March 26, 1984

GOVERNMENT ORDERS

CANADA HEALTH ACT


The House proceeded to the consideration of Bill C-3, an Act relating to cash contributions by Canada in respect of insured health services provided under provincial health care insurance plans and amounts payable by Canada in respect of extended health care services and to amend and repeal certain Acts in consequence thereof, as reported (with amendments) from the Standing Committee on Health, Welfare and Social Affairs.


LIB

Gildas L. Molgat (Speaker pro tempore)

Liberal

Mr. Speaker:

As Hon. Members are aware, there are seven motions standing on the Notice Paper at the report stage of Bill C-3. Motions Nos. 1, 2 and 3 should be grouped for debate and voted on as follows: Motion No. 1 by itself; a vote on Motion No. 2 will dispose of Motion No. 3. Motions Nos. 4, 5 and 6 will be debated separately and voted on separately. Motion No. 7 seeks to provide a means of disposing of the funds withheld from cash contributions to provinces found not to be in compliance with the Act. Nowhere in the Bill is there any mention of a proposal to dispose of such funds. As a result, the introduction of this kind of provision in the Bill would be entirely irrelevant to the Bill.

[DOT] (1110)

Should the Hon. Member for Winnipeg-Birds Hill (Mr. Blaikie), who is present in the House, wish to present procedural arguments on this motion, I will hear him now, if he wishes to be recognized for this purpose.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Blaikie:

Mr. Speaker, I would like to make this perfectly clear. I take it you are ruling it out of order.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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LIB

Gildas L. Molgat (Speaker pro tempore)

Liberal

Mr. Speaker:

The Chair is trying to indicate to the Hon. Member the thinking of the Chair. Before ruling, the Chair is inviting the Hon. Member to present his arguments. This is a practice we have developed in an attempt to accommodate Members. In fairness to the Hon. Member, I thought he should have an idea of what was in the Speaker's mind.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Blaikie:

Mr. Speaker, I am not sure what bearing this will have on your decision, but this is an amendment which

was regarded as being in order when it was presented in committee. It was debated at that time. It is because I feel strongly about the amendment that I took the opportunity to reintroduce it. We are talking about moneys which the federal Government proposes, through this Bill, to withhold from provinces. We are talking about an identifiable sum of money. That money will go to a particular place, that is to say it will go into the public accounts and stay there presumably, unless of course it is returned to a province, which is another provision in the Bill indicating where the money will go under certain circumstances. In this amendment we are saying that in a different set of circumstances, for example in the case of the federal Government withholding the money permanently, this is how the money shall be spent.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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LIB

Gildas L. Molgat (Speaker pro tempore)

Liberal

Mr. Speaker:

The Chair is prepared to rule at this stage. May I refer Hon. Members to Beauchesne's Fifth Edition, Citation 773(1), which states in part:

An amendment is out of order if it is irrelevant to the bill, beyond its scope-

After hearing the argument of the Hon. Member, it still appears to the Chair that this amendment is irrelevant and beyond the scope of the Bill and, therefore, out of order. I must so rule.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Bill Blaikie (Winnipeg-Birds Hill) moved:

Motion No. 1

That Bill C-3 be amended in Clause 12 by striking out line 10 at page 9 and substituting the following therefor:

"of the cost of insured health services; and

(e) must, in accordance with the regulations of this Act, provide for an acceptable ratio of ward versus private and semi-private beds in hospitals, including hospitals owned or operated by Canada.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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PC

Bruce Halliday

Progressive Conservative

Mr. Bruce Halliday (Oxford) moved:

Motion No. 2

That Bill C-3 be amended in Clause 12 by striking out line 10 at page 9 and substituting the following therefor:

"of the cost of insured health services; and

(e) must provide that all medical practitioners or where applicable, dentists may participate in the plan."

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Bill Blaikie (Winnipeg-Birds Hill) moved:

Motion No. 3

That Bill C-3 be amended in Clause 12 by striking out line 10 at page 9 and substituting the following therefor:

"of the cost of insured health services; and

(e) must provide that any duly qualified medical practitioner and, where applicable, dentist, who has been licensed by the province to practice in the province, may participate in the plan.

