William Gordon RITCHIE

RITCHIE, William Gordon, M.D.

Personal Data

Progressive Conservative
Dauphin (Manitoba)
Birth Date
September 27, 1918
Deceased Date
November 20, 1998
physician, surgeon

Parliamentary Career

June 25, 1968 - September 1, 1972
  Dauphin (Manitoba)
October 30, 1972 - May 9, 1974
  Dauphin (Manitoba)
July 8, 1974 - March 26, 1979
  Dauphin (Manitoba)
May 22, 1979 - December 14, 1979
  Dauphin (Manitoba)

Most Recent Speeches (Page 5 of 197)

December 4, 1978

Mr. Gordon Ritchie (Dauphin):

Mr. Speaker, I have a question for the right hon. Prime Minister. Can he inform the House whether the new Russian Mig fighters in Cuba represent an escalation of international tensions at this time?

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December 4, 1978

Mr. Ritchie:

Can the Prime Minister say whether they represent a threat to the security of this continent and, if they do, as they are reported to have the most advanced design with nuclear capabilities, has the government any information as to whether or not there are nuclear weapons in Cuba?

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November 28, 1978

Mr. Gordon Ritchie (Dauphin):

Mr. Speaker, it is with considerable interest that I rise to speak on this bill. Perhaps it is somewhat sad to have to speak about a program, which was of considerable value, being phased out. In retrospect, it seems obvious that it is really a return to the 1960s when there was a vast push by the federal government to inflict on the provinces a heavy burden in the comprehensive health care system, over provincial objections in many cases. The principle of universality was thrust on the provinces, a move which will now have to be limited. We recognize now that these plans cannot be continued. I should like to say to my friend, the hon. member for Yorkton-Melville (Mr. Nystrom), speaking of the record in the province of Manitoba, that in the last 13 months 12,000 new jobs have been created, almost as many as the government of Mr. Schreyer created in the last three years.

Speaking of the health resource fund, it seemed like one of the better ones in that it trained people in the health professions or in occupations associated with the health professions, and in conducting research in the health field. Now that the fund is being wiped out by the federal government, the tab will have to be picked up by the provincial taxpayer or the programs will have to be deleted altogether.

It is unfortunate that the type of programs financed by this fund will fall short, and that any research program that was started in the previous three years will be wasted in view of the fact that programs are based on a five-year period. In fact, most of the programs which are in the mill, so to speak, will be of little value. Furthermore, education and research, have been the most promising fields for governments so far as health return is concerned, because the education of professionals in the area of health has brought a return over many years.

I should like to say that when the Fathers of Confederation designated the provinces to care for the health, welfare and education of their citizens, they chose very wisely. The strains on confederation in the last ten years can be directly attributed to the move of the federal government into the tax Field through income tax in order to finance the federal government's incursion into health, welfare and education, areas which rightly belong to the provinces. Previous Liberal administrations have inflicted on our citizens grandiose health plans which we find we cannot now sustain. The federal

November 28, 1978

government is washing its hands of the dollars needed for health care and allowing the provinces to make do as best they can, all the while attempting to force on the provinces expanded language training, thus moving into areas under their jurisdiction.

I would like to use this opportunity to discuss some of the problems associated with medical practice and health care. This bill only deals with one small portion of health care, but I should like to point out the differences between the health professions and the government and the direction of medical care in this country. Also, I should like to point out some means by which we might avoid some of the bad features of the socialized government health care system which we have at present. Although 1 will speak mainly of physicians in the health care field, I would like to include also other professionals involved in the health care delivery system. When I use the term physician, other disciplines in the health field are included.

There are many points of conflict between doctors and politicians, but the most fundamental one is their differing attitudes toward individual patients. Doctors who devote their professional lives to the care of patients like to feel that they have a duty to their patients on an individual basis in a one to one relationship. This is where the conflict arises between the attitude of the doctor and that of the politician who claims to have a much wider responsibility for the health of the people, so that he is not primarily interested in providing the best possible care for individual patients but is more interested in providing that care for as many people as possible, within the constraints of the available resources. The tension between the groups arises because of the demands of the individual and the priorities of the doctor, and the demands of the group and the priorities of the politician.

