- The Empire Club of Canada Addresses (Toronto, Canada), 20 Mar 1986, p. 324-335
- Grossman, Larry, Speaker
- Media Type
- Item Type
- The issue of the provincial government's drive to pass the "Health Care Accessibility Act," legislation designed to end extra-billing by Ontario physicians. The speaker's background, especially as Minister of Health, and some of his experiences during that time. Some basic questions about the way health care policy is developed in Ontario and whether the system can keep pace with the changing demands for health care in the eighties. A review of those questions and issues and how they were dealt with during the time that the speaker was Minister of Health. Now, the escalating confrontation between the Government of Ontario and the province's physicians. The common belief by all three political parties in the fundamental principles of universality and accessibility. Differences in how to achieve these basic principles. A detailed exploration and discussion of those differences, with a critical focus on the present government. Some concluding remarks about what the speaker feels is needed for health care reform, and some suggestions as to what can be done.
- Date of Original
- 20 Mar 1986
- Language of Item
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- Full Text
- BUILDING THE NEW ONTARIO
March 20, 1986
Larry Grossman, Q.C., M.P.P. Leader of Her Majesty's Official Opposition, Province of Ontario
The President, Harry T. Seymour, Chairman
Reverend Sir, distinguished head table guests, members and friends of The Empire Club of Canada: It is my pleasure to welcome as our guest speaker today Larry Grossman, Q.C., M.P.P., Leader of the Official Opposition, Province of Ontario.
Since Larry Grossman last addressed The Empire Club one year ago, as Treasurer of Ontario and Minister of Economics, his political life has been transformed completely, from Government to Opposition, from Minister into leader of his party.
After the May 2, 1985, election, he was appointed Minister of Education and Colleges and Universities, Provincial Secretary for Social Development, and Government House Leader in the short-lived government of Premier Frank Miller.
In June, following the ruling by the then-Lieutenant Governor of Ontario, the Honourable John Aird, initiating the orderly transference of power, Larry Grossman was appointed House Leader.
With those rapid changes in political fortunes came a desire on the part of our guest to review the events of the previous nine months so as to establish in his mind a clearer picture as to his possible political or professional career. As part of this review, he agreed in July to join the law firm of Fogler, Rubinoff on a part-time basis in an advisory role. When Frank Miller announced his intention in late summer to step down as leader, Grossman's review took on a new meaning.
Backed by at least 22 M.P.P.s and the Big Blue Machine, Larry Grossman formally launched his second bid to capture the leadership of the Ontario Progressive Conservative Party on September 18, 1986. At the convention in November, he narrowly defeated fellow Tory hopeful Dennis Timbrell and assumed the leadership of the party in what many considered a major shift in party philosophy.
The Financial Post of November 30, 1985, wrote: "There is little doubt that Grossman is a Progressive Conservative although he may be more progressive than conservative. His victory... represents a triumph of the liberal wing of the party and a break with the past. In a larger sense, it reflects the seismic shift in Ontario Politics in the last year...
"Grossman succeeded because he convinced Conservatives that their defeat was an accident, a mistake, only a way-station on the road to redemption. With a little work and a little luck, he preached, the dynasty would be restored."
First elected to the Legislature in 1975 for the riding of St. Andrew-St. Patrick, he achieved political successes that have served to extend the Grossman political dynasty founded by his father.
Larry's wife Carole, a successful entrepreneur in her own right, and their three children Melissa, Jamie and Robbie, give every indication of continuing to extend the Grossman tradition of "unstinting service to the community," from which all the citizens of Ontario have benefited.
Ladies and gentlemen, it gives me great pleasure to introduce Larry Grossman, Q.C., M.P.P., Leader of the Official Opposition, Province of Ontario, who will address us on the subject "Building the New Ontario."
Ordinarily, I would address an Empire Club audience on economic matters-on issues such as free trade, technological development, skills training and the like.
But I have chosen, instead, to talk about an issue that is causing deep division, acrimony and unrest throughout the province. That issue, of course, is the government's unbending drive to pass the Health Care Accessibility Act-legislation designed to end extra-billing by Ontario physicians.
As you may recall, I served as Minister of Health for 18 months. During that time, I learned a great deal about the health care system and about the medical profession.