March 26, 1984

Canada Health Act

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Blaikie:

Mr. Speaker, I rise on a point of order. I would like to speak to my amendment and then to the amendment of the Hon. Member for Oxford (Mr. Halliday). Must I do that within the same time frame?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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LIB

Gildas L. Molgat (Speaker pro tempore)

Liberal

Mr. Speaker:

The Chair decided that amendments Nos. 1, 2 and 3 would be lumped together for debate but voted on as indicated. No. 1 is voted on separately and No. 2 would dispose of No. 3. The Hon. Member is invited to make his remarks concerning the three amendments in this intervention.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Bill Blaikie (Winnipeg-Birds Hill):

Mr. Speaker, the intent of our amendment with regard to providing for an acceptable ratio of ward versus private and semi-private beds in hospitals is to ensure that the overall goals of the Canada Health Act are indeed achieved throughout the country. One of our concerns is that if this is not specified in the Bill it is possible that a two-tier hospital care system could develop.

We have seen, particularly since 1977, and more specifically in the last couple of years, a trend on the part of certain provincial governments to encourage hospitals to find ways of generating revenue on their own. One way to achieve that, of course, is by turning more of their bed capacity over to the classification of private or semi-private rooms so that they generate revenue over and above that which would be generated through ordinary ward beds under the health insurance plan.

We wanted to ensure that this Act would provide a mandate to the Minister of National Health and Welfare to take action, should she or he in the future discern that a province is evading universality and accessibility, with respect to clause 12, by not making a suitable number of beds available under the plan. This is not a new idea and has been done before by regulation. We feel this should be made explicit in the Canada Health Act. If this is not done, a situation could arise where accessibility could be threatened by a lack of availability of ward beds. This would then create a situation in which Canadians would rightly want to insure themselves against the unavailability of those beds, if it were seen as something that is inevitable. Eventually Canadians would feel that they have to take out private health insurance to make sure that they could get a bed when they needed it because the hospitals in their area were following that kind of policy. Very soon, the very thing we are trying to prevent in this Bill, through elimination of extra billing and user fees, could take place with respect to the availability of beds. Therefore, this amendment seems to be self-evidently in keeping with the spirit of the Canada Health Act.

I did not see any reason in committee and I do not see any reason now why this amendment cannot be enshrined in the Bill.

The amendment proposed by the Hon. Member for Oxford is a reintroduction of an amendment many of us tried to move in committee in various forms which would meet what I consider to be the very legitimate concerns of the Canadian

Association of Interns and Residents, which is that all people who graduate from medicine and are licensed to practice medicine should be able to do so in the plan wherever they so choose, so long as they want to meet the conditions of the plan.

I am not saying doctors who want to extra-bill in a province where extra billing has been outlawed should be able to operate within the plan. That is not the kind of right we are talking about. We are talking about the right of physicians to have geographical freedom within a particular province. This Bill is directed at what is going on in British Columbia and what could go on in many other provinces where we find provincial governments, through the limitation of billing numbers per area, restricting the right of physicians to practise in a particular area. I think this is something that should be addressed in another way. If provinces want to find ways of redistributing physician manpower, then there must be a way that is more acceptable than refusing the right to practise in this way, particularly when you consider that there are people now graduating from our medical colleges who are now interns and residents and who, if they want to practise in B.C., for instance, face the possibility of not being able to do so. Also, as was pointed out to me by people concerned, there is one case where a husband got a billing number and the wife did not. The wife is also a physician. The only way she could practise medicine was to move away from where her husband was living and practise somewhere else. That is completely unacceptable. We have an opportunity to do something about that in this Bill. This amendment is the result of many, many refinements. I see no reason, nor, I am sure, does the Hon. Member for Oxford why we could not meet in the Bill those very legitimate concerns of the Canadian Association of Interns and Residents.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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LIB

Monique Bégin (Minister of National Health and Welfare)

Liberal

Hon. Monique Begin (Minister of National Health and Welfare):

Mr. Speaker, if I understand correctly, the New Democratic Party Member, the party critic, has just spoken to motions No. 1, No. 2 and No. 3. Regarding motion No. 1, his Party is asking us to amend the Bill to include "an acceptable ratio of ward" (beds), which are usually four to a room, versus semi-private beds, which are two to a room, and private rooms.