Politicians and doctors in their respective ways attempt to act for the good of individuals, but the doctor's action is a narrow one while the politician's is much broader. The conflict between the two groups may be summarized thus: the politician wishes to ensure that scarce skills are used for the general good, while the doctor who is confronted by a sick patient sees the good of the patient as the dominant factor. Doctors struggle for what they consider to be professional freedom and independence, whereas politicians put the need of public provision and public decisions over private decisions in health care.

Mr. Enoch Powell, the minister of health in Britain in the previous Conservative administration, has pointed out that one of the basic attitudes of the medical profession is respect for the independent and individual professional judgment made for the benefit of individual patients, whereas the politicians' concern is with the general consequences of individual decisions or, as he stated:

The politician practices the subordination of individual judgments, while the doctor glories in the development and exercise of it.

There are other aspects to the politician. Politicians can achieve nothing without power, and in order to attain power in a democratic society they need votes. To win votes, they must convince the voters that their programs are worthy of support.

Health Resources Fund Act

Therefore it is easy to see that in the decades gone by, packages of health care programs, growing greater and more elaborate, have strained our resources, along with other transfer programs, to the extent that one-quarter of every dollar spent by the federal government has to be borrowed. Certainly this cannot continue. Of course politicians must be concerned with the health of the nation in broad terms. The scope of modern medicine is so broad and costly, and the expectations of the public so high, that politicians have become more involved in health care programs, particularly where there appear to be inequities both in terms of access and in the ability of individuals to provide for their own medical needs.

It is interesting to note that in the United Kingdom the dialogue between doctors and the state has been a long and continuing battle. Medical physicians in the United Kingdom have been attempting to preserve some independence, while the state has attempted largely to control their actions and limit their freedom of treatment. One of the great difficulties was the approach of the state to health care programs. The conventional feeling was that poor health is the direct result of poor medical care, and that if the health of the nation could be brought up to standard, then the need for medical treatment would diminish. But time has proven that the demand for health and medical care is insatiable, and that we can expect ever-increasing demands on the nation's resources of money and workers to feed this persistent expanding demand.

Medical care brings with it infinite demand on finite resources. Furthermore, it brings to the political side the necessity to make decisions as to whether primary care should be provided. Should primary care be provided by an office staffed with highly and expensively trained doctors, or should this be done by less trained and presumably cheaper professionals? Should there be increased services for the elderly and infirm? In what manner should these increased services be carried out?

At the present time there is a drive to reduce acute care beds on the basis that they are expensive and unnecessary. But, in practice, acute care beds are occupied by the productive age group of society. Keeping them out of hospital beds only prolongs their absence from work. Outpatient treatment is now in vogue. In the days of fee for service medicine, outpatient treatment was a means of saving money. But it has its drawbacks: how can we expect many people to drive 50 miles in order to attend at a hospital each morning?

Medicare and hospitalization have been installed for a number of years. They were patterned on the private experience previous to the inauguration of the health care program. But so many years have passed now that the experience of private medicine has been blurred and no longer provides signposts for guidelines. New planning must come into effect, and it must be done by people who have little actual contact with the medical world for which they will be responsible. It must come from either Ottawa or the provincial capitals. With the thrust of the bill before us, it would seem that Ottawa is

November 28, 1978

Health Resources Fund Act

tending toward getting out of this area. In the long run it will be good idea, but it poses a number of problems.

At the present time we have reached a situation where the health care system requires reorganization. Some questions must be asked. How can the health care program be constructed and administered? We must decide on the global sum available to finance such a program. How will the global sum be apportioned regionally and locally? How can individuals attain access to the system? How will physicians and others in the system be paid? In what manner will they be paid?

The obvious disadvantage of such a system is that political expediency may make the state decide to construct a health care system which does not recognize the genuine needs of patients. Because health care is more infinite in its demands and resources are finite, perhaps politicians will have to minimize expenditures on health care so that other social policies can be pursued. Politicians run from one social program to another expending their energies, particularly in an attempt to ingratiate themselves with the electorate. An attempt at distributing resources to provide an adequate level for all certainly will downgrade the maintenance of high standards and threaten excellence. The creation of a monopoly in health care will remove freedom of choice almost completely, except in a few cases.