My tenure began with a complex round of fee negotiations marked by "job action" which was, in effect, a strike by the Ontario Medical Association against the Government generally and against me in particular.
But when I got to the negotiating table, I discovered that very little of the conflict was actually related to the issue of compensation. Most of it was rooted in the pride of the medical profession-in their sense of autonomy, their desire to influence health policy and their belief that government could not and should not be the sole force in health care planning and delivery.
Indeed, I remember meeting with the 24-member OMA board of directors at the height of the negotiations. I was impressed-and frankly rather surprised-to find that money was only the manifestation of the problem. The source was professional integrity.
The experience of those fee negotiations-and other contact I had with physicians during my term as Minister of Health-taught me a number of things about our system of health care delivery.
It taught me that there is a need for thoughtful, co-operative, long-term strategic planning in the health care system. It taught me how easily the system could be reduced to a battlefield between warring interests and proud professionals. It taught me about the need for sensitivity, forethought, and care, tact and diplomacy in creating new policy and programmes in the health care field. I saw immediately that power politics would destroy, not accomplish.
That experience also left me, as Minister, asking some basic questions about the way health care policy is developed in Ontario-and whether the system, as it existed, could keep pace with the changing demands for health care in the Eighties.
Taking all of this into account, we decided to create a process of consultation on the future of health care delivery in Ontario.
So we began a series of 11 separate conferences all across the province. We brought together close to 1,500 health professionals, government officials and health care consumers, to work together in developing a long-term strategic plan for the future of the health care system.
I believe that the result of this process was a new beginning for health care in Ontario.
There was a recognition that the large institutions-the big hospitals-were not answering all the needs of the community. A new thrust towards community and neighbourhood clinics was the result.
There was a recognition that we were not providing the right kind of facilities and care for the elderly, the disabled, and those suffering from mental illness. And what came out of our discussions was a massive expansion in programmes offering a choice between institutional care and communitybased care for those groups.
There was a recognition that our health care system should focus much more on preventing illness and disease. The result was a much stronger focus on programmes to promote good health.
These were just a few of the key reforms that developed out of the consultative process. There were others, such as the creation of a paramedic programme, now under some attack by the new Government, the improvement of emergency services and the compulsory vaccination of school children.
But the whole process proved that our health care system can be improved. That the quality of services can be enhanced. And that better linkages can be developed between institutions and the communities they serve.
But the most important thing we learned throughout that process is that reforms within the system will only be achieved through co-operation and consultation. That, when government, health-care practitioners and consumers work together, we can bring about real and measurable improvements.
Surely that same formula can-and must-be applied to the issue of accessibility.
Instead, what we have seen over the past few months is an escalating confrontation between the Government of Ontario and the province's physicians.
All three political parties are united in a common belief in the fundamental principles of universality and accessibility. We all believe that high-quality medical care must be a right of every citizen-regardless of ability to pay.
Where we differ is on how to achieve these basic principles. The accord partners have selected one route and one route only-a ban on extra-billing.
We have acknowledged that that may be one option to achieve accessibility-at least, in theory, but it is the most negative and punitive approach that could be taken.
What we have seen from Government is a single-minded determination to reduce the debate to "them" versus "us"-and the forces of "evil" versus the forces of "good."
They have abandoned negotiation, conciliation or consulation. Instead, they have chosen a style of management that is divisive, acrimonious and confrontational.
And to make the exercise even more cynical, and more a political chess game, the Minister and the Premier keep saying they are prepared to negotiate-the media prints the words in headlines-and then in brackets (but not the principle of banning extra-billing). It is to change the game to a simple sham to tell the public you will negotiate and tell the doctors you won't.
I think it's important that we start by putting this debate into some context.
The first point we have to examine is the impact of the penalty provision in the Canada Health Act.
The Ontario Government claims that the federal government is forcing it to ban extra-billing or face the loss of $54 million a year.
I think it's important to understand that this will not result in a $54-million cost-saving as the Premier, his Treasurer, and the Minister of Health like to claim.
In fact, if the Ontario Health Insurance Plan (OHIP) fee schedule is adjusted by as little as 5 per cent-to compensate doctors for being forcibly brought into the plan and losing their existing right to extra-bill-then it would actually add more than $100 million to our annual health care bill.
This $100 million can surely be better spent on CAT scanners, improvements to Princess Margaret Hospital, more chronic-care beds, better perinatal units, modern equipment and paramedics.