We have already discussed the motion in Committee, where it was decided to drop the proposal. The point I raised at the time was, that by including a provision for ward beds in the Bill, we would be putting an additional and unnecessary constraint on the system, and that for the time being, the situation was not alarming anywhere in Canada, and that in any case, the federal Minister could use regulatory powers existing under the Act, if necessary, and without having to resort to an amendment, could pass regulations and discuss them with the provinces, as I said before.

I do not remember exactly what the statistics are, but in Ontario, for instance, which has the largest population of any province in Canada, two-thirds of hospital-days for all kinds of

March 26, 1984

patients are attributed to wards. In fact, public demand is for private or semi-private rooms rather than wards. Since I have been Minister of Health, there have never been, to my knowledge, any complaints from Canadians because they did not have access to a ward. If a patient wants to be on a ward, in other words, a room with four beds, the hospital is obliged to provide the bed free of charge, and if the hospital in question has no ward available, it must provide a semi-private or private room, without extra charge.

I believe this answers the question raised by motion No. 1.

[DOT] 0125)

We discussed Motion No. 2 a great deal because it causes concern to all members of the Standing Committee on Health, Welfare and Social Affairs. The spirit of the motion, if not the exact wording, was defeated.

The motion put forward by the Hon. Member for Oxford (Mr. Halliday) is well intentioned; it wants to overcome a new problem in the system which refers to procedures used by provinces to control the number and distribution of doctors when this applies. It applies in many parts of Canada as we have a great number of doctors in proportion to the population. If provinces had a special practice it was usually to provide positive, financial incentives. This technique has worked best in the experience that has been accumulated, coupled with other incentives such as refresher courses and material or professional incentives. One province tackled the problem by a disincentive, a reduction in salary. Another province started the practice of issuing billing numbers through a provincial mechanism and commission in a way that could be considered discriminatory.

After a study of the legislation by the Department of Justice, we think that medical practitioners are protected for practising within medicare through the concept of reasonable compensation. In other words, it is not for the federal Government to decide where doctors will settle, once they are licensed; this is purely a provincial matter. Through federal legislation regarding conditions for federal funding, however, reasonable compensation must be provided for all medical practitioners who practise within medicare and provide insured services. We think that medical practitioners who provide insured services must be reasonably compensated. They should have a billing number. Individuals or groups-although the latter must be verified-could take a provincial government to court if this were denied to a medical practitioner who provided insured health services.

Motion No. 3 was also presented by the health critic of the New Democratic Party and in a way has the same meaning as Motion No. 2. Unless Hon. Members have questions on it, therefore, I think I have made the point and should not take up more time of the House.

[DOT] (1130)

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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PC

Bruce Halliday

Progressive Conservative

Mr. Bruce Halliday (Oxford):

Mr. Speaker, we are debating Motions Nos. 1, 2 and 3 this morning. All three deal with

Canada Health Act

Clause 12 of Bill C-3. Clause 12 defines the requirements that will be expected of the provinces with respect to accessibility to the health care plan in any province. It makes a lot of sense that there should be something in the Bill to provide for a uniform type of insured health service with uniform terms and conditions, as paragraph (a) of Clause 12 provides. Similarly, there should be a tariff payable to physicians and other health practitioners. We take no issue with that whatsoever.

As both the Hon. Member for Winnipeg-Birds Hill (Mr. Blaikie) and the Minister have said, we are concerned that there are changes taking place in the administration of health care in the provinces. Because of the perceived over-supply of doctors and perhaps an under-supply of doctors in certain areas, attempts are being made at the provincial level to limit the number of physicians permitted to practise in a specific area of a province. British Columbia has found a method whereby it can do this by refusing a billing number to a physician.

The Canadian Association of Interns and Residents, as can be surmised from the name, represents the up and coming professionals. They realize that the way the Act is presently written, they have no protection whatsoever. After having spent many years in universities, medical schools and one to six years of interning, graduating and getting a licence to practice, having been granted a licence to practice in any given province-and we must remember the provinces control the education, training, admission to medical schools and the licensing of these physicians-they can then be told by the province that even though they have completed their course successfully and are licensed to practice, they are not going to receive a billing number.