What about physicians themselves? Individually patients usually trust their physicians, but society as a whole does not care much for doctors. Of course doctors are no different than any other professional. I should like to refer to what Samuel Hartlip once wrote of Puritan times. It reads as follows:

The liberty of our Commonwealth is most infringed by three sorts of men- priests, physicians and lawyers. The one deceives man in matters belonging to their souls, the other in matters belonging to their bodies, and the third in matters belonging to their estates.

Indeed the profession seemed to be under some kind of attack. Now some suggests doctors must administer a proper professional altruism, while others think the public expects too much of doctors. In a general way, perhaps society expects doctors to display unalloyed altruism, and indicates surprise and indignation when doctors take on the habits of the larger society of which they are a part.

Students of the welfare state have expressed some views as to where we are going. One suggestion was that the welfare state, as we understand it, more properly should be called "the entitlement state". People accepting welfare from the state now feel they are entitled to a considerable portion of the nation's largesse, regardless of their contribution to it. Perhaps it can be described as the expectation of the ultimate responsibility of public authority that individuals are not permitted to suffer persistent deprivation and despair. We have reached the stage where we feel no one should be deprived, but this poses a challenge to both freedom and responsibility.

One can well ask how we can revive and preserve in an entitlement state the sense that rights must be earned. Entitlement is not a one way street. Society demands a contribution to the whole, not each individual securing for himself as much as he can. The transition from a welfare state to an entitlement

state will result in great disruption of benefits, unless individuals capable of accepting responsibility for their welfare are encouraged to do so.

I would regard this bill as a high water mark. In a sense it can be used to signal a new era. It can be used to ensure that those who can afford to provide their own health benefits will do so at their own expense, either totally or partially.

The criteria laid down by the federal government in many cost-shared programs always were too rigid. Many provinces had different plans to limit and provide control over the infinite demands of free health care service. Even though the federal government still provides a large amount of money, it should loosen demands and constraints in order to allow the provinces leeway to innovate and make health care delivery systems suitable to peculiar circumstances and regions.

The retention of the fee-for-service provided a much better method of payment to physicians than a total salaried or a per capitation service. A salaried system would be inappropriate because it is very difficult, as we are now finding within the civil service, to measure productivity. At one time it was thought that fee-for-service would be expensive and make for excessive medical income, but it seems to have turned out just the opposite. Medical fees have not risen as fast as the wage structure has in the early 1970s. Those who practice in offices have had their overheads substantially increased to the point where 50 per cent of their gross fees now go to overhead expenditures, as compared with 35 per cent a few years ago. Nearly all the offices of which I am aware have had little increase in actual dollars in the last few years, and if you consider inflation they have suffered a decrease in their income. This has resulted in the migratrion of physicians to the United States, particularly those who are ambitious, energetic and perhaps individualistic and who have generally found that the practice of medicine in that country has less bureaucratic interference, and that they can practice a better standard of medicine in their own individual way.

Under the present fee structure in Canada it is impossible for a physician to spend much time with an individual patient and still have a high enough income to make the profession worth while. Many doctors have stated that each year they average one or two more consultations per day. An older practitioner once said there is no way under the present fee structure that he could give the time he would like to give to individual patients and still make an adequate income or even keep his office overhead at bay. Nevertheless, the fee-for-service system has allowed physicians to give extra service and consultation to patients who wish it over and above what the medical plans allow. The plan has allowed these physicians to charge extra, enabling them to limit this demand and at the same time satisfy their patients' requests for greater care. Perhaps the provincial agency could encourage physicians who wish to practice in this manner to take on patients who may wish the extra care.

[Mr. Ritchie.)

November 28, 1978

However, there is a tendency for bureaucrats to be suspicious of both physicians and patients who depart from the accepted pattern. Doctors are limited in practising outside the plan even though there is a demand for their services over and above what the plan allows. In fact if this demand grows, it indicates, presumably, that either fees are too low, the government's pay is too low, or that there are not enough physicians to go around.

As I said, Canada has lost some of its doctors to the United States. I do not consider the loss serious, however, because we are probably in an oversupply situation, and with the immigration of doctors into Canada from other parts of the world, I am sure that we have adequate numbers, even though they may not be distributed quite the way people would like.

