CAT Scan. Right JW they'r e insured only in two hospitals. There might e some legisl ation. There's always somebody that's ying to beat the system that will have to be looked I, but rig ht now this is the situation. We 'r e talking tlout the insured service now. IR. D.

ORCHARD: Agreed we're talking about the 1su red services, and that's why since this act has no :>plication to someone like Morgen taler, it likewise ould probably have no effect on someone like the (ample I mentioned about a mobile diagn ostic clinic Jming into the province. ON. L. DESJARDINS: I would imagine that in the ase when somebody challenge s the law - and you and can't prevent them from challenging the law - the :>ur ts will have to decide. Now if the cou rts decide gainst the intent of a go vernment, the gov ernment 1en will have to bring in proper legislati on. That was one in B.C. not too long ago.

But the court ruled ertain things that the Department of Health was doing s illegal. They brought in legisla ti on, and now they' re oing the same thing I'm to ld. So these are things that my honourable friend is jus t ointing out that we'll have to be carefu l at all times. 's not only true of the medical care but, rig ht now, tis act deals with insured services. Those services are ot insured except in certain places. You can go and see a physiotherapist privately; he's ot covered, not insured. He charges what he wants, ut we'r e trying to cover it through the hospitals.

That ; covered, and there are physiot herapists on salary tere. IR. D. ORCHARD: Mr. Chairman, I thought the rovisions of this bill were giving the Minister of Health , nbeknownst to the Atto rney-G eneral, a method of olving the Morgentaler problem . Now he's telling me tat's not the case. ION. L. DESJARDINS: I wish it was. No, the intent ras exactly as I said. There are no hidden motives ere at all. IR. CHA IRMAN: Cla use 2- pass; Title- pass. Mr. Mercier. IR. G. MERCIER: Mr. Chai rman, it 's certainly a matter ,f record that the opposition Con servative Party have up ported the bill and will suppor t the bill.

However, would like to put on the record my personal views 57 with respect to the bill. In my opinion, it strikes a blow against individual freedom, the freedom of individual doctors to practise outs ide of a gov ernment system and the freedom of individual citizens to obtain medical services outs ide of a gov ernment system. Mr. Cha irman, the practical fact of the matter is that the Medicare system is a very attractive system to medical doctors, because they can avoid the problems of outstan ding account s.

There is no pro blem in collecting 100 percent of your accounts, because it all go es through the gov ernment. In effect, if there were a change in what has been proposed, I wou ld anticipate there would be very few doctors in Manitoba or Canada who wou ld practise outs ide of the system . But in principle, Mr. Cha irman, it is a blow to individual freedoms. I'm disappointed, Mr.

Cha irman, and it's not jus t in respect to this Minister, but with respect to the federal parties, that they have not considered other alternatives such as an independent committee that cou ld review concerns by doctors that fees approved by government bodies did not meet the costs of providing those services where allegati ons. of excessive overbilling - and the Minister in the past , I believe, has indicated ther e is really no problem in Manitoba - but if there were allega tions that those could be considered by an independent committee and ruled on. Mr.

Chai rman, we've heard the suggestions of doctors before this committee and the concern expressed with respect to the improvement of the qua lity of the health care system . While the Minister has said in previous discussio ns that these concerns have been expressed in the past and haven't proven to be true, they certainly offered to the committees the basis of having some real concerns in this particu lar area. Mr.

Cha irman, we have a bill that leaves the medical profession at the mercy of any go vernment in power and the Manitoba Health Services Commi ssion to provide an appropriate fee for the service they render. Once again , Mr. Cha irman, as I did in speaking on the second reading of this bill, I simply want to express th ose concerns. · HON. W. PARASIUK: Mr. Cha irman, I'm going to partake in this debate on the basis of the comments just made by the Mem ber for St. Norbert. I think he wants to come down on both sides of the fence.

John Stu art Mill once said that "Freed om without limits is like a room without walls." I believe that what we have here is a very sensible system. it 's a system that provides for no extra billing and provides for arbitration. lt is what doctors themselves have tal ked about. The vast majority of doct ors have said it 's a fair system . One other system conceivably could be that you could have extra billing, but have those who extra bill not receive one cent from Medicare. The doctors have said that the y do not like that type of freedom. They want to be part of the Medicare system.