And while Premier Peterson has promised to ban extrabilling by April 1986, the fact is: the federal legislation has given all provinces until April 1987 to negotiate universal accessibility to their health care systems.
Why hurry? For what? At what cost?
Second, you have to remember that we have not yet developed a mechanism in Ontario for rewarding physicians for their experience and excellence.
A recent graduate from medical school is paid at exactly the same rate as a physician with 20 years of experience, or a physician who has developed an international reputation in his or her field.
Without some way of rewarding experience and excellence, we may lose some of our best physicians.
Let us not forget that when Quebec banned extra-billing, 287 specialists moved to Ontario. Premier Peterson says he is prepared to lose some-cavalierly says we have too many doctors.
My question: Who? How many? Why?
Third, when the Minister of Health introduced his legislation last December, the number of doctors choosing to optout of OHIP was down from 18 per cent in 1979 to a record low of 11.8 per cent-indicating an obvious pattern of decline.
Indeed, since most opted-out doctors extra-bill in-office, and perform their hospital services as part of an opted-in group, only 3.1 percent of all doctors are totally opted-out. Those that are opted-out extra-bill only 23 per cent of the time.
The net result? Perhaps only 3 to 4 per cent of patients are extra-billed.
It is not to deny, however, that there may be problems of accessibility in certain medical specialties and in certain geographical communities. Clearly, those concerns must be dealt with in a positive and constructive way.
Unfortunately that is not the approach we have seen. We have seen confrontation.
But that style does not serve the long-term needs of the people of this province. Neither does it build progressively upon the institutions and the systems that we have evolved here in Ontario.
Just think for a moment about what the health care system will be like five years from now if this style of management continues.
If physicians feel that some of their basic rights have been destroyed because they were forced, rather than negotiated, into the plan, what will be the long-term impact on our health care system?
If anyone here does not think that our society is going to pay a significant and real human and financial price because of the way in which the Liberals are handling the issue of accessibility, then they are sadly mistaken.
What the Peterson Government forgets is that the health care system is run by people: by physicians, nurses, hospital administrators, technicians, and other health professionals. They're people, just like you and me. They have the same motivations as you and me. When they are happy, they're productive. But when their morale is destroyed, or when they are fighting within the system, the quality of their work suffers-just as ours would suffer under the same circumstances.
By failing to negotiate a compromise agreement with the OMA the provincial government runs the risk of permanently damaging its relations with the province's doctors.
After all, this battle is not about money alone. Many physicians who are opted-in-physicians who have never and will never extra-bill-have taken up the cause because they believe fundamentally that this legislation threatens the traditional doctor/patient relationship, threatens their independence, unbalances the scales.
For those physicians, the issue is how the government of the day treats the medical profession. Whether it treats doctors as partners who will play a pivotal role in the long-term development of health care delivery. Or whether it treats them as adversaries, employees and servants.
Doctors are concerned about the direction of public policy. And they have every reason to be concerned.
They fear an erosion of their status as independent professsionals. And whether it is justified or not, some doctors fear they will become civil servants.
And is it justified? Well, let me read you the quote from (NDP leader) Bob Rae on the second reading of Bill 94 in the Legislature:
"There are those who say we are talking about the socialization of medicine. To those who say that, I say amen." I call on Mr. Peterson to dissociate himself from the socialization of medicine as described by his friend and colleague, Mr. Rae.
How does the Government treat doctors who are civil servants?
Psychiatrists working in the province's mental health facilities are threatening "job action" this week because the Peterson Liberals will not negotiate improvements to their working conditions-improvements that would enable them to provide better treatment for their patients.
If this is how the Government treats doctors in the civil service, it is little wonder that OMA members are concerned. And if the future of this basic partnership is in jeopardy, so too is the future of continued reform and improvement of our health care delivery system.
We have asked Premier Peterson-in the Legislature and in the Standing Committee on Social Development-to end the stalemate.
We have asked him to end the posturing. Stop trying to pretend that he is interested in negotiating, while insisting on policy that makes negotiation impossible.
We have asked him, and will continue to ask him, to set aside his legislation. I call on him to set aside the Bill and sit down with the OMA and with other health care workers and professionals in this province.