At the hospital level, it is obvious that great changes are taking place and that bureaucratic administration, of necessity, seems to be an all-encompassing grey blanket over the time of physicians and other health care professions. I would estimate that fully one third of a physician's time in a small general hospital is taken up with paper work, which takes away from the medical treatment for patients, but seems to be necessary to get through the bureaucratic jungle of a hospital. The accreditation service of hospitals may have originally been a help, but it has created a vast waste in terms of the time of physicians, management and other staff within the hospitals, who must get ready for the visit of the often uninformed inspector who comes from an entirely different environment.

It seems to me that hospitals should be encouraged to set aside a small number of beds for patients who desire privacy or admission at their convenience and are willing to pay for it. I have already stated that there is an infinite demand for medical service today, but only finite resources. The rate charged for those wishing these special services would have to be high enough to return to the hospital enough extra income to provide for some of the amenities, but more than that, would provide extra funds at the administrative level for their own use. One of the great difficulties of hospital management is that they have no money to spend on their own, but are controlled by the provincial paying agency.

Of necessity, health care and health decisions must be made by managers who are not themselves health professionals, and it is difficult for them to understand the rationale of health decisions. The management of hospitals and general medical care must become more divorced from the day to day operations of medical care. Unless conditions change, many professionals now in the health care field will leave and take up other endeavours where the pay and conditions of work are better and where they would not have to work under a non-understanding bureaucracy.

I am glad that I have had this opportunity, Mr. Speaker, to put on the record some of my thoughts with regard to health care, of which this bill forms a small part.

Export Development Act

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November 14, 1978

Mr. Gordon Ritchie (Dauphin):

Mr. Speaker, I would like to say a few words on this borrowing bill and to reiterate our concern about the difficult situation in which we find ourselves with the ever increasing deficit which we are running. For instance, in the two years from 1966 to 1968, the net financing requirement of the Government of Canada was for $2,578 million; from 1969 to 1971, the financing requirements were for $3,671 million; from 1972 to 1974, the financing requirements were for $3,271 million; and from 1975 to 1977, they were for $14,334 million. The projected figure for 1978-1979 is over $20 billion; that is not taking into account the foreign borrowings with which this bill is dealing.

I think these figures are significant. For instance, in the two years from 1969 to 1971, the deficit amounted to $3,671 million, or an average of $1.8 billion a year. The g.n.p. for this year is projected to be around $260 billion, but in 1971 constant dollars it was only $130 billion. So, in effect, our deficit is around five to six times what it was in 1971, based on the value of the dollar that year.

I think we should also remember how the government, through inflation, has taken a great deal of money from bond holders. It has filched that money from them through the mechanics of inflation. For instance, a $1,000 bond bought in

1971 would only be worth $500 in buying power today, based on the present inflation rate. How long can we continue to be bond holders if we are rooked this way? Taking out a Canada bond is an invitation to certain loss, because not only will the bond purchaser see the value of his bond depreciate by 10 per cent a year, but he will also be taxed on the interest, so that he will not even be able to keep even.

When the Government of Canada, in the two years from

1972 to 1974, had a deficit of $3,271 million, the Bank of Canada purchased $2,172 million, or 66 per cent of that deficit. It meant that the bank just monetized the debt. It did not take the money from the public or out of its savings, but merely printed money to carry us through. What we must keep in mind in discussing this amendment to the bill is: Will the Canada Savings Bonds which are now being sold be taken up? Will we have enough in borrowings to cover the $10 billion to $11 billion necessary for this year, and how much money will the Bank of Canada print? I suspect the amount will be pretty substantial.

It is obvious that the inflationary pressures are continuing. In today's issue of the Globe and Mail, an article in the report on business is entitled "Money growth rate causes concern." It is written by Hugh Anderson who states the following:

November 14, 1978

Increasing concern over the high rate of growth in the money supply in both Canada and the United States is being shown by financial market commentators.

The situation is more clear-cut south of the border, where the picture is not clouded by such temporary phenomena as a postal strike and a banking year end.

The article goes on to say that it has been concluded:

-that money supply growth will have to be curtailed if the Federal Reserve Board's targets are to be met.