I think that this is a fundamental que stion. If, in fact, you have a fair system tha t provid es uni versal accessibility to al l, why woul d you have some doctors charging more to provide a different type of care to a certain portion of your society? lt then, in my estimation, provides a very different perception of society than I have and th at I think my colleagues have.

Tuesday, 11 June, 1985 There has to be freedom based on some ability to pay. I look at our system in Canada which has tried to provide universal accessibility and has done so in a fair way, and I compare it to the United States system where I think the United Sta tes spend something in the order of about 9.9 percent of gr oss national product - of their economic out put, 9.9 percent is spent on health care. In Canada, I believe that it's something in the order of about 7.8 percent, 7.6 percent. Jus t think of the value we get for our 7.6 percent or 7.8 percent expenditur e.

Ju st think of the type of medical system that we have. Do those people who were laid off in the United States and, after six months of being laid off, lost all their Medicare benefits that they might have negoti ated as part of their collective ag reement, did they have any type of freedom?

Did they have any type of secu rity when that happened to them because, during the course of their recession in 1981, 1982 and part of 1983, they indicated that there were literally millions of people who were put in that position. · I know of a specific case of a person in San Francisco who is 63 years old and has to pay a private insurance premium of $2,400 - $2,400 at the age of 63 - and she has some medical problems so she is terrified. Obviously she is between a rock and a hard place. What type of freedom do those people have?

So I believe that the whole notion of Medicare was to provide a system where people weren't insecu re; where they weren't terrified and you try and do that in a fair and equitable way to all parties. I think it's important that we try and improve Medicare as we proceed . The danger to Medicare can indeed come from ·g overnments that aren't fair.

That's why the doctors were looking for arbitration, but if I was someone who was part of a health care system , either as a deliverer of health care, as a doctor or a nurse or a nurse's aide; or as a recipient of health care, namely, a patient, I would be terrified of a gov ernment such as exists in B.C., where you wou ld have the prospect of massive cut-ba ck. I find it surprising - and I don't say that the Mem ber for St.

Norbert is of that ilk - but there are other people who have criticized the notion of extra billing or limiting extra billing, who come from that fairly extreme position; who argue th at somehow this restricts liberty, while at the same time their very act ions, while in go vernment or in support of gov ernment is to, in fact, take away the freedom too from a lot of people in B. C. or in other parts of this count ry. 58 So I don't believe that the people of Manitoba have anything to fear; in fact , they will be benefit ing a lot from this.

I think we will in fact be setting a very good model for the rest of the countr y. Certai nly I think there can be differences, as the Member for St. Norbert has put forward, and I respond to his comments in a general way. I do not attack him personally. I just say that that position has been put forward in this cou ntry by a lot of other people who have not tried to protect the health care system; who have not tr ied to provide an underpi nning to it; who have not provided fairness and equ ity to it.

I think that when one has to balance out freedom - freedom from as well as freedom to - then I think that one has to come down 100 percent in favour of this leg islation, which I think we are very proud to do on this side. · MR. C. SANTOS: Thank you , Mr. Chairman. I'd like to supp ort what my colleagues have said. I think that in our society there can be no freedom to the fulle st absolute limit without responsibility. To say that there can be freedom without responsibility is to . advance anarchy in our society. There can be no responsi bility without legitima te institutional limits.

Individual freedom without limits amounts to a system whereby the st rong take advantage of the weak and the weak are helpless. If society and civilization are to survive, there must be a system whereby the powers of the economically strong can be limited in order to protect the weak. Another point I'd like to make, Mr. Chairman, is that th ose who have the benefit under any system must also share in the burden.

The members of the medical pro fess ion and the mem bers of the chi rop ractic profession who want to take advantage of the benefits offered by Medicare, must also share in the bu rden, in order to keep the system efficient, affordable and workable, for the benefit and welfare of all the people of Manitoba. Thank you. MR. CHA IRMAN: Title- pass;

Preamble- pass; Bill be reported . That completes Bill No. 2. That was the only bill on the notic e for the Law Amendments meeting. There are sti ll th ree other bills pending. Wha t is the will of the commit tee? Commit tee rise. COMMITTEE ROSE AT: 11:29 a.m.