Sit down with our health care practitioners and discuss openly and honestly-without any hidden agenda, without an eye to headlines in the morning newspapers or a sixtysecond clip on the evening news-and discuss ways of achieving accessibility and meeting the other concerns and challenges facing our health care system.
The Premier should also stop talking about "capping" the number of doctors in Ontario. He is only fuelling fears in the medical profession by making comments like those he made last weekend when he said there are too many doctors in our province.
He is compounding their current fears about a hidden agenda. One of control, dictation, and subservience. Then yesterday he said: "Trust me."
We have a specific, known and serious shortfall-not, Mr. Peterson, a surplus-in several specialties: psychiatry, anaesthesia, opthalmology, orthopaedic surgery, oncology, general surgery, laboratory physicians, ear, nose and throat specialists. We need more specialists in all these areas.
We have also put forward several specific proposals that could be discussed between the Government and the OMA. We have suggested that they try to reach an agreement to ensure that there is no extra-billing for seniors; for people on social assistance or fixed incomes; and for people receiving OHIP premium assistance.
We have suggested that they discuss expanding our excellent network of community health centres and health service organizations, so they can compete head-to-head with the opted-out extra-billing physicians.
We have suggested that all Ontario residents be provided with the legal right to receive insured health services at the OHIP rate-allowing extra-billing with the patient's consent and agreement only.
Other groups have come forward with their own compromise positions as well.
Over the past several weeks, group after group has appeared before the Legislative Committee reviewing the Government's Bill to ban extra-billing. And while each group has put forward its own unique views, the common theme has been: resolve the issue.
They all say:
"Sit down and negotiate some form of guaranteed access to the system."
One group suggested that no more than 30 per cent of the members of any specialty should be engaged in extra-billing at any time.
Another suggested limiting the ban on extra-billing to all services performed in a public hospital.
Another suggested that, for emergency and non-elective services performed in hospitals, a physician who does not extra-bill should be available at all times and in all specialties. The list goes on. But all of these suggestions are designed to ensure that the principle of universality is protected.
Perhaps some of these ideas might work-perhaps they are not all perfect solutions.
The Government ignores the committee hearings. It ignores the committee's valid suggestions that may accomplish the goal of accessibility without leaving wounds, injuries, and permanent scars.
It wants its political victory-not its alleged social goal. The point I want to make is this: Nothing can be accomplished in the health care system without dialogue, without consultation, and without a strong partnership involving Government, health care providers, and consumers.
I think we provided that back in 1983 when we undertook our series of extensive reforms based on wide consensus and agreement.
What worked in 1983 could be just as effective today. A new consensus for improved accessibility and more effective services can and must be built on the system already in place.
The time has come to stop the confrontation, the threats, and the insults.
The time has come to sit down and build anew.
There are many reforms needed in the health care system. Reforms that mean much more to more people. Better care ` for the elderly, more specialists in Northern Ontario, better community-based care, out-reach programs in hospitals, better co-ordination of services, paramedic programs, CHC's, HSO's, improved nursing homes, nurse practitioners.
Instead of all these, the government seeks one reform. The cost of the one is to give up all chance for all the other reforms for perhaps five or ten years-a tragic price to pay for a political victory.
I have a message for Premier David Peterson today. Your government can have a ban on extra billing or it can have some of the health care reforms this province needs. You can have a ban on extra billing or better care for the elderly.
You can have a ban on extra billing or more co-ordinated home care services.
You can have a ban on extra billing or doctors working together with nurses to provide more nurse practitioners.
You can have a ban on extra billing or the kind of health care system the people of Ontario want and deserve.
But, Mr. Peterson, with the damage you are now doing, you can't have both.
There is no dishonour in Government retreating, having a second look, admitting it needs more time. There is great dishonour in rushing through legislation that is wrong-or ill timed-or insensitively handled-or politically convenient.
My plea to the Government: Stop! Pause! Think! Negotiate! Your children and mine want to inherit a system united by negotiation; stronger by reform; progressive by cooperation.
Your style will leave instead a system fragmented through confrontation; stale by Government control; dispirited by subservience; and wounded by the loss of some of our best people.
The time has come to strengthen a health care system that is the pride of our province and the envy of the world.
The appreciation of the audience was expressed by Michael A. Meighen, Second Vice-President of The Empire Club.