Speaking of Canada, Hugh Anderson has this to say:

Similar problems may well be building up in Canada where the chart lines showing the rate of growth in M-l have shot well above the Bank of Canada's target range of 6 to 10 per cent, measured on a weekly basis. The central bank has warned that recent numbers may be misleading because of the unknown effects of the brief postal stoppage last month ...

The fact remains, however, that curbing money supply growth seems likely to become a preoccupation for the central bank . . .

It seems to me that the somewhat more vigorous rate of Canadian economic growth expected in 1979 and the amount of federal debt to be monetized both suggest further upward pressure on M-l after the January-February seasonal decline.

The problem of inflation remains with us, and much of what we will be seeing and watching for depends on the success or otherwise of the recent issue of Canada Savings Bonds-on how many of these bonds will be taken up by the Bank of Canada.

The real wages of the average Canadian worker are falling because prices are rising faster than his pay. The normal and natural thing for him to do is to try to get enough pay to keep his standard of living from falling any further. But the government has been trying to persuade him to grit his teeth. As the deputy governor of the Bank of Canada stated:

Canadians will be wise enough to recognize that the burst in consumer prices is temporary and that it should be met with moderation and patience.

But is this inflation temporary? I doubt it. What are some of the indications? We find that wholesale prices are on the rise, which is a fairly sure indicator of inflation down the road. It is a sign of higher retail prices to come. Until recently, the wholesale price index has been trailing behind the consumer price index, but it has now surged ahead and is quoted at 14 per cent for September.

High interest rates are both an indication and a cause of high inflation to come. One element in interest rates is an allowance for future inflation. At the same time, increased interest rates feed into prices by raising costs of production, of construction and of holding inventories.

Those of us who have studied the inflationary process since as far back as 1970 have noted, as did the current finance committee, that the real interest rate had to be 3 per cent and that anything above that figure was what the lender expected inflation to be; and since he made that allowance, the raised interest rates and the higher inflation were taken into account by him.

We are likely to get secondhand inflationary pressure as a result of the slump in the U.S. dollar, and of course our dollar has slumped much more. The U.S. dollar has dropped 20 per cent in relation to the German mark and more in relation to

Borrowing Authority Act

the Japanese yen. Therefore, we are bound to have inflation as a result.

The U.S. president has attempted to contain inflation through voluntary guidelines. Where can he hope to go? We have had them in Canada. We had the Food Prices Review Board and voluntary guidelines. This indicates that they are merely a smokescreen to obscure what is really happening. Inflation is like a hot potato, tossed from one section of the economy to another, each sector hoping that the other one will take it up. Labour will decline to hang on to the hot potato of the inflationary spiral without demanding further wage increases, which bring on the demand for wage and price controls. The borrowings indicate that our accounts are pretty well out of control. The seeking of additional borrowings indicates the bad state of our economy.

I should like to refer to the recent takeover of Phillips Petroleum by Petro-Canada. That takeover does not seem to make much sense. This company was paying taxes, and I understand that it was a well-run company. It is being taken over by Petro-Canada, which takeover will be financed by the borrowing of American dollars. Perhaps one can say that this is the repatriation of a company which is owned approximately 70 per cent by United States interests.

Is exchanging equity for a mortgage any better? In a mortgage the interest and principal must be repaid, regardless of whether Petro-Canada makes any money or what its profitability is, whereas when there is equity investment and the company does not make money, the people who have invested in the company do not receive dividends either. To go forward with the borrowing of SI billion to buy a well-established company in Canada makes no sense at this time. It increases liabilities by another $1 billion. The government has said that it is not responsible. As a federal company, Petro-Canada in the final analysis must be backed up by the Canadian government. Its borrowings and losses are picked up by the government.

Last spring the Export Development Act was before the House. Everyone who studied that act realized that in effect the Government of Canada was the covenant for the borrowing of the Export Development Corporation. On that occasion the government was honest enough to admit, if the worst came to the worst, that EDC could call upon the federal treasury to cover its borrowings. The Export Development Corporation raised money in the Eurodollar market, which action increased the pressure on the United States dollar.