The Canadian Association of Interns and Residents perceived this as a real threat to them after having spent up to ten years trying to learn their profession. For all practical purposes they may not be allowed to practise in their own province. They could practise outside the plan. Across this country, 95 per cent of the physicians want to be in a plan if it is a suitable plan.

The Canadian Association of Interns and Residents are to be commended on the effort they made during the committee stage of this Bill. They had representatives in attendance the whole time the Bill was before the committee. From time to time they supplied us with various amendments which would take care of their problem. They consulted with leading constitutional experts regarding the legality of such amendments. They were assured by the authorities that the amendment would not be in conflict in any constitutional way.

It was my impression as well as that of my colleagues from all Parties on the committee that there should be protection for these young graduate doctors. I believe it is fair to say that the Government feels the same way. For some reason, however, there is not an amendment in the Bill or a change to give the protection that these interns must have.

The Government raises the argument that possibly there will be some difficulty inasmuch as we are perceived as intruding into the provincial domain. The whole Bill is an intrusion into

March 26, 1984

Canada Health Act

the provincial domain in one way or another. The amendment of the Hon. Member for Winnipeg-Birds Hill and my amendment in no way take away the ability of the province to license and qualify physicians to practise in their province. All the amendments say is that if they are to be given that right and privilege, it should be extended a bit further to allow them the opportunity of having a billing number so that they can practise within the plan.

I suspect the Minister has received a lot of pressure from the provincial governments. I can understand why it will cause them difficulty. We have a broader obligation. Our main obligation is to protect the interest of all Canadians. We are not doing that by passing a Bill that is discriminatory. A province would not have to allow a physician who is duly qualified and licensed to practise within that plan. This is what concerns Opposition Members.

1 hope that when government Members see the difficulty caused by this Bill to young graduates, they will be prepared to accept either my amendment or the amendment of the Hon. Member for Winnipeg-Birds Hill, which is more complete than my simplified amendment. I would say that when we last consulted with the Association of Interns and Residents on Friday, they found this simplified version that I proposed quite acceptable. I would be willing to vote for both those amendments.

With regard to Motion No. 1 in the name of the Hon. Member for Winnipeg-Birds Hill, we share his concern that there be a sufficient number of public and standard wards available in a hospital. As the Minister pointed out, if a person is admitted to a hospital on an emergency basis and requires hospital accommodation, if all standard ward beds are taken up, they automatically receive private room coverage at no extra cost. There is no extra charge to them.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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NDP

William Alexander (Bill) Blaikie (N.D.P. Caucus Chair)

New Democratic Party

Mr. Blaikie:

What if the private rooms are all full?

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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PC

Bruce Halliday

Progressive Conservative

Mr. Halliday:

They will get a bed somewhere in the hospital. My concern is that this Bill does not provide what Mr. Blaikie is asking for, namely, enough hospital beds. Unfortunately, that part of the health care system is not addressed in this Bill. In spite of Mr. Blaikie's amendment, over the next number of years we will find people in dire straits because the Government has not provided in this Bill any mechanism to increase the availability of hospital beds. In my view, it is unimportant whether it is a private bed, a semi-private bed or a standard ward bed, because we need all three. If Mr. Blaikie is concerned about two-tiered-

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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LIB

Eymard G. Corbin (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

Mr. Deputy Speaker:

Order. I simply wish to draw to the Hon. Member's attention that he must refer to another Hon. Member by his riding.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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PC

Bruce Halliday

Progressive Conservative

Mr. Halliday:

I was doing that, Mr. Speaker, until I was so taken up with my argument that I overlooked it. My apologies to you, Sir.

My point is that there will be a shortage of all three types of beds in the immediate future. Unfortunately, this Bill does not

take care of that situation. The amendment of the Hon. Member for Winnipeg-Birds Hill will not take care of it either. It will take more than that kind of change to really look after the needs of the health care system.

In conclusion, I and my colleagues in this Party will oppose Motion No. 1. However, we are prepared to support either or both Motions Nos. 2 and 3.

Topic:   GOVERNMENT ORDERS
Subtopic:   CANADA HEALTH ACT
Sub-subtopic:   MEASURE TO AMEND
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March 26, 1984