In the Eurodollar market, the holders of foreign dollars have a defence against the devaluation of the American dollar and hence the Canadian dollar. They create more dollars by borrowing. Loans create deposits faster than engraving greenbacks. All the Eurodollar need to do is increase strong currency loans to Eurodollar accounts, thereby building up dollar deposits without an obligation to liquidate assets put up as collateral. In effect, EDC is adding to our debt responsibility abroad by borrowing in the Eurodollar market. In turn, pres-

November 14, 1978

Borrowing Authority Act

sures are created on the American dollar and finally the Canadian dollar.

The objective of this amendment is to ensure that this act shall come into force on a date, after royal assent, to be fixed by proclamation. To date it back to November 1, 1978 is not in the best interests of this legislation. I hope the government and hon. members see fit to support the amendment before the Elouse at this time.

[ Translation]

Mir. Herb Breau (Gloucester): Mr. Speaker, I am glad to rise on the amendment put forward by the hon. member for York-Simcoe (Mr. Stevens) at the report stage of Bill C-7, an act to provide the government with supplementary borrowing authority for the fiscal year 1978-79.

First of all, I should like to say that I am against the amendment because I think that it is useless and, second, that it is contrary to parliamentary practice relating to government business put before parliament, that is to say that on budget or tax matters it is normal for the government to propose legislation subject to parliament approval. When the government introduced this legislation at the outset, it felt that to ensure the orderly issue of Canada Savings Bonds it was better to have a set date for the coming into force of such a legislation once passed by parliament, that is November 1, which coincides with the issue of the new Canada Savings Bonds series.

So that is why I find the amendment moved by the hon. member for York-Simcoe to be useless and contrary to the practice in budget and tax matters put before parliament. However, Mr. Speaker, I want to speak on that amendment and on the general issue, because it should be noted that we are now merely discussing the question of increasing the borrowing authority of the federal government and not necessarily of authorizing expenditures. During the debate on second reading of Bill C-7, as in committee, I was a member of the Standing Committee on Finance, Trade and Economic Affairs, when members criticized the bill they wanted to deal with government expenditures. The bill does not provide for any government expenditure but it is aimed at allowing the government to increase its borrowing authority. Of course, if the government is borrowing, before those expenditures can be made, they must be approved by parliament. This is not a debate on government expenditures but on whether or not to increase the borrowing authority of the government. Once the government has borrowed, before spending that money, it must obtain authority to do so.

In this debate we are obviously getting the same reaction from the Conservative party when they tell us that the government spends too much, that government borrowings will fuel inflation, that its spending is ill-conceived, that its intervention in the Canadian economy is excessive, yet in all debates or every day some members on the other side who pretend they speak for their parties have nothing else to do than to propose measures which would imply more government spending.

Whenever the government proposes reductions, the Conservatives stand on both sides of the fence at the same time. On the one hand, they say, "Cut the spending, reduce the government's deficit. You interfere too much in the economy. It's bad." But the minute the government proposes a reduction, the same people on the other side who said "Cut, cut, cut" stand up one after another and say, "It's terrible! You are going to close a laboratory here. Shame, you are going to close a laboratory there. It is awful, you are going to put people on unemployment." Well, Mr. Speaker, the Conservatives should make up their minds about whether they want the government to reduce its intervention in the economy or to increase it.

In my opinion, additional fiscal measures by the government are healthy for the economy. Those who want better redistribution of wealth and more social justice must recognize that it is up to the government to do that on behalf of Canadians. It levies taxes or uses its borrowing power to redistribute this wealth. It is the only way to do it and anyone suggesting that we can build a better society without doing that either fails to understand how the economy works or is being a hypocrite. It is one or the other.

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November 14, 1978

Mr. Gordon Ritchie (Dauphin):

Mr. Speaker, I should like to direct a question to the Minister of Energy, Mines and Resources.

Why did Petro-Canada buy into Phillips Petroleum when it was at the end of a long rise in share prices of the past four

Oral Questions

years and only a year ago averaged $31? On what grounds did Petro-Canada evaluate the purchase, which seems to be some $20 higher than it was on the trading day? Is this to be another Texas Gulf type of transaction, when the CDC bought at the height of the market and the stock has not done very well since?

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